I
nte
rna
t
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na
l J
o
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l o
f
Adv
a
nces in Applie
d Science
s
(
I
J
AAS)
Vo
l.
5
,
No
.
4
,
Dec
em
b
er
2
0
1
6
,
p
p
.
1
5
7
~
1
6
2
I
SS
N:
2252
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8814
157
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R
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©
201
6
In
s
t
it
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d
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C
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Miz
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1.
I
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RO
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8814
IJ
AA
S
Vo
l.
5
,
No
.
4
,
Dec
em
b
er
20
1
6
:
157
–
1
6
2
158
w
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n
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to
a
s
s
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[
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Desp
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h
y
s
icia
n
’
s
d
o
cu
m
en
tatio
n
s
t
y
le.
O
f
co
u
r
s
e,
clin
ical
d
o
cu
m
e
n
tatio
n
(
r
ec
o
r
d
)
h
as b
ee
n
f
o
u
n
d
co
m
p
lete
an
d
ap
p
r
o
p
r
iate
f
o
r
clin
ical
d
ec
i
s
io
n
s
w
h
e
n
d
ata
ar
e
f
illed
o
n
ti
m
e
[
4
]
.
B
u
t,
s
tu
d
y
s
h
o
w
s
t
h
at
m
a
n
y
p
h
y
s
ician
s
an
d
o
th
er
h
ea
lt
h
ca
r
e
p
r
o
v
id
er
s
h
av
e
ar
g
u
ed
th
at
t
h
e
q
u
alit
y
f
o
r
clin
ical
d
o
cu
m
e
n
t
atio
n
is
in
ad
eq
u
a
te
an
d
o
v
er
lo
ad
in
g
w
i
th
ir
r
ele
v
an
t d
ata
[
5
]
.
P
ap
er
-
b
ased
d
o
cu
m
e
n
tatio
n
is
p
r
ac
ticed
in
m
o
s
t
d
ev
elo
p
i
n
g
co
u
n
tr
ies
[
6
]
;
as
an
Af
r
ican
i
t
is
a
b
asi
c
is
s
u
e
to
ass
ess
t
h
is
d
o
cu
m
e
n
ta
tio
n
p
r
a
ctice
o
f
h
ea
lth
p
r
o
f
ess
i
o
n
als
an
d
r
elate
d
f
ac
to
r
s
to
w
a
r
d
s
d
o
cu
m
e
n
tatio
n
.
Dev
elo
p
in
g
co
u
n
t
ies
th
er
e
f
o
r
e
ar
e,
h
ig
h
l
y
r
elied
o
n
s
tan
d
ar
d
to
o
ls
,
clin
ical
g
u
id
eli
n
es,
d
o
cu
m
e
n
tat
io
n
b
o
o
k
s
f
o
r
m
s
/
f
o
r
m
ats,
p
r
o
ce
d
u
r
es
an
d
o
th
er
r
eso
u
r
ce
s
/
m
ater
ials
to
r
ec
o
r
d
p
ati
en
t’
s
i
n
f
o
r
m
ati
o
n
in
h
o
s
p
ital
s
an
d
o
th
er
h
ea
lt
h
ce
n
ter
s
d
u
e
to
a
v
er
y
li
m
ited
h
ea
lt
h
p
r
o
f
ess
io
n
al
s
’
p
r
ac
tice
u
n
li
k
e
t
h
e
d
ev
elo
p
e
d
w
o
r
ld
(
i.e
.
E
HR
)
[
6
]
.
T
h
e
in
f
o
r
m
a
tio
n
i
n
t
h
e
m
e
d
ical
d
o
cu
m
en
tatio
n
i
s
d
ef
in
ite
l
y
v
alu
ab
le.
Ho
w
e
v
er
,
th
ep
r
o
ce
s
s
o
f
d
o
cu
m
e
n
ti
n
g
it
is
g
iv
e
n
les
s
p
r
io
r
ity
b
y
m
a
n
y
h
ea
lt
h
ca
r
e
g
iv
er
s
.
A
b
u
s
y
p
h
y
s
ician
m
a
y
ac
cid
en
tall
y
r
e
co
r
d
a
p
r
o
g
r
ess
n
o
te
in
t
h
e
w
r
o
n
g
p
atie
n
t
’
s
h
ea
lt
h
r
ec
o
r
d
s
.
Me
d
ical
o
r
clin
ical
as
s
ess
m
en
t
o
f
v
ital
s
i
g
n
s
m
i
g
h
t
b
e
co
n
s
i
s
ten
t,
b
u
t
t
h
e
d
o
cu
m
en
tatio
n
p
r
o
ce
s
s
w
as
h
ig
h
l
y
v
ar
iab
le
w
it
h
i
n
g
r
o
u
p
s
an
d
a
m
o
n
g
h
o
s
p
ita
ls
.
Di
f
f
er
en
t
h
ea
lt
h
ca
r
e
p
r
o
f
ess
io
n
al
s
an
d
s
p
ec
ialties
h
av
e
d
ev
elo
p
ed
th
eir
o
w
n
t
y
p
e
s
o
f
d
o
cu
m
en
tatio
n
s
t
y
le
to
d
o
cu
m
en
t
p
atien
t
’
s
ca
r
e
in
th
e
p
ap
er
-
b
ased
p
atien
t r
ec
o
r
d
s
y
s
te
m
.
L
ac
k
o
f
a
u
n
i
f
ied
d
o
cu
m
e
n
tatio
n
ap
p
r
o
ac
h
f
in
all
y
lead
s
to
a
n
atio
n
al
p
r
o
p
o
s
al
to
g
en
er
ate
a
u
n
i
f
ied
p
ap
er
-
b
ased
p
atien
t
r
ec
o
r
d
.
T
h
is
s
er
v
es
as
a
g
o
o
d
b
asis
f
o
r
a
u
n
if
ied
n
atio
n
a
l
d
o
cu
m
en
tatio
n
s
t
y
le.
Sin
ce
,
t
r
an
s
f
o
r
m
i
n
g
t
h
e
p
ap
er
b
ased
r
ec
o
r
d
in
to
d
ig
ital
f
o
r
m
b
y
p
u
r
el
y
d
i
g
itizi
n
g
th
e
n
ar
r
ativ
e
te
x
t
d
o
es
n
o
t
y
ield
th
e
b
en
ef
its
.
So
,
it
is
es
s
e
n
tial
t
h
at
th
e
s
tr
u
ct
u
r
e,
d
ata
s
et
h
ea
d
in
g
s
a
n
d
class
i
f
icatio
n
s
ar
e
u
s
ed
as
cle
ar
m
ed
ical
/
cli
n
ical
d
o
cu
m
en
tatio
n
g
u
id
es
an
d
co
n
te
n
t
s
[
7
]
.
A
n
u
r
s
e
m
a
y
g
et
a
ca
ll to
ass
is
t a
p
atie
n
t a
n
d
f
o
r
g
et
to
r
ec
o
r
d
m
ed
icatio
n
g
i
v
e
n
t
o
an
o
th
er
p
atien
t [
8
]
.
A
lt
h
o
u
g
h
clin
ical
g
u
id
eli
n
es
a
n
d
s
tan
d
ar
d
ized
to
o
ls
a
r
e
ess
en
tial
f
o
r
ev
id
en
ce
b
ased
d
ec
is
io
n
m
ak
i
n
g
h
ea
lt
h
ca
r
e
p
r
o
v
is
io
n
an
d
m
a
n
u
all
y
w
r
it
ten
d
o
cu
m
en
ta
tio
n
p
r
ac
tice;th
eir
u
s
ab
ilit
y
u
s
ed
b
y
h
ea
lt
h
p
r
o
f
ess
io
n
al
s
is
lo
w
b
ec
au
s
e
o
f
p
h
y
s
ician
’
s
attitu
d
e
[
9
]
.
E
v
id
en
ce
i
n
d
icate
s
th
at
b
e
s
id
es
o
f
th
eir
b
en
e
f
it
s
f
o
r
d
o
cu
m
e
n
tatio
n
p
r
ac
tice,
g
u
id
eli
n
es,
d
o
cu
m
e
n
tatio
n
s
h
ee
ts
/f
o
r
m
a
ts
,
s
ta
n
d
ar
d
to
o
ls
in
to
tal
w
er
e
i
n
d
o
u
b
t
o
f
r
esis
ta
n
ce
f
r
o
m
h
ea
lt
h
p
r
o
f
ess
io
n
als.
I
n
f
o
r
m
ati
o
n
r
etr
iev
al
f
r
o
m
n
ar
r
ativ
e
d
o
cu
m
e
n
t
s
o
f
c
h
ar
t
o
r
w
r
it
ten
d
o
cu
m
en
tatio
n
i
s
r
ar
el
y
u
s
ed
o
u
ts
id
e
lab
o
r
ato
r
ies
w
h
er
e
in
f
o
r
m
atio
n
ex
tr
ac
tio
n
s
y
s
te
m
s
h
a
v
e
b
ee
n
d
ev
elo
p
ed
[
1
0
]
.
Fro
m
all
th
e
ab
o
v
e
r
ev
ie
w
s
,
m
ed
ical
d
o
cu
m
e
n
ta
tio
n
s
(
m
a
n
u
all
y
w
r
i
tten
d
o
cu
m
e
n
t
s
)
ar
e
th
e
o
n
l
y
w
ar
e
h
o
u
s
e
o
f
p
atie
n
t
’
s
in
f
o
r
m
atio
n
.
B
u
t,
t
h
ese
d
o
cu
m
en
tatio
n
s
ar
e
w
i
th
m
a
n
y
p
r
o
b
le
m
s
a
n
d
s
o
m
eti
m
es
n
e
g
li
g
i
b
le
f
o
r
s
o
m
e
h
ea
lth
p
r
o
f
ess
io
n
al
s
.
T
h
is
is
d
u
e
to
v
ar
iatio
n
s
o
f
d
o
cu
m
e
n
tatio
n
s
t
y
les
a
n
d
d
o
cu
m
e
n
tatio
n
s
ta
n
d
ar
d
s
,
s
h
ee
t
s
/
f
o
r
m
ats
th
e
y
u
s
ed
.
On
th
e
o
th
er
h
a
n
d
,
d
ata
in
h
o
s
p
itals
r
e
m
ai
n
i
n
co
m
p
lete
a
n
d
in
ap
p
r
o
p
r
iatew
h
il
e
d
o
cu
m
en
tin
g
,
r
ep
o
r
tin
g
,
ch
ar
ti
n
g
a
n
d
etc.
An
d
th
u
s
,
m
o
s
t
r
ec
o
r
d
s
n
eg
lect
th
ep
atie
n
t
s
’
p
r
o
b
le
m
an
d
p
r
ac
tices
r
eg
ar
d
in
g
d
o
cu
m
e
n
tatio
n
i
n
t
h
e
h
o
s
p
ital b
ein
g
ex
p
er
ien
ce
d
[
1
1
]
.
T
h
er
e
ar
e
g
ap
s
i
n
E
th
io
p
ian
co
n
tex
t.
B
ec
au
s
e,
t
h
er
e
is
n
o
s
t
u
d
y
co
n
d
u
cted
to
in
f
o
r
m
w
h
et
h
er
th
e
ab
o
v
e
m
en
tio
n
ed
s
ta
n
d
ar
d
to
o
ls
ar
e
p
r
o
p
er
ly
u
s
ed
to
th
e
co
m
p
leten
ess
o
f
d
o
cu
m
en
ta
tio
n
o
r
n
o
t.
Sin
ce
E
th
io
p
ia
is
o
n
e
o
f
th
e
d
ev
elo
p
in
g
n
atio
n
s
,
th
ep
r
o
b
lem
r
eg
ar
d
in
g
p
atien
t
’
s
w
r
i
tte
n
r
ec
o
r
d
o
r
d
o
cu
m
e
n
t
ed
in
f
o
r
m
atio
n
is
a
s
er
io
u
s
i
s
s
u
e
f
r
o
m
d
i
f
f
er
e
n
t
c
o
r
n
er
s
.
Ho
w
ev
er
,
t
h
e
lev
el
o
f
d
o
cu
m
e
n
tat
io
n
p
r
ac
tice
o
f
h
ea
lth
p
r
o
f
ess
io
n
als,
attitu
d
e
s
to
w
ar
d
s
d
o
cu
m
e
n
ta
tio
n
ab
o
u
t
p
atien
t
’
s
in
f
o
r
m
a
tio
n
an
d
ev
en
o
t
h
er
r
elate
d
f
ac
to
r
s
af
f
ec
tin
g
d
o
cu
m
en
tatio
n
p
r
ac
tice
ar
e
n
o
t
k
n
o
w
n
i
n
d
ee
d
.
On
l
y
,
t
h
e
f
ed
er
al
m
in
i
s
tr
y
o
f
h
ea
lt
h
(
F
Mo
H)
w
as
tr
y
i
n
g
to
allev
iate
s
u
ch
p
r
o
b
lem
s
b
y
g
iv
in
g
tr
ai
n
in
g
f
o
r
h
ea
lt
h
w
o
r
k
er
s
an
d
p
r
ep
a
r
in
g
g
u
id
elin
e
s
lik
e
E
th
io
p
ian
h
o
s
p
ital
s
r
ef
o
r
m
i
m
p
le
m
e
n
tatio
n
g
u
id
el
in
e.
B
u
t,
n
o
r
esear
ch
es
w
er
e
d
o
n
e
to
s
h
o
w
w
h
er
e
th
e
s
tat
u
s
o
f
d
o
cu
m
en
ta
tio
n
p
r
ac
tices
an
d
th
e
g
ap
s
ar
e
n
at
io
n
all
y
.
So
,
it
is
b
etter
to
f
o
cu
s
o
n
r
ed
u
cin
g
th
e
g
ap
s
b
et
w
e
en
p
r
ac
tice
lev
el
o
f
p
r
o
f
ess
io
n
al
s
a
n
d
th
eir
a
ttit
u
d
e
to
d
o
cu
m
e
n
tatio
n
u
s
i
n
g
e
v
id
en
ce
.
O
n
t
h
e
o
th
er
h
an
d
w
h
e
n
to
d
o
cu
m
e
n
t,
w
h
at
to
d
o
cu
m
e
n
t,
h
o
w
to
d
o
cu
m
en
t e
tc
ar
e
cr
u
cial
asp
ec
ts
to
f
ill t
h
e
g
ap
s
.
2.
E
XI
ST
I
N
G
M
E
T
H
O
DS
Me
d
ical
Do
cu
m
en
ta
tio
n
P
r
ac
t
ice
Si
n
ce
2
0
0
6
,
A
MI
A
h
as
o
r
g
an
ized
Hea
lt
h
P
o
lic
y
to
e
x
a
m
i
n
e
is
s
u
es
co
n
ce
r
n
i
n
g
h
ea
lt
h
ca
r
e
an
d
h
e
alth
i
n
f
o
r
m
atio
n
p
o
lic
y
to
war
d
s
th
e
g
en
er
atio
n
o
f
h
ea
lt
h
r
ec
o
r
d
s
(
m
ed
ical
d
o
cu
m
en
tatio
n
s
)
t
h
at
w
il
l
g
iv
e
u
p
t
h
e
r
ic
h
p
atien
ts
’
d
ata.
T
h
i
s
is
an
ev
id
e
n
ce
i
n
w
h
ic
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159
clin
ical
r
esear
ch
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q
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alit
y
i
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p
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v
e
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t
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en
t
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f
p
u
b
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h
ea
lt
h
o
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j
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tiv
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s
;
all
o
f
w
h
ic
h
w
o
r
k
to
w
ar
d
s
d
o
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n
tat
io
n
s
y
s
te
m
i
m
p
r
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v
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m
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n
t(
1
2
)
.
Stu
d
y
s
h
o
w
s
t
h
at
h
ea
lt
h
p
r
o
f
es
s
io
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h
a
v
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a
p
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itiv
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p
er
s
p
ec
tiv
e
ab
o
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t
d
o
cu
m
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n
tat
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y
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te
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s
,
b
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th
eir
‘
f
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ll
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ct
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’
p
r
ac
tice
is
lo
w
:
3
.
6
%
in
2
0
0
6
to
6
.
9
%
in
2
0
0
9
[
1
2
,
1
3
]
.
Me
d
ical
r
ec
o
r
d
k
ee
p
in
g
h
a
s
b
ee
n
al
m
o
s
t
f
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ll
y
i
m
p
le
m
e
n
t
ed
ev
en
in
s
e
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d
ev
elo
p
ed
co
u
n
tr
ie
s
in
cl
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S
w
ed
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n
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Den
m
ar
k
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th
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Net
h
er
lan
d
s
a
n
d
UK
alt
h
o
u
g
h
it
h
as
b
ee
n
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m
p
le
m
e
n
ted
i
n
les
s
th
a
n
2
0
%
o
f
US
h
o
s
p
ital
s
.
L
i
k
e
w
i
s
e,
p
ap
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-
b
ased
d
o
cu
m
e
n
tatio
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is
p
r
ac
ticed
in
m
o
s
t
d
e
v
elo
p
in
g
co
u
n
tr
ies
[
6
]
.
Nu
r
s
es
i
n
th
e
Net
h
er
la
n
d
s
r
ec
o
r
d
ed
lo
w
s
co
r
es
o
n
t
h
e
ac
c
u
r
ac
y
o
f
t
h
e
d
o
cu
m
e
n
tatio
n
o
f
th
eir
i
n
te
r
v
en
tio
n
s
[
1
4
]
.
T
h
e
s
tu
d
y
co
n
d
u
cted
in
J
am
a
ican
b
ased
o
n
d
escr
ip
tiv
e
cr
o
s
s
s
ec
tio
n
al
d
esig
n
,
2
0
1
3
b
y
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w
ed
9
0
p
atien
ts
r
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o
r
d
s
o
f
3
w
ar
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s
w
er
e
a
u
d
ited
d
o
cu
m
en
tatio
n
p
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ac
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h
ea
lth
p
r
o
f
es
s
io
n
al
s
u
s
in
g
J
a
m
aica
n
Min
is
tr
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o
f
Hea
lt
h
to
o
l.
T
h
e
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lt
s
h
o
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s
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9
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%,
9
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9
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d
9
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p
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tag
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n
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d
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a
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d
f
o
llo
w
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d
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l
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6
%
o
f
th
e
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in
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s
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w
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co
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r
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m
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is
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4
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ted
ev
id
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ce
o
f
d
is
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h
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p
l
an
n
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g
[
1
5
]
.
I
n
Fin
la
n
d
,
p
ap
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b
ased
p
atie
n
t
r
ec
o
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s
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av
e
b
ee
n
a
lo
n
g
it
u
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in
al
(
co
n
ti
n
u
in
g
)
co
llectio
n
o
f
p
atien
t
d
ata
[
7
]
.
Do
cu
m
e
n
tatio
n
o
f
p
atie
n
ts
w
i
t
h
ch
r
o
n
ic
p
ai
n
f
r
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m
th
e
So
u
t
h
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h
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h
ca
r
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n
ter
r
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io
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o
f
Sto
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h
o
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m
r
es
u
lts
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at
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u
r
s
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r
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ted
in
s
u
f
f
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(
2
4
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o
f
d
is
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m
ar
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s
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f
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s
p
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e
alth
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r
e
p
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id
er
s
p
o
s
s
ess
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h
e
n
ec
es
s
ar
y
s
k
ills
f
o
r
q
u
alit
y
clin
ical
d
o
cu
m
en
tat
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n
b
u
t
lack
th
e
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ll.
W
h
en
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o
r
a
m
a
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a
l
s
y
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is
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s
ed
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th
e
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ctio
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o
f
ac
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ate
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ea
lt
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r
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d
s
d
ep
en
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s
o
n
t
h
e
p
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v
id
er
s
’
r
ec
o
r
d
k
ee
p
in
g
p
r
ac
tices
[
1
6
]
.
R
es
u
lts
f
r
o
m
9
g
e
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er
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l
h
o
s
p
itals
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f
So
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h
Af
r
ica
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4
5
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d
s
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1
9
8
9
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7
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%
(
1
2
7
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th
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o
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d
s
w
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m
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n
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ts
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9
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4
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s
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r
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n
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ts
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1
4
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6
f
r
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m
p
ed
iatr
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n
its
a
n
d
th
e
r
e
m
ai
n
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g
f
r
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m
t
h
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g
en
er
al
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n
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ts
;
it
s
h
o
w
s
in
s
u
f
f
icien
t a
n
d
p
o
o
r
ly
d
o
cu
m
en
ted
p
r
ac
tice
[
1
7
]
.
3.
M
E
T
H
O
DO
L
O
G
Y
3
.
1
.
Study
Desig
n
A
n
i
n
s
tit
u
tio
n
b
ased
cr
o
s
s
s
ec
ti
o
n
al
q
u
an
t
itati
v
e
s
t
u
d
y
w
a
s
co
n
d
u
cted
in
U
n
i
v
er
s
it
y
o
f
Go
n
d
ar
h
o
s
p
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f
r
o
m
Ma
r
ch
1
5
to
A
p
r
il
3
0
2
0
1
6
.
T
h
e
s
tu
d
y
w
a
s
co
n
d
u
cted
at
Un
i
v
er
s
it
y
o
f
Go
n
d
ar
Ho
s
p
ital,
No
r
th
Go
n
d
ar
,
No
r
th
W
est
E
t
h
io
p
ia.
T
h
e
h
o
s
p
ital
w
as
e
s
tab
lis
h
ed
i
n
1
9
2
0
in
Am
h
ar
ar
e
g
io
n
al
s
tate
i
n
No
r
th
Go
n
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ar
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e,
No
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th
W
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E
th
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p
ia,
Go
n
d
ar
to
w
n
ad
m
i
n
is
tr
atio
n
7
4
8
f
ar
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o
m
A
d
d
is
A
b
ab
a.
I
n
2
0
1
6
,
t
h
e
to
tal
n
u
m
b
er
o
f
h
ea
lt
h
p
r
o
f
ess
io
n
al
s
in
th
i
s
h
o
s
p
ital
is
ab
o
u
t
7
9
3
w
h
o
p
r
o
v
i
d
e
s
er
v
ices
f
o
r
th
e
ca
tch
m
e
n
t
ar
ea
w
i
th
esti
m
ate
d
n
u
m
b
er
o
f
p
o
p
u
latio
n
s
m
o
r
e
t
h
an
f
i
v
e
m
il
lio
n
.
A
l
l
h
ea
l
th
p
r
o
f
ess
io
n
als
w
h
o
w
er
e
w
o
r
k
ed
at
th
e
U
n
i
v
er
s
it
y
o
f
Go
n
d
ar
Ho
s
p
ital d
u
r
in
g
d
ata
co
llectio
n
p
er
io
d
.
3
.
2
.
T
he
I
nclus
io
n a
nd
E
x
clu
s
io
n
Crit
er
ia
Al
l
h
ea
l
th
p
r
o
f
e
s
s
io
n
als
w
h
o
w
er
e
n
o
t
w
illi
n
g
,
th
o
s
e
w
h
o
wer
e
o
n
leav
e
a
n
d
th
o
s
e
p
h
ar
m
a
cist
s
w
er
e
ex
clu
d
ed
.
Sa
m
p
le
s
ize
i
n
t
h
is
s
tu
d
y
w
as
ca
lc
u
lated
as
f
o
ll
o
w
s
u
s
i
n
g
t
h
e
ass
u
m
p
tio
n
s
o
f
s
i
n
g
le
p
o
p
u
latio
n
p
r
o
p
o
r
tio
n
f
o
r
m
u
la
b
y
th
e
a
s
s
u
m
p
tio
n
s
o
f
.
n
=
s
a
m
p
le
s
ize
z=
s
tan
d
ar
d
ized
n
o
r
m
al
d
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tr
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n
v
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e
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9
5
% C
I
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w
h
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s
1
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9
6
p
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m
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o
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r
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ctice
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0
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d
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w
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n
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[
Z
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(
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2
n
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Her
e
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r
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w
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s
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d
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p
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p
u
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B
y
a
s
s
u
m
in
g
t
h
e
n
o
n
-
r
esp
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n
s
e
r
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1
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1
8
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th
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to
tal
s
a
m
p
le
s
ize
b
ec
a
m
e
2
6
4
.
3
.
3
.
Sa
m
pli
ng
Select
io
n P
ro
ce
du
re
Stra
tif
ied
s
a
m
p
li
n
g
p
r
o
ce
d
u
r
e
w
a
s
u
s
ed
to
s
elec
t
th
e
r
esp
o
n
d
en
ts
.
Hea
lt
h
p
r
o
f
es
s
io
n
al
s
in
e
ac
h
w
ar
d
o
f
in
p
atie
n
t d
ep
ar
t
m
e
n
t
w
er
e
r
an
d
o
m
l
y
s
elec
ted
u
s
i
n
g
s
i
m
p
le
r
an
d
o
m
s
a
m
p
l
in
g
a
f
ter
p
r
o
p
o
r
tio
n
al
allo
ca
tio
n
o
f
h
ea
lt
h
p
r
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f
es
s
io
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s
i
n
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ch
p
r
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io
n
a
n
d
w
o
r
k
s
etti
n
g
w
a
s
e
n
s
u
r
ed
.
T
h
e
s
tr
ata
wer
e
w
ar
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s
i
n
w
h
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h
th
ep
ar
ticip
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t
h
ea
lt
h
p
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f
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s
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e
w
o
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k
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.
T
h
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f
o
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r
s
tr
ata
w
er
e
m
ed
ical,
s
u
r
g
i
ca
l,
p
ed
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ics
an
d
o
b
s
tetr
ics
&
g
y
n
ec
o
lo
g
y
w
ar
d
s
.
Sa
m
p
li
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s
elec
tio
n
p
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ce
d
u
r
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o
f
h
ea
lth
p
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f
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s
f
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ach
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at
Uo
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IJ
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IJ
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8814
Med
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W
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]
Ch
a
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KS
F
J,
W
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r
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P
,
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[4
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6(
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)
,
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9
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.
[5
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.
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,
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t
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d
In
f
,
v
o
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6
4
(2
-
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),
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p
.
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.
[6
]
Org
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Rec
o
rd
s: M
a
n
u
a
l
f
o
r De
v
e
lo
p
in
g
Co
u
n
tries
,
2
0
0
6
.
[7
]
K.
Hä
y
rin
e
n
KH
P
,
Ny
k
ä
n
e
n
,
“
Us
e
o
f
h
e
a
d
in
g
s
a
n
d
c
las
sif
ica
ti
o
n
s
b
y
p
h
y
sic
i
a
n
s
in
m
e
d
ica
l
n
a
rra
ti
v
e
s
o
f
EHRs
–
a
n
e
v
a
lu
a
t
io
n
stu
d
y
in
a
F
in
n
ish
h
o
sp
it
a
l,
”
A
p
p
li
e
d
Cli
n
ica
l
I
n
f
o
rm
a
ti
c
s
,
v
o
l.
2
2
(
2
)
,
p
p
.
1
4
3
–
57
,
M
a
rc
h
2
0
1
1
.
[8
]
EK
H.
M
e
d
ica
l
Re
c
o
r
d
M
a
n
a
g
e
m
e
n
t.
9
t
h
e
d
n
.
Be
rwy
n
,
Ill
in
o
is:
P
h
y
sic
ian
’s Rec
o
rd
s
Co
m
p
a
n
y
.
1
9
9
0
:
5
9
6
.
[9
]
Iv
a
n
S
o
la
JMCea
.
A
tt
it
u
d
e
a
n
d
p
e
rc
e
p
ti
o
n
s
a
b
o
u
t
c
li
n
ica
l
g
u
i
d
e
li
n
e
s:
A
q
u
a
li
tativ
e
stu
d
y
w
it
h
sp
a
n
ish
p
h
y
sic
ian
s.
A
p
lo
s
,
v
o
l.
9
(
2
)
.
F
e
b
ru
a
ry
2
0
1
4
.
[1
0
]
M
e
y
stre
S
M
S
G
e
a
.
Ex
trac
ti
n
g
in
fo
rm
a
ti
o
n
f
ro
m
te
x
tu
a
l
d
o
c
u
m
e
n
ts
in
t
h
e
e
lec
tro
n
ic
h
e
a
lt
h
re
c
o
r
d
:
a
r
e
v
ie
w
o
f
r
e
c
e
n
t
re
se
a
rc
h
.
Ye
a
rb
M
e
d
In
f
o
rm
,
p
p
.
1
2
8
-
44
,
2
0
0
8
.
[1
1
]
Ch
a
p
m
a
n
Y
.
F
K,
“
T
h
e
stu
d
y
o
f
n
u
rs
in
g
d
o
c
u
m
e
n
tatio
n
c
o
m
p
lec
x
it
ies
,
”
In
ter
n
a
ti
o
n
a
l
j
o
u
rn
a
l
o
f
n
u
rs
in
g
p
ra
c
ti
c
e
,
v
o
l.
1
2
,
p
p
.
3
6
6
-
74
,
2
0
0
6
.
[1
2
]
M
E
G
.
Early
g
li
m
p
se
s
o
f
th
e
lea
rn
in
g
h
e
a
lt
h
c
a
re
sy
st
e
m
:
th
e
p
o
te
n
ti
a
l
im
p
a
c
t
o
f
h
e
a
lt
h
IT
A
c
a
d
e
m
y
H
e
a
lt
h
.
Ju
l
y
2
0
1
2
.
[1
3
]
Hs
iao
C
HE,
S
o
c
e
y
T
C,
a
n
d
Ca
i
B.
El
e
c
tro
n
ic
m
e
d
ica
l
re
c
o
rd
/ele
c
tro
n
ic
h
e
a
lt
h
re
c
o
rd
sy
ste
m
s
o
f
o
ff
ice
-
b
a
se
d
p
h
y
sic
ian
s.Na
ti
o
n
a
l
Ce
n
ter f
o
r
H
e
a
lt
h
S
tatisti
c
s.
2
0
1
0
[1
4
]
P
a
a
n
s
W
,
S
e
rm
e
u
s,
e
t
a
l
.,
“
P
re
v
a
l
e
n
c
e
o
f
a
c
c
u
ra
te
n
u
rsin
g
d
o
c
u
m
e
n
tatio
n
in
p
a
ti
e
n
t
re
c
o
r
d
s,”
J
o
u
r
n
a
l
o
f
Ad
v
a
n
c
e
d
Nu
rs
in
g
,
v
o
l.
6
6
,
p
p
.
2
4
8
1
-
9
,
2
0
1
0
.
[1
5
]
Blak
e
-
M
o
wa
tt
,
C
.
,
“
Ev
a
lu
a
ti
o
n
o
f
re
g
istere
d
n
u
rse
s’
k
n
o
w
led
g
e
a
n
d
p
ra
c
ti
c
e
o
f
d
o
c
u
m
e
n
tatio
n
a
t
a
Ja
m
a
ic
a
n
h
o
sp
i
tal,
”
In
ter
n
a
ti
o
n
a
l
N
u
rs
in
g
Rev
iew
,
v
o
l.
6
0
,
p
p
.
3
2
8
-
34
,
2
0
1
3
.
[1
6
]
Co
ra
A
C
D
G
,
Ch
a
n
d
D.
,
“
Un
d
e
rsta
n
d
in
g
th
e
w
o
rk
o
f
m
e
d
ica
l
tran
sc
rip
ti
o
n
ists
i
n
t
he
p
r
o
d
u
c
ti
o
n
o
f
m
e
d
ica
l
re
c
o
rd
s,”
He
a
lt
h
I
n
fo
rm
a
ti
c
s J
o
u
r
n
a
l
,
v
o
l.
1
6
,
p
p
.
87
-
1
0
0
,
2
0
1
0
.
[1
7
]
L
R.
U
y
s.
S
tan
d
a
rd
s f
o
r
Nu
rsin
g
D
o
c
u
m
e
n
tatio
n
i
n
G
e
n
e
ra
l
Ho
sp
i
tal
in
S
o
u
th
A
f
rica
,
p
p
.
1
2
.
J
u
ly
1
9
8
9
.
[1
8
]
P
iette JD
,
e
t
a
l
.
,
“
Im
p
a
c
ts o
f
e
-
h
e
a
lt
h
o
n
th
e
o
u
tco
m
e
s o
f
c
a
re
in
lo
w
-
a
n
d
m
id
d
le
in
c
o
m
e
c
o
u
n
tri
e
s: w
h
e
re
d
o
we
g
o
f
ro
m
h
e
re
?
”
Bu
ll
e
ti
n
o
f
th
e
W
o
rl
d
He
a
lt
h
Or
g
a
n
iza
ti
o
n
,
v
o
l.
1
(
9
0
),
p
p
.
3
6
5
–
72
,
2
0
1
2
.
[1
9
]
C.
Blak
e
-
M
o
w
a
tt
J
L
M
L
,
a
n
d
J.
Be
n
n
e
tt
,
“
Ev
a
lu
a
ti
o
n
o
f
re
g
istere
d
n
u
rse
s'
k
n
o
w
led
g
e
a
n
d
p
ra
c
ti
c
e
o
f
d
o
c
u
m
e
n
tati
o
n
a
t
a
Ja
m
a
ica
n
h
o
sp
it
a
l,
”
I
n
ter
n
a
t
i
o
n
a
l
Co
u
n
c
il
o
f
Nu
rs
e
s
,
p
p
.
3
2
8
–
34
.
7
J
un
e
2
0
1
3
.
[2
0
]
M
a
d
in
e
h
Ja
se
m
i
V
Z,
A
.
Ra
h
m
a
n
i,
A
.
M
o
h
a
jj
e
l
,
a
n
d
F
.
A
lsa
d
a
th
o
se
in
i
,
“
Kn
o
w
led
g
e
a
n
d
P
ra
c
ti
c
e
o
f
T
a
b
riz T
e
a
c
h
in
g
Ho
sp
it
a
ls’
Nu
rse
s Re
g
a
rd
in
g
Nu
r
sin
g
Do
c
u
m
e
n
tatio
n
,
”
I
n
ter
n
a
t
io
n
a
l
me
d
ica
l
jo
u
rn
a
l
.
Oc
t
2
9
,
2
0
1
2
.
[2
1
]
M
a
n
sf
ield
CD.,
“
A
tt
it
u
d
e
s
a
n
d
b
e
h
a
v
io
u
rs
to
w
a
rd
s
c
li
n
ica
l
g
u
id
e
li
n
e
s
,
”
T
h
e
c
li
n
icia
n
s
'p
e
rs
p
e
c
ti
v
e
,
v
o
l.
4
,
p
p
.
2
5
0
-
5
,
1
9
9
5
.
[
O
n
li
n
e
].
A
v
a
il
a
b
le:
g
ro
u
p
.
b
m
j.
c
o
m
.
[2
2
]
a
l.
A
-
De
.
Un
d
e
rs
ta
n
d
in
g
th
e
b
a
r
rie
rs
to
se
tt
in
g
u
p
a
h
e
a
l
th
c
a
re
q
u
a
li
ty
imp
ro
v
e
me
n
t
p
ro
c
e
ss
in
re
so
u
rc
e
-
li
mited
se
tt
in
g
s:
a
situ
a
ti
o
n
a
l
a
n
a
lys
is
a
t
th
e
M
e
d
ica
l
De
p
a
rtme
n
t
o
f
Ka
m
u
zu
Ce
n
tr
a
l
Ho
s
p
it
a
l
in
L
il
o
n
g
w
e
,
BM
C
He
a
lt
h
S
e
rv
ice
s Re
s
e
a
rc
h
.
M
a
law
i,
2014
.
[2
3
]
Ib
ra
h
im
Tai
w
o
A
O,
Ka
y
o
d
e
A
b
io
d
u
n
,
e
t
a
l.
,
“
Da
ta
q
u
a
li
ty
a
ss
e
ss
m
e
n
t
in
h
e
a
lt
h
c
a
re
:
a
3
6
5
-
d
a
y
c
h
a
rt
re
v
ie
w
o
f
in
p
a
ti
e
n
ts’
h
e
a
lt
h
re
c
o
r
d
s
a
t
a
Nig
e
rian
tertiary
h
o
sp
it
a
l,
”
J
Am
M
e
d
In
fo
rm
Asso
c
.
,
v
o
l.
1
9
,
p
p
.
1
0
3
9
-
4
2
.
1
4
Ju
ly
2
0
1
2
.
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