Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis.

PubMed

Dalton, Kieran; O'Brien, Gary; O'Mahony, Denis; Byrne, Stephen

2018-06-08

computerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) for hospitalised older adults. This systematic review and meta-analysis examined the evidence for efficacy of computerised interventions designed to reduce PIP in this patient group. an electronic literature search was conducted using eight databases up to October 2017. Included studies were controlled trials of computerised interventions aiming to reduce PIP in hospitalised older adults (≥65 years). Risk of bias was assessed using Cochrane's Effective Practice and Organisation of Care criteria. of 653 records identified, eight studies were included-two randomised controlled trials, two interrupted time series analysis studies and four controlled before-after studies. Included studies were mostly at a low risk of bias. Overall, seven studies showed either a statistically significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM) (absolute risk reduction {ARR} 1.3-30.1%), or in PIMs ordered (ARR 2-5.9%). However, there is insufficient evidence thus far to suggest that these interventions can routinely improve patient-related outcomes. It was only possible to include three studies in the meta-analysis-which demonstrated that intervention patients were less likely to be prescribed a PIM (odds ratio 0.6; 95% CI 0.38, 0.93). No computerised intervention targeting potential prescribing omissions (PPOs) was identified. this systematic review concludes that computerised interventions are capable of statistically significantly reducing PIMs in hospitalised older adults. Future interventions should strive to target both PIMs and PPOs, ideally demonstrating both cost-effectiveness data and clinically significant improvements in patient-related outcomes.

[A computerised clinical decision-support system for the management of depression in Primary Care].

PubMed

Aragonès, Enric; Comín, Eva; Cavero, Myriam; Pérez, Víctor; Molina, Cristina; Palao, Diego

Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system

PubMed Central

Colombet, Isabelle; Dart, Thierry; Leneveut, Laurence; Zunino, Sylvain; Ménard, Joël; Chatellier, Gilles

2003-01-01

Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. Methods The system called EsPeR (Personalised Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the help of EsPeR, and three senior investigators leaded structured discussion sessions. Results The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations. Conclusion Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials. PMID:14641924

Incidence of potential drug interactions in a transplant centre setting and relevance of electronic alerts for clinical practice support.

PubMed

Polidori, Piera; Di Giorgio, Concetta; Provenzani, Alessio

2012-01-01

Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed. DDIs were assessed using a Micromedex® healthcare series database. The system, adopted by the hospital, generates alerts for prescriptions with negative interactions and thanks to an 'acknowledgement function' it is possible to verify physician adherence to alerts. This function, although used previously, became mandatory from September 2010. Physician adherence to alerts and mean monthly incidence of potential DDIs in analysed units, before and after the mandatory 'acknowledgement function', were calculated. The intensive care unit (ICU) registered the greatest incidence of potential DDIs (49.0%), followed by the abdominal surgery unit and dialysis (43.4 and 42.0%, respectively). The cardiothoracic surgery unit (41.6%), step-down unit (38.3%) and post-anaesthesia care unit (30.0%) were comparable. The operating theatre and endoscopy registered the fewest potential DDIs (28.2 and 22.7%, respectively). Adherence to alerts after the 'acknowledgement function' increased by 25.0% in the ICU, 54.0% in the cardiothoracic surgery unit, 52.5% in the abdominal surgery unit, 58.0% in the stepdown unit, 67.0% in dialysis, 51.0% in endoscopy and 48.0% in the post-anaesthesia care unit. In the operating theatre, adherence to alerts decreased from 34.0 to 30.0%. The incidence of potential DDIs after mandatory use of the 'acknowledgement function' decreased slightly in endoscopy (-2.9%), the abdominal surgery unit (-2.7%), dialysis (-1.9%) and the step-down unit (-1.4%). Improving DDI alerts will improved patient safety by more appropriately alerting clinicians.

The effects of an educational meeting and subsequent computer reminders on the ordering of laboratory tests by rheumatologists: an interrupted time series analysis.

PubMed

Lesuis, Nienke; den Broeder, Nathan; Boers, Nadine; Piek, Ester; Teerenstra, Steven; Hulscher, Marlies; van Vollenhoven, Ronald; den Broeder, Alfons A

2017-01-01

To examine the effects of an educational meeting and subsequent computer reminders on the number of ordered laboratory tests. Using interrupted time series analysis we assessed whether trends in the number of laboratory tests ordered by rheumatologists between September 2012 and September 2015 at the Sint Maartenskliniek (the Netherlands) changed following an educational meeting (September 2013) and the introduction of computer reminders into the Computerised Physician Order Entry System (July 2014). The analyses were done for the set of tests on which both interventions had focussed (intervention tests; complement, cryoglobulins, immunoglobins, myeloma protein) and a set of control tests unrelated to the interventions (alanine transferase, anti-cyclic citrullinated peptide, C-reactive protein, creatine, haemoglobin, leukocytes, mean corpuscular volume, rheumatoid factor and thrombocytes). At the start of the study, 101 intervention tests and 7660 control tests were ordered per month by the rheumatologists. After the educational meeting, both the level and trend of ordered intervention and control tests did not change significantly. After implementation of the reminders, the level of ordered intervention tests decreased by 85.0 tests (95%-CI -133.3 to -36.8, p<0.01), the level of control tests did not change following the introduction of reminders. In summary, an educational meeting alone was not effective in decreasing the number of ordered intervention tests, but the combination with computer reminders did result in a large decrease of those tests. Therefore, we recommend using computer reminders in addition to education if reduction of inappropriate test use is aimed for.

An evaluation of the NCI Physician Data Query (PDQ) dissemination in Europe.

PubMed

Arrigo, C

1997-06-01

The Physician Data Query (PDQ) is a computerised medical database aimed at communicating cancer-related information through computer technology. PDQ has been distributed in Europe since 1988 and in the U.S. since 1985. A study aimed at evaluating whether PDQ had reached a wide medical community was conducted among European PDQ distributors in 1992 as part of an evaluation of PDQ use and impact. Results indicate that PDQ promotion was limited and that several countries were underserved. A preference was expressed for on-line systems. It was found that PDQ access was limited by the requirement of special equipment, by subscription costs and by language barriers. Subscribers were found mainly in the countries with the highest number of distributors. Among a total 12,205 reported subscribers, only 20% were physicians. The proportion of physicians subscribing to the system was, therefore, low (range 4-39.7/10,000). Altogether 453 searches (range 0-213) and 84.5 h of connection time (range 0-52.5) were reported per month for Europe. It is obvious that additional investigation is needed to further evaluate the impact of PDQ on clinical practice.

Dose versus diagnosis: iatrogenic radiation exposure by multidetector computerised tomography in an academic emergency department with measurement of clinically actionable results and emergently treatable findings.

PubMed

Baskerville, J R; Chang, J H; Viator, M; Rutledge, W; Miryala, R; Duval, K E; Nishino, T K

2009-01-01

To determine the iatrogenic absorbed dosage of radiation of the patient in milligray (mGy) computerised tomography dose index volume (CTDIvol) when tested with multidetector computerised tomography (MDCT) in the emergency department (ED) setting and calculate the absorbed dosage of radiation per clinically actionable result and emergently treatable finding (ETF). The University of Texas Medical Branch (UTMB) ED located in Galveston, Texas, USA, is a level 1 trauma and tertiary referral centre treating 70,000 patients per annum. A retrospective cross-sectional data analysis of 770 emergency patients investigated by MDCT in July 2007. The presence of actionable results and ETF were determined by chart review. A total of 5320 emergency patients was treated in the UTMB ED in July 2007. This included 4508 medical and 812 trauma patients. A total of 1094 MDCT studies was performed, of which complete data were available on 1046. A total of 770 patients was investigated by MDCT, representing 14.47% of all emergency patients. This included 33.99% of trauma patients and 10.96% of medical patients. Actionable results were found in 341 studies and ETF in 105 studies. The mean radiation was 163.27 and 530.23 mGy CTDIvol for actionable results and ETF, respectively, for all studies. The mean radiation was 53.27 and 106.36 mGy CTDIvol for medical and trauma patients, respectively. The absorbed dosage of radiation of patients investigated by MDCT is clinically significant. The actionable results and ETF in our study demonstrate considerable opportunity for improvement in the utilisation of this technology by physicians.

Computerised sepsis protocol management. Description of an early warning system.

PubMed

de Dios, Begoña; Borges, Marcio; Smith, Timothy D; Del Castillo, Alberto; Socias, Antonia; Gutiérrez, Leticia; Nicolás, Jordi; Lladó, Bartolomé; Roche, Jose A; Díaz, Maria P; Lladó, Yolanda

2018-02-01

New strategies need to be developed for the early recognition and rapid response for the management of sepsis. To achieve this purpose, the Multidisciplinary Sepsis Team (MST) developed the Computerised Sepsis Protocol Management (PIMIS). The aim of this study was to evaluate the convenience of using PIMIS, as well as the activity of the MST. An analysis was performed on the data collected from solicited MST consultations (direct activation of PIMIS by attending physician or telephone request) and unsolicited ones (by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software [SIDCV]), as well as the hospital department, source of infection, treatment recommendation, and acceptance of this. Of the 1,581 first consultations, 65.1% were solicited consultations (84.1% activation of PIMIS and 15.9% by telephone). The majority of unsolicited consultations were generated by the microbiology laboratory (95.2%), and 4.8% from the SIDCV. Referral from solicited consultations were generated sooner (5.63days vs 8.47days; P<.001) and came from clinical specialties rather than from the surgical ward (73.0% vs 39.1%; P<.001). A recommendation was made for antimicrobial prescription change in 32% of first consultations. The treating physician accepted 78.1% of recommendations. The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource, and that PIMIS software is perceived to be useful and convenient to use, as it is the main source of referral. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Diagnoses have the greatest impact on variation in sick-leave certification rate among primary-care patients in Sweden: A multilevel analysis including patient, physician and primary health-care centre levels.

PubMed

Starzmann, Karin; Hjerpe, Per; Dalemo, Sofia; Ohlsson, Henrik; Björkelund, Cecilia; Bengtsson Boström, Kristina

2015-11-01

The aims of this study were to determine and evaluate simultaneously the importance of factors known to influence sick-leave certification such as the sick leave-related diagnoses, the patients' socio-economic status, and characteristics of the physicians. Computerised medical records from 24 public primary health-care centres (PHCC) were used in a multilevel logistic regression analysis at three levels: patients (n=64,354; sex, age, socio-economic status, workplace factors and diagnoses), physicians (n=574; sex and level of experience) and PHCC (n=24). The variation of sick-leave certification at each level was the outcome. Most of the variation was attributed to the patient level and only 3.5% to the physician and 1.2% to the PHCC levels. Among the patient characteristics, psychiatric diagnoses (mostly acute stress) had the highest odds ratio (OR) for sick leave (OR=16.0; 95% confidence interval [CI] 15-17.2), followed by musculoskeletal diagnoses (OR=6.1; 95% CI 5.8-6.5). Other factors with increased OR were low education (OR=1.7; 95% CI 1.6-1.8), use of social allowance (OR=1.4; 95% CI 1.2-1.7) and certain workplaces (manufacture and health and social care). Being older was not associated with increased certified sick leave. The greatest variation in sick-leave certification rate was seen at the patient level, specifically psychiatric diagnoses. Socio-economic factors increasing the risk for sick-leave certification were education, social allowance and occupations in manufacture and caregiving. Understanding the impact of the different factors that influence certified sick leave is important both for targeted interventions in order to facilitate patients' return to work. © 2015 the Nordic Societies of Public Health.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

[Survey on computerized immunization registries in Italy].

PubMed

Alfonsi, V; D'Ancona, F; Ciofi degli Atti, M L

2008-01-01

Computerized immunization registries are essential for conducting and monitoring vaccination programs. In fact, they enable to improve vaccine offering to target population, generating needed-immunization lists and assessing levels of vaccination coverage. In 2007, a national survey on immunization registries was conducted in Italy. In February 2007, all the 21 Regional Health Authorities (RHAs) completed and returned an ad hoc questionnaire. In June 2007, RHAs were further contacted by telephone in order to verify and update the information provided in questionnaires. In 9 Italian Regions (42.8%), vaccination registries are computerized in all Local Health Units (LHUs). In five of these Regions, all LHUs use the same software, while in the remaining four Regions, different softwares are in use. In six additional Regions (28.6%), only some LHUs use computerized immunization registries (range 61.5%-95%). In the remaining 6 Regions (28.6%), which are all in Southern Italy, there are no computerised immunization registries at all. In total, computerised immunization registries cover 126/180 Italian LHUs (70%); in 76/126 (60%) of these LUHs, immunization registries are linked with population registries. This survey shows the need to improve the implementation of computerised immunization registries in Italy, especially in Southern Regions.

Computerised Analysis of Telemonitored Respiratory Sounds for Predicting Acute Exacerbations of COPD.

PubMed

Fernandez-Granero, Miguel Angel; Sanchez-Morillo, Daniel; Leon-Jimenez, Antonio

2015-10-23

Chronic obstructive pulmonary disease (COPD) is one of the commonest causes of death in the world and poses a substantial burden on healthcare systems and patients' quality of life. The largest component of the related healthcare costs is attributable to admissions due to acute exacerbation (AECOPD). The evidence that might support the effectiveness of the telemonitoring interventions in COPD is limited partially due to the lack of useful predictors for the early detection of AECOPD. Electronic stethoscopes and computerised analyses of respiratory sounds (CARS) techniques provide an opportunity for substantial improvement in the management of respiratory diseases. This exploratory study aimed to evaluate the feasibility of using: (a) a respiratory sensor embedded in a self-tailored housing for ageing users; (b) a telehealth framework; (c) CARS and (d) machine learning techniques for the remote early detection of the AECOPD. In a 6-month pilot study, 16 patients with COPD were equipped with a home base-station and a sensor to daily record their respiratory sounds. Principal component analysis (PCA) and a support vector machine (SVM) classifier was designed to predict AECOPD. 75.8% exacerbations were early detected with an average of 5 ± 1.9 days in advance at medical attention. The proposed method could provide support to patients, physicians and healthcare systems.

Dosimetry and Image Quality in Control Studies in Computerised Tomography Realized to Paediatric Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hernandez, M. R.; Gamboa-deBuen, I.; Dies, P.

Computerised tomography (CT) is a favourite method of medical diagnosis. Its use has thus increased rapidly throughout the world, particularly in studies relating to children. However to avoid administering unnecessarily high doses of radiation to paediatric patients it is important to have correct dose reference levels to minimize risk. The research is being developed within the public health sector at the Hospital Infantil de Mexico 'Dr. Federico Gomez.' We measured the entrance surface air kerma (K{sub P}) in paediatric patients, during the radiological studies of control in CT (studies of head, thorax and abdomen). Phantom was used to evaluate imagemore » quality as the tomograph requires a high resolution image in order to operate at its optimum level.« less

Immunisation registers in Italy: a patchwork of computerisation.

PubMed

Alfonsi, V; D'Ancona, F; Rota, M C; Giambi, C; Ranghiasci, A; Iannazzo, S

2012-04-26

In Italy, the 21 regional health authorities are in charge of organising and implementing their own vaccination strategy, based on the national vaccine plan. Immunisation coverage varies greatly among the regions for certain vaccines. Efforts to increase childhood immunisation coverage have included initiatives to develop and implement computerised immunisation registers in as many regions as possible. We undertook a cross-sectional online survey in July 2011 to provide an updated picture of the use, heterogeneity and main functions of different computerised immunisation registers used in the Italian regions and to understand the flow of information from local health units to the regional authorities and to the Ministry of Health. Comparing current data with those obtained in 2007, a substantial improvement is evident. A total of 15 regions are fully computerised (previously nine), with 83% of local health units equipped with a computerised register (previously 70%). Eight of the 15 fully computerised regions use the same software, simplifying data sharing. Only four regions are able to obtain data in real time from local health units. Despite the progress made, the capacity to monitor vaccination coverage and to exchange data appears still limited.

Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial.

PubMed

Kamradt, Martina; Kaufmann-Kolle, Petra; Andres, Edith; Brand, Tonia; Klingenberg, Anja; Glassen, Katharina; Poß-Doering, Regina; Uhlmann, Lorenz; Hees, Katharina; Weber, Dorothea; Gutscher, Andreas; Wambach, Veit; Szecsenyi, Joachim; Wensing, Michel

2018-02-05

Despite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis and otitis media), community-acquired pneumonia and non-complicated cystitis, in order to counter the advancing antimicrobial resistance development. A three-armed cluster randomised trial will be conducted in 14 practice networks in two German federal states (Bavaria and North Rhine-Westphalia) and an added cohort that reflects standard care. The trial is accompanied by a process evaluation. Each arm will receive a different set of implementation strategies. Arm A receives a standard set, comprising of e-learning on communication with patients and quality circles with data-based feedback for physicians, information campaigns for the public, patient information material and performance-based additional reimbursement. Arm B receives this standard set plus e-learning on communication with patients and quality circles with data-based feedback tailored for non-physician health professionals of the practice team and information material for tablet computers (culture sensitive). Arm C receives the standard set as well as a computerised decision support system and quality circles in local multidisciplinary groups. The study aims to recruit 193 practices which will provide data on 23,934 patients each year (47,867 patients in total). The outcome evaluation is based on claims data and refers to established indicators of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Primary and secondary outcomes relate to prescribing of antibiotics, which will be analysed in multivariate regression models. The process evaluation is based on interviews with surveys among physicians, non-physician health professionals of the practice team and stakeholders. A patient survey is conducted in one of the study arms. Interview data will be qualitatively analysed using thematic framework analysis. Survey data of physicians, non-physician health professionals of the practice team and patients will use descriptive and exploratory statistics for analysis. The ARena trial will examine the effectiveness of large scale implementation strategies and explore their delivery in routine practice. ISRCTN, ISRCTN58150046 . Registered 24 August 2017.

Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya

PubMed Central

2014-01-01

Background The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes. Methods This cross sectional descriptive study was conducted among staff nurses working at one public hospital (Kenyatta National Hospital, (KNH) and one private hospital (Aga Khan University Hospital (AKUH). A convenience sample of 200 nurses filled the questionnaires. Data was collected using the modified Nurses’ Attitudes Towards Computerisation (NATC) questionnaire. Results Nurses had a favorable attitude towards computerisation. Non-users had a significantly higher attitude score compared to the users (p = 0.0274). Statistically significant associations were observed with age (p = 0.039), level of education (p = 0.025), duration of exposure to computers (p = 0.025) and attitudes towards computerisation. Conclusion Generally, nurses have positive attitudes towards computerisation. This information is important for the planning and implementation of computerisation in the hospital as suggested in other studies. PMID:24774008

A computer system for processing data from routine pulmonary function tests.

PubMed Central

Pack, A I; McCusker, R; Moran, F

1977-01-01

In larger pulmonary function laboratories there is a need for computerised techniques of data processing. A flexible computer system, which is used routinely, is described. The system processes data from a relatively large range of tests. Two types of output are produced--one for laboratory purposes, and one for return to the referring physician. The system adds an automatic interpretative report for each set of results. In developing the interpretative system it has been necessary to utilise a number of arbitrary definitions. The present terminology for reporting pulmonary function tests has limitations. The computer interpretation system affords the opportunity to take account of known interaction between measurements of function and different pathological states. Images PMID:329462

The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service.

PubMed

Laing, G L; Bruce, J L; Aldous, C; Clarke, D L

2014-01-01

The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured. The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths. The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Computerised decision support in physical activity interventions: A systematic literature review.

PubMed

Triantafyllidis, Andreas; Filos, Dimitris; Claes, Jomme; Buys, Roselien; Cornelissen, Véronique; Kouidi, Evangelia; Chouvarda, Ioanna; Maglaveras, Nicos

2018-03-01

The benefits of regular physical activity for health and quality of life are unarguable. New information, sensing and communication technologies have the potential to play a critical role in computerised decision support and coaching for physical activity. We provide a literature review of recent research in the development of physical activity interventions employing computerised decision support, their feasibility and effectiveness in healthy and diseased individuals, and map out challenges and future research directions. We searched the bibliographic databases of PubMed and Scopus to identify physical activity interventions with computerised decision support utilised in a real-life context. Studies were synthesized according to the target user group, the technological format (e.g., web-based or mobile-based) and decision-support features of the intervention, the theoretical model for decision support in health behaviour change, the study design, the primary outcome, the number of participants and their engagement with the intervention, as well as the total follow-up duration. From the 24 studies included in the review, the highest percentage (n = 7, 29%) targeted sedentary healthy individuals followed by patients with prediabetes/diabetes (n = 4, 17%) or overweight individuals (n = 4, 17%). Most randomized controlled trials reported significantly positive effects of the interventions, i.e., increase in physical activity (n = 7, 100%) for 7 studies assessing physical activity measures, weight loss (n = 3, 75%) for 4 studies assessing diet, and reductions in glycosylated hemoglobin (n = 2, 66%) for 3 studies assessing glycose concentration. Accelerometers/pedometers were used in almost half of the studies (n = 11, 46%). Most adopted decision support features included personalised goal-setting (n = 16, 67%) and motivational feedback sent to the users (n = 15, 63%). Fewer adopted features were integration with electronic health records (n = 3, 13%) and alerts sent to caregivers (n = 4, 17%). Theoretical models of decision support in health behaviour to drive the development of the intervention were not reported in most studies (n = 14, 58%). Interventions employing computerised decision support have the potential to promote physical activity and result in health benefits for both diseased and healthy individuals, and help healthcare providers to monitor patients more closely. Objectively measured activity through sensing devices, integration with clinical systems used by healthcare providers and theoretical frameworks for health behaviour change need to be employed in a larger scale in future studies in order to realise the development of evidence-based computerised systems for physical activity monitoring and coaching. Copyright © 2017 Elsevier B.V. All rights reserved.

Mortality Benefits of Antibiotic Computerised Decision Support System: Modifying Effects of Age.

PubMed

Chow, Angela L P; Lye, David C; Arah, Onyebuchi A

2015-11-30

Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital's antibiotic CDSS on patients' clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS's recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26-1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20-1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91-1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34-3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42-2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

PubMed

Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

2013-01-01

To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

Software for computerised analysis of cardiotocographic traces.

PubMed

Romano, M; Bifulco, P; Ruffo, M; Improta, G; Clemente, F; Cesarelli, M

2016-02-01

Despite the widespread use of cardiotocography in foetal monitoring, the evaluation of foetal status suffers from a considerable inter and intra-observer variability. In order to overcome the main limitations of visual cardiotocographic assessment, computerised methods to analyse cardiotocographic recordings have been recently developed. In this study, a new software for automated analysis of foetal heart rate is presented. It allows an automatic procedure for measuring the most relevant parameters derivable from cardiotocographic traces. Simulated and real cardiotocographic traces were analysed to test software reliability. In artificial traces, we simulated a set number of events (accelerations, decelerations and contractions) to be recognised. In the case of real signals, instead, results of the computerised analysis were compared with the visual assessment performed by 18 expert clinicians and three performance indexes were computed to gain information about performances of the proposed software. The software showed preliminary performance we judged satisfactory in that the results matched completely the requirements, as proved by tests on artificial signals in which all simulated events were detected from the software. Performance indexes computed in comparison with obstetricians' evaluations are, on the contrary, not so satisfactory; in fact they led to obtain the following values of the statistical parameters: sensitivity equal to 93%, positive predictive value equal to 82% and accuracy equal to 77%. Very probably this arises from the high variability of trace annotation carried out by clinicians. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

PubMed Central

de Graaf, L Esther; Gerhards, Sylvia AH; Evers, Silvia MAA; Arntz, Arnoud; Riper, Heleen; Severens, Johan L; Widdershoven, Guy; Metsemakers, Job FM; Huibers, Marcus JH

2008-01-01

Background Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods/Design In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65) will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life. Discussion Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed. Trial registration The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). PMID:18590518

Using computerised interactive response technology to assess electrocardiographers and for aggregating diagnoses.

PubMed

Peace, Aaron; Ramsewak, Adesh; Cairns, Andrew; Finlay, Dewar; Guldenring, Daniel; Clifford, Gari; Bond, Raymond

2015-01-01

The 12-lead electrocardiogram (ECG) is a crucial diagnostic tool. However, the ideal method to assess competency in ECG interpretation remains unclear. We sought to evaluate whether keypad response technology provides a rapid, interactive way to assess ECG knowledge. 75 participants were enrolled [32 (43%) Primary Care Physicians, 24 (32%) Hospital Medical Staff and 19 (25%) Nurse Practitioners]. Nineteen ECGs with 4 possible answers were interpreted. Out of 1425 possible decisions 1054 (73.9%) responses were made. Only 570/1425 (40%) of the responses were correct. Diagnostic accuracy varied (0% to 78%, mean 42%±21%) across the entire cohort. Participation was high, (median 83%, IQR 50%-100%). Hospital Medical Staff had significantly higher diagnostic accuracy than nurse practitioners (50±20% vs. 38±19%, p=0.04) and Primary Care Physicians (50±20% vs. 40±21%, p=0.07) although not significant. Interactive voting systems can be rapidly and successfully used to assess ECG interpretation. Further education is necessary to improve diagnostic accuracy. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Impact of order set design on urine culturing practices at an academic medical centre emergency department.

PubMed

Munigala, Satish; Jackups, Ronald R; Poirier, Robert F; Liang, Stephen Y; Wood, Helen; Jafarzadeh, S Reza; Warren, David K

2018-01-20

Urinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the 'frequently ordered test' in the computerised physician order entry system (CPOE) on urine testing practices. We conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining 'urinalysis with reflex to microscopy' as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends. During the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, P<0.001). When adjusted for temporal trends, the daily culture rate per 1000 ED visits decreased by 46.6% (-46.6%, 95% CI -66.2% to -15.6%), but urinalysis (0.4%, 95% CI -30.1 to 44.4%), microscopy (-6.5%, 95% CI -36.0% to 36.6%) and catheterised urine culture rates (17.9%, 95% CI -16.9 to 67.4) were unchanged. A simple intervention of retaining only 'urinalysis with reflex to microscopy' and removing all other urine tests from the 'frequently ordered' window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Investigating pulmonary embolism in the emergency department with lower limb plethysmography: the Manchester Investigation of Pulmonary Embolism Diagnosis (MIOPED) study

PubMed Central

Hogg, K; Dawson, D; Mackway‐Jones, K

2006-01-01

Objectives To measure the diagnostic accuracy of computerised strain gauge plethysmography in the diagnosis of pulmonary embolism (PE). Methods Two researchers prospectively recruited 425 patients with pleuritic chest pain presenting to the emergency department (ED). Lower limb computerised strain gauge plethysmography was performed in the ED. All patients underwent an independent reference standard diagnostic algorithm to establish the presence or absence of PE. A low modified Wells' clinical probability combined with a normal D‐dimer excluded PE. All others required diagnostic imaging with PIOPED interpreted ventilation perfusion scanning and/or computerised tomography (CT) pulmonary angiography. Patients with a nondiagnostic CT had digital subtraction pulmonary angiography. All patients were followed up clinically for 3 months. Results The sensitivity of computerised strain gauge plethysmography was 33.3% (95% confidence interval (CI) 16.3 to 56.2%) and specificity 64.1% (95% CI 59.0 to 68.8%). The negative likelihood ratio was 1.04 (95% CI 0.68 to 1.33) and positive likelihood ratio 0.93 (95% CI 0.45 to 1.60). Conclusions Lower limb computerised strain gauge plethysmography does not aid in the diagnosis of PE. PMID:16439734

Mortality Benefits of Antibiotic Computerised Decision Support System: Modifying Effects of Age

PubMed Central

Chow, Angela L. P.; Lye, David C.; Arah, Onyebuchi A.

2015-01-01

Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital’s antibiotic CDSS on patients’ clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS’s recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26–1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20–1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91–1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34–3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42–2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48–2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations. PMID:26617195

Mortality Benefits of Antibiotic Computerised Decision Support System: Modifying Effects of Age

NASA Astrophysics Data System (ADS)

Chow, Angela L. P.; Lye, David C.; Arah, Onyebuchi A.

2015-11-01

Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital’s antibiotic CDSS on patients’ clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS’s recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26-1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20-1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91-1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34-3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42-2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

Profound Expressive Language Impairment in Low Functioning Children with Autism: An Investigation of Syntactic Awareness Using a Computerised Learning Task

ERIC Educational Resources Information Center

McGonigle-Chalmers, Maggie; Alderson-Day, Ben; Fleming, Joanna; Monsen, Karl

2013-01-01

Nine low-functioning children with profound expressive language impairment and autism were studied in terms of their responsiveness to a computer-based learning program designed to assess syntactic awareness. The children learned to touch words on a screen in the correct sequence in order to see a corresponding animation, such as "monkey…

Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record.

PubMed

Hamiel, Uri; Hecht, Idan; Nemet, Achia; Pe'er, Liron; Man, Vitaly; Hilely, Assaf; Achiron, Asaf

2018-05-01

Abbreviations are common in the medical record. Their inappropriate use may ultimately lead to patient harm, yet little is known regarding the extent of their use and their comprehension. Our aim was to assess the extent of their use, their comprehension and physicians' attitudes towards them, using ophthalmology consults in a tertiary hospital as a model. We first mapped the frequency with which English abbreviations were used in the departments' computerised databases. We then used the most frequently used abbreviations as part of a cross-sectional survey designed to assess the attitudes of non-ophthalmologist physicians towards the abbreviations and their comprehension of them. Finally, we tested whether an online lecture would improve comprehension. 4375 records were screened, and 235 physicians responded to the survey. Only 42.5% knew at least 10% of the abbreviations, and no one knew them all. Ninety-two per cent of respondents admitted to searching online for the meanings of abbreviations, and 59.1% believe abbreviations should be prohibited in medical records. A short online lecture improved the number of respondents answering correctly at least 50% of the time from 1.2% to 42% (P<0.001). Abbreviations are common in medical records and are frequently misinterpreted. Online teaching is a valuable tool for physician education. The majority of respondents believed that misinterpreting abbreviations could negatively impact patient care, and that the use of abbreviations should be prohibited in medical records. Due to low rates of comprehension and negative attitudes towards abbreviations in medical communications, we believe their use should be discouraged. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Training and transfer effects of N-back training for brain-injured and healthy subjects.

PubMed

Lindeløv, Jonas Kristoffer; Dall, Jonas Olsen; Kristensen, Casper Daniel; Aagesen, Marie Holt; Olsen, Stine Almgren; Snuggerud, Therese Ruud; Sikorska, Anna

2016-10-01

Working memory impairments are prevalent among patients with acquired brain injury (ABI). Computerised training targeting working memory has been researched extensively using samples from healthy populations but this field remains isolated from similar research in ABI patients. We report the results of an actively controlled randomised controlled trial in which 17 patients and 18 healthy subjects completed training on an N-back task. The healthy group had superior improvements on both training tasks (SMD = 6.1 and 3.3) whereas the ABI group improved much less (SMD = 0.5 and 1.1). Neither group demonstrated transfer to untrained tasks. We conclude that computerised training facilitates improvement of specific skills rather than high-level cognition in healthy and ABI subjects alike. The acquisition of these specific skills seems to be impaired by brain injury. The most effective use of computer-based cognitive training may be to make the task resemble the targeted behaviour(s) closely in order to exploit the stimulus-specificity of learning.

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units.

PubMed

Weiss, Manfred; Marx, Gernot; Iber, Thomas

2017-08-04

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

Applying Adaptive Variables in Computerised Adaptive Testing

ERIC Educational Resources Information Center

Triantafillou, Evangelos; Georgiadou, Elissavet; Economides, Anastasios A.

2007-01-01

Current research in computerised adaptive testing (CAT) focuses on applications, in small and large scale, that address self assessment, training, employment, teacher professional development for schools, industry, military, assessment of non-cognitive skills, etc. Dynamic item generation tools and automated scoring of complex, constructed…

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

PubMed

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

Computerised Attention Training for Children with Intellectual and Developmental Disabilities: A Randomised Controlled Trial

ERIC Educational Resources Information Center

Kirk, Hannah E.; Gray, Kylie M.; Ellis, Kirsten; Taffe, John; Cornish, Kim M.

2016-01-01

Background: Children with intellectual and developmental disabilities (IDD) experience heightened attention difficulties which have been linked to poorer cognitive, academic and social outcomes. Although, increasing research has focused on the potential of computerised cognitive training in reducing attention problems, limited studies have…

Development and impact of computerised decision support systems for clinical management of depression: A systematic review.

PubMed

Triñanes, Yolanda; Atienza, Gerardo; Louro-González, Arturo; de-las-Heras-Liñero, Elena; Alvarez-Ariza, María; Palao, Diego J

2015-01-01

One of the proposals for improving clinical practice is to introduce computerised decision support systems (CDSS) and integrate these with electronic medical records. Accordingly, this study sought to systematically review evidence on the effectiveness of CDSS in the management of depression. A search was performed in Medline, EMBASE and PsycInfo, in order to do this. The quality of quantitative studies was assessed using the SIGN method, and qualitative studies using the CASPe checklist. Seven studies were identified (3 randomised clinical trials, 3 non-randomised trials, and one qualitative study). The CDSS assessed incorporated content drawn from guidelines and other evidence-based products. In general, the CDSS had a positive impact on different aspects, such as the screening and diagnosis, treatment, improvement in depressive symptoms and quality of life, and referral of patients. The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Do Computerised Training Programmes Designed to Improve Working Memory Work?

ERIC Educational Resources Information Center

Apter, Brian J. B.

2012-01-01

A critical review of working memory training research during the last 10 years is provided. Particular attention is given to research that has attempted to investigate the efficacy of commercially marketed computerised training programmes such as "Cogmed" and "Jungle Memory". Claimed benefits are questioned on the basis that research methodologies…

Demography, Social Structure and Learning through Life

ERIC Educational Resources Information Center

van der Veen, Ruud

2010-01-01

The modernisation of the Western world during the last two centuries has been a mix of industrialisation/computerisation and urbanisation. Consequently, reports on the future of adult learning and adult education have been a mix on the one hand of the learning requirements that follow from industrialisation/computerisation and on the other hand,…

Computerised Accounting Software; A Curriculum That Enhances an Accounting Programme

ERIC Educational Resources Information Center

Machera, Robert P.; Machera, Precious C.

2017-01-01

There has been an outcry in commerce and industry about students who fail to perform in the accounting department due to lack of "practical accounting skills". It is from this background that the researchers were motivated to investigate the impact of a Computerised Accounting Software Curriculum that enhances an Accounting Programme. At…

Using 'nudge' principles for order set design: a before and after evaluation of an electronic prescribing template in critical care.

PubMed

Bourdeaux, Christopher P; Davies, Keith J; Thomas, Matthew J C; Bewley, Jeremy S; Gould, Timothy H

2014-05-01

Computerised order sets have the potential to reduce clinical variation and improve patient safety but the effect is variable. We sought to evaluate the impact of changes to the design of an order set on the delivery of chlorhexidine mouthwash and hydroxyethyl starch (HES) to patients in the intensive care unit. The study was conducted at University Hospitals Bristol NHS Foundation Trust, UK. Our intensive care unit uses a clinical information system (CIS). All drugs and fluids are prescribed with the CIS and drug and fluid charts are stored within a database. Chlorhexidine mouthwash was added as a default prescription to the prescribing template in January 2010. HES was removed from the prescribing template in April 2009. Both interventions were available to prescribe manually throughout the study period. We conducted a database review of all patients eligible for each intervention before and after changes to the configuration of choices within the prescribing system. 2231 ventilated patients were identified as appropriate for treatment with chlorhexidine, 591 before the intervention and 1640 after. 55.3% were prescribed chlorhexidine before the change and 90.4% after (p<0.001). 6199 patients were considered in the HES intervention, 2177 before the intervention and 4022 after. The mean volume of HES infused per patient fell from 630 mL to 20 mL after the change (p<0.001) and the percentage of patients receiving HES fell from 54.1% to 3.1% (p<0.001). These results were well sustained with time. The presentation of choices within an electronic prescribing system influenced the delivery of evidence-based interventions in a predictable way and the effect was well sustained. This approach has the potential to enhance the effectiveness of computerised order sets.

Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis.

PubMed

Pennant, Mary E; Loucas, Christina E; Whittington, Craig; Creswell, Cathy; Fonagy, Peter; Fuggle, Peter; Kelvin, Raphael; Naqvi, Sabrina; Stockton, Sarah; Kendall, Tim

2015-04-01

One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12-25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD -0.77, 95% CI -1.45 to -0.09, k = 6, N = 220) and depression (SMD -0.62, 95% CI -1.13 to -0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD -0.15, 95% CI -0.26 to -0.03; N = 1273) and depression (SMD -0.15, 95% CI -0.26 to -0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5-11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children. Copyright © 2015 Elsevier Ltd. All rights reserved.

Development and evaluation of a centralised computerised registry for ureteric stents: completing the audit cycle.

PubMed

Davis, N F; Murray, G; O'Connor, T; Browne, C; MacCraith, E; Galvin, D; Mulvin, D; Quinlan, D; Lennon, G

2017-11-01

A forgotten ureteric stent may result in severe renal impairment leading to nephrectomy. To compare the effectiveness of a centralised computerised registry for monitoring ureteric stent activity with a previously established theatre stent logbook system. This prospective audit was performed in two 9-monthly intervals. During the first interval, insertion/removal of a ureteric stent was documented in a specific theatre stent logbook. In the second interval, an electronic centralised computerised registry was developed to document insertion/removal of a ureteric stent onto an accessible hospital server. A computerised traffic-light system was also developed to identify patients with an indwelling stent for >3 months. The primary outcome variable was the number of prolonged indwelling ureteric stents in both groups. During the first time interval, 188 ureteric stents were inserted and 182 (96%) were removed or changed. Six (4%) patients underwent insertion of a ureteric stent for a prolonged period of time (>6 months). This subgroup required complex endourological intervention for stent removal due to encrustation. During the second time interval, 157 ureteric stents were inserted and all patients had their stent removed or changed within 6 months. No patients in this group were lost to follow-up. This study demonstrates that a centralised computerised ureteric stent registry is superior to a conventional logbook for monitoring ureteric stent activity. We propose the introduction a centralised nationalised ureteric stent registry for eliminating the potential for prolonged or forgotten ureteric stents.

Computerised Axial Tomography (CAT)

DTIC Science & Technology

1990-06-01

commercial market. EMI, which had originally counted on being the only firm selling CT units , subsequently increased its production in order to overtake...to a rough estimate’"’ the number of CT scanners at present working in Italy is about 18 units installed. apart from those in the large cities such as...hGdcl scanners and 198 total body scanners): among othar things, they emphasise that a CT unit , works, on an average, for 5.4 days in the week and

Evaluation of three indices for biofilm accumulation on complete dentures.

PubMed

Paranhos, Helena de Freitas Oliveira; Lovato da Silva, Claudia Helena; de Souza, Raphael Freitas; Pontes, Karina Matthes de Freitas

2010-03-01

The objective of this study was to evaluate the accuracy and reproducibility of three complete denture biofilm indices (Prosthesis Hygiene Index; Jeganathan et al. Index; Budtz-Jørgensen Index) by means of a computerised comparison method. Clinical studies into denture hygiene have employed a large number of biofilm indices among their outcome variables. However, the knowledge about the validity of these indices is still scarce. Sixty-two complete denture wearers were selected. The internal surfaces of the upper complete dentures were stained (5% erythrosine) and photographed. The slides were projected on paper, and the biofilm indices were applied over the photos by means of a scoring method. For the computerised method, the areas (total and biofilm-covered) were measured by dedicated software (Image Tool). In addition, to compare the results of the computerised method and Prosthetic Hygiene Index, a new scoring scale (including four and five graded) was introduced. For the Jeganathan et al. and Budtz-Jørgensen indices, the original scales were used. Values for each index were compared with the computerised method by the Friedman test. Their reproducibility was measured by means of weighed kappa. Significance for both tests was set at 0.05. The indices tested provided similar mean measures but they tended to overestimate biofilm coverage when compared with the computerised method (p < 0.001). Agreement between the Prosthesis Hygiene Index and the computerised method was not significant, regardless of the scale used. Jeghanathan et al. Index showed weak agreement, and consistent results were found for Budtz-Jorgensen Index (kappa = 0.19 and 0.39 respectively). Assessment of accuracy for the biofilm indices showed instrument bias that was similar among the tested methods. Weak inter-instrument reproducibility was found for the indices, except for the Budtz-Jørgensen Index. This should be the method of choice for clinical studies when more sophisticated approaches are not possible.

Lesson of the month 1: Lobar pulmonary consolidation in an immunocompromised host.

PubMed

Reynolds, Daniel J; Andersen, Carl A; Hoskote, Sumedh S; Lee, Hee Eun; Raghunathan, Aditya; Kalra, Sanjay; Limper, Andrew H

2016-12-01

A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. Computerised tomography (CT) of the chest revealed the presence of a lobar pneumonia and he was treated with broad spectrum antibiotics, which did not improve his symptoms. Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation. Pathology revealed non-budding yeasts, consistent with Pneumocystis Serological and urine studies were positive for both Histoplasma and Blastomyces The diagnosis of Histoplasma pneumonia was made because of the presentation being inconsistent with Pneumocystis pneumonia, and serology, urine and pathology testing being more consistent with Histoplasma The patient was treated with oral itraconazole and was doing well at follow-up 12 weeks after hospitalisation. © Royal College of Physicians 2016. All rights reserved.

Effectiveness of a Computerised Working Memory Training in Adolescents with Mild to Borderline Intellectual Disabilities

ERIC Educational Resources Information Center

Van der Molen, M. J.; Van Luit, J. E. H.; Van der Molen, M. W.; Klugkist, I.; Jongmans, M. J.

2010-01-01

Background: The goal of this study is to evaluate the effectiveness of a computerised working memory (WM) training on memory, response inhibition, fluid intelligence, scholastic abilities and the recall of stories in adolescents with mild to borderline intellectual disabilities attending special education. Method: A total of 95 adolescents with…

Evaluation of Computerised Reading-Assistance Systems for Reading Japanese Texts--From a Linguistic Point of View

ERIC Educational Resources Information Center

Toyoda, Etsuko

2016-01-01

For second-language learners to effectively and efficiently gather information from online texts in their target language, a well-designed computerised system to assist their reading is essential. While many articles and websites which introduce electronic second-language learning tools exist, evaluation of their functions in relation to the…

An Investigation of Integrative and Independent Listening Test Tasks in a Computerised Academic English Test

ERIC Educational Resources Information Center

Wei, Wei; Zheng, Ying

2017-01-01

This research provided a comprehensive evaluation and validation of the listening section of a newly introduced computerised test, Pearson Test of English Academic (PTE Academic). PTE Academic contains 11 item types assessing academic listening skills either alone or in combination with other skills. First, task analysis helped identify skills…

Using a Computerised Graphics Package to Achieve a Technology-Oriented Classroom

ERIC Educational Resources Information Center

Aladejana, Francisca; Idowu, Lanre

2009-01-01

The present situation in Nigeria involves students of fine arts, a practical-oriented subject, being exposed to poor methods of teaching with consequent poor performances. This study examined the extent to which the use of a computerised graphics package could make the classroom technology-oriented and affect the performance of learners. This is…

A New Computerised Advanced Theory of Mind Measure for Children with Asperger Syndrome: The ATOMIC

ERIC Educational Resources Information Center

Beaumont, Renae B.; Sofronoff, Kate

2008-01-01

This study examined the ability of children with Asperger Syndrome (AS) to attribute mental states to characters in a new computerised, advanced theory of mind measure: The Animated Theory of Mind Inventory for Children (ATOMIC). Results showed that children with AS matched on IQ, verbal comprehension, age and gender performed equivalently on…

Student Evaluation in Higher Education: A Comparison between Computer Assisted Assessment and Traditional Evaluation

ERIC Educational Resources Information Center

Ghilay, Yaron; Ghilay, Ruth

2012-01-01

The study examined advantages and disadvantages of computerised assessment compared to traditional evaluation. It was based on two samples of college students (n=54) being examined in computerised tests instead of paper-based exams. Students were asked to answer a questionnaire focused on test effectiveness, experience, flexibility and integrity.…

[The application of new technologies to hospital pharmacy in Spain].

PubMed

Bermejo Vicedo, T; Pérez Menéndez Conde, C; Alvarez, Ana; Codina, Carlos; Delgado, Olga; Herranz, Ana; Hidalgo Correas, Francisco; Martín, Isabel; Martínez, Julio; Luis Poveda, José; Queralt Gorgas, María; Sanjurjo Sáez, María

2007-01-01

To describe the degree of introduction of new technologies in the medication use process in pharmacy services in Spain. A descriptive study via a survey into the degree of introduction of computer systems for: management, computerized physician order entry (CPOE), automated unit dose drug dispensing, preparation of parenteral nutrition solutions, recording drug administration, pharmaceutical care and foreseen improvements. The survey was sent by electronic mail to the heads of the pharmacy services of 207 hospitals throughout Spain. Response index: 82 hospitals (38.6%). 29 hospitals (36.7%) have a modular management system, 24 (30.4%) an integrated one and 34 (44.9%) a modular-integrated one. CPOE is utilised in 17 (22.4%). According to the size of the hospital, between 17.9 and 26.7% of unit dose dispensing is done online with a management software; between 5.1 and 33.3% of unit dose dispensing is automated. Automation of unit dose dispensing centred in the pharmacy service varies between 10 and 33.3%. Between 13.2 and 35.7% of automated in-ward dispensing systems are utilised. Administration records are kept manually on a computerised sheet at 23 (31.5%) of the hospitals; at 4 (5.4%) on CPOE and 7 (9.5%) online on the integral management programme and 4 (5.4%) on specific nursing softwares. Sixty-three per cent foresee the implementation of improvements in the short to medium term. The introduction of new technologies is being developed in Spain aiming to improve the safety and management of drugs, and there is a trend towards increasing their deployment in the near future. It is hoped that their fomentation could help to bring about process reengineering within pharmacy services in order to increase the time available for devotion to pharmaceutical care.

Which breast cancer decisions remain non-compliant with guidelines despite the use of computerised decision support?

PubMed Central

Séroussi, B; Laouénan, C; Gligorov, J; Uzan, S; Mentré, F; Bouaud, J

2013-01-01

Background: Despite multidisciplinary tumour boards (MTBs), non-compliance with clinical practice guidelines is still observed for breast cancer patients. Computerised clinical decision support systems (CDSSs) may improve the implementation of guidelines, but cases of non-compliance persist. Methods: OncoDoc2, a guideline-based decision support system, has been routinely used to remind MTB physicians of patient-specific recommended care plans. Non-compliant MTB decisions were analysed using a multivariate adjusted logistic regression model. Results: Between 2007 and 2009, 1624 decisions for invasive breast cancers with a global non-compliance rate of 8.3% were analysed. Patient factors associated with non-compliance were age>80 years (odds ratio (OR): 7.7; 95% confidence interval (CI): 3.7–15.7) in pre-surgical decisions; microinvasive tumour (OR: 5.2; 95% CI: 1.5–17.5), surgical discovery of microinvasion in addition to a unique invasive tumour (OR: 4.2; 95% CI: 1.4–12.5), and prior neoadjuvant treatment (OR: 4.2; 95% CI: 1.1–15.1) in decisions with recommendation of re-excision; age<35 years (OR: 4.7; 95% CI: 1.9–11.4), positive hormonal receptors with human epidermal growth factor receptor 2 overexpression (OR: 15.7; 95% CI: 3.1–78.7), and the absence of prior axillary surgery (OR: 17.2; 95% CI: 5.1–58.1) in adjuvant decisions. Conclusion: Residual non-compliance despite the use of OncoDoc2 illustrates the need to question the clinical profiles where evidence is missing. These findings challenge the weaknesses of guideline content rather than the use of CDSSs. PMID:23942076

Imaging tests in staging and surveillance of non-metastatic breast cancer: changes in routine clinical practice and cost implications.

PubMed

De Placido, S; De Angelis, C; Giuliano, M; Pizzi, C; Ruocco, R; Perrone, V; Bruzzese, D; Tommasielli, G; De Laurentiis, M; Cammarota, S; Arpino, G; Arpino, G

2017-03-14

Although guidelines do not recommend computerised tomography (CT), positron emission tomography (PET) or magnetic resonance imaging (MRI) for the staging or follow-up of asymptomatic patients with non-metastatic breast cancer, they are often requested in routine clinical practice. The aim of this study was to determine the staging and follow-up patterns, and relative costs in a large population of breast cancer patients living and treated in a Southern Italian region. We analysed the clinical computerised information recorded by 567 primary-care physicians assisting about 650 000 inhabitants in the Campania region. Patients with non-metastatic breast cancer were identified and divided into calendar years from 2001 to 2010. The number of diagnostic tests prescribed per 100 patients (N/Pts) and the mean cost per patient was determined 3 months before diagnosis and up to 1 year after diagnosis. Costs are expressed in constant 2011 euros. We identified 4680 newly diagnosed cases of asymptomatic non-metastatic breast cancer. N/Pts increased significantly (P<0.0001) from 2001 to 2010. The mean number of prescribed mammograms, bone scans, abdominal ultrasound and chest X-rays ('routine tests'), and costs was unchanged. However, the number of CT, PET scans and MRI ('new tests')prescriptions almost quadrupled and the mean cost per patient related to these procedures significantly increased from [euro ]357 in 2001 to [euro ]830 in 2010 (P<0.0001). New test prescriptions and relative costs significantly and steadily increased throughout the study period. At present there is no evidence that the delivery of new tests to asymptomatic patients improves breast cancer outcome. Well-designed clinical trials are urgently needed to shed light on the impact of these tests on clinical outcome and overall survival.

Future of computerised electrocardiography.

PubMed Central

Meijler, F L; Robles de Medina, E O; Helder, J C

1980-01-01

The advent of computerised electrocardiography has been of prime importance for the storage and retrieval of data, but none of the available systems is of universal application for analysis of patterns. Future needs require hierarchical systems of increasing degrees of complexity, depending on the source of requests, and there should be appropriate provision for review by cardiologists before the final report is issued. PMID:7000098

Review and Reward within the Computerised Peer-Assessment of Essays

ERIC Educational Resources Information Center

Davies, Phil

2009-01-01

This article details the implementation and use of a "Review Stage" within the CAP (computerised assessment by peers) tool as part of the assessment process for a post-graduate module in e-learning. It reports upon the effect of providing the students with a "second chance" in marking and commenting their peers' essays having been able to view the…

Computerised lung sound monitoring to assess effectiveness of chest physiotherapy and secretion removal: a feasibility study.

PubMed

Ntoumenopoulos, G; Glickman, Y

2012-09-01

To explore the feasibility of computerised lung sound monitoring to evaluate secretion removal in intubated and mechanically ventilated adult patients. Before and after observational investigation. Intensive care unit. Fifteen intubated and mechanically ventilated adult patients receiving chest physiotherapy. Chest physiotherapy included combinations of standard closed airway suctioning, saline lavage, postural drainage, chest wall vibrations, manual-assisted cough and/or lung hyperinflation, dependent upon clinical indications. Lung sound amplitude at peak inspiration was assessed using computerised lung sound monitoring. Measurements were performed immediately before and after chest physiotherapy. Data are reported as mean [standard deviation (SD)], mean difference and 95% confidence intervals (CI). Significance testing was not performed due to the small sample size and the exploratory nature of the study. Fifteen patients were included in the study [11 males, four females, mean age 65 (SD 14) years]. The mean total lung sound amplitude at peak inspiration decreased two-fold from 38 (SD 59) units before treatment to 17 (SD 19) units after treatment (mean difference 22, 95% CI of difference -3 to 46). The mean total lung sound amplitude from the lungs of patients with a large amount of secretions (n=9) was over four times 'louder' than the lungs of patients with a moderate or small amount of secretions (n=6) [56 (SD 72) units vs 12 (13) units, respectively; mean difference -44, 95% CI of difference -100 to 11]. The mean total lung sound amplitude decreased in the group of 'loud' right and left lungs (n=15) from 37 (SD 36) units before treatment to 15 (SD 13) units after treatment (mean difference 22, 95% CI of difference 6 to 38). Computerised lung sound monitoring in this small group of patients demonstrated a two-fold decrease in lung sound amplitude following chest physiotherapy. Subgroup analysis also demonstrated decreasing trends in lung sound amplitude in the group of 'loud' lungs following chest physiotherapy. Due to the small sample size and large SDs with high variability in the lung sound amplitude measurements, significance testing was not reported. Further investigation is needed in a larger sample of patients with more accurate measurement of sputum wet weight in order to distinguish between secretion-related effects and changes due to other factors such as airflow rate and pattern. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

PubMed Central

Weiss, Manfred; Marx, Gernot; Iber, Thomas

2017-01-01

Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician’s workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs. PMID:28828300

What is the true definition of a "Do-Not-Resuscitate" order? A Japanese perspective.

PubMed

Hiraoka, Eiji; Homma, Yosuke; Norisue, Yasuhiro; Naito, Takaki; Kataoka, Yuko; Hamada, Osamu; Den, Yo; Takahashi, Osamu; Fujitani, Shigeki

2016-01-01

Japan has no official guidelines for do-not-resuscitate (DNR) orders. Therefore, we investigated the effect of DNR orders on physician decision making in relation to performing noncardiopulmonary resuscitation (CPR) and CPR procedures. A case-scenario-based questionnaire that included a case of advanced cancer, a case of advanced dementia, and a case of nonadvanced heart failure was administered to physicians. The questions determined whether physicians would perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The number of non-CPR procedures each physician would perform and the number of physicians who would perform each non-CPR and CPR procedure in the absence and presence of DNR ocrders were compared. Physicians from three Japanese municipal acute care hospitals participated. We analyzed 111 of 161 (69%) questionnaires. Physicians would perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all three case scenarios (median [interquartile range] percentages: Case 1: 72% [45%-90%] vs 100% [90%-100%]; Case 2: 55% [36%-72%] vs 91% [63%-100%]; Case 3: 78% [55%-88%] vs 100% [88%-100%]). Fewer physicians would perform non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. However, considerable numbers of physicians would perform electric shock treatment for ventricular fibrillation in the presence of DNR orders (Case 1: 26%; Case 2: 16%; Case 3: 20%). DNR orders affect physician decision making about performing non-CPR procedures. Although some physicians would perform CPR for ventricular fibrillation in the presence of DNR orders, others would not. Therefore, a consensus definition for DNR orders should be developed in Japan, otherwise DNR orders may cause harm.

The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

PubMed

Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

2014-12-01

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

A Computerized Wear Particle Atlas for Ferrogram and Filtergram Analyses

DTIC Science & Technology

1998-01-01

A Computerised Wear Particle Atlas for Ferrogram and Filtergram Analyses Jian G. Ding Lubrosoft P/L P 0 Box 2368, Rowville Melbourne VIC 3178...Australia (61-3) 9759-9083 Abstract: A new computerised wear particle atlas has been developed for identification of solid particles and...differentiation of wear severity of lubricated equipment. This atlas contains 892 images of representative solid particles selected from thousands of filtergram

A systematic review of computerised serious educational games about alcohol and other drugs for adolescents.

PubMed

Rodriguez, Daniel M; Teesson, Maree; Newton, Nicola C

2014-03-01

Serious educational games (SEG) have been shown to be effective in educating young people about a range of topics, including languages and maths. This paper identifies the use of computerised SEGs in education about alcohol and other drugs and reviews their impact on the prevention of alcohol and drug use. The Cochrane Library, EMBASE, MEDLINE, ERIC, Scopus, psychINFO, pubMED and DRUG databases were searched in February 2013. Additional publications were obtained from the reference lists of the relevant papers. Studies were included if they described an evaluation of a computerised SEG that targeted alcohol and/or other drugs and had been trialled with adolescents. Eight SEGs were identified targeting tobacco, alcohol, cannabis, methamphetamine, ecstasy, inhalants, cocaine and opioids. Six reported positive outcomes in terms of increased content knowledge and two reported increased negative attitudes towards the targeted drugs. Only one reported a decrease in the frequency of drug use. This is the first review of the efficacy of computerised SEGs for alcohol and other drugs for adolescents. Results suggest that SEGs can increase content knowledge of alcohol and other drugs. Evidence concerning impacts on negative attitudes and alcohol and drug use is limited, with few studies examining these outcomes. © 2013 Australasian Professional Society on Alcohol and other Drugs.

Feasibility and effectiveness of a cognitive remediation programme with original computerised cognitive training and group intervention for schizophrenia: a multicentre randomised trial.

PubMed

Matsuda, Yasuhiro; Morimoto, Tsubasa; Furukawa, Shunichi; Sato, Sayaka; Hatsuse, Norifumi; Iwata, Kazuhiko; Kimura, Mieko; Kishimoto, Toshifumi; Ikebuchi, Emi

2018-04-01

Devising new methods to improve neurocognitive impairment through cognitive remediation is an important research goal. We developed an original computer programme termed the Japanese Cognitive Rehabilitation Programme for Schizophrenia (JCORES) that provides cognitive practice across a broad range of abilities. The current study examined for the first time whether a cognitive remediation programme, including both computerised cognitive training using JCORES and group intervention such as enhancing meta-cognition and teaching strategies, is more effective than treatment as usual for improving neurocognitive and social functioning. Sixty-two outpatients with schizophrenia were randomised to either a cognitive remediation group or a control group. Participants engaged in two computerised cognitive training sessions and one group meeting per week for 12 weeks. The average number of total sessions attended (computerised cognitive practice + group intervention) was 32.3 (89.7%). The cognitive remediation group showed significantly more improvements in verbal memory, composite score of the Brief Assessment of Cognition in Schizophrenia, Japanese version (BACS-J), and general psychopathology on the Positive and Negative Syndrome Scale (PANSS) than the control group. These findings demonstrate that a cognitive remediation programme is feasible in Japan and is a more effective way to improve neurocognitive functioning and psychiatric symptoms.

42 CFR 424.507 - Ordering and referring covered items and services for Medicare beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ordered or referred by a resident or an intern, the claim must identify the teaching physician as the... referred by a resident or an intern, the claim must identify the teaching physician as the ordering or... intern, the claim must identify the teaching physician as the ordering or referring physician. The claim...

42 CFR 424.507 - Ordering and referring covered items and services for Medicare beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ordered or referred by a resident or an intern, the claim must identify the teaching physician as the... referred by a resident or an intern, the claim must identify the teaching physician as the ordering or... intern, the claim must identify the teaching physician as the ordering or referring physician. The claim...

The Melbourne East Monash General Practice Database (MAGNET): Using data from computerised medical records to create a platform for primary care and health services research.

PubMed

Mazza, Danielle; Pearce, Christopher; Turner, Lyle Robert; De Leon-Santiago, Maria; McLeod, Adam; Ferriggi, Jason; Shearer, Marianne

2016-07-04

The Melbourne East MonAsh GeNeral PracticE DaTabase (MAGNET) research platform was launched in 2013 to provide a unique data source for primary care and health services research in Australia.  MAGNET contains information from the computerised records of 50 participating general practices and includes data from the computerised medical records of more than 1,100,000 patients.  The data extracted is patient-level episodic information and includes a variety of fields related to patient demographics and historical clinical information, along with the characteristics of the participating general practices.  While there are limitations to the data that is currently available, the MAGNET research platform continues to investigate other avenues for improving the breadth and quality of data, with the aim of providing a more comprehensive picture of primary care in Australia.

Computerised electronic foetal heart rate monitoring in labour: automated contraction identification.

PubMed

Georgieva, A; Payne, S J; Redman, C W G

2009-12-01

The foetal heart rate (FHR) response to uterine contractions is crucial to detect foetal distress by electronic FHR monitoring during labour. We are developing a new automated system (OxSys) for decision support in labour, using the Oxford database of intrapartum FHR records. We describe here a novel technique for automated detection of uterus contractions. In addition, we present a comparison of the new method with four other computerised approaches. During training, OxSys achieved sensitivity above 95% and positive predictive value (PPV) of up to 90% for traces of good quality. During testing, OxSys achieved sensitivity = 87% and PPV = 75%. For comparison, a second clinical expert obtained sensitivity = 93% and PPV = 80%, and all other computerised approaches achieved lower values. It was concluded that the proposed method can be employed with confidence in our study on foetal health assessment in labour and future OxSys development.

SFINX-a drug-drug interaction database designed for clinical decision support systems.

PubMed

Böttiger, Ylva; Laine, Kari; Andersson, Marine L; Korhonen, Tuomas; Molin, Björn; Ovesjö, Marie-Louise; Tirkkonen, Tuire; Rane, Anders; Gustafsson, Lars L; Eiermann, Birgit

2009-06-01

The aim was to develop a drug-drug interaction database (SFINX) to be integrated into decision support systems or to be used in website solutions for clinical evaluation of interactions. Key elements such as substance properties and names, drug formulations, text structures and references were defined before development of the database. Standard operating procedures for literature searches, text writing rules and a classification system for clinical relevance and documentation level were determined. ATC codes, CAS numbers and country-specific codes for substances were identified and quality assured to ensure safe integration of SFINX into other data systems. Much effort was put into giving short and practical advice regarding clinically relevant drug-drug interactions. SFINX includes over 8,000 interaction pairs and is integrated into Swedish and Finnish computerised decision support systems. Over 31,000 physicians and pharmacists are receiving interaction alerts through SFINX. User feedback is collected for continuous improvement of the content. SFINX is a potentially valuable tool delivering instant information on drug interactions during prescribing and dispensing.

Examination of changes in pathology tests ordered by Diagnosis-Related Group (DRGs) following CPOE introduction.

PubMed

Vecellio, Elia; Georgiou, Andrew; Toouli, George; Eigenstetter, Alex; Li, Ling; Wilson, Roger; Westbrook, Johanna I

2013-01-01

Electronic test ordering, via the Electronic Medical Record (EMR), which incorporates computerised provider order entry (CPOE), is widely considered as a useful tool to support appropriate pathology test ordering. Diagnosis-related groups (DRGs) are clinically meaningful categories that allow comparisons in pathology utilisation by patient groups by controlling for many potentially confounding variables. This study used DRG data linked to pathology test data to examine changes in rates of test ordering across four years coinciding with the introduction of an EMR in six hospitals in New South Wales, Australia. This method generated a list of high pathology utilisation DRGs. We investigated patients with a Chest pain DRG to examine whether tests rates changed for specific test groups by hospital emergency department (ED) pre- and post-EMR. There was little change in testing rates between EDs or between time periods pre- and post-EMR. This is a valuable method for monitoring the impact of EMR and clinical decision support on test order rates.

Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial.

PubMed

Ryskina, Kira; Jessica Dine, C; Gitelman, Yevgeniy; Leri, Damien; Patel, Mitesh; Kurtzman, Gregory; Lin, Lisa Y; Epstein, Andrew J

2018-05-22

Social comparison feedback is an increasingly popular strategy that uses performance report cards to modify physician behavior. Our objective was to test the effect of such feedback on the ordering of routine laboratory tests for hospitalized patients, a practice considered overused. This was a single-blinded randomized controlled trial. Between January and June 2016, physicians on six general medicine teams at the Hospital of the University of Pennsylvania were cluster randomized with equal allocation to two arms: (1) those e-mailed a summary of their routine laboratory test ordering vs. the service average for the prior week, linked to a continuously updated personalized dashboard containing patient-level details, and snapshot of the dashboard and (2) those who did not receive the intervention. The primary outcome was the count of routine laboratory test orders placed by a physician per patient-day. We modeled the count of orders by each physician per patient-day after the intervention as a function of trial arm and the physician's order count before the intervention. The count outcome was modeled using negative binomial models with adjustment for clustering within teams. One hundred and fourteen interns and residents participated. We did not observe a statistically significant difference in adjusted reduction in routine laboratory ordering between the intervention and control physicians (physicians in the intervention group ordered 0.14 fewer tests per patient-day than physicians in the control group, 95% CI - 0.56 to 0.27, p = 0.50). Physicians whose absolute ordering rate deviated from the peer rate by more than 1.0 laboratory test per patient-day reduced their laboratory ordering by 0.80 orders per patient-day (95% CI - 1.58 to - 0.02, p = 0.04). Personalized social comparison feedback on routine laboratory ordering did not change targeted behavior among physicians, although there was a significant decrease in orders among participants who deviated more from the peer rate. Clinicaltrials.gov registration: #NCT02330289.

Severe hypertriglyceridemia. Clinical characteristics and therapeutic management.

PubMed

Masson, Walter; Rossi, Emiliano; Siniawski, Daniel; Damonte, Juan; Halsband, Ana; Barolo, Ramiro; Scaramal, Miguel

2018-05-19

The therapeutic management of severe hypertriglyceridaemia represents a clinical challenge. The objectives of this study were 1) to identify the clinical characteristics of patients with severe hypertriglyceridaemia, and 2) to analyse the treatment established by the physicians in each case. A cross-sectional study was carried out using the computerised medical records of all patients>18 years of age with a blood triglyceride level≥1,000mg/dL between 1 January 2011 and 31 December 2016. Clinical and laboratory variables were collected. The behaviour of the physicians in the 6 months after the lipid finding was analysed. A total of 420 patients were included (mean age 49.1±11.4 years, males 78.8%). The median of triglycerides was 1,329mg/dL (interquartile range 1,174-1,658). No secondary causes were found in 34.1% of the patients. The most frequent secondary causes were obesity (38.6%) and diabetes (28.1%). Physical activity was recommended and a nutritionist was referred to in 49.1% and 44.2% of the patients, respectively. Secondary causes were identified and attempts were made to correct them in 40.7% of cases. The most indicated pharmacological treatments were fenofibrate 200mg/day (26.5%) and gemfibrozil 900mg/day (19.3%). Few patients received the indication of omega 3 fatty acids or niacin. This study showed, for the first time in our country, the characteristics of a population with severe hypertriglyceridaemia. The therapeutic measures instituted by the physicians were insufficient. Knowing the characteristics in this particular clinical scenario could improve the current approach of these patients. Copyright © 2018 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

[Is the ICU staff satisfied with the computerized physician order entry? A cross-sectional survey study].

PubMed

Fumis, Renata Rego Lins; Costa, Eduardo Leite Vieira; Martins, Paulo Sergio; Pizzo, Vladimir; Souza, Ivens Augusto; Schettino, Guilherme de Paula Pinto

2014-01-01

To evaluate the satisfaction of the intensive care unit staff with a computerized physician order entry and to compare the concept of the computerized physician order entry relevance among intensive care unit healthcare workers. We performed a cross-sectional survey to assess the satisfaction of the intensive care unit staff with the computerized physician order entry in a 30-bed medical/surgical adult intensive care unit using a self-administered questionnaire. The questions used for grading satisfaction levels were answered according to a numerical scale that ranged from 1 point (low satisfaction) to 10 points (high satisfaction). The majority of the respondents (n=250) were female (66%) between the ages of 30 and 35 years of age (69%). The overall satisfaction with the computerized physician order entry scored 5.74±2.14 points. The satisfaction was lower among physicians (n=42) than among nurses, nurse technicians, respiratory therapists, clinical pharmacists and diet specialists (4.62±1.79 versus 5.97±2.14, p<0.001); satisfaction decreased with age (p<0.001). Physicians scored lower concerning the potential of the computerized physician order entry for improving patient safety (5.45±2.20 versus 8.09±2.21, p<0.001) and the ease of using the computerized physician order entry (3.83±1.88 versus 6.44±2.31, p<0.001). The characteristics independently associated with satisfaction were the system's user-friendliness, accuracy, capacity to provide clear information, and fast response time. Six months after its implementation, healthcare workers were satisfied, albeit not entirely, with the computerized physician order entry. The overall users' satisfaction with computerized physician order entry was lower among physicians compared to other healthcare professionals. The factors associated with satisfaction included the belief that digitalization decreased the workload and contributed to the intensive care unit quality with a user-friendly and accurate system and that digitalization provided concise information within a reasonable time frame.

Understanding the acceptability of e-mental health--attitudes and expectations towards computerised self-help treatments for mental health problems.

PubMed

Musiat, Peter; Goldstone, Philip; Tarrier, Nicholas

2014-04-11

E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population. An advisory group of service users identified dimensions that potentially influence an individual's decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA. Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants' expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future. Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such interventions.

Understanding the acceptability of e-mental health - attitudes and expectations towards computerised self-help treatments for mental health problems

PubMed Central

2014-01-01

Background E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population. Methods An advisory group of service users identified dimensions that potentially influence an individual’s decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA. Results Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants’ expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future. Conclusions Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such interventions. PMID:24725765

[Teletransmission, health care and deontology].

PubMed

Lousson, J P

1995-01-01

EDI is the technique the most frequently used by Chemists to relay their daily orders to their suppliers. Three out of four Chemists in France are computerised using various forms of computer hardware and software. The Health Care organisations propose that Chemists use the EDI to relay to the CETELIC all the items of information concerning their invoicing. This means handing over administrative information identifying the patient, the doctor ... as well as financial and confidential data such as the CIP code of the prescribed and delivered medicine. The law of the 4th January 1993 was instigated to control the rising expenses of the Health Care organisations and it mandates the Caisse Primaire d'Assurance Maladie (the French social security organisations) to retrieve and analyse the information thus gathered from all of the medical professionals involved. However, the accumulation of all these items of computerised information constitutes in effect a confidential medical file on each patient. This raises the following issues: Who does this confidential data belong to? Who should the Chemists give it to? What is to be done with it? Who will be responsible for its analysis in respect of the confidentiality problem? (Another medical professional bound by oath?) And how can we insure against subsequent abuse of this material?

INRstar: computerised decision support software for anticoagulation management in primary care.

PubMed

Jones, Robert Treharne; Sullivan, Mark; Barrett, David

2005-01-01

Computerised decision support software (CDSS) for anticoagulation management has become established practice in the UK, offering significant advantages for patients and clinicians over traditional methods of dose calculation. The New GMS Contract has been partly responsible for this shift of management from secondary to primary care, in which INRstar has been the market leader for many years. In September 2004, INRstar received the John Perry Prize, awarded by the PHCSG for excellence and innovation in medical applications of information technology.

Key Attributes of a Successful Physician Order Entry System Implementation in a Multi-hospital Environment

PubMed Central

Ahmad, Asif; Teater, Phyllis; Bentley, Thomas D.; Kuehn, Lynn; Kumar, Rajee R.; Thomas, Andrew; Mekhjian, Hagop S.

2002-01-01

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University Health System extensively implemented physician order entry across inpatient units. Implementation for specialty and community services is targeted for completion in 2002. On implemented units, all orders are processed through the system, with 80 percent being entered by physicians and the rest by nursing or other licensed care providers. The system is deployable across diverse clinical environments, focused on physicians as the primary users, and accepted by clinicians. These are the three criteria by which the authors measured the success of their implementation. They believe that the availability of specialty-specific order sets, the engagement of physician leadership, and a large-scale system implementation were key strategic factors that enabled physician-users to accept a physician order entry system despite significant changes in workflow. PMID:11751800

Design and Use of a Joint Order Vocabulary Knowledge Representation Tier in a Multi-tier CPOE Architecture

PubMed Central

Rucker, Donald W.; Steele, Andrew W.; Douglas, Ivor S.; Couderc, Carmela A.; Hardel, Gary G.

2006-01-01

Two major barriers to adoption of computerized physician order entry (CPOE) systems are the initial physician effort to learn the system and ongoing time costs to use the system. These barriers stem from the CPOE system’s need to reformulate physician orders into services that can be electronically communicated to ancillary clinical systems such as pharmacy, nursing, lab or radiology as well as to billing systems. Typical CPOE systems use significant custom user interface programming to match the terms used by physicians to order services as well as the aggregation of those orders into order sets with the underlying orderable services. We describe the design and implementation of a commercial CPOE system that has a formal separate intermediate mapping layer to match physician screen vocabulary and ordering behaviors to underlying services, both individually and in groups, supported by powerful search tools. PMID:17238425

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

PubMed

Muething, S E; Conway, P H; Kloppenborg, E; Lesko, A; Schoettker, P J; Seid, M; Kotagal, U

2010-10-01

To describe how in-depth analysis of adverse events can reveal underlying causes. Triggers for adverse events were developed using the hospital's computerised medical record (naloxone for opiate-related oversedation and administration of a glucose bolus while on insulin for insulin-related hypoglycaemia). Triggers were identified daily. Based on information from the medical record and interviews, a subject expert determined if an adverse drug event had occurred and then conducted a real-time analysis to identify event characteristics. Expert groups, consisting of frontline staff and specialist physicians, examined event characteristics and determined the apparent cause. 30 insulin-related hypoglycaemia events and 34 opiate-related oversedation events were identified by the triggers over 16 and 21 months, respectively. In the opinion of the experts, patients receiving continuous-infusion insulin and those receiving dextrose only via parenteral nutrition were at increased risk for insulin-related hypoglycaemia. Lack of standardisation in insulin-dosing decisions and variation regarding when and how much to adjust insulin doses in response to changing glucose levels were identified as common causes of the adverse events. Opiate-related oversedation events often occurred within 48 h of surgery. Variation in pain management in the operating room and post-anaesthesia care unit was identified by the experts as potential causes. Variations in practice, multiple services writing orders, multidrug regimens and variations in interpretation of patient assessments were also noted as potential contributing causes. Identification of adverse drug events through an automated trigger system, supplemented by in-depth analysis, can help identify targets for intervention and improvement.

Investigating healthcare IT innovations: a "conceptual blending" approach.

PubMed

Cranfield, Steven; Hendy, Jane; Reeves, Barnaby; Hutchings, Andrew; Collin, Simon; Fulop, Naomi

2015-01-01

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS). To analyse these multi-level dynamics, the authors blend Rogers' diffusion of innovations theory (DoIT) with Webster's sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts. Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application - in particular speed, ease of use, reliability and flexibility and levels of readiness - were highly relevant but their influence was modulated through interaction with complex structural and relational issues. Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of "co-construction" between designers and end-users. The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

Malpractice Liability Risk and Use of Diagnostic Imaging Services: A Systematic Review of the Literature.

PubMed

Li, Suhui; Brantley, Erin

2015-12-01

A widespread concern among physicians is that fear of medical malpractice liability may affect their decisions for diagnostic imaging orders. The purpose of this article is to synthesize evidence regarding the defensive use of imaging services. A literature search was conducted using a number of databases. The review included peer-reviewed publications that studied the link between physician orders of imaging tests and malpractice liability pressure. We identified 13 peer-reviewed studies conducted in the United States. Five of the studies reported physician assessments of the role of defensive medicine in imaging-order decisions; five assessed the association between physicians' liability risk and imaging ordering, and three assessed the impact of liability risk on imaging ordering at the state level. Although the belief that medical liability risk could influence decisions is highly prevalent among physicians, findings are mixed regarding the impact of liability risk on imaging orders at both the state and physician level. Inconclusive evidence suggests that physician ordering of imaging tests is affected by malpractice liability risk. Further research is needed to disentangle defensive medicine from other reasons for inefficient use of imaging. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Time to cranial computerised tomography for acute traumatic brain injury in paediatric patients: Effect of the shorter stays in emergency departments target in New Zealand.

PubMed

Jones, Peter G; Kool, Bridget; Dalziel, Stuart; Shepherd, Michael; Le Fevre, James; Harper, Alana; Wells, Susan; Stewart, Joanna; Curtis, Elana; Reid, Papaarangi; Ameratunga, Shanthi

2017-07-01

Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influenced the timeliness of cranial CT scanning in children who presented to ED with acute TBI. We retrospectively reviewed a random sample of charts of children <15 years with acute TBI from 2006 to 2012. Cases were identified using International Classification of Disease 10 codes consistent with TBI. General linear models investigated changes in time to CT and other indicators before and after the shorter stays in ED target was introduced in 2009. Among the 190 cases eligible for study (n = 91 pre-target and n = 99 post-target), no significant difference was found in time to CT scan pre- and post-target: least squares mean (LSM) with 95% confidence interval = 68 (56-81) versus 65 (53-78) min, respectively, P = 0.66. Time to neurosurgery (LSM 8.7 (5-15) vs. 5.1 (2.6-9.9) h, P = 0.19, or hospital length of stay (LSM: 4.9 (3.9-6.3) vs. 5.2 (4.1-6.7) days, P = 0.69) did not change significantly. However, ED length of stay decreased by 45 min in the post-target period (LSM = 211 (187-238) vs. 166 (98-160) min, P = 0.006). Implementation of the shorter stays in ED target was not associated with a change in the time to CT for children presenting with acute TBI, but an overall reduction in the time spent in ED was apparent. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Development of a computerised decisions support system for renal risk drugs targeting primary healthcare

PubMed Central

Helldén, Anders; Al-Aieshy, Fadiea; Bastholm-Rahmner, Pia; Bergman, Ulf; Gustafsson, Lars L; Höök, Hans; Sjöviker, Susanne; Söderström, Anders; Odar-Cederlöf, Ingegerd

2015-01-01

Objectives To assess general practitioners (GPs) experience from the implementation and use of a renal computerised decision support system (CDSS) for drug dosing, developed for primary healthcare, integrated into the patient’s electronic health record (EHR), and building on estimation of the patient's creatinine clearance (ClCG). Design Qualitative research design by a questionnaire and a focus group discussion. Setting and participants Eight GPs at two primary healthcare centres (PHCs). Interventions The GP at PHC 1, and the project group, developed and tested the technical solution of the CDSS. Proof-of-concept was tested by seven GPs at PHC 2. They also participated in a group discussion and answered a questionnaire. A web window in the EHR gave drug and dosage in relation to ClCG. Each advice was according to three principles: If? Why? Because. Outcome measures (1) The GPs’ experience of ‘easiness to use’ and ‘perceived usefulness’ at PHC 2, based on loggings of use, answers from a questionnaire using a 5-point Likert scale, and answers from a focus group discussion. (2) The number of patients aged 65 years and older with an estimation of ClCG before and after the implementation of the CDSS. Results The GPs found the CDSS fast, simple and easy to use. They appreciated the automatic presentation of the CICG status on opening the medication list, and the ability to actively look up specific drug recommendations in two steps. The CDSS scored high on the Likert scale. All GPs wanted to continue the use of the CDSS and to recommend it to others. The number of patients with an estimated ClCG increased 1.6-fold. Conclusions Acceptance of the simple graphical interface of this push and pull renal CDSS was high among the primary care physicians evaluating this proof of concept. The graphical model should be useful for further development of renal decision support systems. PMID:26150141

Cognitive analysis of physicians' medication ordering activity.

PubMed

Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine

2005-01-01

Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

Application of computerised penile arterial waveform analysis in the diagnosis of arteriogenic impotence. An initial study in potent and impotent men.

PubMed

Desai, K M; Gingell, J C; Skidmore, R; Follett, D H

1987-11-01

A new method is described for evaluating arteriogenic impotence by means of noninvasive quantification of penile Doppler arterial waveforms using computerised analysis based on the Laplace Transform model. The haemodynamic changes occurring during a papaverine-induced erection in healthy potent volunteers have been recorded by this technique, which has also been shown to be capable of discriminating between a normal and an abnormal penile arterial supply in an initial study of potent and impotent men.

78 FR 19271 - Special Fraud Alert: Physician-Owned Entities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... selling, or arranging for the sale of, implantable medical devices ordered by their physician-owners for..., implantable medical devices ordered by their physician-owners for use in procedures the physician-owners... medical device manufacturers and distributors in an October 6, 2006 letter.\\3\\ In that letter, we noted...

Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis

PubMed Central

Fine, Benjamin; Schultz, Susan E.; White, Lawrence; Henry, David

2017-01-01

Background: In 2012, the Ontario government withdrew public insurance coverage of imaging tests for uncomplicated low back pain. We studied the impact of this restriction on test ordering by physicians. Methods: We compared the numbers of lumbar spine radiography, computed tomography (CT) and single-segment magnetic resonance imaging (MRI) studies ordered by physicians in the 3 years before and after the policy change. We linked claims data from the Ontario Health Insurance Program with physician details to calculate rates per test-ordering physician. We compared changes in rates of monthly test ordering by family physicians and specialists before and after the policy change using segmented regression analysis of interrupted time series data. Results: The number of lumbar spine radiography and spine CT studies ordered by family physicians decreased by 98 597 (28.7%) and 17 499 (28.7%), respectively, in the year after the policy change; there was little change in ordering by specialists. The number of lumbar spine radiography studies ordered per family physician by month decreased by 0.81 tests (p < 0.001) after the intervention, followed by a smaller rebound increase that remained below baseline. Monthly ordering of spine CT per family physician declined by 0.1 tests (p < 0.001), and that of limited spine MRI rose before the intervention, decreased by 0.18 tests (p < 0.001) after the intervention, then started to rise again. Monthly ordering of limited spine MRI by specialists, which had been stable before the policy change, decreased by 0.1 tests per specialist (p < 0.001) afterward, then rose to preintervention levels. Interpretation: The restriction in coverage of imaging tests caused a larger decrease in test ordering by family physicians than by specialists and a larger, more sustained reduction in the use of lumbar spine radiography and spine CT than of spine MRI. PMID:29042408

Multidisciplinary and multisetting team management programme in heart failure patients affects hospitalisation and costing.

PubMed

Piepoli, M F; Villani, G Q; Aschieri, D; Bennati, S; Groppi, F; Pisati, M S; Rosi, A; Capucci, A

2006-08-28

We evaluated whether multidisciplinary disease management programme developed with collaboration of physicians and nurses inside and outside general district hospital settings can affect clinical outcomes in heart failure population over a 12-month period. 571 patients hospitalised with CHF were referred to our unit and 509 patients agreed to participation. The intervention team included physicians and nurses from Internal Medicine and Cardiac Dept., and the patient's general practitioners. Contacts were on a pre-specified schedule, included a computerised programme of hospital visits and phone calls; in case of NYHA functional class III and IV patients, home visits were also planned. The median age of patients was 77.7+/-9 years (43.3% women). At baseline the percentage of patients with NYHA class III and IV was 56.0% vs. 26.0% after 12 months (P<0.05). Programme enrolment reduced total hospital admissions (82 vs. 190, -56%, P<0.05), number of patients hospitalised (62 vs. 146, 57%, P<0.05). All NYHA functional class benefited (class I=75%, class IV=67%), with reduction in the costing (-48%, P<0.05). Improvement in symptoms (-9.0+/-3.2) and signs (-5.2+/-3.1) scores was measured (P<0.01). Therapy optimisation was obtained by 20.5% increase in patients taking betablockade and 21.0% increase in those on anti-aldosterone drugs. Multidisciplinary approach to CHF management can improve clinical management, reducing hospitalisation rate and costing.

Evolution of a residue laboratory network and the management tools for monitoring its performance.

PubMed

Lins, E S; Conceição, E S; Mauricio, A De Q

2012-01-01

Since 2005 the National Residue & Contaminants Control Plan (NRCCP) in Brazil has been considerably enhanced, increasing the number of samples, substances and species monitored, and also the analytical detection capability. The Brazilian laboratory network was forced to improve its quality standards in order to comply with the NRCP's own evolution. Many aspects such as the limits of quantification (LOQs), the quality management systems within the laboratories and appropriate method validation are in continuous improvement, generating new scenarios and demands. Thus, efficient management mechanisms for monitoring network performance and its adherence to the established goals and guidelines are required. Performance indicators associated to computerised information systems arise as a powerful tool to monitor the laboratories' activity, making use of different parameters to describe this activity on a day-to-day basis. One of these parameters is related to turnaround times, and this factor is highly affected by the way each laboratory organises its management system, as well as the regulatory requirements. In this paper a global view is presented of the turnaround times related to the type of analysis, laboratory, number of samples per year, type of matrix, country region and period of the year, all these data being collected from a computerised system called SISRES. This information gives a solid background to management measures aiming at the improvement of the service offered by the laboratory network.

Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour.

PubMed

Meidani, Z; Mousavi, G A; Kheirkhah, D; Benar, N; Maleki, M R; Sharifi, M; Farrokhian, A

2017-12-01

Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions. Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identified, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most influential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period. Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after first and second intervention, respectively. There was a significant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001). Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.

Trends in use of the only Food and Drug Administration-approved commercially available fenestrated endovascular aneurysm repair device in the United States.

PubMed

Simons, Jessica P; Shue, Bing; Flahive, Julie M; Aiello, Francesco A; Steppacher, Robert C; Eaton, Elizabeth A; Messina, Louis M; Schanzer, Andres

2017-05-01

Fenestrated endografts are customized, patient-specific, endovascular devices with potential to significantly reduce morbidity and mortality of short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. The Zenith fenestrated endovascular graft (ZFEN) for abdominal aortic aneurysms (Cook Medical, Bloomington, Ind), Food and Drug Administration-approved in 2012, remains the only fenestrated device available in the United States. This technology is among the most technically complex catheter-based procedures and, therefore, inherently associated with serious risk for device-related complications. We sought to define patterns of physician and hospital adoption of ZFEN. Deidentified datasets containing numbers of physicians trained, orders by physicians and hospitals, and designs (fenestration/scallop configuration) was provided for U.S. ZFEN devices ordered (April 2012-August 2015). We evaluated the number of physicians trained, the number of devices ordered, hospital characteristics, and fenestration/scallop design configurations. Cook Medical assembled the datasets but played no role in study design, analysis, or interpretation of data. Between April 2012 and August 2015, 553 physicians attended formal ZFEN training sessions, 388 (70%) of whom ordered a total of 2669 devices. An increase in orders per month (nine in June 2012 and 91 in August 2015, 911% growth; P < .001) and in number of physicians ordering per month (eight in June 2012 and 62 in August 2015, 675% growth; P < .001) was observed. Teaching hospitals, representing all U.S. regions (Midwest 927, 35%; South 799, 30%; Northeast 547, 20%; West 396, 15%), accounted for 1703 (64%) ZFEN orders. Of 553 trained physicians, 165 (30%) ordered no devices, 116 (21%) ordered 1 device, 144 (26%) ordered 2-5 devices, 61 (11%) ordered 6-10 devices, 39 (7%) ordered 11-20, and 28 (5%) ordered >20 devices. For physicians contributing >6 months of data (n = 336), the average number of devices ordered per year was three (standard deviation, 4); 272 (81%) ordered ≤ 5 devices/year, 15 (4.5%) ordered 11-20 devices/year, and 3 (0.9%) ordered >20 devices/year. Of devices with design details available (2618 of 2669; 98%), most common designs were 2 small fenestrations/1 scallop (1443; 55%), 2 small fenestrations/1 large fenestration (568; 22%), 1 small fenestration/1 scallop (173, 6.6%), and 2 small fenestrations (169; 6.5%). The average number of target vessels incorporated in each design was 2.7/device; 2071 (79%) incorporated three, 398 (15%) incorporated two. Since 2012, ZFEN has demonstrated a ninefold increase in monthly orders, with 553 physicians trained. Unlike the experience of rapid dissemination seen with infrarenal endografts, only 28 (5%) physicians have ordered >20, whereas 165 (30%) have ordered none, and 272 (81%) ordered ≤ 5 devices/year. Assuming that volume, in general, correlates with outcomes, this adoption pattern raises questions whether fenestrated technology should be regionalized to high-volume centers. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Structural and congenital heart disease interventions: the role of three-dimensional printing.

PubMed

Meier, L M; Meineri, M; Qua Hiansen, J; Horlick, E M

2017-02-01

Advances in catheter-based interventions in structural and congenital heart disease have mandated an increased demand for three-dimensional (3D) visualisation of complex cardiac anatomy. Despite progress in 3D imaging modalities, the pre- and periprocedural visualisation of spatial anatomy is relegated to two-dimensional flat screen representations. 3D printing is an evolving technology based on the concept of additive manufacturing, where computerised digital surface renders are converted into physical models. Printed models replicate complex structures in tangible forms that cardiovascular physicians and surgeons can use for education, preprocedural planning and device testing. In this review we discuss the different steps of the 3D printing process, which include image acquisition, segmentation, printing methods and materials. We also examine the expanded applications of 3D printing in the catheter-based treatment of adult patients with structural and congenital heart disease while highlighting the current limitations of this technology in terms of segmentation, model accuracy and dynamic capabilities. Furthermore, we provide information on the resources needed to establish a hospital-based 3D printing laboratory.

The security of patient identifiable information in doctors' homes.

PubMed

McLean, Iain; Anderson, C Mary

2004-08-01

Ethically and legally doctors bear a responsibility to ensure the security of patient identifiable information in their possession. Many doctors, especially those in forensic medicine, hold paper or computerised medical records at home. This survey was conducted to assess the level of security for these records and awareness of the issues. Fifty-six forensic physicians (30 male, 26 female) answered a questionnaire. Eighty-nine percent used a computer to write patient notes and reports, but only 26 of these were on the Data Protection Register, and only 24 password-protected their files. Few doctors took steps to protect data on old computers they had stopped using. Of those responding, 88% held paper records at home but only of these had lockable filing cabinets. Burglar alarms were fitted in 77% of homes, yet 36% of homes had been burgled. No participants had written instructions for disposal of records and reports after their death. Older participants were more likely to have been burgled, yet less likely to have antiviral software than their younger counterparts. Participants expressed the need for information, education and training in data security.

Computer-based physician order entry: the state of the art.

PubMed Central

Sittig, D F; Stead, W W

1994-01-01

Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry. PMID:7719793

Practices to prevent venous thromboembolism: a brief review

PubMed Central

Lau, Brandyn D; Haut, Elliott R

2014-01-01

Background Venous thromboembolism (VTE) is a common cause of preventable harm for hospitalised patients. Over the past decade, numerous intervention types have been implemented in attempts to improve the prescription of VTE prophylaxis in hospitals, with varying degrees of success. We reviewed key articles to assess the efficacy of different types of interventions to improve prescription of VTE prophylaxis for hospitalised patients. Methods We conducted a search of MEDLINE for key studies published between 2001 and 2012 of interventions employing education, paper based tools, computerised tools, real time audit and feedback, or combinations of intervention types to improve prescription of VTE prophylaxis for patients in hospital settings. Process outcomes of interest were prescription of any VTE prophylaxis and best practice VTE prophylaxis. Clinical outcomes of interest were any VTE and potentially preventable VTE, defined as VTE occurring in patients not prescribed appropriate prophylaxis. Results 16 articles were included in this review. Two studies employed education only, four implemented paper based tools, four used computerised tools, two evaluated audit and feedback strategies, and four studies used combinations of intervention types. Individual modalities result in improved prescription of VTE prophylaxis; however, the greatest and most sustained improvements were those that combined education with computerised tools. Conclusions Many intervention types have proven effective to different degrees in improving VTE prevention. Provider education is likely a required additional component and should be combined with other intervention types. Active mandatory tools are likely more effective than passive ones. Information technology tools that are well integrated into provider workflow, such as alerts and computerised clinical decision support, can improve best practice prophylaxis use and prevent patient harm resulting from VTE. PMID:23708438

Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

PubMed

Meyer, T A

2000-12-15

Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient prescriptions indicate improvements in handwriting and completeness, but continuing educational efforts are needed. The quality of order writing for inpatients and outpatients continues to be monitored on a regular basis. Ongoing educational programs, follow-up reminders, and feedback to physicians have greatly improved the prescription-writing habits of physicians.

The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments.

PubMed

Austin, Jodie A; Smith, Ian R; Tariq, Amina

2018-01-22

Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment. To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration. Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy. Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8-57 min versus 120 min, 30-180 min, P < 0.001). For time-critical medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities. The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time. © 2018 Royal Pharmaceutical Society.

Short-term morbidities and neurodevelopmental outcomes in preterm infants exposed to magnesium sulphate treatment.

PubMed

Morag, Iris; Yakubovich, Daniel; Stern, Orly; Siman-Tov, Maya; Schushan-Eisen, Irit; Strauss, Tzipi; Simchen, Michal

2016-04-01

The aim of the study is to examine whether baseline serum Mg concentration has an impact on short-term and long-term outcomes in preterm infants exposed antenatally to MgSO4. Participants included all infants admitted to the neonatal intensive care unit at <32 weeks of gestational age. Infant serum Mg concentration (iMgC) was examined immediately after birth in those exposed to maternal MgSO4. Data for short-term outcomes were collected from the infants' computerised charts. Neurodevelopmental outcomes at 6-12 months corrected age were assessed using the Griffiths Mental Developmental Scales. Of 197 eligible infants, 145 were exposed to MgSO4. Baseline iMgC was available for 88 infants. Mean iMgC was 3.5 ± 0.88 mg/dL (1.6-5.7 mg/dL). Baseline iMgC was not associated with an increased risk for neither early morbidities nor adverse long-term outcome. However, iMgC above the mean (>3.5 mg/dL) was associated with significantly lower scores on locomotor (P = 0.016) and personal-social (0.041) scales in the first year of life. In a cohort of preterm infants antenatally exposed to MgSO4, elevated baseline iMgC (>3.5 mg/dL) was associated with lower locomotor scores. Further research is needed in order to study the relationship between supra-physiologic iMgC and its effect on the developing brain. © 2016 The Author. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Association of Liability Concerns with Decisions to Order Echocardiography and Cardiac Stress Tests with Imaging.

PubMed

Kini, Vinay; Weiner, Rory B; McCarthy, Fenton H; Wiegers, Susan E; Kirkpatrick, James N

2016-12-01

Professional societies have made efforts to curb overuse of cardiac imaging and decrease practice variation by publishing appropriate use criteria. However, little is known about the impact of physician-level determinants such as liability concerns and risk aversion on decisions to order testing. A web-based survey was administered to cardiologists and general practice physicians affiliated with two academic institutions. The survey consisted of four clinical scenarios in which appropriate use criteria rated echocardiography or stress testing as "may be appropriate." Respondents' degree of liability concerns and risk aversion were measured using validated tools. The primary outcome variable was tendency to order imaging, calculated as the average likelihood to order an imaging test across the clinical scenarios (1 = very unlikely, 6 = very likely). Linear regression models were used to evaluate the association between tendency to order imaging and physician characteristics. From 420 physicians invited to participate, 108 complete responses were obtained (26% response rate, 54% cardiologists). There was no difference in tendency to order imaging between cardiologists and general practice physicians (3.46 [95% CI, 3.12-3.81] vs 3.15 [95% CI, 2.79-3.51], P = .22). On multivariate analysis, a higher degree of liability concerns was the only significant predictor of decisions to order imaging (mean difference in tendency to order imaging, 0.36; 95% CI, 0.09-0.62; P = .01). In clinical situations in which performance of cardiac imaging is rated as "may be appropriate" by appropriate use criteria, physicians with higher liability concerns ordered significantly more testing than physicians with lower concerns. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Is the problem list in the eye of the beholder? An exploration of consistency across physicians.

PubMed

Krauss, John C; Boonstra, Philip S; Vantsevich, Anna V; Friedman, Charles P

2016-09-01

Quantify the variability of patients' problem lists - in terms of the number, type, and ordering of problems - across multiple physicians and assess physicians' criteria for organizing and ranking diagnoses. In an experimental setting, 32 primary care physicians generated and ordered problem lists for three identical complex internal medicine cases expressed as detailed 2- to 4-page abstracts and subsequently expressed their criteria for ordering items in the list. We studied variability in problem list length. We modified a previously validated rank-based similarity measure, with range of zero to one, to quantify agreement between pairs of lists and calculate a single consensus problem list that maximizes agreement with each physician. Physicians' reasoning for the ordering of the problem lists was recorded. Subjects' problem lists were highly variable. The median problem list length was 8 (range: 3-14) for Case A, 10 (range: 4-20) for Case B, and 7 (range: 3-13) for Case C. The median indices of agreement - taking into account the length, content, and order of lists - over all possible physician pairings was 0.479, 0.371, 0.509, for Cases A, B, and C, respectively. The median agreements between the physicians' lists and the consensus list for each case were 0.683, 0.581, and 0.697 (for Cases A, B, and C, respectively).Out of a possible 1488 pairings, 2 lists were identical. Physicians most frequently ranked problem list items based on their acuity and immediate threat to health. The problem list is a physician's mental model of a patient's health status. These mental models were found to vary significantly between physicians, raising questions about whether problem lists created by individual physicians can serve their intended purpose to improve care coordination. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

System requirements for a computerised patient record information system at a busy primary health care clinic.

PubMed

Blignaut, P J; McDonald, T; Tolmie, C J

2001-05-01

A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

The effect of maternal methadone use on the fetal heart pattern: a computerised CTG analysis.

PubMed

Navaneethakrishnan, R; Tutty, S; Sinha, C; Lindow, S W

2006-08-01

Using a computerised analysis, the cardiotocograph (CTG) from women who use methadone (n= 25) when compared with women who do not use methadone (n= 25) showed a significant reduction in the fetal heart baseline rate, with a significant reduction in number of accelerations and episodes of high variation. The short-term variation, number of decelerations and episodes of low variation were not different between the two groups. The time taken to meet the standardised criteria was not different, and it is possible that a computer-assisted CTG analysis could be more accurate than a naked eye interpretation.

Computerised analysis of facial emotion expression in eating disorders.

PubMed

Leppanen, Jenni; Dapelo, Marcela Marin; Davies, Helen; Lang, Katie; Treasure, Janet; Tchanturia, Kate

2017-01-01

Problems with social-emotional processing are known to be an important contributor to the development and maintenance of eating disorders (EDs). Diminished facial communication of emotion has been frequently reported in individuals with anorexia nervosa (AN). Less is known about facial expressivity in bulimia nervosa (BN) and in people who have recovered from AN (RecAN). This study aimed to pilot the use of computerised facial expression analysis software to investigate emotion expression across the ED spectrum and recovery in a large sample of participants. 297 participants with AN, BN, RecAN, and healthy controls were recruited. Participants watched film clips designed to elicit happy or sad emotions, and facial expressions were then analysed using FaceReader. The finding mirrored those from previous work showing that healthy control and RecAN participants expressed significantly more positive emotions during the positive clip compared to the AN group. There were no differences in emotion expression during the sad film clip. These findings support the use of computerised methods to analyse emotion expression in EDs. The findings also demonstrate that reduced positive emotion expression is likely to be associated with the acute stage of AN illness, with individuals with BN showing an intermediate profile.

Exploring the impact of instructional approaches on the learning and transfer of medication dosage calculation competency.

PubMed

Glaister, Karen

2005-09-01

The ability of nurses to perform accurate drug dosage calculations has repercussions for patients' well-being. How best to assist nurses develop competency in this area is paramount. This paper presents findings of a study conducted with undergraduate nurses to determine the effect of three instructional approaches on the learning of this skill. The quasi-experimental study exposed participants to one of three instructional approaches: integrative learning, computerised learning and a combination of integrative and computerised learning. Quantitative and qualitative approaches were used to explore differences in the instructional approaches and gain further understanding of the learning process. There was no statistical difference between the three instructional approaches on knowledge acquisition and transfer measures, other than measures for procedural knowledge, which was significant (F(2,47) = 3.33 at p < .044). A least-significant difference post hoc test (alpha = 0. 10) indicated computerised learning was significantly more effective in developing procedural knowledge. The provision of instructional strategies, which facilitate development of conditional knowledge and automaticity, is necessary for competency development in dosage calculations. Furthermore, the curriculum must incorporate authentic tasks and permit time to support competency attainment.

Practice Variation and Effects of E-mail-only Performance Feedback on Resource Use in the Emergency Department.

PubMed

Tavarez, Melissa M; Ayers, Brandon; Jeong, Jong H; Coombs, Carmen M; Thompson, Ann; Hickey, Robert W

2017-08-01

Higher resource utilization in the management of pediatric patients with undifferentiated vomiting and/or diarrhea does not correlate consistently with improved outcomes or quality of care. Performance feedback has been shown to change physician practice behavior and may be a mechanism to minimize practice variation. We aimed to evaluate the effects of e-mail-only, provider-level performance feedback on the ordering and admission practice variation of pediatric emergency physicians for patients presenting with undifferentiated vomiting and/or diarrhea. We conducted a prospective, quality improvement intervention and collected data over 3 consecutive fiscal years. The setting was a single, tertiary care pediatric emergency department. We collected admission and ordering practices data on 19 physicians during baseline, intervention, and postintervention periods. We provided physicians with quarterly e-mail-based performance reports during the intervention phase. We measured admission rate and created four categories for ordering practices: no orders, laboratory orders, pharmacy orders, and radiology orders. There was wide (two- to threefold) practice variation among physicians. Admission rates ranged from 15% to 30%, laboratory orders from 19% to 43%, pharmacy orders from 29% to 57%, and radiology orders from 11% to 30%. There was no statistically significant difference in the proportion of patients admitted or with radiology or pharmacy orders placed between preintervention, intervention, or postintervention periods (p = 0.58, p = 0.19, and p = 0.75, respectively). There was a significant but very small decrease in laboratory orders between the preintervention and postintervention periods. Performance feedback provided only via e-mail to pediatric emergency physicians on a quarterly basis does not seem to significantly impact management practices for patients with undifferentiated vomiting and/or diarrhea. © 2017 by the Society for Academic Emergency Medicine.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

PubMed

Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

2004-07-01

The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

Pretest expectations strongly influence interpretation of abnormal laboratory results and further management

PubMed Central

2010-01-01

Background Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may - in a more implicit manner - influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management. Methods Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management. Results The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001). Conclusions Interpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results. PMID:20158908

Pretest expectations strongly influence interpretation of abnormal laboratory results and further management.

PubMed

Houben, Paul H H; van der Weijden, Trudy; Winkens, Bjorn; Winkens, Ron A G; Grol, Richard P T M

2010-02-16

Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may--in a more implicit manner--influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management. Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management. The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when the physician estimated a high pretest disease probability, compared to a low pretest probability estimate (OR = 0.18, 95% CI = 0.07-0.52, p < 0.001). Interpretation and management of abnormal test results were strongly influenced by physicians' estimation of pretest disease probability and by the reason for ordering the test. By relating abnormal laboratory results to their pretest expectations, physicians may seek a balance between over- and under-reacting to laboratory test results.

Medical informatics--an Australian perspective.

PubMed

Hannan, T

1991-06-01

Computers, like the X-ray and stethoscope can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide. Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice. The rapid technological advances in computers over the last two decades has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care. As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators ...) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.

42 CFR 409.43 - Plan of care requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... physician. (d) Oral (verbal) orders. If any services are provided based on a physician's oral orders, the... ordered services. Oral orders may only be accepted by personnel authorized to do so by applicable State and Federal laws and regulations as well as by the HHA's internal policies. The oral orders must also...

THE RELIABILITY OF HAND-WRITTEN AND COMPUTERISED RECORDS OF BIRTH DATA COLLECTED AT BARAGWANATH HOSPITAL IN SOWETO

PubMed Central

Ellison, GTH; Richter, LM; de Wet, T; Harris, HE; Griesel, RD; McIntyre, JA

2007-01-01

This study examined the reliability of hand-written and computerised records of birth data collected during the Birth to Ten study at Baragwanath Hospital in Soweto. The reliability of record-keeping in hand-written obstetric and neonatal files was assessed by comparing duplicate records of six different variables abstracted from six different sections in these files. The reliability of computerised record-keeping was assessed by comparing the original hand-written record of each variable with records contained in the hospital’s computerised database. These data sets displayed similar levels of reliability which suggests that similar errors occurred when data were transcribed from one section of the files to the next, and from these files to the computerised database. In both sets of records reliability was highest for the categorical variable infant sex, and for those continuous variables (such as maternal age and gravidity) recorded with unambiguous units. Reliability was lower for continuous variables that could be recorded with different levels of precision (such as birth weight), those that were occasionally measured more than once, and those that could be measured using more than one measurement technique (such as gestational age). Reducing the number of times records are transcribed, categorising continuous variables, and standardising the techniques used for measuring and recording variables would improve the reliability of both hand-written and computerised data sets. OPSOMMING In hierdie studie is die betroubaarheid van handgeskrewe en gerekenariseerde rekords van ge boortedata ondersoek, wat versamel is gedurende die ‘Birth to Ten’ -studie aan die Baragwanath hospitaal in Soweto. Die betroubaarheid van handgeskrewe verloskundige en pasgeboortelike rekords is beoordeel deur duplikaatrekords op ses verskillende verander likes te vergelyk, wat onttrek is uit ses verskillende dele van die betrokke lêers. Die gerekenariseerde rekords se betroubaarheid is beoordeel deur die oorspronklike geskrewe rekord van elke veranderlike te vergelyk met rekords wat beskikbaar is in die hospitaal se gerekenariseerde databasis Hierdie datastelle her vergelykbare vlakke van betroubaarheid getoon, waaruit afgelei kan word dat soortgelyke foute voorkom warmeer data oorgeplaas word vaneen deeivan ’n lêer na ’n ander, en vanaf die lêer na die gerekenariseerde databasis. In albei stelle rekords was die betroubaarheid die hoogste vir die kategoriese veranderlike suigeling se geslag, en vir daardie kontinue veranderlikes (soos moeder se ouderdom en gravida) wat in terme van ondubbelsinmge eenhede gekodeer kan word. Kontinue veranderlikes wat op wisselende vlakke van akkuratheid gemeet word (soos gewig met geboorte), veranderlikes wat soms meer as een keer gemeet is, en veranderlikes wat voigens meer as een metingstegniek bepaal is (soos draagtydsouderdom), was minder betroubaar Deur die aantal kere wat rekords oorgeskryf moet word te verminder, kontinue veranderlikes tat kategoriese veranderlikes te wysig. en tegnieke vir meting en aantekening van veranderlikes te standardiseer, kan die betroubaarheid van sowel handgeskrewe as gerekenariseerde datastelle verbeter word. PMID:9287552

Mixed results in the safety performance of computerized physician order entry.

PubMed

Metzger, Jane; Welebob, Emily; Bates, David W; Lipsitz, Stuart; Classen, David C

2010-04-01

Computerized physician order entry is a required feature for hospitals seeking to demonstrate meaningful use of electronic medical record systems and qualify for federal financial incentives. A national sample of sixty-two hospitals voluntarily used a simulation tool designed to assess how well safety decision support worked when applied to medication orders in computerized order entry. The simulation detected only 53 percent of the medication orders that would have resulted in fatalities and 10-82 percent of the test orders that would have caused serious adverse drug events. It is important to ascertain whether actual implementations of computerized physician order entry are achieving goals such as improved patient safety.

Reducing nurses'. Workload using a computerized nursing support system linked to the hospital information system.

PubMed

Ito, C; Satoh, I; Michiya, H; Kitayama, Y; Miyazaki, K; Ota, S; Satoh, H; Sakurai, T; Shirato, H; Miyasaka, K

1997-01-01

A computerised nursing support system (CNSS) linked to the hospital information system (HIS) was developed and has been in use for one year, in order to reduce the workload of nurses. CNSS consists of (1) a hand held computer for each nurse (2) desk-top computers in the nurses' station and doctors' rooms (3) a data server (4) an interface with the main hospital information system. Nurses enter vital signs, food intake and other information about the patients into the hand held computer at the bed-side. The information is then sent automatically to the CNSS data server, which also receives patients' details (prescribed medicines etc.) from the HIS. Nurses and doctors can see all the information on the desk-top and hand held computers. This system was introduced in May 1995 into a university hospital ward with 40 beds. A questionnaire was completed by 23 nurses before and after the introduction of CNSS. The mean time required to post vital data was significantly reduced from 121 seconds to 54 seconds (p < 0.01). After three months 30% of nurses felt CNSS had reduced their workload, while 30% felt it had complicated their work; after five months 70% noted a reduction and 0% reported that CNSS had made their work more complex. The study therefore concludes that the interface between a computerised nursing support system and the hospital information system reduced the workload of nurses.

The Impact of State Tort Reforms on Imaging Utilization.

PubMed

Li, Suhui; Dor, Avi; Deyo, Darwyyn; Hughes, Danny R

2017-02-01

Defensive medicine, broadly defined as medical practices that protect physicians from malpractice lawsuits without providing benefits to patients, can lead to wasteful use of health care resources and higher cost. Although physicians cite malpractice liability as an important factor driving their decisions to order imaging tests, little research has been done to examine the systematic impact of liability pressure on overall imaging. The authors examined the extent to which radiography use is influenced by malpractice liability pressure among office-based physicians. Using National Ambulatory Medical Care Survey data from 1999 to 2010, the authors used multivariate difference-in-difference logistic regression to examine the effects of different types of state tort reforms on the probability of radiography orders by primary care physicians (PCPs) and specialists. The probability that a PCP ordered radiography decreased when states enacted permanent caps on noneconomic damages (-1.0%, P < .01), periodic payment reforms (-1.6%, P < .05), and the total number of tort reforms (-0.5%, P < .05). Specialist physicians were responsive to two reforms: caps on punitive damages (-6.1%, P < .01) and the total number of medical tort laws (-1.2%, P < .01). The passage of new indirect reforms was found to reduce radiography orders for PCPs (-1.8%, P < .05), and the repeal of indirect reforms was found to increase radiography orders for specialists (+3.4%, P < .01). State tort reform seems to reduce physicians' ordering of radiography. This analysis also suggests that reforms that make it harder to sue physicians have a stronger impact than reforms that directly reduce physicians' malpractice claim payments. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

42 CFR 483.360 - Consultation with treatment team physician.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the resident's...

Who Explicitly Requests the Ordering of Computed Tomography for Emergency Department Patients? A Multicenter Prospective Study

PubMed Central

Broder, Joshua Seth; Bhat, Rahul; Boyd, Joshua P.; Ogloblin, Ivan A.; Limkakeng, Alexander; Hocker, Michael Brian; Drake, Weiying Gao; Miller, Taylor; Harringa, John Brian; Repplinger, Michael Dean

2016-01-01

Background Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. Objective To determine the proportion of CT scans ordered due to explicit requests by various stakeholders in ED patient care. Methods Prospective, observational study at three university hospital EDs. CT scans ordered during research assistant hours were eligible for inclusion. Attending emergency physicians (EPs) completed standardized data forms to indicate all parties who had explicitly requested that a specific CT be performed. Forms were completed before the CT results were known in order to minimize bias. Results Data were obtained from 77 EPs regarding 944 CTs. The parties most frequently requesting CTs were attending EPs (82.0%, 95% CI 79.4–84.3), resident physicians (28.6%, 95%CI 25.8–31.6), consulting physicians (24.4%, 95%CI 21.7–27.2), and admitting physicians (3.9%, 95%CI 2.9–5.4). In the 168 instances in which the attending EP did not explicitly request the CT, requests most commonly came from consulting physicians (51.2%, 95%CI 43.7–58.6), resident physicians in the ED (39.9%, 95%CI, 32.8–47.4), and admitting physicians (8.9%, 95%CI, 5.5–14.2). EPs were the sole party requesting CT in 46.2% of cases while multiple parties were involved in 39.0%. Patients, families, and radiologists were uncommon sources of such requests. Conclusions Emergency physicians requested the majority of CTs, though nearly 20% were actually not desired by them. Admitting, consulting, and resident physicians in the ED were important contributors to CT utilization. PMID:26873604

Computerized N-acetylcysteine physician order entry by template protocol for acetaminophen toxicity.

PubMed

Thompson, Trevonne M; Lu, Jenny J; Blackwood, Louisa; Leikin, Jerrold B

2011-01-01

Some medication dosing protocols are logistically complex for traditional physician ordering. The use of computerized physician order entry (CPOE) with templates, or order sets, may be useful to reduce medication administration errors. This study evaluated the rate of medication administration errors using CPOE order sets for N-acetylcysteine (NAC) use in treating acetaminophen poisoning. An 18-month retrospective review of computerized inpatient pharmacy records for NAC use was performed. All patients who received NAC for the treatment of acetaminophen poisoning were included. Each record was analyzed to determine the form of NAC given and whether an administration error occurred. In the 82 cases of acetaminophen poisoning in which NAC was given, no medication administration errors were identified. Oral NAC was given in 31 (38%) cases; intravenous NAC was given in 51 (62%) cases. In this retrospective analysis of N-acetylcysteine administration using computerized physician order entry and order sets, no medication administration errors occurred. CPOE is an effective tool in safely executing complicated protocols in an inpatient setting.

Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis.

PubMed

Young, A; Dixon, A; Getty, J; Renton, P; Vacher, H

1981-06-01

A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An unusual feature of this case was the relapsing and remitting nature of the condition, but there is sufficient evidence to explain the clinical picture on the basis of a recurrent intraspinal inflammatory process. The clinical and radiological features are similar to those of a further 28 reported in the literature. An electromyogram (EMG) proved important in defining the extent of neurological involvement. Computerised tomography (CT) showed marked laminar erosion and no bony exit foramen encroachment. We believe that the clinical diagnosis of this condition can be adequately confirmed with plain radiology, EMG, and CT scan.

Developing the Coach Analysis and Intervention System (CAIS): establishing validity and reliability of a computerised systematic observation instrument.

PubMed

Cushion, Christopher; Harvey, Stephen; Muir, Bob; Nelson, Lee

2012-01-01

We outline the evolution of a computerised systematic observation tool and describe the process for establishing the validity and reliability of this new instrument. The Coach Analysis and Interventions System (CAIS) has 23 primary behaviours related to physical behaviour, feedback/reinforcement, instruction, verbal/non-verbal, questioning and management. The instrument also analyses secondary coach behaviour related to performance states, recipient, timing, content and questioning/silence. The CAIS is a multi-dimensional and multi-level mechanism able to provide detailed and contextualised data about specific coaching behaviours occurring in complex and nuanced coaching interventions and environments that can be applied to both practice sessions and competition.

Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial

PubMed Central

2014-01-01

Background Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool. Methods/Design This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. Discussion We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. Trial registration Clinical Trials.gov identifier NCT01877018 PMID:24685117

Computerized physician order entry from a chief information officer perspective.

PubMed

Cotter, Carole M

2004-12-01

Designing and implementing a computerized physician order entry system in the critical care units of a large urban hospital system is an enormous undertaking. With their significant potential to improve health care and significantly reduce errors, the time for computerized physician order entry or physician order management systems is past due. Careful integrated planning is the key to success, requiring multidisciplinary teams at all levels of clinical and administrative management to work together. Articulated from the viewpoint of the Chief Information Officer of Lifespan, a not-for-profit hospital system in Rhode Island, the vision and strategy preceding the information technology plan, understanding the system's current state, the gap analysis between current and future state, and finally, building and implementing the information technology plan are described.

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

Methods Clinical guideline adherence for diagnostic imaging (DI) and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 DI orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. Results Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their DI order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their work flow, which dropped to 16% as physicians gained experience with the software. Conclusions Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine work flow. PMID:21486884

The SMile Card: a computerised data card for multiple sclerosis patients. SMile Card Scientific Board.

PubMed

Mancardi, G L; Uccelli, M M; Sonnati, M; Comi, G; Milanese, C; De Vincentiis, A; Battaglia, M A

2000-04-01

The SMile Card was developed as a means for computerising clinical information for the purpose of transferability, accessibility, standardisation and compilation of a national database of demographic and clinical information about multiple sclerosis (MS) patients. In many European countries, centres for MS are organised independently from one another making collaboration, consultation and patient referral complicated. Only the more highly advanced clinical centres, generally located in large urban areas, have had the possibility to utilise technical possibilities for improving the organisation of patient clinical and research information, although independently from other centres. The information system, developed utilising the Visual Basic language for Microsoft Windows 95, stores information via a 'smart card' in a database which is initiated and updated utilising a microprocessor, located at each neurological clinic. The SMile Card, currently being tested in Italy, permits patients to carry with them all relevant medical information without limitations. Neurologists are able to access and update, via the microprocessor, the patient's entire medical history and MS-related information, including the complete neurological examination and laboratory test results. The SMile Card provides MS patients and neurologists with a complete computerised archive of clinical information which is accessible throughout the country. In addition, data from the SMile Card system can be exported to other database programs.

Computerised analysis of facial emotion expression in eating disorders

PubMed Central

2017-01-01

Background Problems with social-emotional processing are known to be an important contributor to the development and maintenance of eating disorders (EDs). Diminished facial communication of emotion has been frequently reported in individuals with anorexia nervosa (AN). Less is known about facial expressivity in bulimia nervosa (BN) and in people who have recovered from AN (RecAN). This study aimed to pilot the use of computerised facial expression analysis software to investigate emotion expression across the ED spectrum and recovery in a large sample of participants. Method 297 participants with AN, BN, RecAN, and healthy controls were recruited. Participants watched film clips designed to elicit happy or sad emotions, and facial expressions were then analysed using FaceReader. Results The finding mirrored those from previous work showing that healthy control and RecAN participants expressed significantly more positive emotions during the positive clip compared to the AN group. There were no differences in emotion expression during the sad film clip. Discussion These findings support the use of computerised methods to analyse emotion expression in EDs. The findings also demonstrate that reduced positive emotion expression is likely to be associated with the acute stage of AN illness, with individuals with BN showing an intermediate profile. PMID:28575109

A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study.

PubMed

Campbell, J; Langdon, D; Cercignani, M; Rashid, W

2016-01-01

Aim. To explore the efficacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom software ( n = 19) three times weekly for six weeks or to a control condition ( n = 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and after a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging. Results. The treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group ( p = 0.005). The treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 ( p < 0.05 FWE  corrected ). No significant changes were observed on QMT. Conclusion. This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.

Artificial time constraints on the Iowa Gambling Task: the effects on behavioural performance and subjective experience.

PubMed

Bowman, Caroline H; Evans, Cathryn E Y; Turnbull, Oliver H

2005-02-01

In the last decade, the Iowa Gambling Task (IGT) has become a widely employed neuropsychological research instrument for the investigation of executive function. The task has been employed in a wide range of formats, from 'manual' procedures to more recently introduced computerised versions. Computer-based formats often require that responses on the task should be artificially delayed by a number of seconds between trials to collect skin-conductance data. Participants, however, may become frustrated when they want to select from a particular deck in the time-limited versions--so that an unintended emotional experience of frustration might well disrupt a task presumed to be reliant on emotion-based learning. We investigated the effect of the various types of Iowa Gambling Task format on performance, using three types of task: the classic manual administration, with no time limitations; a computerised administration with a 6-s enforced delay; and a control computerised version which had no time constraints. We also evaluated the subjective experience of participants on each task. There were no significant differences in performance, between formats, in behavioural terms. Subjective experience measures on the task also showed consistent effects across all three formats-with substantial, and rapidly developing, awareness of which decks were 'good' and 'bad.'

Computerised respiratory sounds can differentiate smokers and non-smokers.

PubMed

Oliveira, Ana; Sen, Ipek; Kahya, Yasemin P; Afreixo, Vera; Marques, Alda

2017-06-01

Cigarette smoking is often associated with the development of several respiratory diseases however, if diagnosed early, the changes in the lung tissue caused by smoking may be reversible. Computerised respiratory sounds have shown to be sensitive to detect changes within the lung tissue before any other measure, however it is unknown if it is able to detect changes in the lungs of healthy smokers. This study investigated the differences between computerised respiratory sounds of healthy smokers and non-smokers. Healthy smokers and non-smokers were recruited from a university campus. Respiratory sounds were recorded simultaneously at 6 chest locations (right and left anterior, lateral and posterior) using air-coupled electret microphones. Airflow (1.0-1.5 l/s) was recorded with a pneumotachograph. Breathing phases were detected using airflow signals and respiratory sounds with validated algorithms. Forty-four participants were enrolled: 18 smokers (mean age 26.2, SD = 7 years; mean FEV 1 % predicted 104.7, SD = 9) and 26 non-smokers (mean age 25.9, SD = 3.7 years; mean FEV 1 % predicted 96.8, SD = 20.2). Smokers presented significantly higher frequency at maximum sound intensity during inspiration [(M = 117, SD = 16.2 Hz vs. M = 106.4, SD = 21.6 Hz; t(43) = -2.62, p = 0.0081, d z  = 0.55)], lower expiratory sound intensities (maximum intensity: [(M = 48.2, SD = 3.8 dB vs. M = 50.9, SD = 3.2 dB; t(43) = 2.68, p = 0.001, d z  = -0.78)]; mean intensity: [(M = 31.2, SD = 3.6 dB vs. M = 33.7,SD = 3 dB; t(43) = 2.42, p = 0.001, d z  = 0.75)] and higher number of inspiratory crackles (median [interquartile range] 2.2 [1.7-3.7] vs. 1.5 [1.2-2.2], p = 0.081, U = 110, r = -0.41) than non-smokers. Significant differences between computerised respiratory sounds of smokers and non-smokers have been found. Changes in respiratory sounds are often the earliest sign of disease. Thus, computerised respiratory sounds might be a promising measure to early detect smoking related respiratory diseases.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat.

PubMed

Joshi, Anuradha; Buch, Jatin; Kothari, Nitin; Shah, Nishal

2016-06-01

Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient's age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat

PubMed Central

Buch, Jatin; Kothari, Nitin; Shah, Nishal

2016-01-01

Introduction Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. Aim To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. Materials and Methods A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Statistical Analysis Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Results Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient’s age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. Conclusion As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice. PMID:27504305

The construction of ethnic differences in work incapacity risks: Analysing ordering practices of physicians in the Netherlands.

PubMed

Meershoek, Agnes; Krumeich, Anja; Vos, Rein

2011-01-01

Drawing from Science and Technology Studies we investigate the consequences for social differentiation of physicians' practices in Dutch illness certification. Using participant observation methods, we followed six 'Arbodienst' physicians for two weeks each. Our analysis explores whether and how the work of Dutch physicians contributes to the appearance of a category of 'problematic migrant patients'. We present how physicians, in using instruments to distinguish plausible from implausible claims for sick leave, impose order upon reality. In particular situations this ordering involves a distinction between Dutch and migrant clients. Here ethnicity appears in physicians' practice as a separate instrument to constitute order, which in the case of migrants overrules the productive instruments that are used for 'Dutch' clients. By interpreting clients' behaviour in cultural terms and making them into strangers, physicians lose their ability to fine-tune their coaching activities to the needs of these clients. As a result migrants remain work incapacitated for a longer period, which leads to a higher risk of their ending up in the disability pension program. As a consequence migrants become visible as a problematic group in the data on work incapacity and disability. The practice to categorise migrant clients with separate instruments thus results in a 'hard' category of problematic migrant clients and leads to social differentiation. Copyright © 2010 Elsevier Ltd. All rights reserved.

Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain

PubMed Central

Peña-Sánchez, Juan Nicolás; Lepnurm, Rein; Morales-Asencio, José Miguel; Delgado, Ana; Domagała, Alicja; Górkiewicz, Maciej

2014-01-01

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians. PMID:26973935

Computerisation of diabetic clinic records.

PubMed Central

Watkins, G B; Sutcliffe, T; Pyke, D A; Watkins, P J

1980-01-01

A simple system for putting diabetic records on a computer file is achieved by using stationery that combines the usual handwritten records (not computerised) with the minimum of essential data suitable for punching on to computer tape. The record may be brought up to date at a selected time time interval. This simple, cheap system has been in use in a busy clinic for six years. The information on about 8000 diabetics now held in the computer file is used chiefly to help research by creating registers of patients with specified characteristics, such as treatment, heredity complications, and pregnancy. A complete up-to-date index of the entire clinic population is always available, and routine clinic statistics are returned every six months. PMID:7437814

Total hip arthroplasty in dwarfism. A case report.

PubMed

De Fine, Marcello; Traina, Francesco; Palmonari, Massimo; Tassinari, Enrico; Toni, Aldo

2008-05-01

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.

The VA Computerized Patient Record — A First Look

PubMed Central

Anderson, Curtis L.; Meldrum, Kevin C.

1994-01-01

In support of its in-house DHCP Physician Order Entry/Results Reporting application, the VA is developing the first edition of a Computerized Patient Record. The system will feature a physician-oriented interface with real time, expert system-based order checking, a controlled vocabulary, a longitudinal repository of patient data, HL7 messaging support, a clinical reminder and warning system, and full integration with existing VA applications including lab, pharmacy, A/D/T, radiology, dietetics, surgery, vitals, allergy tracking, discharge summary, problem list, progress notes, consults, and online physician order entry. PMID:7949886

Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.

PubMed

Meyer, Ashley N D; Thompson, Pamela J; Khanna, Arushi; Desai, Samir; Mathews, Benji K; Yousef, Elham; Kusnoor, Anita V; Singh, Hardeep

2018-04-20

Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions.

Do differences in visuospatial ability between senile dementias of the Alzheimer and Lewy body types reflect differences solely in mnemonic function?

PubMed

Sahgal, A; McKeith, I G; Galloway, P H; Tasker, N; Steckler, T

1995-02-01

Visuospatial memory was investigated in two groups of patients suffering from senile dementias of the Alzheimer (SDAT) or Lewy body (SDLT) types; a, third, age-matched, healthy control group was also included. The two patient groups were mildly demented and could not be distinguished from each other by traditional tests of cognitive function. A different pattern of performance emerged in the two groups on a computerised test of spatial working memory, which is a self-ordered pointing task requiring the subject to search for hidden tokens. An analysis of the pattern of errors revealed that the SDLT group made more of both possible types of error ("Within Search" and "Between Search") than the SDAT group. Neither patient groups' performance differed from each other when assessed on a computerised Corsi spatial span task. A measure of planning ability was obtained by examining search strategies. Although an index previously developed to measure the subject's use of a particular strategy in the spatial working memory task failed to detect any differences between the three groups, a novel index was calculated which focuses on performance within a search, and this revealed deficits in both demented groups. Since the two patient groups differed from each other in the spatial working memory, but not the Corsi spatial span, task, it is suggested that the differences between the two demented groups are not due to a specific mnemonic impairment, but reflect dysfunctions in non-mnemonic processes mediated by fronto-subcortical circuits, which are more severely damaged in SDLT.

Liability of emergency physicians for studies ordered in the emergency department: court cases and legal defenses.

PubMed

Moore, Gregory P

2011-02-01

Laboratory tests are frequently ordered in the Emergency Department (ED), with results returning at a later time. Emergency physicians (EPs) are frequently held liable when the test results are not followed-up. Recent legal malpractice cases are presented to provide examples of the medical-legal risks encountered when poor patient outcomes occur because the results of laboratory tests and other studies done in the ED are not followed-up and communicated to the patient. Emergency physicians are obligated to follow-up with patients when the results of laboratory and radiographic studies ordered in the ED are returned at a later time, and EPs are liable for any poor outcome if there is no follow-up. Appropriate follow-up mechanisms must be in place to improve patient outcomes and reduce the risk for the physician. Knowledge of the legal concepts of contributory negligence and comparative fault allows EPs to place themselves in an optimal position for a legal defense if a challenge is raised. It is imperative that abnormal results of tests done for ED evaluation and orders must be properly noted and followed-up. Optimal communication and relay of information to both the patient and the primary physician will reduce physician liability and enhance patient outcomes. Published by Elsevier Inc.

Mean Abnormal Result Rate: Proof of Concept of a New Metric for Benchmarking Selectivity in Laboratory Test Ordering.

PubMed

Naugler, Christopher T; Guo, Maggie

2016-04-01

There is a need to develop and validate new metrics to access the appropriateness of laboratory test requests. The mean abnormal result rate (MARR) is a proposed measure of ordering selectivity, the premise being that higher mean abnormal rates represent more selective test ordering. As a validation of this metric, we compared the abnormal rate of lab tests with the number of tests ordered on the same requisition. We hypothesized that requisitions with larger numbers of requested tests represent less selective test ordering and therefore would have a lower overall abnormal rate. We examined 3,864,083 tests ordered on 451,895 requisitions and found that the MARR decreased from about 25% if one test was ordered to about 7% if nine or more tests were ordered, consistent with less selectivity when more tests were ordered. We then examined the MARR for community-based testing for 1,340 family physicians and found both a wide variation in MARR as well as an inverse relationship between the total tests ordered per year per physician and the physician-specific MARR. The proposed metric represents a new utilization metric for benchmarking relative selectivity of test orders among physicians. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Patient preference: a comparison of electronic patient-completed questionnaires with paper among cancer patients.

PubMed

Martin, P; Brown, M C; Espin-Garcia, O; Cuffe, S; Pringle, D; Mahler, M; Villeneuve, J; Niu, C; Charow, R; Lam, C; Shani, R M; Hon, H; Otsuka, M; Xu, W; Alibhai, S; Jenkinson, J; Liu, G

2016-03-01

In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format. © 2015 John Wiley & Sons Ltd.

Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women receiving community supervision.

PubMed

Gilbert, Louisa; Shaw, Stacey A; Goddard-Eckrich, Dawn; Chang, Mingway; Rowe, Jessica; McCrimmon, Tara; Almonte, Maria; Goodwin, Sharun; Epperson, Matthew

2015-12-10

The high rate of intimate partner violence (IPV) victimisation found among substance-using women receiving community supervision underscores the need for effective IPV victimisation screening, brief intervention and referral to treatment services (SBIRT) for this population. This randomised controlled trial (RCT) aims to assess the feasibility, safety and efficacy of a single-session computerised self-paced IPV SBIRT (Computerised WINGS) in identifying IPV victimisation among women under community supervision and increasing access to IPV services, compared to the same IPV SBIRT service delivered by a case manager (Case Manager WINGS). This RCT was conducted with 191 substance-using women in probation and community court sites in New York City. No significant differences were found between Computerised and Case Manager WINGS arms on any outcomes. Both arms reported identical high rates of any physical, sexual or psychological IPV victimisation in the past year (77% for both arms) during the intervention. Both arms experienced significant increases from baseline to the 3-month follow-up in receipt of IPV services, social support, IPV self-efficacy and abstinence from drug use. Findings suggest that both modalities of WINGS show promise in identifying and addressing IPV victimisation among substance-using women receiving community supervision. Copyright © 2015 John Wiley & Sons, Ltd.

Computerised CBT for depressed adolescents: Randomised controlled trial.

PubMed

Smith, Patrick; Scott, Rebecca; Eshkevari, Ertimiss; Jatta, Fatoumata; Leigh, Eleanor; Harris, Victoria; Robinson, Alex; Abeles, Paul; Proudfoot, Judy; Verduyn, Chrissie; Yule, William

2015-10-01

Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents. Copyright © 2015 Elsevier Ltd. All rights reserved.

Computerized decision support for medication dosing in renal insufficiency: a randomized, controlled trial.

PubMed

Terrell, Kevin M; Perkins, Anthony J; Hui, Siu L; Callahan, Christopher M; Dexter, Paul R; Miller, Douglas K

2010-12-01

Emergency physicians prescribe several discharge medications that require dosage adjustment for patients with renal disease. The hypothesis for this research was that decision support in a computerized physician order entry system would reduce the rate of excessive medication dosing for patients with renal impairment. This was a randomized, controlled trial in an academic emergency department (ED), in which computerized physician order entry was used to write all prescriptions for patients being discharged from the ED. The sample included 42 physicians who were randomized to the intervention (21 physicians) or control (21 physicians) group. The intervention was decision support that provided dosing recommendations for targeted medications for patients aged 18 years and older when the patient's estimated creatinine clearance level was below the threshold for dosage adjustment. The primary outcome was the proportion of targeted medications that were excessively dosed. For 2,783 (46%) of the 6,015 patient visits, the decision support had sufficient information to estimate the patient's creatinine clearance level. The average age of these patients was 46 years, 1,768 (64%) were women, and 1,523 (55%) were black. Decision support was provided 73 times to physicians in the intervention group, who excessively dosed 31 (43%) prescriptions. In comparison, control physicians excessively dosed a significantly larger proportion of medications: 34 of 46, 74% (effect size=31%; 95% confidence interval 14% to 49%; P=.001). Emergency physicians often prescribed excessive doses of medications that require dosage adjustment for renal impairment. Computerized physician order entry with decision support significantly reduced excessive dosing of targeted medications. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Computerized Physician Order Entry: Reluctance of Physician Adoption of Technology Linked to Improving Health Care

ERIC Educational Resources Information Center

Ulinski, Don

2013-01-01

Physicians are the influential force in the complex field of patient care delivery. Physicians determine when and where patient healthcare is delivered and affect 80% of the money spent on it. Computerized systems used in the delivery of healthcare information have become an integral part that physicians use to provide patient care. This study…

Birth order, family size, and children's use of physician services.

PubMed Central

Tessler, R

1980-01-01

The purpose of this study is to separate out the effects of number of siblings and birth order on children's use of physician services. Prior research has consistently revealed an inverse relationship between family size and physician visits, but the possible confounding influence of the child's ordinal position in the family has been ignored. Later born children may be taken to the doctor less often than first and other early borns because of their parents' increasing knowledgeability in regard to child care as well as their growing understanding of the uses and limitations of physician visits. On the assumption that part of the family size effect observed in prior research may have been due to the clustering of first and early borns in small families, an inverse relationship between birth order and physician utilization is hypothesized. Support for this hypothesis comes from an empirical study of 1,665 children from 587 families in which variation in family size is statistically controlled. PMID:7372499

Examining structural and clinical factors associated with implementation of standing orders for adult immunization.

PubMed

Yonas, Michael A; Nowalk, Mary Patricia; Zimmerman, Richard K; Ahmed, Faruque; Albert, Steven M

2012-01-01

A proven method to increase vaccination rates in primary care is a standing orders program (SOP) for nonphysician staff to assess and vaccinate eligible individuals without a specific written physician order. This study describes a mixed methods approach to examining physicians' beliefs and attitudes about and adoption of SOPs for adult immunizations, specifically, influenza and pneumococcal polysaccharide vaccine. Focus groups and in-depth interviews of physicians, nurses, practice managers, and the medical director of a managed care health plan were conducted. Results were used to enrich a concise survey based on the Awareness-to-Adherence model of physician behavior and previous research, which was mailed to 1,640 general internists and family physicians nationwide. Barriers to SOPs identified through qualitative methods were lack of interest in changing the status quo, a physician-dominated hierarchy, and fear of malpractice. Facilitators included having an electronic medical record and a practice culture that was open to change. The survey (response rate 67%) confirmed the facilitators and further identified patient, physician, and practice factors that served as barriers to establishing and maintaining SOPs. This mixed methods approach provided the opportunity to develop a tailored and practice-oriented survey for examining the contextual factors influencing clinical providers' decisions to implement SOPs for adult immunization. © 2011 National Association for Healthcare Quality.

Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

PubMed

Carrard, Valérie; Schmid Mast, Marianne; Jaunin-Stalder, Nicole; Junod Perron, Noëlle; Sommer, Johanna

2018-05-01

A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

Case study: physicians develop results viewer amid Y2K commotion.

PubMed

Wurz, J A; Manis, J L

2000-01-01

Amid a flurry of Y2K preparations, which included converting patient accounting and order processing systems for six of its eight hospitals, Advocate Health Care needed to address physician complaints that the compliant software was awkward. By partnering with physicians, information systems (IS) rapidly developed a solution that met both the need for compliance and the demand for an easy-to-use, patient-centric clinical information system. A robust, browser-based results viewer provides physician access to information from patient accounting, order processing, and several clinical ancillary systems. Advocate anticipates greater challenges as the system is promoted to other sites and clinical communities.

The use of microtomography in bone tissue and biomaterial three-dimensional analysis.

PubMed

Bedini, Rossella; Meleo, Deborah; Pecci, Raffaella; Pacifici, Luciano

2009-01-01

X-ray computed microtomography (micro-CT, microComputerised Tomography) is a miniaturized form of conventional computerized axial tomography (CAT ). This sophisticated technology enables 3D riconstruction of the internal structure of small X-ray opaque objects without sample destruction or preparation. The aim of this study is to show the possible applications of micro-CT in the analysis of bone graft materials of different origins (i.e. homologous, heterologous, alloplastic) in order to define their morphometric properties by means of SkyScan 1072 3D microtomography system. Since there is a close relationship between the properties of the materials and their microstructure, it is necessary to examine them using the highest levels of resolution before being able to improve existing materials or create new products.

76 FR 6796 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-08

... perform the ``Quantitative Survey of Physician Practices in Laboratory Test Ordering and Interpretation... technology. Written comments should be received within 60 days of this notice. Proposed Project Quantitative Survey of Physician Practices in Laboratory Test Ordering and Interpretation-NEW-the Office of...

The usefulness of rapid point-of-care creatinine testing for the prevention of contrast-induced nephropathy in the emergency department.

PubMed

You, Je Sung; Chung, Yong Eun; Park, Jong Woo; Lee, Woonhyoung; Lee, Hye-Jeong; Chung, Tae Nyoung; Chung, Sung Phil; Park, Incheol; Kim, Seungho

2013-07-01

Renal dysfunction is the most important factor to consider when predicting a patient's risk of developing contrast-induced nephropathy (CIN). Measurement of creatinine (Cr) via rapid point-of-care blood urea nitrogen/creatinine testing (POCT-BUN/Cr) to determine CIN risk could potentially reduce the time required to achieve an accurate diagnosis and to initiate and complete treatment in the emergency department (ED). The aim of our study was to compare the results of POCT-BUN/Cr and reference laboratory tests for BUN and serum Cr. A retrospective analysis of suspected stroke patients who presented between November 2009 and November 2010, and had BUN and Cr levels measured by POCT-BUN/Cr, and the reference laboratory tests performed with the blood sample which was transferred to the central laboratory by an air-shoot system. Two assays were conducted on the whole blood (POCT) and serum (reference) by trained technicians. The time interval from arrival at the ED to reporting of the results was assessed for both assays via a computerised physician order entry system. The mean standard deviation (SD) interval from arrival at the ED to reporting of the results was 11.4 (4.9) min for POCT-BUN/Cr and 46.8 (38.5) min for the serum reference laboratory tests (p<0.001). Intra-class correlation coefficient (ICC) analysis demonstrated a high level of agreement (the consistency agreement) between POCT and the serum reference tests for both BUN (ICC=0.914) and Cr (ICC=0.980). This study suggests that POCT-BUN/Cr results correlate well with those of serum reference tests in terms of BUN and Cr levels and, in turn, predicting CIN. POCT-BUN/Cr is easily performed with a rapid turnaround time, suggesting its use in the ED may have substantial clinical benefit.

Implementing security in a distributed web-based EHCR.

PubMed

Sucurovic, Snezana

2007-01-01

In many countries there are initiatives for building an integrated patient-centric electronic health record. There are also initiatives for transnational integrations. These growing demands for integration result from the fact that it can provide improving healthcare treatments and reducing the cost of healthcare services. While in European highly developed countries computerisation in healthcare sector began in the 1970s and reached a high level, some developing countries, and Serbia among them, have started computerisation recently. This is why MEDIS (MEDical Information System) is aimed at integration itself from the very beginning instead of integration of heterogeneous information systems on a middle layer or using HL7 protocol. The implementation of a national healthcare information system requires using standards as integrated and widely accepted solutions. Therefore, we have started building MEDIS to meet the requirements of CEN ENV 13606 and CEN ENV 13729 standards. The prototype version has a distributed component-based architecture with modern security solutions applied. MEDIS has been implemented as a federated system where the central server hosts basic EHCR information about a patient, and clinical servers contain their own part of patients' EHCR. At present, there is an initial version of prototype planned to be deployed at first in a small community. In particular, open source API for X.509 authentication and authorisation has been developed. Our project meets the requirements for education in health informatics, including appropriate knowledge and skills on EHCR. The points included in this article have been presented on several national conferences and widely discussed. MEDIS has explored a federated, component-based EHCR architecture and related security aspects. In its initial version it shows acceptable performances and administrative simplicity. It emphasizes the importance of using standards in building EHCR in our country, in order to prepare it for future integrations.

Investigating a computerised test of the Stroop effect extended by inclusion of a third, more difficult task.

PubMed

Federmann, Rolf; Goldsmith, Robert; Bäckström, Martin

2007-04-01

A validation study of a computerised test recently developed involving the Stroop effect, extended here by inclusion of a third, more difficult test series, is presented. Three groups of men belonging to the Swedish armed forces and adjudged to differ in their qualifications (20, 32, and 19 men of levels 1, 2, and 3, respectively) and a fourth group of 18 men convicted of serious crimes of violence were given this test, termed the Stress Strategy Test. Discriminant analysis of the test's 12 variables (four for each of the three test series) yielded a discriminant power of 65% for the total group, highest for the level 1 group (80%) and for the nonmilitary group (72%), results substantially better than obtained for the original version of the test with use of similar subject groups.

Modelling the costs and outcomes of changing rates of screening for alcohol misuse by GPs in the Australian context.

PubMed

Shanahan, Marian; Shakeshaft, Anthony; Mattick, Richard P

2006-01-01

To assess the relative cost effectiveness of four strategies (academic detailing, computerised reminder systems, target payments and interactive continuing medical education) to increase the provision of screening and brief interventions by Australian GPs with the ultimate goal of decreasing risky alcohol consumption among their patients. This project used a modelling approach to combine information on the effectiveness and costs of four separate strategies to change GP behaviours to estimate their relative cost effectiveness. The computerised reminder system and academic detailing appear most effective in achieving a decrease in the number of standard drinks consumed by risky drinkers. Regardless of the assumptions made, the targeted payment strategy appeared to be the least cost-effective method to achieve a decrease in risky alcohol consumption while the other three strategies appear reasonably comparable.

An Australian case study of patient attitudes towards the use of computerised medical records and unique identifiers.

PubMed

Bomba, D; de Silva, A

2001-01-01

Research into patient attitudes towards the use of technology in health care needs to be given much greater attention within health informatics. Past research has often focused more on the needs of health care providers rather than the end users. This article attempts to redress this knowledge bias by reporting on a case study of the responses gained from patients in a selected Australian medical practice towards the use of computerised medical records and unique identifiers. The responses (n=138) were gained from a survey of patients over a 13 day period of practice operation. This case study serves as an example of the type of future consumer health informatics research which can be undertaken not just in Australia but also in other countries, both at local regional levels and at a national level.

Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis

PubMed Central

Pombo, Nuno; Garcia, Nuno; Bousson, Kouamana; Spinsante, Susanna; Chorbev, Ivan

2016-01-01

Background: Mobile and web technologies are becoming increasingly used to support the treatment of chronic pain conditions. However, the subjectivity of pain perception makes its management and evaluation very difficult. Pain treatment requires a multi-dimensional approach (e.g., sensory, affective, cognitive) whence the evidence of technology effects across dimensions is lacking. This study aims to describe computerised monitoring systems and to suggest a methodology, based on statistical analysis, to evaluate their effects on pain assessment. Methods: We conducted a review of the English-language literature about computerised systems related to chronic pain complaints that included data collected via mobile devices or Internet, published since 2000 in three relevant bibliographical databases such as BioMed Central, PubMed Central and ScienceDirect. The extracted data include: objective and duration of the study, age and condition of the participants, and type of collected information (e.g., questionnaires, scales). Results: Sixty-two studies were included, encompassing 13,338 participants. A total of 50 (81%) studies related to mobile systems, and 12 (19%) related to web-based systems. Technology and pen-and-paper approaches presented equivalent outcomes related with pain intensity. Conclusions: The adoption of technology was revealed as accurate and feasible as pen-and-paper methods. The proposed assessment model based on data fusion combined with a qualitative assessment method was revealed to be suitable. Data integration raises several concerns and challenges to the design, development and application of monitoring systems applied to pain. PMID:27089351

Virtual classroom helps medical education for both Chinese and foreign students.

PubMed

Shi, C; Wang, L; Li, X; Chai, S; Niu, W; Kong, Y; Zhou, W; Yin, W

2015-11-01

The rapid development of computer and internet technology has a strong influence over one's quality of education within different fields of study. To determine the potential benefits of introducing internet into medical school classes, a pilot study was conducted in three different Chinese medical schools. Seven hundred and eight medical school undergraduates, 385 dental school students and 366 foreign students were randomly recruited to complete a self-administered questionnaire. The contents included personal information, current usage of computer and internet, and attitudes towards the computerised teaching methods. Two forum groups were created using instant message software and were randomly assigned to two classes, allowing students to freely ask or discuss questions with the help of their teachers in these two virtual classrooms. All 1539 questionnaires were accepted and analysed. Although there were some differences between Chinese and foreign undergraduates, both group of students were highly proficient in internet usage and navigation. Overwhelmingly, 88.37% of the students owned a computer and frequently logged onto the internet. Most of them believed that the internet is a helpful adjunct to their studies and held positive attitudes towards computerised teaching. Compared to the classes that were not assigned internet forums, the two experimental classes performed significantly better on the examination. Our results suggest that computerised teaching methods have significant potential to assist in learning for both Chinese and foreign medical undergraduates. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

When is diagnostic testing inappropriate or irrational? Acceptable regret approach.

PubMed

Hozo, Iztok; Djulbegovic, Benjamin

2008-01-01

The authors provide a new model within the framework of theories of bounded rationality for the observed physicians' behavior that their ordering of diagnostic tests may not be rational. Contrary to the prevailing thinking, the authors find that physicians do not act irrationally or inappropriately when they order diagnostic tests in usual clinical practice. When acceptable regret (i.e., regret that a decision maker finds tolerable upon making a wrong decision) is taken into account, the authors show that physicians tend to order diagnostic tests at a higher level of pretest probability of disease than predicted by expected utility theory. They also show why physicians tend to overtest when regret about erroneous decisions is extremely small. Finally, they explain variations in the practice of medicine. They demonstrate that in the same clinical situation, different decision makers might have different acceptable regret thresholds for withholding treatment, for ordering a diagnostic test, or for administering treatment. This in turn means that for some decision makers, the most rational strategy is to do nothing, whereas for others, it may be to order a diagnostic test, and still for others, choosing treatment may be the most rational course of action.

Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists' interventions.

PubMed

Bedouch, Pierrick; Tessier, Alexandre; Baudrant, Magalie; Labarere, José; Foroni, Luc; Calop, Jean; Bosson, Jean-Luc; Allenet, Benoît

2012-08-01

To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward. A prospective cohort study was conducted in seven wards of a French teaching hospital using CPOE along with the presence of a full-time on-ward pharmacy resident. We documented the characteristics of pharmacists' interventions communicated to physicians during the medication order validation process whenever a drug-related problem was identified. Independent predictors of the physician's acceptance of the pharmacist's intervention were assessed using multiple logistic regression analysis. The 448 pharmacists' interventions concerned: non-conformity to guidelines or contraindications (22%), too high doses (19%), drug interactions (15%) and improper administration (15%). The interventions consisted of changes in drug choice (41%), dose adjustment (23%), drug monitoring (19%) and optimization of administration (17%). Interventions were communicated via the CPOE in 57% of cases and 43% orally. The rate of physicians' acceptance was 79.2%. In multivariate analysis, acceptance was significantly associated with the physician's status [higher for residents vs. seniors: OR = 7.23, CI 95 (2.37-22.10), P < 0.01], method of communication [higher for oral vs. computer communication: OR = 12.5, CI 95 (4.16-37.57), P < 0.01] and type of recommendation [higher for drug monitoring vs. drug choice recommendations: OR = 10.32, CI 95 (3.20-33.29), P < 0.01]. When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist-physician communication is needed. © 2011 Blackwell Publishing Ltd.

Head multidetector computed tomography: emergency medicine physicians overestimate the pretest probability and legal risk of significant findings.

PubMed

Baskerville, Jerry Ray; Herrick, John

2012-02-01

This study focuses on clinically assigned prospective estimated pretest probability and pretest perception of legal risk as independent variables in the ordering of multidetector computed tomographic (MDCT) head scans. Our primary aim is to measure the association between pretest probability of a significant finding and pretest perception of legal risk. Secondarily, we measure the percentage of MDCT scans that physicians would not order if there was no legal risk. This study is a prospective, cross-sectional, descriptive analysis of patients 18 years and older for whom emergency medicine physicians ordered a head MDCT. We collected a sample of 138 patients subjected to head MDCT scans. The prevalence of a significant finding in our population was 6%, yet the pretest probability expectation of a significant finding was 33%. The legal risk presumed was even more dramatic at 54%. These data support the hypothesis that physicians presume the legal risk to be significantly higher than the risk of a significant finding. A total of 21% or 15% patients (95% confidence interval, ±5.9%) would not have been subjected to MDCT if there was no legal risk. Physicians overestimated the probability that the computed tomographic scan would yield a significant result and indicated an even greater perceived medicolegal risk if the scan was not obtained. Physician test-ordering behavior is complex, and our study queries pertinent aspects of MDCT testing. The magnification of legal risk vs the pretest probability of a significant finding is demonstrated. Physicians significantly overestimated pretest probability of a significant finding on head MDCT scans and presumed legal risk. Copyright © 2012 Elsevier Inc. All rights reserved.

42 CFR 414.50 - Physician or other supplier billing for diagnostic tests performed or interpreted by a physician...

Code of Federal Regulations, 2011 CFR

2011-10-01

...) or professional component (PC) of a diagnostic test that was ordered by the physician or other... behalf of the beneficiary) for the TC or PC of the diagnostic test may not exceed the lowest of the... who supervised the TC, and with respect to the PC, the performing supplier is the physician who...

Multiple job contracts of physicians in Ceará, Northeastern Brazil.

PubMed

Maciel, Regina Heloisa; Santos, João Bosco Feitosa dos; Sales, Telma Bessa; Alves, Marco Aurélio de Andrade; Luna, Ana Paula; Feitosa, Leonardo Bezerra

2010-10-01

To analyze the multiple job contracts of physicians in the Brazilian National Health System in the State of Ceará. Documental research was performed about the work contracts of the physicians, based on data of health professional contracts in the municipalities of Ceará state, Northeastern Brazil, in 2008. Indices were created for the quantity of contracts of each physician, as well as the municipalities where each physician maintained work contracts. The distances between the municipalities where they worked was calculated in order to estimate the total weekly hours of work. Of the 7,008 physicians employed by the Ceará state, 3,751 (53.5%) maintain between two and four job contracts and 39 (0.6%) between 11 and 20 contracts. One professional maintained 20 contracts. More than half (51.9%) of the physicians had work contracts that when summed totaled more than 40 weekly working hours and 27.0% (1,894) maintained job contracts with more than one municipality. In order to increase their work income, physicians undertake various jobs, practicing their profession in different locations and various municipalities, involving constant travel and contributing to the precarious conditions of their own lives and, therefore, of the public health system.

Collaboration of occupational physicians with national health system and general practitioners in Italy

PubMed Central

PERSECHINO, Benedetta; FONTANA, Luca; BURESTI, Giuliana; RONDINONE, Bruna Maria; LAURANO, Patrizia; FORTUNA, Grazia; VALENTI, Antonio; IAVICOLI, Sergio

2016-01-01

A good cooperation between occupational physicians and other healthcare professionals is essential in order to achieve an overall improvement of workers/patients’ well-being. Unfortunately, collaboration between occupational physicians and other physicians is often lacking or very poor. In this context, using a self-administered questionnaire, we investigated the cooperation of Italian occupational physicians with the National Health System (NHS) facilities and with the general practitioners in order to identify any potential critical issues that may hinder an effective and collaborative relationships between these professionals. The survey was conducted from October 2013 to January 2014. Nearly all of the interviewed occupational physicians have had contacts with colleagues of the Departments for Prevention and Occupational Health and Safety of the NHS. Regarding the relationship between occupational physicians and general practitioners findings showed that their cooperation is quite difficult and it would not seem a two-way collaboration. Cooperation between occupational physicians and NHS would benefit from the development of communication strategies and tools enhancing the support and assistance functions of the NHS facilities. The elaboration and subsequent application of operational guidelines and standardized procedures of communication would also improve collaboration between occupational physicians and general practitioners that is currently considered rather insufficient and incomplete. PMID:27733729

Assessments of managed care organizations in the Greater Baton Rouge area by physicians and physicians' office managers.

PubMed

Cassidy, W M; Dyson, T; Grenier, C E

2001-03-01

Health care quality assessment under managed care organizations is usually derived from two sources: (1) consumer satisfaction surveys, and (2) The Health Plan Employer Data Information Set reports. There is little published data regarding physicians' critiques. This study surveyed physicians and office managers as to the quality of healthcare under 10 managed care organizations in the Greater Baton Rouge area. Performance indicators in the physician questionnaire focused on personal satisfaction, perception of patient satisfaction, and mental health coverage. The office managers' checklist included payment and certification issues, telephone time spent gaining certification, level of knowledge among plan enrollees of their benefits, appeal process, and adequacy of reimbursement. Means were calculated for each performance indicator and managed care organizations were ranked. Tukey-Kramer's post-hoc multiple comparisons test was used to confirm rank order validity. Significant differences were found among companies. Significant rank-order agreement by both physicians and office managers was evident. The usefulness of such surveys and performing them annually is discussed.

Managed care penetration and other factors affecting computerized physician order entry in the ambulatory setting.

PubMed

Menachemi, Nir; Ford, Eric W; Chukmaitov, Askar; Brooks, Robert G

2006-12-01

To estimate the current uses level of ambulatory computerized physician order entry (A-CPOE) among physicians and to examine the relationship of managed care penetration as well as other market and practice characteristics to use of A-CPOE by physicians. This study uses both primary and secondary data sources. The primary data source was a large-scale survey of physicians' use of information technologies in Florida. Secondary data on managed care penetration were obtained from the Florida Agency for Health Care Administration, and other market-level data were extracted from the area resource file. A hierarchical logistic regression model was used to examine the correlation of county-level and practice-level characteristics with physicians' self-reported use of A-CPOE systems. Overall, 1360 physicians (32.4%) indicated use of an A-CPOE system. Findings suggest that 1% more managed care penetration was associated with 2.1% lower use of A-CPOE (P = .003). Additionally, practice size, multispecialty affiliation, and primary care practice were significantly and positively correlated with the use of A-CPOE. Physician age was negatively associated with A-CPOE use. Managed care organizations may experience significant financial savings from A-CPOE use by physicians; however, managed care penetration in a community negatively affects A-CPOE use among physicians in their practices. Further study regarding the causal nature of this association is warranted.

The Impact of Order Source Misattribution on Computerized Provider Order Entry (CPOE) Performance Metrics

PubMed Central

Gellert, George A.; Catzoela, Linda; Patel, Lajja; Bruner, Kylynn; Friedman, Felix; Ramirez, Ricardo; Saucedo, Lilliana; Webster, S. Luke; Gillean, John A.

2017-01-01

Background One strategy to foster adoption of computerized provider order entry (CPOE) by physicians is the monthly distribution of a list identifying the number and use rate percentage of orders entered electronically versus on paper by each physician in the facility. Physicians care about CPOE use rate reports because they support the patient safety and quality improvement objectives of CPOE implementation. Certain physician groups are also motivated because they participate in contracted financial and performance arrangements that include incentive payments or financial penalties for meeting (or failing to meet) a specified CPOE use rate target. Misattribution of order sources can hinder accurate measurement of individual physician CPOE use and can thereby undermine providers’ confidence in their reported performance, as well as their motivation to utilize CPOE. Misattribution of order sources also has significant patient safety, quality, and medicolegal implications. Objective This analysis sought to evaluate the magnitude and sources of misattribution among hospitalists with high CPOE use and, if misattribution was found, to formulate strategies to prevent and reduce its recurrence, thereby ensuring the integrity and credibility of individual and facility CPOE use rate reporting. Methods A detailed manual order source review and validation of all orders issued by one hospitalist group at a midsize community hospital was conducted for a one-month study period. Results We found that a small but not dismissible percentage of orders issued by hospitalists—up to 4.18 percent (95 percent confidence interval, 3.84–4.56 percent) per month—were attributed inaccurately. Sources of misattribution by department or function were as follows: nursing, 42 percent; pharmacy, 38 percent; laboratory, 15 percent; unit clerk, 3 percent; and radiology, 2 percent. Order management and protocol were the most common correct order sources that were incorrectly attributed. Conclusion Order source misattribution can negatively affect reported provider CPOE use rates and should be investigated if providers perceive discrepancies between reported rates and their actual performance. Preventive education and communication efforts across departments can help prevent and reduce misattribution. PMID:28566988

Pathological investigation of caries and occlusal pulpar exposure in donkey cheek teeth using computerised axial tomography with histological and ultrastructural examinations.

PubMed

Toit, Nicole du; Burden, Faith A; Kempson, Sue A; Dixon, Padraic M

2008-12-01

Post-mortem examination of 16 donkey cheek teeth (CT) with caries (both peripheral and infundibular) and pulpar exposure were performed using computerised axial tomography (CAT), histology and scanning electron microscopy. CAT imaging was found to be useful to assess the presence and extent of caries and pulp exposure in individual donkey CT. Histology identified the loss of occlusal secondary dentine, and showed pulp necrosis in teeth with pulpar exposure. Viable pulp was present more apically in one exposed pulp horn, with its occlusal aspect sealed off from the exposed aspect of the pulp horn by a false pulp stone. Scanning electron microscopy showed the amelo-cemental junction to be a possible route of bacterial infection in infundibular cemental caries. The basic pathogenesis of dental caries in donkeys appears very similar to its description in other species.

[Evaluation of residual osteomuscular function using computerised movement analysis for building sector workers: specificity and technical problem].

PubMed

D'Orso, M I; Centemeri, R; Latocca, R; Riva, M; Cesana, G

2012-01-01

Occupational Health Doctors active in building sector firms frequently have to evaluate residual workers' osteomuscular function in patients coming back to work after an accident happened during work time or free time. Definition of their specific individual work suitability is usually carried out utilizing semeiotic tests in which subjective evaluation of every single Medical Doctor is real important in definition of final results and this fact can cause legal controversies. In our research we describe the application of computerised movement analysis on 10 workers of building sector. In every patient examined this technical method has been able to study objectively the tridimensional ranges of motion of most important osteomuscular districts. The possibility to have an objective evaluation of residual osteomuscular function has a relevant importance both in definition of workers' work suitability at the moment in which they start again their activities and in possible future legal conflicts.

Geospatial Data for Computerisation of Public Administration in the Czech Republic

NASA Astrophysics Data System (ADS)

Cada, V.; Mildorf, T.

2011-08-01

The main aim of the eGovernment programme in the Czech Republic is to enhance the efficiency of public administration. The Digital Map of Public Administration (DMVS) should be composed of digital orthophotographs of the Czech Republic, digital and digitised cadastral maps, digital purpose cadastral map (ÚKM) and a technical map of municipality, if available. The DMVS project is a part of computerisation of public administration in the Czech Republic. The project enhances the productivity of government administration and also simplifies the processes between citizens and public administration. The DMVS project, that should be compliant with the INSPIRE (Infrastructure for Spatial Information in the European Community) initiative, generates definite demand for geodata on the level of detail of land data model. The user needs that are clearly specified and required are not met due to inconsistencies in terminology, data management and level of detail.

[Computerised monitoring of integrated cervical screening. Indicators of diagnostic performance].

PubMed

Bucchi, L; Pierri, C; Amadori, A; Folicaldi, S; Ghidoni, D; Nannini, R; Bondi, A

2003-12-01

In a previous issue of this journal, we presented the background, rationale, general methods, and indicators of participation of a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. We also reported the results of the application of those indicators in the general database of the Pathology Department of Imola Health District in northern Italy. In the current paper, we present the rationale and definitions of indicators of diagnostic performance (total Pap smears and rate of unsatisfactory Pap smears, distribution by cytology class reported, rate of patients without timely follow-up, detection rate, positive predictive value, distribution of cytology classes reported by histology diagnosis, and distribution of cases of CIN and carcinoma registered by detection modality) as well as the results of their application in the same database as above.

Pathologists dislike sound? Evaluation of a computerised training microscope.

PubMed Central

Gray, E; Duvall, E; Sprey, J; Bird, C C

1998-01-01

AIM: To evaluate the use of multimedia enhancements, using a computerised microscope, in the training of microscope skills. METHODS: The HOME microscope provides facilities to highlight features of interest in conjunction with either text display or aural presentation. A pilot study was carried out with 10 individuals, eight of whom were at different stages of pathology training. A tutorial was implemented employing sound or text, and each individual tested each version. Both the subjective impressions of users and objective measurement of their patterns of use were recorded. RESULTS: Although both versions improved learning, users took longer to work through the aural than the text version; 90% of users preferred the text only version, including all eight individuals involved in pathology training. CONCLUSIONS: Pathologists appear to prefer visual rather than aural input when using teaching systems such as the HOME microscope and sound does not give added value to the training experience. Images PMID:9659250

The accuracy of real-time procedure coding by theatre nurses: a comparison with the central national system.

PubMed

Maclean, Donald; Younes, Hakim Ben; Forrest, Margaret; Towers, Hazel K

2012-03-01

Accurate and timely clinical data are required for clinical and organisational purposes and is especially important for patient management, audit of surgical performance and the electronic health record. The recent introduction of computerised theatre management systems has enabled real-time (point-of-care) operative procedure coding by clinical staff. However the accuracy of these data is unknown. The aim of this Scottish study was to compare the accuracy of theatre nurses' real-time coding on the local theatre management system with the central Scottish Morbidity Record (SMR01). Paired procedural codes were recorded, qualitatively graded for precision and compared (n = 1038). In this study, real-time, point-of-care coding by theatre nurses resulted in significant coding errors compared with the central SMR01 database. Improved collaboration between full-time coders and clinical staff using computerised decision support systems is suggested.

Computer-assisted image processing to detect spores from the fungus Pandora neoaphidis.

PubMed

Korsnes, Reinert; Westrum, Karin; Fløistad, Erling; Klingen, Ingeborg

2016-01-01

This contribution demonstrates an example of experimental automatic image analysis to detect spores prepared on microscope slides derived from trapping. The application is to monitor aerial spore counts of the entomopathogenic fungus Pandora neoaphidis which may serve as a biological control agent for aphids. Automatic detection of such spores can therefore play a role in plant protection. The present approach for such detection is a modification of traditional manual microscopy of prepared slides, where autonomous image recording precedes computerised image analysis. The purpose of the present image analysis is to support human visual inspection of imagery data - not to replace it. The workflow has three components:•Preparation of slides for microscopy.•Image recording.•Computerised image processing where the initial part is, as usual, segmentation depending on the actual data product. Then comes identification of blobs, calculation of principal axes of blobs, symmetry operations and projection on a three parameter egg shape space.

Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion.

PubMed

Carnie, J; Boden, J; Gao Smith, F

2002-07-01

In this single group observational study on 29 patients, we describe a technique that predicts the depth of the epidural space, calculated from the routine pre-operative chest computerised tomography (CT) scan using Pythagorean triangle trigonometry. We also compared the CT-derived depth of the epidural space with the actual depth of needle insertion. The CT-derived and the actual depths of the epidural space were highly correlated (r = 0.88, R2 = 0.78, p < 0.0001). The mean (95% CI) difference between CT-derived and actual depths was 0.26 (0.03-0.49) cm. Thus, the CT-derived depth tends to be greater than the actual depth by between 0.03 and 0.49 cm. There were no associations between either the CT-derived or the actual depth of the epidural space and age, weight, height or body mass index.

Physician Utilization of a Hospital Information System: A Computer Simulation Model

PubMed Central

Anderson, James G.; Jay, Stephen J.; Clevenger, Stephen J.; Kassing, David R.; Perry, Jane; Anderson, Marilyn M.

1988-01-01

The purpose of this research was to develop a computer simulation model that represents the process through which physicians enter orders into a hospital information system (HIS). Computer simulation experiments were performed to estimate the effects of two methods of order entry on outcome variables. The results of the computer simulation experiments were used to perform a cost-benefit analysis to compare the two different means of entering medical orders into the HIS. The results indicate that the use of personal order sets to enter orders into the HIS will result in a significant reduction in manpower, salaries and fringe benefits, and errors in order entry.

How Should Alternative Medicine Be Taught to Medical Students and Physicians?

ERIC Educational Resources Information Center

Marcus, Donald M.

2001-01-01

Analyzes alleged deficiencies in medical education and concludes they are based on misrepresentations (for example, that physicians ignore mind-body interactions). Examines fundamental differences between traditional and alternative medicine and asserts that physicians need additional education in order to provide guidance to patients, but that…

21 CFR 807.85 - Exemption from premarket notification.

Code of Federal Regulations, 2011 CFR

2011-04-01

... a patient named in the order of the physician or dentist (or other specially qualified person); or (2) It is intended solely for use by a physician or dentist (or other specially qualified person) and is not generally available to, or generally used by, other physicians or dentists (or other specially...

21 CFR 807.85 - Exemption from premarket notification.

Code of Federal Regulations, 2013 CFR

2013-04-01

... a patient named in the order of the physician or dentist (or other specially qualified person); or (2) It is intended solely for use by a physician or dentist (or other specially qualified person) and is not generally available to, or generally used by, other physicians or dentists (or other specially...

21 CFR 807.85 - Exemption from premarket notification.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a patient named in the order of the physician or dentist (or other specially qualified person); or (2) It is intended solely for use by a physician or dentist (or other specially qualified person) and is not generally available to, or generally used by, other physicians or dentists (or other specially...

21 CFR 807.85 - Exemption from premarket notification.

Code of Federal Regulations, 2014 CFR

2014-04-01

... a patient named in the order of the physician or dentist (or other specially qualified person); or (2) It is intended solely for use by a physician or dentist (or other specially qualified person) and is not generally available to, or generally used by, other physicians or dentists (or other specially...

21 CFR 807.85 - Exemption from premarket notification.

Code of Federal Regulations, 2012 CFR

2012-04-01

... a patient named in the order of the physician or dentist (or other specially qualified person); or (2) It is intended solely for use by a physician or dentist (or other specially qualified person) and is not generally available to, or generally used by, other physicians or dentists (or other specially...

Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior.

ERIC Educational Resources Information Center

Massaro, Thomas A.

1993-01-01

Implementation of the University of Virginia Medical Center's computerized system for mandatory recordkeeping of physician orders is discussed, focusing on administrative issues: delays, costs, disruption of work routine and behavior, and the need to bring in a senior management team. Recommendations are made for institutions with similar…

Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario.

PubMed

Meleskie, Jessica; Eby, Don

2009-01-01

Standardized, preprinted or computer-generated physician orders are an attractive project for organizations that wish to improve the quality of patient care. The successful development and maintenance of order sets is a major undertaking. This article recounts the collaborative experience of the Grey Bruce Health Network in adapting and implementing an existing set of physician orders for use in its three hospital corporations. An Order Set Committee composed of primarily front-line staff was given authority over the order set development, approval and implementation processes. This arrangement bypassed the traditional approval process and facilitated the rapid implementation of a large number of order sets in a short time period.

Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis.

PubMed

Newby, Jill M; Twomey, Conal; Yuan Li, Susan Shi; Andrews, Gavin

2016-07-15

An increasing number of computerised transdiagnostic cognitive behavioural therapy programs (TD-cCBT) have been developed in the past decade, but there are no meta-analyses to explore the efficacy of these programs, nor moderators of the effects. The current meta-analysis focused on studies evaluating TD-cCBT interventions to examine their effects on anxiety, depression and quality of life (QOL). Results from 17 RCTs showed computerised TD-cCBT outperformed control conditions on all outcome measures at post-treatment, with large effect sizes for depression (g's=.84), and medium effect sizes for anxiety (g=.78) and QOL (g=.48). RCT quality was generally good, although heterogeneity was moderate to high. Further analyses revealed that studies comparing TD-cCBT to waitlist controls had the largest differences (g=.93) compared to active (g=.59) and usual care control groups (g=.37) on anxiety outcomes, but there was no influence of control group subtype on depression outcomes. Treatment length, symptom target (mixed versus anxiety only), treatment design (standardised versus tailored), and therapist experience (students versus qualified therapists) did not influence the results. Preliminary evidence from 4 comparisons with disorder-specific treatments suggests transdiagnostic treatments are as effective for reducing anxiety, and there may be small but superior outcomes for TD-cCBT programs for reducing depression (g=.21) and improving QOL (g=.21) compared to disorder-specific cCBT. These findings show that TD-cCBT programs are efficacious, and have comparable effects to disorder-specific cCBT programs. Copyright © 2016 Elsevier B.V. All rights reserved.

Intensive Care Unit Physician's Attitudes on Do Not Resuscitate Order in Palestine.

PubMed

Abdallah, Fatima S; Radaeda, Mahdy S; Gaghama, Maram K; Salameh, Basma

2016-01-01

There is some ambiguity concerning the do-not-resuscitate (DNR) orders in the Arabic world. DNR is an order written by a doctor, approved by the patient or patient surrogate, which instructs health care providers to not do CPR when cardiac or respiratory arrest occurs. Therefore, this research study investigated the attitudes of Intensive Care Unit physicians and nurses on DNR order in Palestine. A total of 123 males and females from four different hospitals voluntarily participated in this study by signing a consent form; which was approved by the Ethical Committee at Birzeit University and the Ministry of Health. A non-experimental, quantitative, descriptive, and co-relational method was used, the data collection was done by a three page form consisting of the consent form, demographical data, and 24 item-based questionnaire based on a 5-point-Likert scale from strongly agree (score 1) to strongly disagree (score 5). The Statistical Package for Social Sciences (SPSS) software program version 17.0 was used to analyze the data. Finding showed no significant relationship between culture and opinion regarding the DNR order, but religion did. There was statistical significance difference between the physicians' and nurses' religious beliefs, but there was no correlation. Moreover, a total of 79 (64.3%) physicians and nurses agreed with legalizing the DNR order in Palestine. There was a positive attitude towards the legalization of the DNR order in Palestine, and culture and religion did not have any affect towards their attitudes regarding the legalization in Palestine.

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran

PubMed Central

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, , Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals. PMID:29445698

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran.

PubMed

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.

Evaluation of STAT medication ordering process in a community hospital.

PubMed

Abdelaziz, Hani; Richardson, Sandra; Walsh, Kim; Nodzon, Jessica; Schwartz, Barbara

2016-01-01

In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16-63; p<0.0001.). The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)]. We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.

A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma.

PubMed

Wong, Andrew C; Kowalenko, Terry; Roahen-Harrison, Stephanie; Smith, Barbara; Maio, Ronald F; Stanley, Rachel M

2011-03-01

The objective of the study was to determine whether fear of malpractice is associated with emergency physicians' decision to order head computed tomography (CT) in 3 age-specific scenarios of pediatric minor head trauma. We hypothesized that physicians with higher fear of malpractice scores will be more likely to order head CT scans. Board-eligible/board-certified members of the Michigan College of Emergency Physicians were sent a 2-part survey consisting of case scenarios and demographic questions. Effect of fear of malpractice on the decision to order a CT scan was evaluated using a cumulative logit model. Two hundred forty-six members (36.5%) completed the surveys. In scenario 1 (infant), being a male and working in a university setting were associated with reduced odds of ordering a CT scan (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.18-0.88; and OR, 0.35; 95% CI, 0.13-0.96, respectively). In scenario 2 (toddler), working for 15 years or more, at multiple hospitals, and for a private group were associated with reduced odds of ordering a CT scan (OR, 0.46; 95% CI, 0.26-0.79; OR, 0.36; 95% CI, 0.16-0.80; and OR, 0.51; 95% CI, 0.27-0.94, respectively). No demographic variables were significantly associated with ordering a CT scan in scenario 3 (teen). Overall, the fear of malpractice was not significantly associated with ordering a CT scan (OR, 1.28; 95% CI, 0.73-2.26; and OR, 1.70; 95% CI, 0.97-3.0). Only in scenario 2 was high fear significantly associated with increased odds of ordering a CT scan (OR, 2.09; 95% CI, 1.08-4.05). Members of Michigan College of Emergency Physicians with a higher fear of malpractice score tended to order more head CT scans in pediatric minor head trauma. However, this trend was shown to be statistically significant only in 1 case and not overall.

Improving the quality of the order-writing process for inpatient orders in a teaching hospital.

PubMed

Boehringer, Peter A; Rylander, Jeanette; Dizon, Dominic T; Peterson, Michael W

2007-01-01

Physicians' illegible handwriting is a notorious contributing factor to medical errors. Furthermore, an illegible signature or failure to print prescribers' name interferes with the ability of staff to clarify orders. We surveyed support medical staff at a teaching hospital before and 2 months after providing all internal medicine department residents a self-inking stamp with their name and pager number. Responses were received from 51% at the first and 36% at the second survey of 401 eligible staff. Responses to questions regarding illegible or absent signature, illegible or absent pager number, and failure to print prescribers' name showed a significant improvement (P < .0001) after 52 residents working in the hospital started to sign orders with their stamp. The support staff also noted a significant reduction in the time required to contact a physician to clarify orders, from more than 10 minutes to 1 to 5 minutes (P < .0001). Physicians signing orders using a stamp with their name and pager number provide support staff legible identification, leading to an improvement in the quality of the order-writing process. This kind of signature allows clarification of orders in a timely fashion.

Decrease in medical command errors with use of a "standing orders" protocol system.

PubMed

Holliman, C J; Wuerz, R C; Meador, S A

1994-05-01

The purpose of this study was to determine the physician medical command error rates and paramedic error rates after implementation of a "standing orders" protocol system for medical command. These patient-care error rates were compared with the previously reported rates for a "required call-in" medical command system (Ann Emerg Med 1992; 21(4):347-350). A secondary aim of the study was to determine if the on-scene time interval was increased by the standing orders system. Prospectively conducted audit of prehospital advanced life support (ALS) trip sheets was made at an urban ALS paramedic service with on-line physician medical command from three local hospitals. All ALS run sheets from the start time of the standing orders system (April 1, 1991) for a 1-year period ending on March 30, 1992 were reviewed as part of an ongoing quality assurance program. Cases were identified as nonjustifiably deviating from regional emergency medical services (EMS) protocols as judged by agreement of three physician reviewers (the same methodology as a previously reported command error study in the same ALS system). Medical command and paramedic errors were identified from the prehospital ALS run sheets and categorized. Two thousand one ALS runs were reviewed; 24 physician errors (1.2% of the 1,928 "command" runs) and eight paramedic errors (0.4% of runs) were identified. The physician error rate was decreased from the 2.6% rate in the previous study (P < .0001 by chi 2 analysis). The on-scene time interval did not increase with the "standing orders" system.(ABSTRACT TRUNCATED AT 250 WORDS)

Prosocial motivation and physicians' work attitudes. Effects of a triple synergy on prosocial orientation in a healthcare organization.

PubMed

Kim, Young Shin

2015-01-01

Employees work attitudes are key determinants to organizational performance. This article proposes a model integrating servant leadership, prosocial motivation, and corporate social responsibility (CSR) in order to explain a mechanism through which prosocial motivation plays a central role in enhanding physicians' work attitudes. A cross sectional survey from a sample of physicians indicates that (1) prosocial motivation can be shaped from servant leadership when physicians perceive high value fit with their supervisors, (2) prosocial motivation improves physicians' job satisfaction. Its effects is strengthened when physicians perceive high CSR, and (3) job satisfaction improves organizational commitment. The results provide meaningful insights that a triple synergy of prosocial orientation among physicians, supervisors and organization enhances physicians' work attitudes.

Visualizing the Future: Technology Competency Development in Clinical Medicine, and Implications for Medical Education

ERIC Educational Resources Information Center

Srinivasan, Malathi; Keenan, Craig R.; Yager, Joel

2006-01-01

Objective: In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Method: Through three case…

21 CFR 812.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... individual physician or dentist; (2) Is not generally available to, or generally used by, other physicians or dentists; (3) Is not generally available in finished form for purchase or for dispensing upon prescription... for use by an individual patient named in the order of a physician or dentist, and is to be made in a...

21 CFR 812.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... individual physician or dentist; (2) Is not generally available to, or generally used by, other physicians or dentists; (3) Is not generally available in finished form for purchase or for dispensing upon prescription... for use by an individual patient named in the order of a physician or dentist, and is to be made in a...

21 CFR 812.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... individual physician or dentist; (2) Is not generally available to, or generally used by, other physicians or dentists; (3) Is not generally available in finished form for purchase or for dispensing upon prescription... for use by an individual patient named in the order of a physician or dentist, and is to be made in a...

The effects of physicians' training and personality on test ordering for ambulatory patients.

PubMed Central

Epstein, A M; Begg, C B; McNeil, B J

1984-01-01

We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambiguity" as measured by a standard psychological instrument. These findings suggest that certain types of training may predispose physicians to be high testers. PMID:6496824

Occasional Papers in Open and Distance Learning, Number 14.

ERIC Educational Resources Information Center

Donnan, Peter, Ed.

Five papers focussing on educational technology are presented in this issue. "Computerised Instructional Technologies: Considerations for Lectures and Instructional Designers" (Helen Geissinger) and "The Higher Education Distance Learner and Technology" (Terry Geddes) locates the new technologies within a solidly grounded…

Access and Quality of Care in Direct-to-Consumer Telemedicine.

PubMed

Uscher-Pines, Lori; Mulcahy, Andrew; Cowling, David; Hunter, Gerald; Burns, Rachel; Mehrotra, Ateev

2016-04-01

Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc ( www.teladoc.com ), a large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers. Claims from all enrollees 18-64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians. Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than physician offices (3% versus 50%, p < 0.01). For the back pain measure (not ordering imaging), Teladoc and physician offices had similar performance (88% versus 79%, p = 0.20). For the bronchitis measure (not ordering antibiotics), Teladoc performed worse than physician offices (16.7 versus 27.9%, p < 0.01). In adjusted models, Teladoc users were not more likely to be located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10). Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of quality and additional marketing and education to increase telemedicine use among underserved patients.

Emergency physician perceptions of medically unnecessary advanced diagnostic imaging.

PubMed

Kanzaria, Hemal K; Hoffman, Jerome R; Probst, Marc A; Caloyeras, John P; Berry, Sandra H; Brook, Robert H

2015-04-01

The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging. © 2015 by the Society for Academic Emergency Medicine.

Computerised decision support systems in order communication for diagnostic, screening or monitoring test ordering: systematic reviews of the effects and cost-effectiveness of systems.

PubMed

Main, C; Moxham, T; Wyatt, J C; Kay, J; Anderson, R; Stein, K

2010-10-01

Order communication systems (OCS) are computer applications used to enter diagnostic and therapeutic patient care orders and to view test results. Many potential benefits of OCS have been identified including improvements in clinician ordering patterns, optimisation of clinical time, and aiding communication processes between clinicians and different departments. Many OCS now include computerised decision support systems (CDSS), which are information systems designed to improve clinical decision-making. CDSS match individual patient characteristics to a computerised knowledge base, and software algorithms generate patient-specific recommendations. To investigate which CDSS in OCS are in use within the UK and the impact of CDSS in OCS for diagnostic, screening or monitoring test ordering compared to OCS without CDSS. To determine what features of CDSS are associated with clinician or patient acceptance of CDSS in OCS and what is known about the cost-effectiveness of CDSS in diagnostic, screening or monitoring test OCS compared to OCS without CDSS. A generic search to identify potentially relevant studies for inclusion was conducted using MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), CINAHL (Cumulative Index to Nursing and Allied Health Literature), DARE (Database of Abstracts of Reviews of Effects), Health Technology Assessment (HTA) database, IEEE (Institute of Electrical and Electronic Engineers) Xplore digital library, NHS Economic Evaluation Database (NHS EED) and EconLit, searched between 1974 and 2009 with a total of 22,109 titles and abstracts screened for inclusion. CDSS for diagnostic, screening and monitoring test ordering OCS in use in the UK were identified through contact with the 24 manufacturers/suppliers currently contracted by the National Project for Information Technology (NpfIT) to provide either national or specialist decision support. A generic search to identify potentially relevant studies for inclusion in the review was conducted on a range of medical, social science and economic databases. The review was undertaken using standard systematic review methods, with studies being screened for inclusion, data extracted and quality assessed by two reviewers. Results were broadly grouped according to the type of CDSS intervention and study design where possible. These were then combined using a narrative synthesis with relevant quantitative results tabulated. Results of the studies included in review were highly mixed and equivocal, often both within and between studies, but broadly showed a beneficial impact of the use of CDSS in conjunction with OCS over and above OCS alone. Overall, if the findings of both primary and secondary outcomes are taken into account, then CDSS significantly improved practitioner performance in 15 out of 24 studies (62.5%). Only two studies covered the cost-effectiveness of CDSS: a Dutch study reported a mean cost decrease of 3% for blood tests orders (639 euros) in each of the intervention clinics compared with a 2% (208 euros) increase in control clinics in test costs; and a Spanish study reported a significant increase in the cost of laboratory tests from 41.8 euros per patient per annum to 47.2 euros after implementation of the system. The response rate from the survey of manufacturers and suppliers was extremely low at only 17% and much of the feedback was classified as being commercial-in-confidence (CIC). No studies were identified which assessed the features of CDSS that are associated with clinician or patient acceptance of CDSS in OCS in the test ordering process and only limited data was available on the cost-effectiveness of CDSS plus OCS compared with OCS alone and the findings highly specific. Although CDSS appears to have a potentially small positive impact on diagnostic, screening or monitoring test ordering, the majority of studies come from a limited number of institutions in the USA. If the findings of both primary and secondary outcomes are taken into account then CDSS showed a statistically significant benefit on either process or practitioner performance outcomes in nearly two-thirds of the studies. Furthermore, in four studies that assessed adverse effects of either test cancellation or delay, no significant detrimental effects in terms of additional utilisation of health-care resources or adverse events were observed. We believe the key current need is for a well designed and comprehensive survey, and on the basis of the results of this potentially for evaluation studies in the form of cluster randomised controlled trials or randomised controlled trials which incorporate process, and patient outcomes, as well as full economic evaluations alongside the trials to assess the impact of CDSS in conjunction with OCS versus OCS alone for diagnostic, screening or monitoring test ordering in the NHS. The economic evaluation should incorporate the full costs of potentially developing, testing, and installing the system, including staff training costs. Study registration 61.

Multidrug-resistant bacteria infection control: study of compliance with isolation precautions in a Paris university hospital.

PubMed

Vidal-Trecan, G M; Delamare, N; Tcherny-Lessenot, S; Lamory, J; Baudin, F; de Prittwitz, M; Salmon-Ceron, D

2001-02-01

Isolation practices in a university hospital were analyzed for 137 patients with multidrug-resistant bacteria. Isolation was ordered in writing by physicians for 40% and instituted by nurses for 60%; 74% were isolated. Compliance depended on physician ordering in writing (odds ratio, 36.3; 95% confidence interval, 4.8-274.9). Nurses complied best with hand washing.

Future Physicians' Professional Communication Skills Training at US Universities: Structure and Content

ERIC Educational Resources Information Center

Manyuk, Lubov

2016-01-01

Professional training of physicians able to apply their skills in order to reflect the patients' needs related to care, prevention and treatment of the diseases is one of the most common current trends in higher medical education. Due to the development of patient-centered relationships of physicians the attention of medical educators and…

26 CFR 1.103-11 - Bonds held by substantial users.

Code of Federal Regulations, 2014 CFR

2014-04-01

... in order to construct a medical building for certain physicians and dentists. The facility will contain 30 offices to be leased on equal terms and for the same rental rates to each physician or dentist for use in his trade or business. Each physician or dentist will be a substantial user of the facility...

26 CFR 1.103-11 - Bonds held by substantial users.

Code of Federal Regulations, 2011 CFR

2011-04-01

... in order to construct a medical building for certain physicians and dentists. The facility will contain 30 offices to be leased on equal terms and for the same rental rates to each physician or dentist for use in his trade or business. Each physician or dentist will be a substantial user of the facility...

26 CFR 1.103-11 - Bonds held by substantial users.

Code of Federal Regulations, 2012 CFR

2012-04-01

... in order to construct a medical building for certain physicians and dentists. The facility will contain 30 offices to be leased on equal terms and for the same rental rates to each physician or dentist for use in his trade or business. Each physician or dentist will be a substantial user of the facility...

26 CFR 1.103-11 - Bonds held by substantial users.

Code of Federal Regulations, 2013 CFR

2013-04-01

... in order to construct a medical building for certain physicians and dentists. The facility will contain 30 offices to be leased on equal terms and for the same rental rates to each physician or dentist for use in his trade or business. Each physician or dentist will be a substantial user of the facility...

Variations among Primary Care Physicians in Exercise Advice, Imaging, and Analgesics for Musculoskeletal Pain: Results from a Factorial Experiment

PubMed Central

Maserejian, Nancy N.; Fischer, Michael A.; Trachtenberg, Felicia L.; Yu, Jing; Marceau, Lisa D.; McKinlay, John B.; Katz, Jeffrey N.

2014-01-01

Objective To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider. Methods We conducted a balanced factorial experiment among primary care physicians in the U.S. Physicians (N=192) viewed two videos of different patients (actors) presenting with pain: (1) undiagnosed sciatica symptoms or (2) diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status (SES), race, physician gender and experience (<20 vs. ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the ACR, American Pain Society, and clinical expert consensus. Results Despite current recommendations, under one-third of physicians would provide exercise advice (30.2% for osteoarthritis, 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P<0.01), and to prescribe NSAIDs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment. Conclusion Physician education on disease management recommendations regarding exercise and analgesics, and implementation of quality measures may be useful, particularly for physicians with more years in practice. PMID:24376249

Determining Childhood Blood Lead Level Screening Compliance Among Physicians.

PubMed

Haboush-Deloye, Amanda; Marquez, Erika R; Gerstenberger, Shawn L

2017-08-01

Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

Evaluation of STAT medication ordering process in a community hospital

PubMed Central

Walsh., Kim; Schwartz., Barbara

Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001.). The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process. PMID:27382418

Fecal occult blood testing beliefs and practices of U.S. primary care physicians: serious deviations from evidence-based recommendations.

PubMed

Nadel, Marion R; Berkowitz, Zahava; Klabunde, Carrie N; Smith, Robert A; Coughlin, Steven S; White, Mary C

2010-08-01

Fecal occult blood testing (FOBT) is an important option for colorectal cancer screening that should be available in order to achieve high population screening coverage. However, results from a national survey of clinical practice in 1999-2000 indicated that many primary care physicians used inadequate methods to implement FOBT screening and follow-up. To determine whether methods to screen for fecal occult blood have improved, including the use of newer more sensitive stool tests. Cross-sectional national survey of primary care physicians. Participants consisted of 1,134 primary care physicians who reported ordering or performing FOBT in the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Cancer Screening. Self-reported data on details of FOBT implementation and follow-up of positive results. Most physicians report using standard guaiac tests; higher sensitivity guaiac tests and immunochemical tests were reported by only 22.0% and 8.9%, respectively. In-office testing, that is, testing of a single specimen collected during a digital rectal examination in the office, is still widely used although inappropriate for screening: 24.9% of physicians report using only in-office tests and another 52.9% report using both in-office and home tests. Recommendations improved for follow-up after a positive test: fewer physicians recommend repeating the FOBT (17.8%) or using tests other than colonoscopy for the diagnostic work-up (6.6%). Only 44.3% of physicians who use home tests have reminder systems to ensure test completion and return. Many physicians continue to use inappropriate methods to screen for fecal occult blood. Intensified efforts to inform physicians of recommended technique and promote the use of tracking systems are needed.

The clinical application of genetic testing in type 2 diabetes: a patient and physician survey.

PubMed

Grant, R W; Hivert, M; Pandiscio, J C; Florez, J C; Nathan, D M; Meigs, J B

2009-11-01

Advances in type 2 diabetes genetics have raised hopes that genetic testing will improve disease prediction, prevention and treatment. Little is known about current physician and patient views regarding type 2 diabetes genetic testing. We hypothesised that physician and patient views would differ regarding the impact of genetic testing on motivation and adherence. We surveyed a nationally representative sample of US primary care physicians and endocrinologists (n = 304), a random sample of non-diabetic primary care patients (n = 152) and patients enrolled in a diabetes pharmacogenetics study (n = 89). Physicians and patients favoured genetic testing for diabetes risk prediction (79% of physicians vs 80% of non-diabetic patients would be somewhat/very likely to order/request testing, p = 0.7). More patients than physicians (71% vs 23%, p < 0.01) indicated that a 'high risk' result would be very likely to improve motivation to adopt preventive lifestyle changes. Patients favoured genetic testing to guide therapy (78% of patients vs 48% of physicians very likely to request/recommend testing, p < 0.01) and reported that genetic testing would make them 'much more motivated' to adhere to medications (72% vs 18% of physicians, p < 0.01). Many physicians (39%) would be somewhat/very likely to order genetic testing before published evidence of clinical efficacy. Despite the paucity of current data, physicians and patients reported high expectations that genetic testing would improve patient motivation to adopt key behaviours for the prevention or control of type 2 diabetes. This suggests the testable hypothesis that 'genetic' risk information might have greater value to motivate behaviour change compared with standard risk information.

Traditional Nurse Triage vs. Physician Tele-Presence in a Pediatric Emergency Department

PubMed Central

Marconi, Greg P.; Chang, Todd; Pham, Phung K.; Grajower, Daniel N.; Nager, Alan L.

2014-01-01

Objectives To compare traditional nurse triage (TNT) in a Pediatric Emergency Department (PED) to physician tele-presence (PTP). Methods Prospective, 2×2 crossover study with random assignment using a sample of walk-in patients seeking care in a PED at a large, tertiary care children’s hospital, from May 2012 to January 2013. Outcomes of triage times, documentation errors, triage scores, and survey responses were compared between TNT and PTP. Comparison between PTP to actual treating PED physicians regarding the accuracy of ordering blood and urine tests, throat cultures, and radiologic imaging was also studied. Results Paired samples t-tests showed a statistically significant difference in triage time between TNT and PTP (p=0.03), but no significant difference in documentation errors (p=0.10). Triage scores of TNT were 71% accurate, compared to PTP, which were 95% accurate. Both parents and children had favorable scores regarding PTP and the majority indicated they would prefer PTP again at their next PED visit. PTP diagnostic ordering was comparable to the actual PED physician ordering, showing no statistical differences. Conclusions Utilizing physician tele-presence technology to remotely perform triage is a feasible alternative to traditional nurse triage, with no clinically significant differences in time, triage scores, errors and patient and parent satisfaction. PMID:24445223

Computerised Screening for Dyslexia in Adults

ERIC Educational Resources Information Center

Singleton, Chris; Horne, Joanna; Simmons, Fiona

2009-01-01

Identifying dyslexia in adulthood presents particular challenges because of complicating factors such as acquisition of compensatory strategies, differing degrees of intervention and the problem of distinguishing dyslexic adults from those whose literacy difficulties have non-cognitive causes. One of the implications is that conventional literacy…

32 CFR 234.11 - Alcoholic beverages and controlled substances.

Code of Federal Regulations, 2013 CFR

2013-07-01

... physician or pharmacist in accordance with applicable law. For the purposes of this paragraph, delivery... valid prescription or order by, a licensed physician or pharmacist, or as otherwise allowed by Federal...

32 CFR 234.11 - Alcoholic beverages and controlled substances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... physician or pharmacist in accordance with applicable law. For the purposes of this paragraph, delivery... valid prescription or order by, a licensed physician or pharmacist, or as otherwise allowed by Federal...

32 CFR 234.11 - Alcoholic beverages and controlled substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... physician or pharmacist in accordance with applicable law. For the purposes of this paragraph, delivery... valid prescription or order by, a licensed physician or pharmacist, or as otherwise allowed by Federal...

32 CFR 234.11 - Alcoholic beverages and controlled substances.

Code of Federal Regulations, 2014 CFR

2014-07-01

... physician or pharmacist in accordance with applicable law. For the purposes of this paragraph, delivery... valid prescription or order by, a licensed physician or pharmacist, or as otherwise allowed by Federal...

32 CFR 234.11 - Alcoholic beverages and controlled substances.

Code of Federal Regulations, 2012 CFR

2012-07-01

... physician or pharmacist in accordance with applicable law. For the purposes of this paragraph, delivery... valid prescription or order by, a licensed physician or pharmacist, or as otherwise allowed by Federal...

Physician fees and managed care plans.

PubMed

Zwanziger, Jack

2002-01-01

One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

Effective communication of molecular genetic test results to primary care providers.

PubMed

Scheuner, Maren T; Edelen, Maria Orlando; Hilborne, Lee H; Lubin, Ira M

2013-06-01

We evaluated a template for molecular genetic test reports that was developed as a strategy to reduce communication errors between the laboratory and ordering clinician. We surveyed 1,600 primary care physicians to assess satisfaction, ease of use, and effectiveness of genetic test reports developed using our template and reports developed by clinical laboratories. Mean score differences of responses between the reports were compared using t-tests. Two-way analysis of variance evaluated the effect of template versus standard reports and the influence of physician characteristics. There were 396 (24%) respondents. Template reports had higher scores than the standard reports for each survey item. The gender and specialty of the physician did not influence scores; however, younger physicians gave higher scores regardless of report type. There was significant interaction between report type and whether physicians ordered or reviewed any genetic tests (none versus at least one) in the past year, P = 0.005. For each survey item assessing satisfaction, ease of use, and effectiveness, physicians gave higher ratings to genetic test reports developed with the template than standard reports used by clinical laboratories. Physicians least familiar with genetic test reports, and possibly having the greatest need for better communication, were best served by the template reports.

Properties of the 4.45 eV optical absorption band in LiF:Mg,Ti.

PubMed

Nail, I; Oster, L; Horowitz, Y S; Biderman, S; Belaish, Y

2006-01-01

The optical absorption (OA) and thermoluminescence (TL) of dosimetric LiF:Mg,Ti (TLD-100) as well as nominally pure LiF single crystal have been studied as a function of irradiation dose, thermal and optical bleaching in order to investigate the role of the 4.45 eV OA band in low temperature TL. Computerised deconvolution was used to resolve the absorption spectrum into individual gaussian bands and the TL glow curve into glow peaks. Although the 4.45 eV OA band shows thermal decay characteristics similar to the 4.0 eV band its dose filling constant and optical bleaching properties suggest that it cannot be associated with the TL of composite peaks 4 or 5. Its presence in optical grade single crystal LiF further suggests that it is an intrinsic defect or possibly associated with chance impurities other than Mg, Ti.

Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis

PubMed Central

Chen, H; Ho, H M; Ying, M; Fu, S N

2012-01-01

Objectives The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis. Methods PDU was performed on 44 patients (age range 30–66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18–61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7–10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis. Results Good correlation was found between the averaged VI ratios and Newman's qualitative scale (ρ = 0.70; p<0.001). Intratester and intertester reliability were 0.89 and 0.61, respectively. Furthermore, higher VI was correlated with less reduction in pain after physiotherapeutic intervention. Conclusions The computerised VI not only has a high level of concordance with the Newman grading scale but is also reliable in reflecting the vascularity of proximal plantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies. PMID:22167513

Computerised patient record with distributed objects.

PubMed

Gornik, T; Orel, A; Roblek, D; Verhovsek, R

1999-01-01

The vast spectrum of information and functionality requirements imposed on a Computerised Patient Record (CPR), fueled by an ever changing and expanding business model demands information system interoperability. The management of information, created across the continuum of care, and associated information system functionality, can not be provided by data interchange to and from monolithic applications. WebDoctor is a Computerised Patient Record (CPR) which is fully used at the Institute of Oncology in Ljubljana, Slovenia--a hospital with 500 beds and more than 200 users, all of them medical professionals. The data are stored in an underlying Oracle hospital data base. For logging the username and password security is used. WebDoctor uses Internationalization APIs. Currently GUI is currently written in Slovenian language, but can be easily adapted to any other language. It is available in either Metal or Windows look. Search for patients is based on CPR No. or partial data from demographics. All the available patients data can be found on a single screen divided into several tab sections. The tab sections cover general and speciality data. The general data include demographics, admissions and diagnoses, meanwhile the speciality data are divided into Labs where data are represented numerically by date or by type and graphically with the ability of detailed view in separate window, Radiology where results are represented in textual form as well as pictures together with a special viewer to provide detailed analyses and Radioisotopes where results are also being represented in textual form together with a graphical representation. WebDoctor is running on virtually any platform. It achieved the 100% Java Certification which places the application among the firsts if not the first of this kind in the healthcare industry. It excels with a small and light client which doesn't exceed the 150K.

Validation of the Chinese version of the CogState computerised cognitive assessment battery in Taiwanese patients with heart failure.

PubMed

Chou, Cheng-Chen; Pressler, Susan J; Giordani, Bruno; Fetzer, Susan Jane

2015-11-01

To evaluate the validity of the Chinese version of the CogState battery, a computerised cognitive testing among patients with heart failure in Taiwan. Cognitive deficits are common in patients with heart failure and a validated Chinese measurement is required for assessing cognitive change for this population. The CogState computerised battery is a measurement of cognitive function and has been validated in many languages, but not Chinese. A cross-sectional study. A convenience sample consisted of 76 women with heart failure and 64 healthy women in northern Taiwan. Women completed the Chinese version of the CogState battery and the Montreal Cognitive Assessment. Construct validity of the Chinese version of the battery was evaluated by exploratory factor analysis and known-group comparisons. Convergent validity of the CogState tasks was examined by Pearson correlation coefficients. Principal components factor analysis with promax rotation showed two factors reflecting the speed and memory dimensions of the tests. Scores for CogState battery tasks showed significant differences between the heart failure and healthy control group. Examination of convergent validity of the CogState found a significant association with the Montreal Cognitive Assessment. The Chinese CogState Battery has satisfactory construct and convergent validity to measure cognitive deficits in patients with heart failure in Taiwan. The Chinese CogState battery is a valid instrument for detecting cognitive deficits that may be subtle in the early stages, and identifying changes that provide insights into patients' abilities to implement treatment accurately and consistently. Better interventions tailored to the needs of the cognitive impaired population can be developed. © 2015 John Wiley & Sons Ltd.

Implementing computerized physician order entry: the importance of special people.

PubMed

Ash, Joan S; Stavri, P Zoë; Dykstra, Richard; Fournier, Lara

2003-03-01

To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings. Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users. The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.

Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital

PubMed Central

Junod, P; Morabia, A; de Torrente, A

2002-01-01

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients' involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients' involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. PMID:12468655

Use of predefined biochemical admission profiles does not reduce the number of tests or total cost: a randomized-controlled pilot study.

PubMed

Pareek, Manan; Haidl, Felix; Folkestad, Lars; Brabrand, Mikkel

2014-02-01

The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost. This was a randomized-controlled trial of 191 adult patients admitted to a medical admission unit. Upon admission, the patients were randomized to have their blood tests determined by either using a predefined profile (used routinely and designed by the department head) or ordered individually by the treating physician. All patients were initially assessed by junior physicians. We compared the number of tests, estimated total cost, and length of stay. Data are presented as median (interquartile range). Differences were compared using the Wilcoxon rank-sum test and Fishers' exact test. Ninety-two patients were men, median age 65 years. Patients randomized to the use of the predefined profile had median 17 (14-22) blood tests drawn and patients randomized to physician discretion had median 17 (12-21) tests drawn (P=0.3). The median total cost of tests in the profile group was 618 DKK (493-803) and the cost in the physician group was 564 DKK (434-812) (P=0.19). Length of stay in the profile group was a median of 4 days (2-6 days) and 2 days (2-6 days) in the physician group (P=0.08). The use of a predefined blood test panel did not significantly affect the number of tests, total cost, or length of stay for acutely admitted medical patients compared with tests ordered at the discretion of the treating physician.

Restructuring hospital-physician relationships for future success.

PubMed

Howard, Chris

2003-01-01

Integrating physicians into the Healthfirst administration through employment sowed seeds of mutual understanding among these two groups that would benefit the system immeasurably over the next several years. The immediate future, however, saw only cultural upheaval between our hospitals and newly employed physicians, hospitals and nonemployed physicians, employed and nonemployed physicians, as well as specialists and primary care providers. Traditional physician-relationship-building efforts became difficult, if not impossible, to maintain. Essentially, administration was forced to scrap ten years of physician-development plans in order to reconfigure a relations effort that would maintain hospital support from all sides while restructuring the employed medical group. This article describes the evolution of Healthfirst's approach to maintaining effective physician relationships within our healthcare system and its affiliated entities over the past decade. Specifically, the article details the manner in which our system has evolved physician-relations activity to maintain an effective strategy during times of significant change in the healthcare industry.

Applying modern psychometric techniques to melodic discrimination testing: Item response theory, computerised adaptive testing, and automatic item generation.

PubMed

Harrison, Peter M C; Collins, Tom; Müllensiefen, Daniel

2017-06-15

Modern psychometric theory provides many useful tools for ability testing, such as item response theory, computerised adaptive testing, and automatic item generation. However, these techniques have yet to be integrated into mainstream psychological practice. This is unfortunate, because modern psychometric techniques can bring many benefits, including sophisticated reliability measures, improved construct validity, avoidance of exposure effects, and improved efficiency. In the present research we therefore use these techniques to develop a new test of a well-studied psychological capacity: melodic discrimination, the ability to detect differences between melodies. We calibrate and validate this test in a series of studies. Studies 1 and 2 respectively calibrate and validate an initial test version, while Studies 3 and 4 calibrate and validate an updated test version incorporating additional easy items. The results support the new test's viability, with evidence for strong reliability and construct validity. We discuss how these modern psychometric techniques may also be profitably applied to other areas of music psychology and psychological science in general.

Mechanisation and automation technologies development in work at construction sites

NASA Astrophysics Data System (ADS)

Sobotka, A.; Pacewicz, K.

2017-10-01

Implementing construction work that creates buildings is a very complicated and laborious task and requires the use of various types of machines and equipment. For years there has been a desire for designers and technologists to introduce devices that replace people’s work on machine construction, automation and even robots. Technologies for building construction are still being developed and implemented to limit people’s hard work and improve work efficiency and quality in innovative architectonical and construction solutions. New opportunities for improving work on the construction site include computerisation of technological processes and construction management for projects and processes. The aim of the paper was to analyse the development of mechanisation, automation and computerisation of construction processes and selected building technologies, with special attention paid to 3D printing technology. The state of mechanisation of construction works in Poland and trends in its development in construction technologies are presented. These studies were conducted on the basis of the available literature and a survey of Polish construction companies.

[Importance of an outpatient record in obstetric anesthesia].

PubMed

Lanza, V; Mercadante, S; Pignataro, A; Guglielmo, L; Villari, P; Di Fiore, G; Sapio, M; De Michele, P; Vegna, G

1991-01-01

A computerised record was used to collect data following an anesthesiological check-up of pregnant women at approximately 30 weeks of pregnancy. The record was input onto a portable PC in the anesthesia outpatient clinic, memorized on disk (3.5") and then transferred onto a PC network (one PC for each operating theatre) for "real time" consultation of each patient's data. All pregnant women attending the antenatal clinico were also given a folder illustrating epidural anesthetic techniques. Seven hundred and nine outpatient visits have been performed over the past two years with a 62% utilisation ratio. The collection of data using a computerised system allows a rapid and efficacious system of communication to be set up among the membranes of the anesthesiological team, thus encouraging the use of epidural techniques during labour. The distribution of the folder also facilitated the task of the anesthetist who found that pregnant women visiting the anesthesia clinic were already familiar with the epidural technique.

Propositional idea density in older men's written language: findings from the HIMS study using computerised analysis.

PubMed

Spencer, Elizabeth; Ferguson, Alison; Craig, Hugh; Colyvas, Kim; Hankey, Graeme J; Flicker, Leon

2015-02-01

Decline in linguistic function has been associated with decline in cognitive function in previous research. This research investigated the informativeness of written language samples of Australian men from the Health in Men's Study (HIMS) aged from 76 to 93 years using the Computerised Propositional Idea Density Rater (CPIDR 5.1). In total, 60,255 words in 1147 comments were analysed using a linear-mixed model for statistical analysis. Results indicated no relationship with education level (p = 0.79). Participants for whom English was not their first learnt language showed Propositional Idea Density (PD) scores slightly lower (0.018 per 1 word). Mean PD per 1 word for those for whom English was their first language for comments below 60 words was 0.494 and above 60 words 0.526. Text length was found to have an effect (p = <0.0001). The mean PD was higher than previously reported for men and lower than previously reported for a similar cohort for Australian women.

Follow-up and treatment of an instable patient with heart failure using telemonitoring and a computerised disease management system: a case report.

PubMed

de Vries, Arjen E; van der Wal, Martje Hl; Bedijn, Wendy; de Jong, Richard M; van Dijk, Rene B; Hillege, Hans L; Jaarsma, Tiny

2012-12-01

In the last decades, the introduction of information and communication technology (ICT) in healthcare promised an improved quality of care while reducing workload and improving cost-effectiveness. This might be realised by the use of computer guided decision support systems and telemonitoring. This case study describes the process of care of a patient with chronic heart failure, who was treated with a computerised disease management system in combination with telemonitoring. With the help of these appliances, we think we were probably able to prevent at least two readmissions for heart failure in a period of 10 months. We also gained more insight into patient's behaviour with regards to compliance with the heart failure regimen at home. Frequent contact at distance and the online availability of physiological measurements at home facilitated patient tailored education and helped the patient to react adequately to symptoms of deterioration. Additionally, up-titration of heart failure medication was performed without contacting the patient at the outpatient clinic.

Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time.

PubMed

Fruth, Stacie J; Wiley, Steve

2016-09-01

Emergency department (ED) use in the United States is expected to rapidly increase. Nearly half of all ED visits are classified as semiurgent or nonurgent, and many fall into the musculoskeletal category. Despite growing international evidence that patients are appropriately and safely managed by ED physical therapists in a time-efficient manner, physical therapist practice in EDs is not widely understood or utilized in the United States. To date, no studies have reported the impressions of ED physicians about this practice. The purposes of this study were: (1) to assess ED physicians' impressions of ED physical therapist practice 2 years after practice was initiated and (2) to determine whether physicians' impressions changed 7 years later. All ED staff physicians and medical residents at a level I trauma hospital were invited to complete a survey in 2004 and 2011. In both years, a majority of physicians reported favorable impressions of ED physical therapist practice. Physical therapists were valued for educating patients about safety and injury prevention, providing appropriate gait training, assisting with disposition planning, and providing interventions as alternatives to pain medication. Many physicians supported standing physical therapist orders for certain musculoskeletal conditions. The most common concern was the additional time that patients spend in the ED for a physical therapist consult. The results of this study may not reflect the impressions of physicians in all EDs that employ physical therapists. Emergency department physicians reported favorable impressions of ED physical therapist practice 2 years and 9 years following its implementation in this hospital. This study showed that ED physicians support standing physical therapist orders for certain musculoskeletal conditions, which suggests that direct triage to ED physical therapists for these conditions could be considered. © 2016 American Physical Therapy Association.

Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.

PubMed

Keasberry, Justin; Scott, Ian A; Sullivan, Clair; Staib, Andrew; Ashby, Richard

2017-12-01

Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes. Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool. Outcome measures were benefits and harms relating to electronic medical records (EMRs), computerised physician order entry (CPOE), electronic prescribing (ePrescribing) and computerised decision support systems (CDSS). Results are presented as a narrative overview given marked study heterogeneity. Results Nineteen systematic reviews and two reviews of systematic reviews were included from 1197 abstracts, nine rated as high quality. For EMR functions, there was moderate-quality evidence of reduced hospitalisations and length of stay and low-quality evidence of improved organisational efficiency, greater accuracy of information and reduced documentation and process turnaround times. For CPOE functions, there was moderate-quality evidence of reductions in turnaround times and resource utilisation. For ePrescribing, there was moderate-quality evidence of substantially fewer medications errors and adverse drug events, greater guideline adherence, improved disease control and decreased dispensing turnaround times. For CDSS, there was moderate-quality evidence of increased use of preventive care and drug interaction reminders and alerts, increased use of diagnostic aids, more appropriate test ordering with fewer tests per patient, greater guideline adherence, improved processes of care and less disease morbidity. There was conflicting evidence regarding effects on in-patient mortality and overall costs. Reported harms were alert fatigue, increased technology interaction time, creation of disruptive workarounds and new prescribing errors. Conclusion eHealth technologies in hospital settings appear to improve efficiency and appropriateness of care, prescribing safety and disease control. Effects on mortality, readmissions, total costs and patient and provider experience remain uncertain. What is known about the topic? Healthcare systems internationally are undertaking large-scale digitisation programs with hospitals being a major focus. Although predictive analyses suggest that eHealth technologies have the potential to markedly transform health care delivery, contemporary peer-reviewed research evidence detailing their benefits and harms is limited. What does this paper add? This narrative overview of 19 systematic reviews and two reviews of systematic reviews published over the past 5 years provides a summary of cumulative evidence of clinical and organisational effects of contemporary eHealth technologies in hospital practice. EMRs have the potential to increase accuracy and completeness of clinical information, reduce documentation time and enhance information transfer and organisational efficiency. CPOE appears to improve laboratory turnaround times and decrease resource utilisation. ePrescribing significantly reduces medication errors and adverse drug events. CDSS, especially those used at the point of care and integrated into workflows, attract the strongest evidence for substantially increasing clinician adherence to guidelines, appropriateness of disease and treatment monitoring and optimal medication use. Evidence of effects of eHealth technologies on discrete clinical outcomes, such as morbid events, mortality and readmissions, is currently limited and conflicting. What are the implications for practitioners? eHealth technologies confer benefits in improving quality and safety of care with little evidence of major hazards. Whether EMRs and CPOE can affect clinical outcomes or overall costs in the absence of auxiliary support systems, such as ePrescribing and CDSS, remains unclear. eHealth technologies are evolving rapidly and the evidence base used to inform clinician and managerial decisions to invest in these technologies must be updated continually. More rigorous field research using appropriate evaluation methods is needed to better define real-world benefits and harms. Customisation of eHealth applications to the context of patient-centred care and management of highly complex patients with multimorbidity will be an ongoing challenge.

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions.

PubMed

McCall, Shannon J; Souers, Rhona J; Blond, Barbara; Massie, Larry

2016-10-01

-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. -To survey the level of physician satisfaction with hospital clinical laboratory services. -Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). -Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient "STAT" (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). -There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.

Data Mining on Numeric Error in Computerized Physician Order Entry System Prescriptions.

PubMed

Wu, Xue; Wu, Changxu

2017-01-01

This study revealed the numeric error patterns related to dosage when doctors prescribed in computerized physician order entry system. Error categories showed that the '6','7', and '9' key produced a higher incidence of errors in Numpad typing, while the '2','3', and '0' key produced a higher incidence of errors in main keyboard digit line typing. Errors categorized as omission and substitution were higher in prevalence than transposition and intrusion.

The County Council of the Order of Physicians in Ille et Vilaine (France) during the Second World War.

PubMed

Gentili, Marc E

2013-06-01

Initially, the examination of the archives from the Ille et Vilaine Council of the College of Physicians was based solely on the findings of Dr. George from Rennes who had helped Jews during the Occupation. Gradually I perceived that the quality of available documents permitted writing this article to show a contrasting view of this dark period in our history. This work aimed to analyze the role of the County Council (CC) of Ille et Vilaine through minutes of their meetings and to compare, year by year, directives and circulars from the Supreme Council of the Order of Physicians (SCO) sent to CC at this period. We will observe see that between the institution, acting by strictly following the orders from the "French State", and the county councils, for some at least, there was a gap that men of good will knew not to cross.

A Computerised English Language Proofing Cloze Program.

ERIC Educational Resources Information Center

Coniam, David

1997-01-01

Describes a computer program that takes multiple-choice cloze passages and compiles them into proofreading exercises. Results reveal that such a computerized test type can be used to accurately measure the proficiency of students of English as a Second Language in Hong Kong. (14 references) (Author/CK)

The Experience of External Studies. Occasional Papers No. 4.

ERIC Educational Resources Information Center

Riverina Coll. of Advanced Education, Wagga Wagga, New South Wales (Australia).

This document brings together four invited papers by external students who have graduated from Riverina College: (1) "The External Student: One Profile" (Christine Del Gigante); (2) "Managing Life as a External Student" (Robert Landow); (3) "The Computerised Student" (John Chant); and (4) "The Right to…

The novel language-systematic aphasia screening SAPS: screening-based therapy in combination with computerised home training.

PubMed

Krzok, Franziska; Rieger, Verena; Niemann, Katharina; Nobis-Bosch, Ruth; Radermacher, Irmgard; Huber, Walter; Willmes, Klaus; Abel, Stefanie

2018-03-01

SAPS-'Sprachsystematisches Aphasiescreening'-is a novel language-systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality-specific psycholinguistic components at different levels of complexity and the derivation of impairment-based treatment foci from the individual performance profile. However, SAPS has not yet been evaluated in combination with the new SAPS-based treatment. To replicate the practicality of SAPS and to investigate the effectiveness of a SAPS-based face-to-face therapy combined with computerised home training in a feasibility study. To examine the soundness of the treatment design, to determine treatment-induced changes in patient performance as measured by SAPS, to assess parallel changes in communicative abilities, and to differentiate therapy effects achieved by face-to-face therapy versus add-on effects achieved by later home training. Sixteen participants with post-stroke aphasia (PWAs) were included into the study. They were administered the SAPS and communicative testing before and after the treatment regimen. Each PWA received one therapy session followed by home training per day, with the individual treatment foci being determined according to initial SAPS profile, and duration of treatment and possible change of focus dependent on performance assessed by continuous therapy monitoring. The combination of therapy and home training based on the SAPS was effective for all participants. We showed significant improvements for impairment-based SAPS performance and, with high inter-individual variability, in everyday communication. These two main targets of speech and language therapy were correlated and SAPS improvements after therapy were significantly higher than after home training. SAPS offers the assessment of an individual performance profile in order to derive sufficiently diversified, well-founded and specific treatment foci and to follow up changes in performance. The appending treatment regimen has shown to be effective for our participants. Thus, the study revealed feasibility of our approach. © 2017 Royal College of Speech and Language Therapists.

[Tuberculosis in day-to-day medical practice and the boomerang effect of neglect].

PubMed

Selig, Lia; Geluda, Kátia; Junqueira, Túlio; Brito, Rossana; Trajman, Anete

2012-01-01

The scope of this study was to understand the perceptions and feelings of physicians dealing with tuberculosis (TB) in Rio de Janeiro. Eleven physicians working in a large public hospital were interviewed using a semi-structured questionnaire. The interpretation of the interviews was based on hermeneutic-dialectic phenomenology. The answers were analyzed in order to identify and understand their live TB-related experiences from their statements. Among the categories that emerged, neglect was chosen as the focus of this article in its four dimensions: respect, responsibility, conditions of care and discomfort. The boomerang effect of neglect was perceived during interviews with physicians: the one who neglects is also neglected. Other reported feelings included lack of motivation, anger, and frustration. The mental health of physicians is a preoccupation because of overwork in inadequate conditions. The question that arises is how health staff working in such environments can adequately care for their patients. We conclude that in order to achieve TB control as well as other health system goals, human resource policies that respond to physicians' job needs should be implemented.

Provider perceptions concerning use of chest x-ray studies in adult blunt trauma assessments.

PubMed

Calderon, Georgina; Perez, Daniel; Fortman, Jonathan; Kea, Bory; Rodriguez, Robert M

2012-10-01

Although they infrequently lead to management changing diagnoses, chest x-rays (CXRs) are the most commonly ordered imaging study in blunt trauma evaluation. To determine: 1) the reasons physicians order chest X-ray studies (CXRs) in blunt trauma assessments; 2) what injuries they expect CXRs to reveal; and 3) whether physicians can accurately predict low likelihood of injury on CXR. At a Level I Trauma Center, we asked resident and attending physicians treating adult blunt trauma patients: 1) the primary reason(s) for getting CXRs; 2) what, if any, significant intrathoracic injuries (SITI) they expected CXRs to reveal; and 3) the likelihood of these injuries. An expert panel defined SITI as two or more rib fractures, sternal fracture, pulmonary contusion, pneumothorax, hemothorax, or aortic injury on official CXR readings. There were 484 patient encounters analyzed--65% of participating physicians were residents and 35% were attendings; 16 (3.3%) patients had SITI. The most common reasons for ordering CXRs were: "enough concern for significant injury" (62.9%) and belief that CXR is a "standard part of trauma work-up" (24.8%). Residents were more likely than attendings to cite "standard trauma work-up" (mean difference = 13.5%, p = 0.003). When physicians estimated a < 10% likelihood of SITI on CXR, 2.1% (95% confidence interval [CI] 1.0-4.1%) of patients had SITI; when they predicted a 10-25% likelihood, 5.7% (95% CI 1.2-15.7%) had SITI; and when they predicted a > 25% likelihood, 9.1% (95% CI 3.0-20.0%) had SITI. Physicians order CXRs in blunt trauma patients because they expect to find injuries and believe that CXRs are part of a "standard" work-up. Providers commonly do not expect CXRs to reveal SITI. When providers estimated low likelihood of SITI, the rate of SITI was very low. Published by Elsevier Inc.

[Situation of legal conflicts in criminal proceedings].

PubMed

Krause, Daniel M

2003-11-01

Criminal proceedings against physicians involving an alleged professional malpractice usually represent a complex problem raising issues in various (potential) areas of conflict. In many cases such proceedings are accompanied by liability actions in civil courts, occasionally proceedings have been initiated by the Medical Board in order to clarify a case of professional misconduct. Often, a medical malpractice insurance is involved. In order to protect the physician's interests in the best possible way, any action in the various matters needs concerted efforts. No statement or comment regarding the allegations should be rendered to the prosecution before access to the investigation file has been granted. No negative conclusions may be drawn from the use of the right to refuse testimony. The preparation of a written statement requires a thorough legal and factual analysis of the allegations as well as the evidence they are based on. In this respect professional legal assistance is essential. It does not constitute a breach of the doctor-patient confidentiality if the physician discloses information in order to defend himself against criminal allegations. If several physicians are charged with an offense it is recommendable in most cases to coordinate defense activities.

Knowledge and practice of travel medicine among primary health care physicians in Qatar.

PubMed

Al-Hajri, Mohammed; Bener, Abdulbari; Balbaid, Omar; Eljack, Ezaeldin

2011-11-01

This prospective descriptive survey was conducted among primary health care (PHC) physicians in Qatar from January to May 2007 in order to determine whether travelers obtained correct travel health information. Of 130 physicians approached, 98 agreed to participate in the study and 76 attended the symposium and complete the questionnaire. The questionnaire included sociodemographic characteristics, knowledge and practices about travel medicine before and after the symposium. Forty-four point seven percent of the subjects provided health advice to travelers. Female physicians (59.2%) outnumbered male physicians (40.8%). Qatari physicians (60.5%) outnumbered non-Qataris (39.5%). Most physicians spent at least 15 minutes with each traveler (44.1%). The symposium increased the knowledge of physicians about travel medicine. A significant increase in knowledge was seen in the post-symposium questionnaire for most questions. The main source of knowledge for most physicians was the internet (78.9%). Nearly half the subjects provided pre-travel health advice. All the subjects had improved knowledge of travel medicine following the symposium.

Scaffolding and Integrated Assessment in Computer Assisted Learning (CAL) for Children with Learning Disabilities

ERIC Educational Resources Information Center

Beale, Ivan L.

2005-01-01

Computer assisted learning (CAL) can involve a computerised intelligent learning environment, defined as an environment capable of automatically, dynamically and continuously adapting to the learning context. One aspect of this adaptive capability involves automatic adjustment of instructional procedures in response to each learner's performance,…

Information Technology and Disabilities, 1994.

ERIC Educational Resources Information Center

McNulty, Tom, Ed.

1994-01-01

Four issues of this newsletter on information technology and disabilities (ITD) contain the following articles: "Building an Accessible CD-ROM Reference Station" (Rochelle Wyatt and Charles Hamilton); "Development of an Accessible User Interface for People Who Are Blind or Vision Impaired as Part of the Re-Computerisation of Royal Blind Society…

Constructing "Nerdiness": Characterisation in "The Big Bang Theory"

ERIC Educational Resources Information Center

Bednarek, Monika

2012-01-01

This paper analyses the linguistic construction of the televisual character Sheldon--the "main nerd" in the sitcom "The Big Bang Theory" (CBS, 2007-), approaching this construction of character through both computerised and "manual" linguistic analysis. More specifically, a computer analysis of dialogue (using concordances and keyword analysis) in…

Computerising the Salesforce: The Introduction of Technical Change in a Non-Union Workforce.

ERIC Educational Resources Information Center

Newell, Helen; Lloyd, Caroline

1998-01-01

Results of interviews with 13 pharmaceutical sales representatives, five sales managers, and six human-resource managers and 47 survey responses showed that introduction of information technology was seen as purely technical; human-resources departments played no role; and informal communication procedures enabled management to ignore individual…

Learner Affect in Computerised L2 Oral Grammar Practice with Corrective Feedback

ERIC Educational Resources Information Center

Bodnar, Stephen; Cucchiarini, Catia; Penning de Vries, Bart; Strik, Helmer; van Hout, Roeland

2017-01-01

Although corrective feedback (CF) has received much interest in the second language acquisition literature, relatively little research has investigated the relationship between CF and learner affect in concrete practice situations. The present study investigates learners' affective states and practice behaviour in a novel context: oral grammar…

Working Memory Interventions with Children: Classrooms or Computers?

ERIC Educational Resources Information Center

Colmar, Susan; Double, Kit

2017-01-01

The importance of working memory to classroom functioning and academic outcomes has led to the development of many interventions designed to enhance students' working memory. In this article we briefly review the evidence for the relative effectiveness of classroom and computerised working memory interventions in bringing about measurable and…

Physical and Psychosocial Environments Associated with Networked Classrooms

ERIC Educational Resources Information Center

Zandvliet, David B.; Fraser, Barry J.

2005-01-01

This article reports a study of the learning environments in computer networked classrooms. The study is unique in that it involved an evaluation of both the physical and psychosocial classroom environments in these computerised settings through the use of a combination of questionnaires and ergonomic evaluations. The study involved administering…

Students' Understanding of Molecular Structure Representations

ERIC Educational Resources Information Center

Ferk, Vesna; Vrtacnik, Margareta; Blejec, Andrej; Gril, Alenka

2003-01-01

The purpose of the investigation was to determine the meanings attached by students to the different kinds of molecular structure representations used in chemistry teaching. The students (n = 124) were from primary (aged 13-14 years) and secondary (aged 17-18 years) schools and a university (aged 21-25 years). A computerised "Chemical…

Computerised data reduction.

PubMed

Datson, D J; Carter, N G

1988-10-01

The use of personal computers in accountancy and business generally has been stimulated by the availability of flexible software packages. We describe the implementation of a commercial software package designed for interfacing with laboratory instruments and highlight the ease with which it can be implemented, without the need for specialist computer programming staff.

Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.

PubMed

Forte, Daniel Neves; Vincent, Jean Louis; Velasco, Irineu Tadeu; Park, Marcelo

2012-03-01

This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors.

PubMed

Hickman, Thu-Trang T; Quist, Arbor Jessica Lauren; Salazar, Alejandra; Amato, Mary G; Wright, Adam; Volk, Lynn A; Bates, David W; Schiff, Gordon

2018-04-01

Computerised prescriber order entry (CPOE) systems users often discontinue medications because the initial order was erroneous. To elucidate error types by querying prescribers about their reasons for discontinuing outpatient medication orders that they had self-identified as erroneous. During a nearly 3 year retrospective data collection period, we identified 57 972 drugs discontinued with the reason 'Error (erroneous entry)." Because chart reviews revealed limited information about these errors, we prospectively studied consecutive, discontinued erroneous orders by querying prescribers in near-real-time to learn more about the erroneous orders. From January 2014 to April 2014, we prospectively emailed prescribers about outpatient drug orders that they had discontinued due to erroneous initial order entry. Of 2 50 806 medication orders in these 4 months, 1133 (0.45%) of these were discontinued due to error. From these 1133, we emailed 542 unique prescribers to ask about their reason(s) for discontinuing these mediation orders in error. We received 312 responses (58% response rate). We categorised these responses using a previously published taxonomy. The top reasons for these discontinued erroneous orders included: medication ordered for wrong patient (27.8%, n=60); wrong drug ordered (18.5%, n=40); and duplicate order placed (14.4%, n=31). Other common discontinued erroneous orders related to drug dosage and formulation (eg, extended release versus not). Oxycodone (3%) was the most frequent drug discontinued error. Drugs are not infrequently discontinued 'in error.' Wrong patient and wrong drug errors constitute the leading types of erroneous prescriptions recognised and discontinued by prescribers. Data regarding erroneous medication entries represent an important source of intelligence about how CPOE systems are functioning and malfunctioning, providing important insights regarding areas for designing CPOE more safely in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

PubMed

Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

2014-12-01

Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin <8 gm/dl and INR >1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Factors Affecting Leave out of General Practitioners from Rural Family Physician Program: A Case of Kerman, Iran

PubMed Central

Amiresmaili, Mohammadreza; Khosravi, Sajad; Feyzabadi, Vahid Yazdi

2014-01-01

Background: Rural family physician program as the new reform in the Iranian health system has been implemented since 2005. Its success depends much on physicians’ retention. The present study aimed to identify influential factors on physicians’ willingness to leave out this program in Kerman province. Methods: The present cross-sectional study was performed in Kerman province in 2011. All family physicians working in this program (n = 271) were studied using a questionnaire. Data analysis was carried out using descriptive statistics and logistic regression through SPSS version 18.0. Results: Twenty-six percent (70) of the physicians had left out the program in the past. In addition, 77.3% (208) intended to leave out in the near future. Opportunity for continuing education, inappropriate and long working hours, unsuitable requirements of salary, irregular payments, lack of job security and high working responsibility were regarded as the most important reasons for leaving out the program in the past and intention to leave out in future orderly. According to univariate logistic regression, younger physicians (odds ratio [OR] =2.479; 95% confidence interval [CI]: 1.261-4.872) and physicians who had older children (OR = 4.743; 95% CI: 1.441-15.607) were more willing to leave out the plan in the near future, however it was not significant in multivariate logistic regression. Conclusions: Physician retention in family physician program is faced with serious doubts due to different reasons. The success of the program is endangered because of the pivotal role of human resources. Hence, the revision of human resources policies of the program seems necessary in order to reduce physicians leave out and improving its effectiveness. PMID:25400891

Bedside interprofessional rounds: perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians.

PubMed

Gonzalo, Jed D; Kuperman, Ethan; Lehman, Erik; Haidet, Paul

2014-10-01

Interprofessional collaboration improves the quality of care, but integration into workflow is challenging. Although a shared conceptualization regarding bedside interprofessional rounds may enhance implementation, little work has investigated providers' perceptions of this activity. To evaluate the perceptions of nurses, attending physicians, and housestaff physicians regarding the benefits/barriers to bedside interprofessional rounds. Observational, cross-sectional survey of hospital-based medicine nurses, attending physicians, and housestaff physicians. Descriptive, nonparametric Wilcoxon rank sum and nonparametric correlation were used. Bedside interprofessional rounds were defined as "encounters including 2 physicians plus a nurse or other care provider discussing the case at the patient's bedside." Eighteen items related to "benefits" and 21 items related to "barriers" associated with bedside interprofessional rounds. Of 171 surveys sent, 149 were completed (87%). Highest-ranked benefits were related to communication/coordination, including "improves communication between nurses-physicians;" lowest-ranked benefits were related to efficiency, process, and outcomes, including "decreases length-of-stay" and "improves timeliness of consultations." Nurses reported most favorable ratings for all items (P < 0.05). Rank order for 3 provider groups showed high correlation (r = 0.92, P < 0.001). Highest-ranked barriers were related to time, including "nursing staff have limited time;" lowest-ranked barriers were related to provider- and patient-related factors, including "patient lack of comfort." Rank order of barriers among all groups showed moderate correlation (r = 0.62-0.82). Although nurses perceived greater benefit for bedside interprofessional rounds than physicians, all providers perceived coordination/teamwork benefits higher than outcomes. To the extent the results are generalizable, these findings lay the foundation for facilitating meaningful patient-centered interprofessional collaboration. © 2014 Society of Hospital Medicine.

How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews.

PubMed

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Ammirati, Christine; Bertrand, Catherine; Dory, Valérie; Charlin, Bernard

2014-12-01

The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses. We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective. The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available. The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The role of laboratory in ensuring appropriate test requests.

PubMed

Ferraro, Simona; Panteghini, Mauro

2017-07-01

This review highlights the role of laboratory professionals and the strategies to be promoted in strict cooperation with clinicians for auditing, monitoring and improving the appropriateness of test request. The introduction of local pathways and care maps in agreement with international and national guidelines as well as the implementation of reflex testing and algorithms have a central role in guiding test request and in correcting the overuse/misuse of tests. Furthermore, removing obsolete tests from laboratory menu and vetting of restricted tests is recommended to increase cost-effectiveness. This saves costs and permits to introduce new biomarkers with increased diagnostic accuracy with a better impact on patient outcome. An additional issue is concerning the periodicity of (re)testing, accounting that only a minority of tests may be ordered as often as necessary. In the majority of cases, a minimum retesting interval should be introduced. The availability of effective computerised order entry systems is relevant in ensuring appropriate test requests and in providing an aid by automated rules that may stop inappropriate requests before they reach the laboratory. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

From socialist principles to motorcycle maintenance: the origin and development of the salaried physician model in the Israeli Public Health Services, 1918 to 1998.

PubMed Central

Shvarts, S; de Leeuw, D L; Granit, S; Benbassat, J

1999-01-01

For more than 70 years, physicians in the Israeli health care system have been employed on a fixed salary rather than on a fee-for-service basis. The present report is a brief review of the origin and development of this unique salaried physician model and its effect on the terms of physicians' employment. Archival documents were reviewed. The salaried physician model was introduced to ensure egalitarian health care for patients rather than equal payment for physicians. It was accepted by physicians because it guaranteed their employment and income. However, over the years, the salaried physician model has evolved into a complex wage scale, with multiple fringe benefits that bypass formal agreements in order to reward individual physicians. In addition, the salaried physician model has encouraged illegal private practice, which is viewed today as one of the major problems of the Israeli Public Health Services. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 PMID:9949759

Career satisfaction and burnout among Ghanaian physicians.

PubMed

Opoku, Samuel T; Apenteng, Bettye A

2014-03-01

Thus far, there has been limited inquiry into the factors associated with physician career satisfaction and burnout in Ghana, although the two have been linked to the brain drain problem. The objective of this study was to assess career satisfaction and burnout among physicians practicing in a developing nation, Ghana. A 21-item instrument was used to assess career satisfaction among actively practicing Ghanaian physicians, using items adapted from the Physician Worklife Study survey. Burnout was assessed using the Abbreviated Maslach's Burnout Inventory. Two hundred physicians participated in the online survey from December 2012 to February 2013. Generally, physicians in Ghana expressed moderate overall career satisfaction. However, they were least satisfied with the availability of resources, their compensation and work-life balance. Overall, burnout was low in the study population; however physicians exhibited moderate levels of emotional exhaustion. Career satisfaction was negatively associated with the burnout dimensions of depersonalization, emotional exhaustion and low personal accomplishment. Health policy-makers in Ghana should address issues relating to resource adequacy, compensation and the work-life balance of physicians in order to improve the overall career satisfaction of an already dwindling physician workforce.

Evaluation of real-time clinical decision support systems for platelet and cryoprecipitate orders.

PubMed

Collins, Ryan A; Triulzi, Darrell J; Waters, Jonathan H; Reddy, Vivek; Yazer, Mark H

2014-01-01

To evaluate cryoprecipitate and platelet ordering practices after the implementation of real-time clinical decision support systems (CDSSs) in a computerized physician order entry (CPOE) system. Uniform platelet and cryoprecipitate transfusion thresholds were implemented at 11 hospitals in a regional health care system with a common CPOE system. Over 6 months, a variety of information was collected on the ordering physicians and the number of alerts generated by the CDSSs when these products were ordered outside of the institutional guidelines. There were 1,889 orders for platelets and 152 orders for cryoprecipitate placed in 6 months. Of these, 1,102 (58.3%) platelet and 74 (48.7%) cryoprecipitate orders triggered an alert. The proportion of orders canceled after an alert was generated ranged from 13.5% to 17.9% for platelets and 0% to 50.0% for cryoprecipitate orders. CDSS alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines.

How Primary Care Physicians Integrate Price Information into Clinical Decision-Making.

PubMed

Schiavoni, Katherine H; Lehmann, Lisa Soleymani; Guan, Wendy; Rosenthal, Meredith; Sequist, Thomas D; Chien, Alyna T

2017-01-01

Little is known about how primary care physicians (PCPs) in routine outpatient practice use paid price information (i.e., the amount that insurers finally pay providers) in daily clinical practice. To describe the experiences of PCPs who have had paid price information on tests and procedures for at least 1 year. Cross-sectional study using semi-structured interviews and the constant comparative method of qualitative analysis. Forty-six PCPs within an accountable care organization. Via the ordering screen of their electronic health record, PCPs were presented with the median paid price for commonly ordered tests and procedures (e.g., blood tests, x-rays, CTs, MRIs). We asked PCPs for (a) their "gut reaction" to having paid price information, (b) the situations in which they used price information in clinical decision-making separate from or jointly with patients, (c) their thoughts on who bore the chief responsibility for discussing price information with patients, and (d) suggestions for improving physician-targeted price information interventions. Among "gut reactions" that ranged from positive to negative, all PCPs were more interested in having patient-specific price information than paid prices from the practice perspective. PCPs described that when patients' out-of-pocket spending concerns were revealed, price information helped them engage patients in conversations about how to alter treatment plans to make them more affordable. PCPs stated that having price information only slightly altered their test-ordering patterns and that they avoided mentioning prices when advising patients against unnecessary testing. Most PCPs asserted that physicians bear the chief responsibility for discussing prices with patients because of their clinical knowledge and relationships with patients. They wished for help from patients, practices, health plans, and society in order to support price transparency in healthcare. Physician-targeted price transparency efforts may provide PCPs with the information they need to respond to patients' concerns regarding out-of-pocket affordability rather than that needed to change test-ordering habits.

Physician responsibility for the cost of unnecessary medical services.

PubMed

Eisenberg, J M; Rosoff, A J

1978-07-13

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

Use of radiography in acute knee injuries: need for clinical decision rules.

PubMed

Stiell, I G; Wells, G A; McDowell, I; Greenberg, G H; McKnight, R D; Cwinn, A A; Quinn, J V; Yeats, A

1995-11-01

To study: 1) the efficiency of the current use of radiography in acute knee injuries, 2) the judgments and attitudes of experienced clinicians in their use of knee radiography, and 3) the potential for decision rules to improve efficiency. This two-stage study of adults with acute knee injuries involved: 1) a retrospective review of all 1,967 patients seen over a 12-month period in the EDs of one community and two teaching hospital, and 2) a prospective survey of another 1,040 patients seen by attending emergency physicians. The prospective survey assessed each clinician's estimate of the probability of a knee or patella fracture; 120 patients were independently assessed by two physicians. Of the 1,967 patients seen in the first stage, 74.1% underwent radiography but only 5.2% were found to have fractures. Of the 1,727 knee and patella radiographic series ordered, 92.4% were negative for fracture. In the second stage, experienced physicians predicted the probability of fracture to be 0 or 0.1 for 75.6% of the patients. The kappa value for this response was 0.51 (95% CI 0.34 to 0.68). The physicians also indicated that they would have been comfortable or very comfortable in not ordering radiography for 55.5% of the patients. The area under the receiver operating characteristics curve for the physicians' prediction of fracture was 0.87 (95% CI 0.82 to 0.91), reflecting good discrimination between fracture and nonfracture cases. Likelihood ratios for the physicians' prediction ranged from 0.09 at the 0 level to 42.9 at the 0.9-1.0 level. Emergency physicians order radiography for most patients with acute knee injuries, even though they can accurately discriminate between fracture and nonfracture cases and expect most of the radiographs to be normal. These findings suggest great potential for more efficient use of knee radiography, possibly through the use of a clinical decision rule.

Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians' and nurses' perceptions.

PubMed

Walker, S; McGeer, A; Simor, A E; Armstrong-Evans, M; Loeb, M

2000-08-08

Antibiotic therapy for asymptomatic bacteriuria in institutionalized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptomatic bacteriuria in this population. The aim of this study was to explore the perceptions, attitudes and opinions of physicians and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in institutionalized elderly people. Focus groups were conducted among physicians and nurses who provide care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions were tape-recorded, and the transcripts of each session were analysed for issues and themes emerging from the text. Content analysis using an open analytic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent themes and issues. We observed that the ordering of urine cultures and the prescribing of antibiotics for residents with asymptomatic bacteriuria were influenced by a wide range of nonspecific symptoms or signs in residents. The physicians felt that the presence of these signs justified a decision to order antibiotics. Nurses played a central role in both the ordering of urine cultures and the decision to prescribe antibiotics through their awareness of changes in residents' status and communication of this to physicians. Education about asymptomatic bacteriuria was viewed as an important priority for both physicians and nurses. The presence of non-urinary symptoms and signs is an important factor in the prescription of antibiotics for asymptomatic bacteriuria in institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term care facilities need more education about antibiotic use and asymptomatic bacteriuria.

Evaluating online continuing medical education seminars: evidence for improving clinical practices.

PubMed

Weston, Christine M; Sciamanna, Christopher N; Nash, David B

2008-01-01

The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

Using Conjoint Analysis to Elicit GPs’ Preferences for Family Physician Contracts: A Case Study in Iran

PubMed Central

Ranjbar Ezatabadi, Mohammad; Rashidian, Arash; Shariati, Mohammad; Rahimi Foroushani, Abbas; Akbari Sari, Ali

2016-01-01

Background Family physician plans in Iran face several challenges, one of which is developing attractive and efficient contracts that motivate physicians to participate in the plan. Objectives This study aimed to elicit GPs’ preferences for family physician contracts. Patients and Methods In a cross-sectional study using the conjoint analysis technique, 580 GPs selected from the family physician database in Iran in 2014. Through qualitative and quantitative methods, 18 contract scenarios were developed via orthogonal design i.e., the impact of each attribute is measured independently from changes in other attributes and a questionnaire was developed. Data were collected through this questionnaire and analyzed using the ordered logistic regression (OLR) model. Results The results show that “quotas for admission to specialized courses” is the strongest preference of GPs (β = 1.123). In order of importance, the other preferences are having the right to provide services outside of the specified package (β = 0.962), increased number of covered population (β = 0.814), capitation payment + 15% bonus (β = 0.644), increased catchment area to 5 km (β = 0.349), and increased length of contract to five years (β = 0.345). Conclusions The conjoint analysis results show that GPs concerned about various factors of family physician contracts. These results can be helpful for policy-makers as they complete the process of creating family physician plans, which can help increase the motivation of GPs to participate in the plan. PMID:28191339

Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

PubMed

Estryn-Behar, M; Fry, C; Guetarni, K; Aune, I; Machet, G; Doppia, M A; Lassaunière, J M; Muster, D; Pelloux, P; Prudhomme, Ch

2011-01-01

France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies

PubMed Central

Cross, Dori A; Boukus, Ellyn R; Cohen, Genna R

2011-01-01

Objective A core feature of e-prescribing is the electronic exchange of prescription data between physician practices and pharmacies, which can potentially improve the efficiency of the prescribing process and reduce medication errors. Barriers to implementing this feature exist, but they are not well understood. This study's objectives were to explore recent physician practice and pharmacy experiences with electronic transmission of new prescriptions and renewals, and identify facilitators of and barriers to effective electronic transmission and pharmacy e-prescription processing. Design Qualitative analysis of 114 telephone interviews conducted with representatives from 97 organizations between February and September 2010, including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions via Surescripts. Results Practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions. Conclusions Electronic transmission of new prescriptions has matured. Changes in technical standards and system design and more targeted physician and pharmacy training may be needed to address barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions. PMID:22101907

Meeting the imperative to improve physician well-being: assessment of an innovative program.

PubMed

Dunn, Patrick M; Arnetz, Bengt B; Christensen, John F; Homer, Louis

2007-11-01

Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. From 2000 to 2005, 22-32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

76 FR 27326 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

.... Proposed Project Quantitative Survey of Physician Practices in Laboratory Test Ordering and Interpretation... Control and Prevention (CDC). Background and Brief Description The Quantitative Survey of Physician... collection. The survey will be funded in full by the Office of Surveillance, Epidemiology, and Laboratory...

The Medical Gopher—A Microcomputer System to Help Find, Organize and Decide About Patient Data

PubMed Central

McDonald, Clement J.; Tierney, William M.

1986-01-01

We have developed a microcomputer-based medical workstation that does some of physicians' “gopher” work of fetching, organizing, reviewing and recording. For two years physicians have used the first version of this system to order all diagnostic tests in a general medicine clinic. They are about to use a newer version to write prescriptions and office visit notes and to find general medical and patient-specific information. Users can enter data into this system by “pointing” with a “mouse” to menu items displayed on a video terminal. In the course of a computer activity, a physician can obtain information about drugs, tests and different diagnoses, as well as about the patient. The microcomputer workstations are linked to each other and to a central hospital information system through a high-speed network link. Our physicians have accepted the initial order-entry system, and early experience suggests they prefer this faster and more sophisticated system. PMID:3811348

[Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription].

PubMed

Díaz Grávalos, G J; Palmeiro Fernández, G; Núnñez Masid, E; Casado Górriz, I

2001-01-01

To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a high percentage of induced prescription perceived. With regard to the expenditure on pharmaceuticals, the majority of those surveyed feel that financial measures, specifically co-payment, are the most effective in order to curtail rising costs.

Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies.

PubMed

Salem-Schatz, S R; Avorn, J; Soumerai, S B

1990-07-25

Evidence shows that blood products, like other health care resources, are often used inappropriately, but the reasons for this have not been well studied. We conducted a face-to-face survey of 122 general surgeons, orthopedic surgeons, and anesthesiologists in three hospitals to evaluate the influence of several clinical and nonclinical factors on transfusion decision making. We found widespread deficiencies in physicians' knowledge of transfusion risks and indications. Each transfusion risk was estimated correctly by fewer than half of the physicians surveyed, and only 31% responded correctly to a set of four questions regarding transfusion indications. Attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge. Residents' transfusion decisions, however, were strongly influenced by the desires of their attending physicians, resulting in their ordering potentially inappropriate transfusions. Of the residents surveyed, 61% indicated that they ordered transfusions that they judged unnecessary at least once a month because a more senior physician suggested that they do so. These findings provide insights for the development of strategies to improve transfusion practices, which would address the dual concerns of quality of care and cost containment.

DANGEROUS AND HYPNOTIC DRUG ACT

PubMed Central

Whelan, William M.

1961-01-01

It is unprofessional conduct within the meaning of the Medical Practice Act to prescribe a dangerous drug without either a medical examination by a physician or other medical indications. Dangerous and hypnotic drugs are specifically defined by both state and federal law and distribution is strictly regulated. A physician may administer to his own patients such amounts of dangerous drugs as are necessary for the immediate needs of the patient. The physician may obtain such needed amounts of these drugs by an order placed with a pharmacist marked “for administration to immediate needs of patients.” A licensed physician may also prescribe dangerous and hypnotic drugs for patients and such prescriptions may be refilled on the specific authorization of the physician. A physician who dispenses dangerous and hypnotic drugs to patients must obtain a hypnotic drug license; he must use specific purchase orders when purchasing; the drugs must be labeled in the manner provided by law; and all records of sale shall be open to inspection by authorized officers of the law and kept for three years. By the Principles of Medical Ethics physicians are bound to limit the source of their professional income to medical services actually rendered. Recent decisions of the Judicial Council answer questions concerning a physician's interest in a corporation which purchases, packages and sells medicines under a corporate name. Also answered are questions as to the measures that exist to prevent physicians from abusing the privilege of owning a pharmacy, and whether a physician can ethically rent space in a building owned by him to a pharmacist with a percentage of the income of the pharmacy as rental. The public welfare of California and the nation as determined by legislation strictly regulates the distribution of dangerous drugs. It is in the best interest of the medical profession and its patients that these laws be understood and carefully observed. PMID:13784776

The Possibilities and Limitations of Applying "Open Data" Principles in Schools

ERIC Educational Resources Information Center

Selwyn, Neil; Henderson, Michael; Chao, Shu-Hua

2017-01-01

Large quantities of data are now being generated, collated and processed within schools through computerised systems and other digital technologies. In response to growing concerns over the efficiency and equity of how these data are used, the concept of "open data" has emerged as a potential means of using digital technology to…

Development of a Computerised Method of Determining Aircraft Maintenance Intervals.

DTIC Science & Technology

1985-09-01

Reliability. Vol.17. 1978. pp461-464. 23. , and Shunji Osaki. "Optimum Preventive Maintenance Policies for a 2-Unit Redundant System." IEEE...Transactions on Reliability. Vol.R-23. No.2. June 1974. pp86-91. 24. _ _, and Shunji Osaki. "A Summary of Optimum Preventive Maintenance Policies for a Two-Unit

Validation of the Portuguese self-administered computerised 24-hour dietary recall among second-, third- and fourth-grade children

USDA-ARS?s Scientific Manuscript database

Current methods for assessing children's dietary intake, such as interviewer-administered 24-h dietary recall (24-h DR), are time consuming and resource intensive. Self-administered instruments offer a low-cost diet assessment method for use with children. The present study assessed the validity of ...

Allocentric versus Egocentric Spatial Memory in Adults with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Ring, Melanie; Gaigg, Sebastian B.; Altgassen, Mareike; Barr, Peter; Bowler, Dermot M.

2018-01-01

Individuals with autism spectrum disorder (ASD) present difficulties in forming relations among items and context. This capacity for relational binding is also involved in spatial navigation and research on this topic in ASD is scarce and inconclusive. Using a computerised version of the Morris Water Maze task, ASD participants showed particular…

Spelling: Computerised Feedback for Self-Correction

ERIC Educational Resources Information Center

Lawley, Jim

2016-01-01

Research has shown that any assumption that L2 learners of English do well to rely on the feedback provided by generic spell checkers (for example, the MS Word spell checker) is misplaced. Efforts to develop spell checkers specifically for L2 learners have focused on training software to offer more appropriate suggestion lists for replacing…

Fruit and vegetables are similarly categorised by 8-13-year-old children

USDA-ARS?s Scientific Manuscript database

This exploratory study assessed how 8- to 13-year-old children categorized and labelled fruit and vegetables (FaV), and how these were influenced by child characteristics, to specify second-level categories in a hierarchical food search system for a computerised 24-h dietary recall (hdr). Two sets o...

Evidence of Virtual Patients as a Facilitative Learning Tool on an Anesthesia Course

ERIC Educational Resources Information Center

Leung, Joseph Y. C.; Critchley, Lester A. H.; Yung, Alex L. K.; Kumta, Shekhar M.

2015-01-01

Virtual patients are computerised representations of realistic clinical cases. They were developed to teach clinical reasoning skills through delivery of multiple standardized patient cases. The anesthesia course at The Chinese University of Hong Kong developed two novel types of virtual patients, formative assessment cases studies and storyline,…

Quest for a Computerised Semantics.

ERIC Educational Resources Information Center

Leslie, Adrian R.

The objective of this thesis was to colligate the various strands of research in the literature of computational linguistics that have to do with the computational treatment of semantic content so as to encode it into a computerized dictionary. In chapter 1 the course of mechanical translation (1947-1960) and quantitative linguistics is traced to…

Identifying Reading Problems with Computer-Adaptive Assessments

ERIC Educational Resources Information Center

Merrell, C.; Tymms, P.

2007-01-01

This paper describes the development of an adaptive assessment called Interactive Computerised Assessment System (InCAS) that is aimed at children of a wide age and ability range to identify specific reading problems. Rasch measurement has been used to create the equal interval scales that form each part of the assessment. The rationale for the…

The Novel Language-Systematic Aphasia Screening SAPS: Screening-Based Therapy in Combination with Computerised Home Training

ERIC Educational Resources Information Center

Krzok, Franziska; Rieger, Verena; Niemann, Katharina; Nobis-Bosch, Ruth; Radermacher, Irmgard; Huber, Walter; Willmes, Klaus; Abel, Stefanie

2018-01-01

Background: SAPS--'Sprachsystematisches Aphasiescreening'--is a novel language-systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality-specific psycholinguistic components at different levels of complexity and the derivation of impairment-based treatment…

Developing a Computerised Multiple Elements Test for Organisational Difficulties

ERIC Educational Resources Information Center

Hynes, Sinead M.; Fish, Jessica; Evans, Jonathan J.; Manly, Tom

2015-01-01

Executive function is best measured in loosely structured, multi-component tasks that reflect real-life demands. These tasks require participants to develop a strategy, keep a plan in mind and monitor time. Errors include ignoring stated goals ("goal neglect"), over-allocation of time to one task and violating rules. Teasing apart such…

Computer-Based Working Memory Training in Children with Mild Intellectual Disability

ERIC Educational Resources Information Center

Delavarian, Mona; Bokharaeian, Behrouz; Towhidkhah, Farzad; Gharibzadeh, Shahriar

2015-01-01

We designed a working memory (WM) training programme in game framework for mild intellectually disabled students. Twenty-four students participated as test and control groups. The auditory and visual-spatial WM were assessed by primary test, which included computerised Wechsler numerical forward and backward sub-tests and secondary tests, which…

Inclusion in Physical Education: A Review of Literature

ERIC Educational Resources Information Center

Qi, Jing; Ha, Amy S.

2012-01-01

The purpose of this review was to analyse empirical studies on inclusion in physical education (PE) over the past 20 years and then propose recommendations for future research. A systematic process was used to search the literature for this review. First, a total of 75 research-based articles from computerised education databases were included in…

Slice-thickness evaluation in CT and MRI: an alternative computerised procedure.

PubMed

Acri, G; Tripepi, M G; Causa, F; Testagrossa, B; Novario, R; Vermiglio, G

2012-04-01

The efficient use of computed tomography (CT) and magnetic resonance imaging (MRI) equipment necessitates establishing adequate quality-control (QC) procedures. In particular, the accuracy of slice thickness (ST) requires scan exploration of phantoms containing test objects (plane, cone or spiral). To simplify such procedures, a novel phantom and a computerised LabView-based procedure have been devised, enabling determination of full width at half maximum (FWHM) in real time. The phantom consists of a polymethyl methacrylate (PMMA) box, diagonally crossed by a PMMA septum dividing the box into two sections. The phantom images were acquired and processed using the LabView-based procedure. The LabView (LV) results were compared with those obtained by processing the same phantom images with commercial software, and the Fisher exact test (F test) was conducted on the resulting data sets to validate the proposed methodology. In all cases, there was no statistically significant variation between the two different procedures and the LV procedure, which can therefore be proposed as a valuable alternative to other commonly used procedures and be reliably used on any CT and MRI scanner.

Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

PubMed

Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

2014-01-01

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.

Acute effects of static stretching on passive stiffness of the hamstring muscles calculated using different mathematical models.

PubMed

Nordez, Antoine; Cornu, Christophe; McNair, Peter

2006-08-01

The aim of this study was to assess the effects of static stretching on hamstring passive stiffness calculated using different data reduction methods. Subjects performed a maximal range of motion test, five cyclic stretching repetitions and a static stretching intervention that involved five 30-s static stretches. A computerised dynamometer allowed the measurement of torque and range of motion during passive knee extension. Stiffness was then calculated as the slope of the torque-angle relationship fitted using a second-order polynomial, a fourth-order polynomial, and an exponential model. The second-order polynomial and exponential models allowed the calculation of stiffness indices normalized to knee angle and passive torque, respectively. Prior to static stretching, stiffness levels were significantly different across the models. After stretching, while knee maximal joint range of motion increased, stiffness was shown to decrease. Stiffness decreased more at the extended knee joint angle, and the magnitude of change depended upon the model used. After stretching, the stiffness indices also varied according to the model used to fit data. Thus, the stiffness index normalized to knee angle was found to decrease whereas the stiffness index normalized to passive torque increased after static stretching. Stretching has significant effects on stiffness, but the findings highlight the need to carefully assess the effect of different models when analyzing such data.

Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

PubMed

Srinivasan, Malathi; Keenan, Craig R; Yager, Joel

2006-01-01

In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.

Attitudes and Practices Among Internists Concerning Genetic Testing

PubMed Central

Chung, Wendy; Marder, Karen; Shanmugham, Anita; Chin, Lisa J.; Stark, Meredith; Leu, Cheng-Shiun; Appelbaum, Paul S.

2012-01-01

Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8%), followed by Breast/Ovarian Cancer (15.0%). In the past 6 months, 65% had counseled patients on genetic issues, 44% had ordered genetic tests, 38.5% had referred patients to a genetic counselor or geneticist, and 27.5% had received ads from commercial labs for genetic testing. Only 4.5% had tried to hide or disguise genetic information, and <2% have had patients report genetic discrimination. Only 53.4% knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7%) and guidelines for genetic testing (87.1%). Most felt needs for more training on when to order tests (79%), and how to counsel patients (82%), interpret results (77.3%), and maintain privacy (80.6%). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p<.001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p<.002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p<.019), counseled patients about genetics, larger practices (p<.032), fewer African-American patients (p<.027), and patients who had reported genetic discrimination (p<.044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests., These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education. PMID:22585186

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.

PubMed

Pirnejad, Habibollah; Niazkhani, Zahra; van der Sijs, Heleen; Berg, Marc; Bal, Roland

2008-11-01

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration. To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses. Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced. This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.

Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico.

PubMed

Molina, María J; Mayor, Angel M; Franco, Alejandro E; Morell, Carlos A; López, Miguel A; Vilá, Luis M

2008-01-01

To examine the utilization of health services and prescription patterns among patients with systemic lupus erythematosus (SLE) followed by primary care physicians and rheumatologists in Puerto Rico. The insurance claims submitted by physicians to a health insurance company of Puerto Rico in 2003 were examined. The diagnosis of lupus was determined by using the International Classification of Diseases, Ninth Revision, code for SLE (710.0). Of 552,733 insured people, 665 SLE patients were seen by rheumatologists, and 92 were followed by primary care physicians. Demographic features, selected co-morbidities, healthcare utilization parameters, and prescription patterns were examined. Fisher exact test, chi2 test, and analysis of variances were used to evaluate differences between the study groups. SLE patients followed by rheumatologists had osteopenia/osteoporosis diagnosed more frequently than did patients followed by primary care physicians. The frequency of high blood pressure, diabetes mellitus, hypercholesterolemia, coronary artery disease, and renal disease was similar for both groups. Rheumatologists were more likely to order erythrocyte sedimentation rate, anti-dsDNA antibodies, and serum complements. No differences were observed for office or emergency room visits, hospitalizations, and utilization of routine laboratory tests. Rheumatologists prescribed hydroxychloroquine more frequently than did primary care physicians. The use of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, glucocorticoids, azathioprine, cyclophosphamide, and methotrexate was similar for both groups. Overall, the utilization of health services and prescription patterns among SLE patients followed by primary care physicians and rheumatologists in Puerto Rico are similar. However, rheumatologists ordered SLE biomarkers of disease activity and prescribed hydroxychloroquine more frequently than did primary care physicians.

Does the insufficient supply of physicians worsen their urban-rural distribution? A Hiroshima-Nagasaki comparison.

PubMed

Matsumoto, M; Inoue, K; Kashima, S; Takeuchi, K

2012-01-01

Studies have suggested that a rapid increase in physicians does not necessarily change an urban-rural inequity in their distribution. However, it is unknown whether an insufficient supply of physicians worsens an inequity. Spatial competition and attraction-repulsion hypotheses were applied to the geographic distribution of physicians during a time of insufficient physician supply in Japan. Trends of physician distribution as well as urban-rural physician flow were compared using Hiroshima Prefecture which had the lowest increase in physician-to-population ratios between 2002 and 2008 (2.7%), and Nagasaki Prefecture where the increase was one of the highest (12.0%) among the 47 Japanese prefectures. The Gini coefficient of physicians compared with population in Hiroshima increased by 4.1%. Movement toward inequity was greater in Hiroshima compared with Nagasaki where the increase was 2.5%. Approximately 245 physicians or 18.8% moved from rural to urban locations in Hiroshima compared with 143 (14.6%) for Nagasaki (p=0.01). In contrast, 228 (7.6%) urban physicians moved to rural areas in Hiroshima compared with 175 (11.6%) in Nagasaki (p<0.001). In a time of insufficient supply of physicians, a region with a smaller increase in physicians may experience worsening of the urban-rural distribution of physicians compared with a region where there is a more rapid increase in physicians. One strategy for achieving a more equitable distribution of physicians is to increase in the physician supply relative to demand in order to stimulate competition among urban physicians and maintain the power equilibrium between attraction-to and repulsion-from urban areas.

Development and testing of a computerised 24-h recall questionnaire measuring fruit and snack consumption among 9-11 year olds.

PubMed

Moore, L; Tapper, K; Dennehy, A; Cooper, A

2005-07-01

To evaluate the validity, reliability and sensitivity of a computerised single day 24-h recall questionnaire designed for the comparison of children's fruit and snack consumption at the group (school) level. Relative validity and reliability were assessed in relation to (i) intake at school and (ii) intake throughout the whole day, using diary-assisted 24-h recall interviews and a 7-day test-retest procedure. Sensitivity was assessed in relation to intake by comparing results from schools with differing food policies, and by sex. Eight schools took part in the validity and reliability assessments, with 78 children completing the 24-h recall interviews and 195 children completing the test-retest procedure. A total of 43 schools (1890 children) took part in the sensitivity analysis. All children were aged 9-11 y. All schools were in South Wales and South-west England. For fruit intake at school, the questionnaire showed fair levels of validity at the individual level (kappa = 0.29). At the group level, there were little or no differences in fruit intake at school between the two measures and two occasions. The questionnaire was sufficiently sensitive to identify statistically significant differences between girls and boys, and between schools with different food policies. For snack intake at school, validity at the individual level was slightly lower (kappa = 0.220.25), but the data remained of value in analyses at the group level. For fruit and snack intake throughout the whole day there was little agreement at the individual level (kappa = 0.00-0.06), and at the group level there tended to be substantial differences between the two measures and two occasions. The computerised questionnaire is a quick and cost-effective means of assessing children's consumption of fruit at school. While further development is required to improve validity and reliability, it has the potential to be particularly useful in randomised controlled trials of school-based dietary interventions.

Real-time pulse oximetry artifact annotation on computerized anaesthetic records.

PubMed

Gostt, Richard Karl; Rathbone, Graeme Dennis; Tucker, Adam Paul

2002-01-01

Adoption of computerised anaesthesia record keeping systems has been limited by the concern that they record artifactual data and accurate data indiscriminately. Data resulting from artifacts does not reflect the patient's true condition and presents a problem in later analysis of the record, with associated medico-legal implications. This study developed an algorithm to automatically annotate pulse oximetry artifacts and sought to evaluate the algorithm's accuracy in routine surgical procedures. MacAnaesthetist is a semi-automatic anaesthetic record keeping system developed for the Apple Macintosh computer, which incorporated an algorithm designed to automatically detect pulse oximetry artifacts. The algorithm labeled artifactual oxygen saturation values < 90%. This was done in real-time by analyzing physiological data captured from a Datex AS/3 Anaesthesia Monitor. An observational study was conducted to evaluate the accuracy of the algorithm during routine surgical procedures (n = 20). An anaesthetic record was made by an anaesthetist using the Datex AS/3 record keeper, while a second anaesthetic record was produced in parallel using MacAnaesthetist. A copy of the Datex AS/3 record was kept for later review by a group of anaesthetists (n = 20), who judged oxygen saturation values < 90% to be either genuine or artifact. MacAnaesthetist correctly labeled 12 out of 13 oxygen saturations < 90% (92.3% accuracy). A post-operative review of the Datex AS/3 anaesthetic records (n = 8) by twenty anaesthetists resulted in 127 correct responses out of total of 200 (63.5% accuracy). The remaining Datex AS/3 records (n = 12) were not reviewed, as they did not contain any oxygen saturations <90%. The real-time artifact detection algorithm developed in this study was more accurate than anaesthetists who post-operatively reviewed records produced by an existing computerised anaesthesia record keeping system. Algorithms have the potential to more accurately identify and annotate artifacts on computerised anaesthetic records, assisting clinicians to more correctly interpret abnormal data.

Investigation of unexplained infant deaths in Jerusalem, Israel 1996–2003

PubMed Central

Eisenstein, Eli M; Haklai, Ziona; Schwartz, Shepard; Klar, Aharon; Stein, Nechama; Kerem, Eitan

2007-01-01

Background Sudden infant death syndrome (SIDS) is a diagnosis of exclusion that may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we carried out a study to determine what examinations are performed to investigate unexplained infant deaths in Jerusalem, Israel. Methods We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in the Jerusalem district from the years 1996–2003. Results Ninety six cases were identified from all sources. Forty nine (51%) infants were brought to a hospital at or near the time of death. Studies to determine the cause of death were performed in 54% of cases for which medical records were available for review. These studies included bacterial cultures (44%), skeletal surveys (12%), computerised tomography (3%) and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by district health physicians. The most frequently assigned cause of death was SIDS. Conclusions : The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious and political milieu in which they work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem. PMID:17074788

Investigation of unexplained infant deaths in Jerusalem, Israel 1996-2003.

PubMed

Eisenstein, Eli M; Haklai, Ziona; Schwartz, Shepard; Klar, Aharon; Stein, Nechama; Kerem, Eitan

2007-08-01

Sudden infant death syndrome (SIDS) is a diagnosis of exclusion that may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we carried out a study to determine what examinations are performed to investigate unexplained infant deaths in Jerusalem, Israel. We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in the Jerusalem district from the years 1996-2003. Ninety six cases were identified from all sources. Forty nine (51%) infants were brought to a hospital at or near the time of death. Studies to determine the cause of death were performed in 54% of cases for which medical records were available for review. These studies included bacterial cultures (44%), skeletal surveys (12%), computerised tomography (3%) and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by district health physicians. The most frequently assigned cause of death was SIDS. : The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious and political milieu in which they work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem.

The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act.

PubMed

Morrell, E D; Brown, B P; Qi, R; Drabiak, K; Helft, P R

2008-09-01

Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate (DNR) order. Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician's specialty and extent of documentation of discussion on end-of-life care. DNR orders were more frequent for patients on a medical service than on a surgical service (77.34% vs 64.20%, p = 0.02) and were made earlier in the hospital stay for medicine than for surgical patients (adjusted mean ratio of time from DNR orders to death versus total length of stay 0.30 for internists vs 0.21 for surgeons, p = 0.04). 22.18% of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death (2.1 days with no or minimal discussion vs 2.8 days with extensive discussion, p<0.01). The physician's specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing.

Working Together Toward a Common Goal: A Grounded Theory of Nurse-Physician Collaboration.

PubMed

Fewster-Thuente, Lori

2015-01-01

Working together toward a common goal is an empirically derived theory that can guide education and practice to improve patient outcomes while saving money and lives. Grounded theory was used to explore nurses' and physicians' experiences with collaboration in order to understand the process intrinsically.

What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians

PubMed Central

2010-01-01

Background Sickness absence is a problem in many Western countries. Physicians have an essential role in sickness certification of patients, which is often recommended in health care but may have side effects. Despite the potentially harming impact of sickness absence, physicians have very limited training in insurance medicine, and there is little research on sickness certification practices. Our aim was to ascertain what knowledge and skills physicians in different clinical settings feel they need in order to improve their competence in sickness certification. Methods The data for analysis were collected in 2004 in Stockholm and Östergötland Counties, Sweden, by use of a comprehensive questionnaire about sickness certification issues, which was sent to 7,665 physicians aged ≤ 64 years. The response rate was 71% (n = 5455). Analyses of association and factor analysis were applied to the various aspects of competence to establish a skills index and a knowledge index, which were used to compare the results for physicians in different clinical settings. Results Most physicians stated they needed more knowledge and skills in handling sickness certification, e.g. regarding how to assess work capacity (44%) and optimal length and degree of sickness absence (50%), and information about aspects of the social insurance system (43-63%). Few (20%) reported needing to know more about issuing sickness certificates. The index scores varied substantially between different clinical settings, and this disparity remained after adjustment for sex, years in practice, workplace policy, and support from management. Scores on the skills index were significantly higher for physicians in primary care than for those working in other areas. Conclusions A majority of physicians in most types of clinics/practices, not only primary care, indicated the need for more knowledge and skills in handling sickness certification cases. Increased knowledge and skills are needed in order to protect both the health and equity of patients. However, few physicians stated that they needed more skills in filling out sickness certificates, which contradicts previous findings about such documents being of poor quality and suggests that factors other than mere knowledge and skills are involved. PMID:20144230

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

PubMed Central

Arnetz, Bengt B.; Christensen, John F.; Homer, Louis

2007-01-01

BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk. PMID:17891503

Resolving disagreements in the patient-physician relationship: tools for improving communication in managed care.

PubMed

Levinson, W; Gorawara-Bhat, R; Dueck, R; Egener, B; Kao, A; Kerr, C; Lo, B; Perry, D; Pollitz, K; Reifsteck, S; Stein, T; Santa, J; Kemp-White, M

1999-10-20

Managed care uses financial incentives and restrictions on tests and procedures to attempt to influence physician decision making and limit costs. Increasingly, the public is questioning whether physicians are truly making decisions based on the patient's best interest or are unduly influenced by economic incentives. These circumstances lead to the potential for disagreements and conflict in the patient-physician relationship. We convened a group of individuals in October 1998, including patient representatives, leaders from health care organizations, practicing physicians, communication experts, and medical ethicists, to articulate the types of disagreements emerging in the patient-physician relationship as a result of managed care. We addressed 3 specific scenarios physicians may encounter, including allocation, illustrated by a patient who is referred to a different ophthalmologist based on a new arrangement in the physician's group; access, illustrated by a patient who wishes to see his own physician for a same-day visit rather than a nurse specialist; and financial incentives, illustrated by a patient who expects to have a test performed and a physician who does not believe the test is necessary but is afraid the patient will think the physician is not ordering the test because of financial incentives. Using these scenarios, we suggest communication strategies that physicians can use to decrease the potential for disagreements. In addition, we propose strategies that health plans or physician groups can use to alleviate or resolve these disagreements.

Aromatherapy: a systematic review.

PubMed

Cooke, B; Ernst, E

2000-06-01

Aromatherapy is becoming increasingly popular; however there are few clear indications for its use. To systematically review the literature on aromatherapy in order to discover whether any clinical indication may be recommended for its use, computerised literature searches were performed to retrieve all randomised controlled trials of aromatherapy from the following databases: MEDLINE, EMBASE, British Nursing Index, CISCOM, and AMED. The methodological quality of the trials was assessed using the Jadad score. All trials were evaluated independently by both authors and data were extracted in a pre-defined, standardised fashion. Twelve trials were located: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These studies suggest that aromatherapy massage has a mild, transient anxiolytic effect. Based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. The hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials.

Aromatherapy: a systematic review.

PubMed Central

Cooke, B; Ernst, E

2000-01-01

Aromatherapy is becoming increasingly popular; however there are few clear indications for its use. To systematically review the literature on aromatherapy in order to discover whether any clinical indication may be recommended for its use, computerised literature searches were performed to retrieve all randomised controlled trials of aromatherapy from the following databases: MEDLINE, EMBASE, British Nursing Index, CISCOM, and AMED. The methodological quality of the trials was assessed using the Jadad score. All trials were evaluated independently by both authors and data were extracted in a pre-defined, standardised fashion. Twelve trials were located: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These studies suggest that aromatherapy massage has a mild, transient anxiolytic effect. Based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. The hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials. PMID:10962794

The effects of 2 weeks of interval vs continuous walking training on glycaemic control and whole-body oxidative stress in individuals with type 2 diabetes: a controlled, randomised, crossover trial.

PubMed

Karstoft, Kristian; Clark, Margaret A; Jakobsen, Ida; Müller, Ida A; Pedersen, Bente K; Solomon, Thomas P J; Ried-Larsen, Mathias

2017-03-01

The aim of this study was to evaluate the effects of oxygen consumption-matched short-term interval walking training (IWT) vs continuous walking training (CWT) on glycaemic control, including glycaemic variability, in individuals with type 2 diabetes. We also assessed whether any training-induced improvements in glycaemic control were associated with systemic oxidative stress levels. Participants (n = 14) with type 2 diabetes completed a crossover trial using three interventions (control intervention [CON], CWT and IWT), each lasting 2 weeks. These were performed in a randomised order (computerised generated randomisation) and separated by washout periods of 4 or 8 weeks after CON or training interventions, respectively. Training included ten supervised treadmill sessions, lasting 60 min/session, and was performed at the research facility. CWT was performed at moderate walking speed (75.6% ± 2.5% of walking peak oxygen consumption [[Formula: see text

Experiences of Slovene ICU physicians with end-of-life decision making: a nation-wide survey.

PubMed

Groselj, Urh; Orazem, Miha; Kanic, Maja; Vidmar, Gaj; Grosek, Stefan

2014-10-21

Advances in intensive care medicine have enormously improved ability to successfully treat seriously ill patients. However, intensive treatment and prolongation of life is not always in the patient's best interest, and many ethical dilemmas arise in end-of-life (EOL) situations. We aimed to assess intensive care unit (ICU) physicians' experiences with EOL decision making and to compare the responses according to ICU type. A cross-sectional survey was performed in all 35 Slovene ICUs, using a questionnaire designed to assess ICU physician experiences with EOL decision making, focusing on limitations of life-sustaining treatments (LST). We distributed 370 questionnaires (approximating the number of Slovene ICU physicians) and 267 were returned (72% response rate). The great majority of ICU physicians reported using do-not-resuscitate (DNR) orders (97%), withholding LST (94%), and withdrawing antibiotics (86%) or inotropes (95%). Fewer ICU physicians reported withdrawing mechanical ventilation (52%) or extubating patients (27%). Hydration was reported to be only rarely terminated (76% of participants reported never terminating it). In addition, 63% of participants had never encountered advance directives, and 39% reported to "never" or "rarely" participating in decision making with relatives of patients. Nurses were reported to be "never" or "rarely" involved in the EOL decision making process by 84% of participants. Limitation of LST was regularly used by Slovene ICU physicians. DNR orders and withholding of LST were the most commonly used measures. Hydration was only rarely terminated. In addition, use of advance directives was almost non-existent in practice, and the patients' relatives and nurses only infrequently participated in the decision making.

Designing Computerized Provider Order Entry Software in Iran: The Nurses' and Physicians' Viewpoints.

PubMed

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Keshtkaran, Ali; Barati, Omid

2016-09-01

This study aimed to identify the functional requirements of computerized provider order entry software and design this software in Iran. This study was conducted using review documentation, interview, and focus group discussions in Shiraz University of Medical Sciences, as the medical pole in Iran, in 2013-2015. The study sample consisted of physicians (n = 12) and nurses (n = 2) in the largest hospital in the southern part of Iran and information technology experts (n = 5) in Shiraz University of Medical Sciences. Functional requirements of the computerized provider order entry system were examined in three phases. Finally, the functional requirements were distributed in four levels, and accordingly, the computerized provider order entry software was designed. The software had seven main dimensions: (1) data entry, (2) drug interaction management system, (3) warning system, (4) treatment services, (5) ability to write in software, (6) reporting from all sections of the software, and (7) technical capabilities of the software. The nurses and physicians emphasized quick access to the computerized provider order entry software, order prescription section, and applicability of the software. The software had some items that had not been mentioned in other studies. Ultimately, the software was designed by a company specializing in hospital information systems in Iran. This study was the first specific investigation of computerized provider order entry software design in Iran. Based on the results, it is suggested that this software be implemented in hospitals.

The patient-physician relationship and the sexual abuse of patients.

PubMed Central

1994-01-01

The CMA's policy on the patient-physician relationship and the sexual abuse of patients follows a review of policies and initiatives of its provincial and territorial divisions and other professional associations. The CMA's approach to this policy has been to consider the overall patient-physician relationship in order to understand factors associated with functional and dysfunctional relationships, including those involving sexual abuse. In addition to defining abuse of patients by physicians in general and sexual abuse in particular this document gives guidelines on such issues as sexual or romantic relationships with current or former patients and provides educational and preventive strategies. PMID:8199968

Duplicate laboratory test reduction using a clinical decision support tool.

PubMed

Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

2014-05-01

Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

Office managers' perception of stress, control, and satisfaction: a comparison between primary care and specialty practices.

PubMed

Chang, Jyh-Hann; Whittier, Nathan; DeFries, Erin; Garfinkle, Amanda

2006-01-01

Perception of stress, control, and satisfaction was measured by office managers in medical practices. Office managers spend enormous amounts of time each day handling difficult interpersonal issues among staff physicians, and patients. As a group, physician disruptions were the most prevalent per day. Other staff members were considered the most stressful by rank order. Significant differences were discovered between primary care practices versus specialty practices in the areas of interactions with physicians.

The aging physician and surgeon.

PubMed

Sataloff, Robert T; Hawkshaw, Mary; Kutinsky, Joshua; Maitz, Edward A

2016-01-01

As the population of aging physicians increases, methods of assessing physicians' cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely. This article reviews literature using MEDLINE, PubMed, and other sources. Articles discussing the problems of geriatric physicians are summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation are proposed. Neuropsychological cognitive test protocols were summarized, and a reduced evaluation protocol is proposed for interdisciplinary longitudinal research. Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time or correlating them with performance. Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or long-standing. A multi-institutional study over many years is proposed. Additional assessments of other factors such as manual dexterity (perhaps using simulators) and physician frailty are recommended.

Assessing the validity of using serious game technology to analyze physician decision making.

PubMed

Mohan, Deepika; Angus, Derek C; Ricketts, Daniel; Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Yealy, Donald M; Barnato, Amber E

2014-01-01

Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory.

Evaluations of care by adults following a denial of an advertisement-related prescription drug request: the role of expectations, symptom severity, and physician communication style.

PubMed

Shah, Mansi B; Bentley, John P; McCaffrey, David J

2006-02-01

As patients continue to take a more active role in their health care, an understanding of patient requests of health care providers, including what happens when requests are not fulfilled, is becoming more important. Although its merits have been debated, direct-to-consumer advertising of prescription drugs generates patient requests. The objective of this study was to assess the influence of physician communication style, respondents' expectations of receiving a requested prescription, and perceived symptom severity on respondents' evaluations of care following a physician denial of a prescription drug request stimulated by direct-to-consumer advertising. A 2 x 2 x 2, between-subjects experimental design was used. The respondents were made up of employees of the University of Mississippi. Physician communication style, respondents' expectations, and respondents' perceived symptom severity were manipulated using vignettes. Respondents' post-visit evaluations of care were assessed by measuring trust in the physician, visit-based satisfaction with the physician, and commitment toward the physician. Factorial analysis of variance procedures for a three-way design were used to test the hypotheses and assess the research questions. Manipulation checks suggested that the independent variables were appropriately manipulated. No significant first-order or second-order interactions were noted in any of the analyses. Post-visit evaluations of care were significantly associated with physician communication style (a partnership response led to better evaluations of care). There were no significant effects of either prior expectation of request fulfillment or perceived symptom severity. However, non-significant trends in mean scores suggested a potential role of these variables in the evaluation process following request denial. The manner in which a physician communicates with an individual is an important determinant of the evaluation of care following the denial of a request. The results suggest that health care providers attempting to minimize the effect of request denials on patient evaluations should make an effort to involve the patient in the decision-making process.

When do doctors follow patients' orders? Organizational mechanisms of physician influence.

PubMed

Menchik, Daniel A; Jin, Lei

2014-11-01

Physicians, like other professionals, are expected to draw from specialized knowledge while remaining receptive to clients' requests. Using nationally representative U.S. survey data from the Community Tracking Study, this paper examines the degree to which physicians are influenced by patients' requests, and how physicians' workplaces may mediate acquiescence rates through three mechanisms: constraints, protection, and incentives. We find that, based on physicians' reports of their responses to patients' suggestions, patient influence is rare. This influence is least likely to be felt in large workplaces, such as large private practices, hospitals, and medical schools. We find that the protection and incentives mechanisms mediate the relationship between workplace types and physician acquiescence but more prescriptive measures such as guidelines and formularies do not affect acquiescence. We discuss these findings in light of the ongoing changes in the structure of medicine. Copyright © 2014 Elsevier Inc. All rights reserved.

The competitive acquisition program for drugs and biologicals.

PubMed

Lace, Daniel A

2006-07-01

Unlike the Medicare Part D program, which has a significant number of participating plans, the new Competitive Acquisition Program (CAP), which was to have started on Jan. 1, 2006, along with Medicare Part D, did not because, in part, of a lack of interest. As a result, the program was delayed until July 1, 2006. This new program separates the physician from the purchase and billing of medications provided in the physician's office. Under CAP, physicians sign with a specialty pharmacy provider that will deliver the medications to the physicians as ordered and then bill Medicare directly. This will alleviate some physician administrative responsibilities. Although it is unlikely that high-volume Medicare Part B medication providers, such as oncologists, will use a CAP provider, it is likely that busy primary care physicians and other specialists not usually involved in providing medications in their offices now may start to take advantage of this valuable service.

Social media: physicians-to-physicians education and communication.

PubMed

Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

2017-06-01

Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

Telehealth physician oversight over direct to consumer testing: doctors working with patients towards patient empowerment.

PubMed

Chung, Rick

2012-06-01

Patient empowerment has increased the demand for direct to consumer (DTC) laboratory testing. Multiple professional societies and advocacy groups have raised concerns over how DTC laboratory testing is being offered to consumers without proper physician oversight. Physician telehealth services can properly oversee DTC laboratory testing in a safe and medically sound manner. Using telehealth protocols and standards established by professional health organizations and state regulators, physician telehealth oversight in DTC laboratory test ordering can be effective to increase patient access to healthcare services. With proper physician oversight in test interpretation, post-test counseling, and information collaboration, DTC laboratory testing can remain a reliable and convenient option for consumers. Working within the channel of distribution of most DTC laboratory testing, physician telehealth services can properly oversee DTC laboratory testing in a safe and medically sound manner to ensure that proper test interpretation, counseling, and information collaboration are achieved. Physician telehealth services can properly oversee DTC laboratory testing to ensure that proper test interpretation, counseling, and information collaboration are achieved.

Working Memory Training and the Effect on Mathematical Achievement in Children with Attention Deficits and Special Needs

ERIC Educational Resources Information Center

Dahlin, Karin I. E.

2013-01-01

Working Memory (WM) has a central role in learning. It is suggested to be malleable and is considered necessary for several aspects of mathematical functioning. This study investigated whether work with an interactive computerised working memory training programme at school could affect the mathematical performance of young children. Fifty-seven…

The Learning Environment Associated with Information Technology Education in Taiwan: Combining Psychosocial and Physical Aspects

ERIC Educational Resources Information Center

Liu, Chia-Ju; Zandvliet, David B.; Hou, I.-Ling

2012-01-01

This study investigated perceptions of senior high school students towards the Taiwanese information technology (IT) classroom with the What Is Happening in this Class? (WIHIC) survey and explored the physical learning environment of the IT classroom using the Computerised Classroom Environment Inventory (CCEI). The participants included 2,869…

A Maximum Likelihood Based Offline Estimation of Student Capabilities and Question Difficulties with Guessing

ERIC Educational Resources Information Center

Moothedath, Shana; Chaporkar, Prasanna; Belur, Madhu N.

2016-01-01

In recent years, the computerised adaptive test (CAT) has gained popularity over conventional exams in evaluating student capabilities with desired accuracy. However, the key limitation of CAT is that it requires a large pool of pre-calibrated questions. In the absence of such a pre-calibrated question bank, offline exams with uncalibrated…

Using Action Research to Design Bereavement Software: Engaging People with Intellectual Disabilities for Effective Development

ERIC Educational Resources Information Center

Read, Sue; Nte, Sol; Corcoran, Patsy; Stephens, Richard

2013-01-01

Background: Loss is a universal experience and death is perceived as the ultimate loss. The overarching aim of this research is to produce a qualitative, flexible, interactive, computerised tool to support the facilitation of emotional expressions around loss for people with intellectual disabilities. This paper explores the process of using…

Peer Assessment: Judging the Quality of Students' Work by Comments Rather than Marks

ERIC Educational Resources Information Center

Davies, Phil

2006-01-01

This paper reports the results of a study into the quality of peer feedback provided by students within a computerised peer-assessment environment. The study looks at the creation of a "feedback index" that represents the quality of an essay based upon the feedback provided during a peer-marking process and identifies a significant…

Organizational Commitment of Employees of TV Production Center (Educational Television ETV) for Open Education Faculty, Anadolu University

ERIC Educational Resources Information Center

Gürses, Nedim; Demiray, Emine

2009-01-01

In like manner as conventional education and teaching approaches distance education tends to model the same procedures. Indeed, formerly enriched on printed material served as a primary source. However, thanks to the developments in technology and evolution in education, computerised information has made inroads in distance education programmes.…

Experiencing Virtual Patients in Clinical Learning: A Phenomenological Study

ERIC Educational Resources Information Center

Edelbring, Samuel; Dastmalchi, Maryam; Hult, Hakan; Lundberg, Ingrid E.; Dahlgren, Lars Owe

2011-01-01

Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students' experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students' experience as a point of departure.…

Effects of Concept Map Extraction and a Test-Based Diagnostic Environment on Learning Achievement and Learners' Perceptions

ERIC Educational Resources Information Center

Lin, Yu-Shih; Chang, Yi-Chun; Liew, Keng-Hou; Chu, Chih-Ping

2016-01-01

Computerised testing and diagnostics are critical challenges within an e-learning environment, where the learners can assess their learning performance through tests. However, a test result based on only a single score is insufficient information to provide a full picture of learning performance. In addition, because test results implicitly…

IFLA General Conference 1988. Division of Regional Activities. Sections on: Asia and Oceania; Africa; Latin America and the Caribbean; Australia.

ERIC Educational Resources Information Center

International Federation of Library Associations, The Hague (Netherlands).

The eight papers in this collection focus on library activities in various geographical regions, e.g., Asia, Oceania, Africa, Latin America, the Caribbean, and Western Australia: (1) "Future Approaches and Prospects of Computerised Information Network among the Countries of South Asian Association for Regional Cooperation (SAARC)" (Abdullah…

Facilitating Other-Awareness in Low-Functioning Children with Autism and Typically-Developing Preschoolers Using Dual-Control Technology

ERIC Educational Resources Information Center

Holt, Samantha; Yuill, Nicola

2014-01-01

Children with autism are said to lack other-awareness, which restricts their opportunities for peer collaboration. We assessed other-awareness in non-verbal children with autism and typically-developing preschoolers collaborating on a shared computerised picture-sorting task. The studies compared a novel interface, designed to support…

Impediments to Effective Utilisation of Information and Communication Technology Tools in Selected Universities in the North-Eastern Nigeria

ERIC Educational Resources Information Center

Momoh, Mustapha

2010-01-01

This study examined the impediments to effective use of Information and Communication Technology (ICT) tools in Nigerian universities. Series of research conducted on the factors militating against computerisation indicated that, there were impediments to effective utilisation of ICT tools in most developing countries. In the light of this, the…

Organizational Commitment of Employees of TV Production Center (Educational Television ETV) for Open Education Facility, Anadolu University

ERIC Educational Resources Information Center

Gurses, Nedim; Demiray, Emine

2009-01-01

In like manner as conventional education and teaching approaches distance education tends to model the same procedures. Indeed, formerly enriched on printed material served as a primary source. However, thanks to the developments in technology and evolution in education, computerised information has made inroads in distance education programmes.…

Satisfaction with Therapist-Delivered vs. Self-Administered Online Cognitive Behavioural Treatments for Depression Symptoms in College Students

ERIC Educational Resources Information Center

Richards, Derek; Timulak, Ladislav

2013-01-01

Participants with symptoms of depression received either eight sessions of therapist-delivered email cognitive behaviour therapy (eCBT; n = 37), or eight sessions of computerised CBT self-administered treatment (cCBT; n = 43). At post-treatment participants completed a questionnaire to determine what they found satisfying about their online…

Medicare payment changes and physicians' incomes.

PubMed

Weeks, William B; Wallace, Amy E

2002-01-01

An effort to control the physician portion of Medicare expenditures and to narrow the income gap between primary care and procedure-based physicians was effected through t he enactment of the Medicare Fee Schedule (MFS). To determine whether academic and private sector physicians' incomes had demonstrated changes consistent with payment changes, we collected income information from surveys of private sector physicians and academic physicians in six specialties: (1) family practice; (2) general internal medicine; (3) psychiatry; (4) general surgery; (5) radiology; and (6) anesthesiology. With the exception of general internal medicine, the anticipated changes in Medicare revenue were not closely associated with income changes in either the academic or private sector group. Academic physicians were underpaid, relative to their private sector counterparts, but modestly less so at the end of the period examined. Our findings suggest that using changes in payment schedules to change incomes in order to influence the attractiveness of different specialties, even with a very large payer, may be ineffective. Should academic incomes remain uncompetitive with private sector incomes, it may be increasingly difficult to persuade physicians to enter academic careers.

[Pre-test and post-test probabilities. Who cares?].

PubMed

Steurer, Johann

2009-01-01

The accuracy of a diagnostic test, i.e. abdomen ultrasound in patients with suspected acute appendicitis, is described in the terms of sensitivity and specificity. According to eminent textbooks physicians should use the values of the sensitivity and specificity of a test in their diagnostic reasoning. Physician's estimate, after taking the history, the pretest-probability of the suspected illness, order one or more tests and then calculate the respective posttest-probability. In practice physicians almost never follow this line of thinking. The main reasons are; to estimate concrete illness probabilities is difficult, the values for the sensitivity and specificity of a test are most often not known by physicians and calculations during daily practice are intricate. Helpful for busy physicians are trustworthy expert recommendations which test to apply in which clinical situation.

A Real Time Interface Between a Computerized Physician Order Entry System and the Computerized ICU Medication Administration Record

PubMed Central

Chen, Jeannie; Shabot, M. Michael; LoBue, Mark

2003-01-01

Prior attempts to interface ICU Clinical Information Systems (CIS) to Pharmacy systems have been less than successful. The major problem is that in ICUs, medications frequently have to be administered and charted in the CIS Medication Administration Record (MAR) before pharmacists can enter them into the Pharmacy system. When the Pharmacy system belatedly sends medication orders to the CIS MAR, this may create duplicate entries for medications that ICU nurses have had to enter manually to chart doses actually given. The authors have implemented a real time interface between a Computerized Physician Order Entry (CPOE) system and a CIS operating in ten ICUs that solves this problem. The interface transfers new medication orders including order details and alerts directly to the CIS Medication Administration Record (MAR), where they are immediately available for nurse charting. PMID:14728315

[Communication training MultiTANDEMplus – A contribution to improve communication between professional caregivers and physicians].

PubMed

Meyer-Kühling, Inga; Wendelstein, Britta; Pantel, Johannes; Specht-Leible, Norbert; Zenthöfer, Andreas; Schröder, Johannes

2015-10-01

Failures of communication between professional caregivers and physicians affect the quality of supply of nursing home residents. As part of a model project it was aimed to develop a training for caregivers to improve communication and promote cooperation with physicians. For the needs assessment as a basis to develop the training 56 professional caregivers and 40 physicians engaged in nursing home care answered questionnaires regarding their cooperation. Based on these results a module for communication between professional caregivers and physicians was developed and adapted the TANDEM communication training for caregivers by Haberstroh and Pantel (2011). 25 professional caregivers in leading positions have been trained as multipliers in order to provide their colleagues the communication training with the additional element (TANDEMplus). TANDEMplus was evaluated in forms of reflection rounds and feedback questionnaires. 254 professional caregivers, housekeeping staff and daytime companions participated in a complete TANDEMplus training by the multipliers until July 2014. The implementation of their developed communication strategies into practice was experienced positively by the participants. The module “communication with physicians” is relevant for professional caregivers to raise awareness of their own competence and facilitate a structured information exchange at eye level. The training of multipliers was executed in order to ensure transfer effects and sustainability.

Adoption of health information technologies by physicians for clinical practice: The Andalusian case.

PubMed

Villalba-Mora, Elena; Casas, Isabel; Lupiañez-Villanueva, Francisco; Maghiros, Ioannis

2015-07-01

We investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. We analysed the physicians' responses to an online survey. First, we performed a statistical descriptive analysis of the data; thereafter, a principal component analysis; and finally an order logit model to explain the effect of the use in the adoption and to analyse which are the existing barriers. The principal component analysis revealed three main uses of Health Information Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians' perceived usefulness. Lack of financing appeared as a common barrier to the adoption of the three types of services. For ePrescription and patient management, the physician's lack of skills is still a barrier. In the case of telemedicine services, lack of security and lack of interest amongst professionals are the existing barriers. EHR functionalities are fully adopted, in terms of perceived usefulness. EPrescription and patient management are almost fully adopted, while telemedicine is in an early stage of adoption. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Consequences of Contextual Factors on Clinical Reasoning in Resident Physicians

ERIC Educational Resources Information Center

McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R., Jr.; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J.

2015-01-01

Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have…

42 CFR 409.45 - Dependent services requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... her rate of recovery. (ii) If these services are furnished to a beneficiary's family member or... care of a physician, in need of skilled services, and under a plan of care) specified in § 409.42. Home... illness or injury. The physician's order must indicate the frequency of the home health aide services...

42 CFR 409.45 - Dependent services requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... her rate of recovery. (ii) If these services are furnished to a beneficiary's family member or... care of a physician, in need of skilled services, and under a plan of care) specified in § 409.42. Home... illness or injury. The physician's order must indicate the frequency of the home health aide services...

42 CFR 409.45 - Dependent services requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... her rate of recovery. (ii) If these services are furnished to a beneficiary's family member or... care of a physician, in need of skilled services, and under a plan of care) specified in § 409.42. Home... illness or injury. The physician's order must indicate the frequency of the home health aide services...

Graduate Medical Education Specialty Mix and Geographic Residency Program Maldistribution: Is There a Role for the ACGME?

PubMed

Nasca, Thomas J; Carlson, Douglas

2016-03-01

As we've stated, GME is the final common pathway toward clinical medical practice in the US. It makes sense, then, that national physician workforce policy aimed at meeting future public health demands should be directed at this phase of medical education. It would also make sense that ACGME, as the single accreditor of all residency programs in the US, should be engaged in physician workforce policymaking on behalf of the public. We identified three issues that must be addressed in order for the ACGME to assume this role: First, there must be a national agreed-upon and long-term plan for the design and implementation of the health care delivery system. Second, there must be a nationally coordinated strategy for identifying long-term physician workforce needs and funding mechanisms to physician and other health care professional developments. Third, in order to execute these roles, the ACGME must receive support from the profession and national and state-level statutory protection from enforcement of state and federal antitrust law.

Does the physician order-entry system increase the revenue of a general hospital?

PubMed

Park, Woong-Sub; Kim, Joon S; Chae, Young Moon; Yu, Seung-Hum; Kim, Chang-Yup; Kim, Sang-A; Jung, Sang Hyuk

2003-08-01

The purpose of this study was to examine whether the physician order-entry system (POE) could increase the outpatient and inpatient revenue of hospitals. We analyzed the inpatient and outpatient revenue data of all general hospitals (212) in South Korea obtained from the Korean National Health Insurance Corporation (KNHIC) during the period from 1996 to 1999 using the mixed model for repeated measure data. Analysis of the 4-years' panel data showed that both outpatient and inpatient revenues increased significantly after POE introduction. The hospital characteristics significantly influencing inpatient revenue were the number of beds, number of physicians and the tertiary status of a hospital; whereas those for outpatient revenue were the number of beds, number of physicians, the private status of a hospital, the tertiary status of a hospital and the urban status of a hospital. The revenues from both outpatients and inpatients were found to be increased after the introduction of the POE, while controlling for population size, competition, income, hospital location, hospital size, tertiary status and public status.

A randomized evaluation of a computer-based physician's workstation: design considerations and baseline results.

PubMed Central

Rotman, B. L.; Sullivan, A. N.; McDonald, T.; DeSmedt, P.; Goodnature, D.; Higgins, M.; Suermondt, H. J.; Young, C. Y.; Owens, D. K.

1995-01-01

We are performing a randomized, controlled trial of a Physician's Workstation (PWS), an ambulatory care information system, developed for use in the General Medical Clinic (GMC) of the Palo Alto VA. Goals for the project include selecting appropriate outcome variables and developing a statistically powerful experimental design with a limited number of subjects. As PWS provides real-time drug-ordering advice, we retrospectively examined drug costs and drug-drug interactions in order to select outcome variables sensitive to our short-term intervention as well as to estimate the statistical efficiency of alternative design possibilities. Drug cost data revealed the mean daily cost per physician per patient was 99.3 cents +/- 13.4 cents, with a range from 0.77 cent to 1.37 cents. The rate of major interactions per prescription for each physician was 2.9% +/- 1%, with a range from 1.5% to 4.8%. Based on these baseline analyses, we selected a two-period parallel design for the evaluation, which maximized statistical power while minimizing sources of bias. PMID:8563376

[Dual-doctor marriages].

PubMed

Gjerberg, Elisabeth

2003-08-28

Dual-doctor marriages are increasingly frequent. The question raised here is whether being married to a fellow physician has a different impact on a doctor's career and family life than having a spouse in a different profession. In 1996 a questionnaire was mailed to physicians who received their authorisation to practise medicine in Norway in the years 1980 through 1983 period; 1142 responded (67 %). They supplied data on their current employment status and data on employment history and marital background. Multivariate analysis was used in order to explore how the educational background of spouses affects a medical career. Female physicians who marry a physician marry and have families at a younger age than other female physicians. Moreover, they more often enter specialties; in some specialities they also qualify earlier than those who marry non-physicians. The same did not hold for male physicians. However, male physicians in dual-doctor marriages more frequently worked part time and they far less frequently had spouses working part time than other male doctors. The results suggest that dual-doctor couples to a higher extent share in giving care to their families, have more interests in common and are more supportive of each other's needs. Female physicians seem to benefit particularly.

Physicians' perspectives on receiving unsolicited genomic results.

PubMed

Pet, Douglas B; Holm, Ingrid A; Williams, Janet L; Myers, Melanie F; Novak, Laurie L; Brothers, Kyle B; Wiesner, Georgia L; Clayton, Ellen W

2018-06-14

Physicians increasingly receive genomic test results they did not order, which we term "unsolicited genomic results" (UGRs). We asked physicians how they think such results will affect them and their patients. Semistructured interviews were conducted with adult and pediatric primary care and subspecialty physicians at four sites affiliated with a large-scale return-of-results project led by the Electronic Medical Records and Genomics (eMERGE) Network. Twenty-five physicians addressed UGRs and (1) perceived need for actionability, (2) impact on patients, (3) health care workflow, (4) return of results process, and (5) responsibility for results. Physicians prioritize actionability of UGRs and the need for clear, evidence-based "paths" for action coupled with clinical decision support (CDS). They identified potential harms to patients including anxiety, false reassurance, and clinical disutility. Clinicians worried about anticipated workflow issues including responding to UGRs and unreimbursed time. They disagreed about who was responsible for responding to UGRs. The prospect of receiving UGRs for otherwise healthy patients raises important concerns for physicians. Their responses informed development of an in-depth survey for physicians following return of UGRs. Strategic workflow integration of UGRs will likely be necessary to empower physicians to serve their patients effectively.

Diagnostic and laboratory test ordering in Northern Portuguese Primary Health Care: a cross-sectional study

PubMed Central

Sá, Luísa; Teixeira, Andreia Sofia Costa; Tavares, Fernando; Costa-Santos, Cristina; Couto, Luciana; Costa-Pereira, Altamiro; Hespanhol, Alberto Pinto; Santos, Paulo

2017-01-01

Objectives To characterise the test ordering pattern in Northern Portugal and to investigate the influence of context-related factors, analysing the test ordered at the level of geographical groups of family physicians and at the level of different healthcare organisations. Design Cross-sectional study. Setting Northern Primary Health Care, Portugal. Participants Records about diagnostic and laboratory tests ordered from 2035 family physicians working at the Northern Regional Health Administration, who served approximately 3.5 million Portuguese patients, in 2014. Outcomes To determine the 20 most ordered diagnostic and laboratory tests in the Northern Regional Health Administration; to identify the presence and extent of variations in the 20 most ordered diagnostic and laboratory tests between the Groups of Primary Care Centres and between health units; and to study factors that may explain these variations. Results The 20 most ordered diagnostic and laboratory tests almost entirely comprise laboratory tests and account for 70.9% of the total tests requested. We can trace a major pattern of test ordering for haemogram, glucose, lipid profile, creatinine and urinalysis. There was a significant difference (P<0.001) in test orders for all tests between Groups of Primary Care Centres and for all tests, except glycated haemoglobin (P=0.06), between health units. Generally, the Personalised Healthcare Units ordered more than Family Health Units. Conclusions The results from this study show that the most commonly ordered tests in Portugal are laboratory tests, that there is a tendency for overtesting and that there is a large variability in diagnostic and laboratory test ordering in different geographical and organisational Portuguese primary care practices, suggesting that there may be considerable potential for the rationalisation of test ordering. The existence of Family Health Units seems to be a strong determinant in decreasing test ordering by Portuguese family physicians. Approaches to ensuring more rational testing are needed. PMID:29146654

["The best among the physicians to Gehinom (to hell)?"].

PubMed

Gesundheit, B

2004-08-01

At first glance, the well-known Mishnaic dictum, "The best among the physicians to Gehinom" (Kiddushin 4:14), is a harsh and sweeping denunciation of doctors and medicine. It is contrary to the respect and regard for physicians and medicine shown by the Talmud and Jewish tradition across the generations. This article explains the statement in its original context in the Mishnah and its parallels. We shall examine how the dictum was understood in both Jewish and non-Jewish literature in order to trace the new meanings that were attached to it over the course of history in both traditions. The article examines the Mishnaic source and its parallels in light of early manuscripts. Furthermore, it investigates the historical background and biographies of the many commentators on this dictum in order to account for the diverse explanations offered by those authors. An examination of the manuscripts demonstrates that this passage did not appear in the original Mishnah, but was added during a later period. The parallel texts imply that condemnation is limited to those physicians who treat their patients using heretical and idolatrous methods. Jewish commentators utilized this exceptional dictum as a means to teach important moral lessons, each author in accordance with his own viewpoint and the needs of the hour. Non-Jewish authors also exploited the passage, supporting their anti-Semitic ideology with Talmudic sources. No conclusions regarding the Jewish attitude toward medicine and doctors may be derived from the dictum: "The best of the physicians to Gehinom." The statement probably relates solely to doctors of that period who employed heretical and idolatrous practices in the treatment of their patients. The Talmud expresses its respect and appreciation for medicine and doctors. Jewish commentators across the generations continued to derive important moral lessons from this exceptional statement in order to enhance the professional and moral responsibility of Jewish physicians.

[What does affect the general practitioners' choice of contract and plans to relocate?].

PubMed

Grytten, J; Skau, I; Sørensen, R; Aasland, O G

2000-10-30

The aim of this study was to examine general practitioners' choice of contract and location in Norway. GPs can choose between two types of contract: a contract by which they are paid a salary, and a contract by which they are paid on a fee-for-service basis plus a fixed grant. The data were collected by a questionnaire sent to a representative sample of GPs in Norway (N = 1,639). Salaried physicians and contract physicians show different characteristics. Salaried physicians tend to be younger than contract physicians and to prefer leisure to higher income. Most salaried physicians were located in rural areas. The following tendencies were observed with respect to location: GPs wanted to move from rural to central areas. Physicians who reported that their workload was too high, wanted to move to an area where the workload was lower. Physicians who reported that they had too few patients did not want to move. Physicians who were often on duty to provide emergency services wanted to move. According to standard market theory, physicians are expected to move to areas where demand is high when demand in their own areas falls. Our results indicate that public regulation is necessary in order to obtain an optimal distribution of physicians.

Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards.

PubMed

Zwarenstein, Merrick; Rice, Kathleen; Gotlib-Conn, Lesley; Kenaszchuk, Chris; Reeves, Scott

2013-11-25

Poor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care. Qualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofessional contexts. Physicians in GIM wards communicated with other professions mainly in structured rounds. Physicians' communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians. Without interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care.Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions.

28 CFR 549.66 - Release from treatment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MEDICAL SERVICES Hunger Strikes, Inmate § 549.66 Release from treatment. Only the physician may order that an inmate be released from hunger strike evaluation and treatment. This order shall be documented in...

Reduction in unnecessary red blood cell folate testing by restricting computerized physician order entry in the electronic health record.

PubMed

MacMillan, Thomas E; Gudgeon, Patrick; Yip, Paul M; Cavalcanti, Rodrigo B

2018-05-02

Red blood cell folate is a laboratory test with limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate, have resulted in only modest success. The objective of this study was to assess the effectiveness and impacts of restricting red blood cell folate ordering in the electronic health record. This was a retrospective observational study from January 2010 to December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients and outpatients who underwent at least 1 red blood cell folate or vitamin B12 test during the study period were included. Red blood cell folate ordering was restricted to clincians in gastroenterology and hematology and was removed from other physicians' computerized order entry screen in the electronic health record in June 2013. Red blood cell folate testing decreased by 94.4% during the study, from a mean of 493.0 (SD 48.0) tests/month before intervention to 27.6 (SD 10.3) tests/month after intervention (P<.001). Restricting red blood cell folate ordering in the electronic health record resulted in a large and sustained reduction in red blood cell folate testing. Significant cost savings estimated at over a quarter-million dollars (CAD) over three years were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency. Copyright © 2018. Published by Elsevier Inc.

Prompting physicians for cost-effective test ordering in the low prevalence conditions of family medicine.

PubMed

Bernstein, R M; Hollingworth, G R; Wood, W E

1994-01-01

We have developed a computerized prompting system for test ordering which we feel will decrease the cost of investigations and at the same time promote an evidence based learning approach to test ordering. Prompting systems have been shown to be cost-effective but suffer from many disadvantages in the family practice setting. They tend to be difficult to modify by the user and contingent on an inflexible rule based structure. Many suggestions are ignored implying that they are not relevant. In family practice most conditions are of low prevalence. Prompting for test ordering where the pre-test likelihood of disease is small will result in a large number of false positives and many unnecessary repeat or confirmatory investigations and attendant anxiety unless the prompting system is specifically designed to be used in a low prevalence environment. PROMPTOR-FM (PRObabilistic Method of Prompting for Test ORdering in Family Medicine) was developed to overcome these perceived difficulties. It allows the physician to rapidly calculate the positive and negative predictive values of a test being considered based on the clinical index of suspicion. The physician is able to repeat the calculations and compare the results with previous calculations. By using PROMPTOR-FM repetitively, the clinician can learn to balance the risk of "missing" a rare but serious condition against the risk of falsely identifying disease with its downstream hazards and costs of further investigation. Prompting for test ordering is therefore uniquely tailored to each patient's situation.

Pain, sympathy and the medical encounter between the mid eighteenth and the mid twentieth centuries.

PubMed

Bourke, Joanna

2012-08-01

Witnessing people in pain inevitably elicits anxiety in physicians and other caregivers. Physicians are often required to inflict certain types of discomforts in order to alleviate other, more destructive, pains. Accusations that physicians lacked sympathy can be heard throughout the centuries. This article explores the diverse medical responses to such claims between the eighteenth and twentieth centuries. It interrogates changing definitions of clinical sympathy. The concept of sympathy was continually being reworked for each generation of medical professional. Crucially, in this reworking, philosophers (such as Adam Smith) and physicians came into dialogue. Cultures of sympathy were understood in both physiological and metaphorical terms, and were tied to changing notions of professionalization.

CPOE: a clear purpose plus top-notch technical support equals high physician adoption.

PubMed

Birk, Susan

2010-01-01

As with any fundamental change, the transition to computerized physician order entry [CPOE] is not a risk-free endeavor, major questions hover around this facet of the arduous and controversial paper-to-electronic conversion currently preoccupying the healthcare industry: Could physician over-reliance on electronic prompts actually lead to an increase in some types of medical errors? Could automated workstations ultimately hinder safety and the delivery of quality care by diminishing face-to-face communication and nuanced discussions? In an ironic twist, could electronic solutions insidiously leach creativity, intuition and judgment from good medicine by keeping physicians tied to tools that consume their time but do not offer effective clinical decision support?

Doctors, apologies, and the law: an analysis and critique of apology laws.

PubMed

Wei, Marlynn

2007-01-01

This Article analyzes and critiques apology laws, their potential use, and effectiveness, both legally and ethically, in light of the strong professional norms that shape physicians' reaction to medical errors. Physicians are largely reluctant to disclose medical errors to patients, patients' families, and even other physicians. Some states have passed so-called apology laws in order to encourage physicians to disclose medical errors to patients. Apology laws allow defendants to exclude statements of sympathy made after accidents from evidence in a liability lawsuit. This Article examines potential barriers to physicians' disclosure of medical mistakes and demonstrates how the underlying problem may actually be rooted in professional norms-norms that will remain outside the scope of law's influence. The Article also considers other legal and policy changes that could help to encourage disclosure.

HL7 Structured Product Labeling - electronic prescribing information for provider order entry decision support.

PubMed

Schadow, Gunther

2005-01-01

Prescribing errors are an important cause of adverse events, and lack of knowledge of the drug is a root cause for prescribing errors. The FDA is issuing new regulations that will make the drug labels much more useful not only to physicians, but also to computerized order entry systems that support physicians to practice safe prescribing. For this purpose, FDA works with HL7 to create the Structured Product Label (SPL) standard that includes a document format as well as a drug knowledge representation, this poster introduces the basic concepts of SPL.

A comprehensive inpatient discharge system.

PubMed Central

O'Connell, E. M.; Teich, J. M.; Pedraza, L. A.; Thomas, D.

1996-01-01

Our group has developed a computer system that supports all phases of the inpatient discharge process. The system fills in most of the physician's discharge order form and the nurse's discharge abstract, using information available from sign-out, order entry, scheduling, and other databases. It supplies information for referrals to outside institutions, and provides a variety of instruction materials for patients. Discharge forms can be completed in advance, so that the patient is not waiting for final paperwork. Physicians and nurses can work on their components independently, rather than in series. Response to the system has been very favorable. PMID:8947755

Determining hospital performance based on rank ordering: is it appropriate?

PubMed

Anderson, Judy; Hackman, Mark; Burnich, Jeff; Gurgiolo, Thomas R

2007-01-01

An increasing number of "pay for performance" initiatives for hospitals and physicians ascribe performance by ranking hospitals or physicians on quality of care measures. Payment is subsequently based on where a hospital or physician ranks among peers. This study examines the variability of ranking hospitals on quality of care measures and its impact on comparing hospital performance. Variability in the ranks of 3 quality of care measures was examined: discharge instruction for congestive heart failure, use of beta-blockers at discharge for heart attack, and timing of initial antibiotic therapy within 4 hours of admission to the hospital for pneumonia. The data are available on the Centers for Medicare and Medicaid Services Web site as part of the Hospital Quality Alliance project. We found that considerable uncertainty exists in ranking of hospitals on these measures, which calls into question the use of rank ordering as a determinant of performance.

Electronic Informational and Educational Environment as a Factor of Competence-Oriented Higher Pedagogical Education in the Sphere of Health, Safety and Environment

ERIC Educational Resources Information Center

Kamerilova, Galina S.; Kartavykh, Marina A.; Ageeva, Elena L.; Veryaskina, Marina A.; Ruban, Elena M.

2016-01-01

The authors consider the question of computerisation in health, safety and environment teachers' training in the context of the general approaches and requirements of the Federal National Standard of Higher Education, which is realised through designing of electronic informational and educational environment. The researchers argue indispensability…

Do Computers Improve the Drawing of a Geometrical Figure for 10 Year-Old Children?

ERIC Educational Resources Information Center

Martin, Perrine; Velay, Jean-Luc

2012-01-01

Nowadays, computer aided design (CAD) is widely used by designers. Would children learn to draw more easily and more efficiently if they were taught with computerised tools? To answer this question, we made an experiment designed to compare two methods for children to do the same drawing: the classical "pen and paper" method and a CAD…

Teaching the Repeated Prisoner's Dilemma with a Non-Computerised Adaptation of Axelrod's Tournament

ERIC Educational Resources Information Center

Dennis, Catherine

2015-01-01

Darwin's theory of evolution is explicitly competitive, yet co-operation between individuals is a common phenomenon. The Prisoner's Dilemma model is central to the teaching of the evolution of co-operation. The best-known explorations of the Prisoner's Dilemma are the tournaments run by Robert Axelrod in the 1980s. Aimed at students of biological…

Shaping the Global Civil Society: An Interview with Michael Peters

ERIC Educational Resources Information Center

Heraud, Richard; Tesar, Marek

2017-01-01

Professor Michael A. Peters has worked in an era of transformation that has taken him from a labour-intensive paper-based form of production to the computerised reproduction of thought, and the current shift in the publishing landscape from a reader-subscription to an author-pays model. Most of what he has learned in publishing and editing he has…

Experiential Learning--A Case Study of the Use of Computerised Stock Market Trading Simulation in Finance Education

ERIC Educational Resources Information Center

Marriott, Pru; Tan, Siew Min; Marriott, Neil

2015-01-01

Finance is a popular programme of study in UK higher education despite it being a challenging subject that requires students to understand and apply complex and abstract mathematical models and academic theories. Educational simulation is an active learning method found to be useful in enhancing students' learning experience, but there has been…

Visual Information Processing Deficits as Biomarkers of Vulnerability to Schizophrenia: An Event-Related Potential Study in Schizotypy

ERIC Educational Resources Information Center

Koychev, Ivan; El-Deredy, Wael; Haenschel, Corinna; Deakin, John Francis William

2010-01-01

We aimed to clarify the importance of early visual processing deficits for the formation of cognitive deficits in the schizophrenia spectrum. We carried out an event-related potential (ERP) study using a computerised delayed matching to sample working memory (WM) task on a sample of volunteers with high and low scores on the Schizotypal…

[Design of computerised database for clinical and basic management of uveal melanoma].

PubMed

Bande Rodríguez, M F; Santiago Varela, M; Blanco Teijeiro, M J; Mera Yañez, P; Pardo Perez, M; Capeans Tome, C; Piñeiro Ces, A

2012-09-01

The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma. For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years. The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them. The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

Volunteer involvement in the support of self-managed computerised aphasia treatment: The volunteer perspective.

PubMed

Palmer, Rebecca; Enderby, Pam

2016-10-01

The speech-language pathology profession has explored a number of approaches to support efficient delivery of interventions for people with stroke-induced aphasia. This study aimed to explore the role of volunteers in supporting self-managed practice of computerised language exercises. A qualitative interview study of the volunteer support role was carried out alongside a pilot randomised controlled trial of computer aphasia therapy. Patients with aphasia practised computer exercises tailored for them by a speech-language pathologist at home regularly for 5 months. Eight of the volunteers who supported the intervention took part in semi-structured interviews. Interviews were audio recorded, transcribed verbatim and analysed thematically. Emergent themes included: training and support requirements; perception of the volunteer role; challenges facing the volunteer, in general and specifically related to supporting computer therapy exercises. The authors concluded that volunteers helped to motivate patients to practise their computer therapy exercises and also provided support to the carers. Training and ongoing structured support of therapy activity and conduct is required from a trained speech-language pathologist to ensure the successful involvement of volunteers supporting impairment-based computer exercises in patients' own homes.

Elastic fibres in the vesicourethral junction and urethra of the guinea pig: quantification with computerised image analysis

PubMed Central

DASS, NARINDER; McMURRAY, GORDON; BRADING, ALISON F.

1999-01-01

Elastic fibres, which are intimately associated with collagen, a major component of the urethra, have been assumed to contribute to the resting urethral closure pressure. The Miller stain for elastin was used to demonstrate elastic fibres in cryostat sections of guinea pig bladder base, vesicourethral junction (VUJ) and urethra. Computerised image analysis was employed to objectively quantify these fibres. Both male and female guinea pigs showed significantly greater amounts of circularly disposed elastic fibres in the VUJ than in the other 2 regions examined. This particular disposition of fibres may be responsible for imparting resiliency and plasticity to the VUJ, allowing it to distend and recoil repeatedly in response to urine outflow. Furthermore, the elastic fibres may be partly responsible for the passive occlusive force in this region. Elastic fibres in the distal urethra were not quantified because of their relative paucity. Sagittal sections of the urethra revealed a mass of longitudinally arranged elastic fibres localised almost exclusively within the mucosa, submucosa and longitudinal smooth muscle layer. Functionally, this arrangement may exist to facilitate urethral length changes that occur in micturition. PMID:10580860

Effectiveness of a computerised working memory training in adolescents with mild to borderline intellectual disabilities.

PubMed

Van der Molen, M J; Van Luit, J E H; Van der Molen, M W; Klugkist, I; Jongmans, M J

2010-05-01

The goal of this study is to evaluate the effectiveness of a computerised working memory (WM) training on memory, response inhibition, fluid intelligence, scholastic abilities and the recall of stories in adolescents with mild to borderline intellectual disabilities attending special education. A total of 95 adolescents with mild to borderline intellectual disabilities were randomly assigned to either a training adaptive to each child's progress in WM, a non-adaptive WM training, or to a control group. Verbal short-term memory (STM) improved significantly from pre- to post-testing in the group who received the adaptive training compared with the control group. The beneficial effect on verbal STM was maintained at follow-up and other effects became clear at that time as well. Both the adaptive and non-adaptive WM training led to higher scores at follow-up than at post-intervention on visual STM, arithmetic and story recall compared with the control condition. In addition, the non-adaptive training group showed a significant increase in visuo-spatial WM capacity. The current study provides the first demonstration that WM can be effectively trained in adolescents with mild to borderline intellectual disabilities.

A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children.

PubMed

Yuen, V M; Li, B L; Cheuk, D K; Leung, M K M; Hui, T W C; Wong, I C; Lam, W W; Choi, S W; Irwin, M G

2017-10-01

Chloral hydrate is commonly used to sedate children for painless procedures. Children may recover more quickly after sedation with dexmedetomidine, which has a shorter half-life. We randomly allocated 196 children to chloral hydrate syrup 50 mg.kg -1 and intranasal saline spray, or placebo syrup and intranasal dexmedetomidine spray 3 μg.kg -1 , 30 min before computerised tomography studies. More children resisted or cried after drinking chloral hydrate syrup than placebo syrup, 72 of 107 (67%) vs. 42 of 87 (48%), p = 0.009, but there was no difference after intranasal saline vs. dexmedetomidine, 49 of 107 (46%) vs. 40 of 87 (46%), p = 0.98. Sedation was satisfactory in 81 of 107 (76%) children after chloral hydrate and 64 of 87 (74%) children after dexmedetomidine, p = 0.74. Of the 173 children followed up for at least 4 h after discharge, 38 of 97 (39%) had recovered normal function after chloral hydrate and 32 of 76 (42%) after dexmedetomidine, p = 0.76. Six children vomited after chloral hydrate syrup and placebo spray vs. none after placebo syrup and dexmedetomidine spray, p = 0.03. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

ACP Best Practice No 166

PubMed Central

Cruickshank, A

2001-01-01

After subarachnoid haemorrhage (SAH), cerebral angiography is usually performed to establish a site of bleeding, which may then be treated surgically to prevent a potentially catastrophic re-bleed. The investigation of choice in the diagnosis of SAH is computerised tomography (CT). However, because CT can miss some patients with SAH, cerebrospinal fluid (CSF) spectrophotometry should be performed in those patients with negative or equivocal CT scans or those who have presented several days after the suspected bleed. Spectrophotometry should aim to detect the presence of both oxyhaemoglobin and bilirubin because either one or both of these pigments may contribute to xanthochromia following SAH. CSF supernatant is scanned using a double beam spectrophotometer at wavelengths between 350 nm and 650 nm. Oxyhaemoglobin alone produces an absorption peak at 413–415 nm, bilirubin alone produces a broad peak at 450–460 nm, and bilirubin together with oxyhaemoglobin produce a shoulder at 450–460 nm on the downslope of the oxyhaemoglobin peak. To minimise the frequency of false positive and false negative results, a protocol has been developed, which is described. Key Words: subarachnoid haemorrhage • computerised tomography • cerebrospinal fluid • spectrophotometry • oxyhaemoglobin • bilirubin • xanthochromia PMID:11684714

Automatic 2D and 3D segmentation of liver from Computerised Tomography

NASA Astrophysics Data System (ADS)

Evans, Alun

As part of the diagnosis of liver disease, a Computerised Tomography (CT) scan is taken of the patient, which the clinician then uses for assistance in determining the presence and extent of the disease. This thesis presents the background, methodology, results and future work of a project that employs automated methods to segment liver tissue. The clinical motivation behind this work is the desire to facilitate the diagnosis of liver disease such as cirrhosis or cancer, assist in volume determination for liver transplantation, and possibly assist in measuring the effect of any treatment given to the liver. Previous attempts at automatic segmentation of liver tissue have relied on 2D, low-level segmentation techniques, such as thresholding and mathematical morphology, to obtain the basic liver structure. The derived boundary can then be smoothed or refined using more advanced methods. The 2D results presented in this thesis improve greatly on this previous work by using a topology adaptive active contour model to accurately segment liver tissue from CT images. The use of conventional snakes for liver segmentation is difficult due to the presence of other organs closely surrounding the liver this new technique avoids this problem by adding an inflationary force to the basic snake equation, and initialising the snake inside the liver. The concepts underlying the 2D technique are extended to 3D, and results of full 3D segmentation of the liver are presented. The 3D technique makes use of an inflationary active surface model which is adaptively reparameterised, according to its size and local curvature, in order that it may more accurately segment the organ. Statistical analysis of the accuracy of the segmentation is presented for 18 healthy liver datasets, and results of the segmentation of unhealthy livers are also shown. The novel work developed during the course of this project has possibilities for use in other areas of medical imaging research, for example the segmentation of internal liver structures, and the segmentation and classification of unhealthy tissue. The possibilities of this future work are discussed towards the end of the report.

Physician Interactions with Electronic Health Records in Primary Care

PubMed Central

Montague, Enid; Asan, Onur

2013-01-01

Objective It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician-patient interactions. Study Design Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Methods Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated objective coding methodology in order to examine how physicians interact with electronic health records. Results Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. Conclusion A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed. PMID:24009982

A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits.

PubMed

Hughes, Danny R; Jiang, Miao; Duszak, Richard

2015-01-01

Little is known about the use of diagnostic testing, such as medical imaging, by advanced practice clinicians (APCs), specifically, nurse practitioners and physician assistants. To examine the use of diagnostic imaging ordered by APCs relative to that of primary care physicians (PCPs) following office-based encounters. Using 2010-2011 Medicare claims for a 5% sample of beneficiaries, we compared diagnostic imaging ordering between APC and PCP episodes of care, controlling for geographic variation, patient demographics, and Charlson Comorbidity Index scores. Provider specialty codes were used to identify PCPs and APCs (general practice, family practice, or internal medicine for PCP; nurse practitioner or physician assistant for APC). Episodes were constructed using evaluation and management (E&M) office visits without any claims 30 days prior to the index visit and (1) no claims at all within the subsequent 30 days; (2) no claims within the subsequent 30 days other than a single imaging event; or (3) claims for any nonimaging services in that subsequent 30-day period. The primary outcome was whether an imaging event followed a qualifying E&M visit. Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. In adjusted estimates and across all patient groups and imaging services, APCs were associated with more imaging than PCPs (odds ratio [OR], 1.34 [95% CI, 1.27-1.42]), ordering 0.3% more images per episode. Advanced practice clinicians were associated with increased radiography orders on both new (OR, 1.36 [95% CI, 1.13-1.66]) and established (OR, 1.33 [95% CI, 1.24-1.43]) patients, ordering 0.3% and 0.2% more images per episode of care, respectively. For advanced imaging, APCs were associated with increased imaging on established patients (OR, 1.28 [95% CI, 1.14-1.44]), ordering 0.1% more images, but were not significantly different from PCPs ordering imaging on new patients. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. Expanding the use of APCs may alleviate PCP shortages. While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level.

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

PubMed

Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

2012-05-01

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

[Sex role orientation and interdisciplinary co-operation].

PubMed

Kada, Olivia; Brunner, Eva; Maier, Marco

2010-01-01

Interdisciplinary collaboration between nurses and physicians contributes to optimal patient outcomes. Both insufficient knowledge of each other's roles and competencies and the power position of physicians impede nurse-physician collaboration. Health care managers play an important role in the promotion of nurse-physician collaboration. Leadership is associated with masculine traits, but female attributes are crucial in social relationships. Austrian health care management students (n=141, response rate: 93 %) rated themselves, the typical nurse and the typical physician with respect to masculine and feminine traits using the Bem sex-role-inventory (BSRI). The respondents saw themselves as equally masculine and feminine (androgynous self-concept); nurses were rated as significantly more masculine than feminine, whereas physicians were described as masculine sex-typed and significantly less feminine than nurses. For health care managers who also have to promote interdisciplinary collaboration an androgynous self-concept can be regarded as advantageous. They need to reflect on their ideas about nurses and physicians in order to manage the challenge of promoting interprofessional co-operation. Copyright © 2010. Published by Elsevier GmbH.

Treatment Availability Influences Physicians' Portrayal of Robotic Surgery During Clinical Appointments.

PubMed

Scherr, Karen A; Fagerlin, Angela; Wei, John T; Williamson, Lillie D; Ubel, Peter A

2017-01-01

In order to empower patients as decision makers, physicians must educate them about their treatment options in a factual, nonbiased manner. We propose that site-specific availability of treatment options may be a novel source of bias, whereby physicians describe treatments more positively when they are available. We performed a content analysis of physicians' descriptions of robotic prostatectomy within 252 appointments at four Veterans Affairs medical centers where robotic surgery was either available or unavailable. We coded how physicians portrayed robotic versus open prostatectomy across specific clinical categories and in the appointment overall. We found that physicians were more likely to describe robotic prostatectomy as superior when it was available [F(1, 42) = 8.65, p = .005]. We also provide initial qualitative evidence that physicians may be shaping their descriptions of robotic prostatectomy in an effort to manage patients' emotions and demand for the robotic technology. To our knowledge, this is the first study to provide empirical evidence that treatment availability influences how physicians describe the advantages and disadvantages of treatment alternatives to patients during clinical encounters, which has important practical implications for patient empowerment and patient satisfaction.

Beware: hospital control or ownership of medical groups.

PubMed

Hepps, S A

1995-01-01

The rapidly changing, unsettled economic and political health care environment is cause for great anxieties for physicians and hospitals alike. Most physicians have joined IPAs or medical groups in order to obtain continued access to patients who are rapidly shifting from indemnity to cost saving HMOs and PPOs. Many hospitals are seeking to increase their primary care provider base by obtaining control of physicians which may increase their opportunity for institutional success. In many cases, hospitals are providing substantial subsidies or buying physician practices, sometimes in apparent violation of anti-trust law. Physicians ostensibly receive good management advice and infrastructure support from hospital business officers or hospital controlled MSOs. However, when the hospital controls individual physicians or medical groups, there is an inherent conflict of interest because of very different strategic needs. It is not in the physicians' best interests to succumb to the siren songs which hospitals are playing. Providing the highest level of care possible for patients requires that physicians maintain professional independence and autonomy now and in the foreseeable future. Equitable negotiation and collaboration between medical groups and hospitals can only be obtained when there is a lawful and level playing field.

Qualitative study of employment of physician assistants by physicians: benefits and barriers in the Ontario health care system.

PubMed

Taylor, Maureen T; Wayne Taylor, D; Burrows, Kristen; Cunnington, John; Lombardi, Andrea; Liou, Michelle

2013-11-01

To explore the experiences and perceptions of Ontario physician assistant (PA) employers about the barriers to and benefits of hiring PAs. A qualitative design using semistructured interviews. Rural and urban eastern and southwestern Ontario. Seven family physicians and 7 other specialists. The 14 physicians participated in semistructured interviews, which were audiorecorded and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis. Physician-specific benefits to hiring PAs included increased flexibility, the opportunity to expand practice, the ability to focus more time on complex patients, overall reduction in work hours and stress, and an opportunity for professional fellowship. Physicians who hired PAs without government financial support said PAs were affordable as long as they were able to retain them. Barriers to hiring PAs included uncertainty about funding, the initial need for intensive supervision and training, and a lack of clarity around delegation of acts. Physicians are motivated to hire PAs to help deal with long wait times and long hours, but few are expecting to increase their income by taking on PAs. Governments, medical colleges, educators, and regulators must address the perceived barriers to PA hiring in order to expand and optimize this profession.

Guideline attribute and implementation preferences among physicians in multiple health systems.

PubMed

Stone, Tamara T; Schweikhart, Sharon B; Mantese, Annamarie; Sonnad, Seema S

2005-01-01

Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments. Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences. Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence. Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.

[Issues related to national university medical schools: focusing on the low wages of university hospital physicians].

PubMed

Takamuku, Masatoshi

2015-01-01

University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.

[A contribution to the needs assessment of faculty development measures in medical schools].

PubMed

Raupach, Tobias; Spering, Christopher; Bäumler, Christine; Burckhardt, Gerhard; Trümper, Lorenz; Pukrop, Tobias

2009-11-15

In addition to patient care and research activity, physicians working in medical school hospitals serve as teachers in undergraduate medical education. However, teaching qualifications of German university hospital physicians have not been studied in great detail. In January 2009, medical students as well as physicians involved in medical teaching at Göttingen Medical School, Germany, were invited to complete an online survey addressing their views on clinical teachers' educational skills. In addition, physicians' motivation to engage in pedagogical training was assessed. During a 12-day period, 359 students and 126 physicians involved in undergraduate medical education completed the survey. The latter did not feel well prepared for their teaching activities. At the same time, they expressed the willingness to improve their teaching skills. Students felt that, across all instructional methods, teachers would benefit from teacher training programs. In order to improve undergraduate education for future physicians, politicians and local representatives alike must set the scene for the implementation of faculty development measures in German medical schools.

Management of work-related stress by Finnish occupational physicians.

PubMed

Kinnunen-Amoroso, M; Liira, J

2013-07-01

Occupational stress is a serious threat to the well-being of employees and organizations and may cause ill-health and loss of productivity. Determining the methods that occupational health (OH) services and employers use to manage work-related stress can help to detect both barriers and facilitating factors for effective stress management. To examine stress management methods used by OH physicians in Finland. Anonymous, self-administered e-mail questionnaire to Finnish OH physicians. A total of 222 OH physicians responded. Neither OH services nor their client organizations used standardized tools to assess or manage work-related stress. Work-related stress was assessed using patient interviews. Physicians reported that the main method used to manage occupational stress was supporting the individual employee. Half of the physicians attempted to involve workplaces in stress management by asking their patients to contact their supervisors regarding stress issues. In order to tackle work-related stress consistently and effectively employers and OH services should have agreed standardized protocols for managing stress in the workplace.

Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".

PubMed

Welch, Lisa C; Lutfey, Karen E; Gerstenberger, Eric; Grace, Matthew

2012-09-01

Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.

Factors influencing physicians' knowledge sharing on web medical forums.

PubMed

Lin, Tung Cheng; Lai, Ming Cheng; Yang, Shu Wen

2016-09-01

Web medical forums are relatively unique as knowledge-sharing platforms because physicians participate exclusively as knowledge contributors and not as knowledge recipients. Using the perspective of social exchange theory and considering both extrinsic and intrinsic motivations, this study aims to elicit the factors that significantly influence the willingness of physicians to share professional knowledge on web medical forums and develops a research model to explore the motivations that underlie physicians' knowledge-sharing attitudes. This model hypothesizes that constructs, including shared vision, reputation, altruism, and self-efficacy, positively influence these attitudes and, by extension, positively impact knowledge-sharing intention. A conventional sampling method and the direct recruitment of physicians at their outpatient clinic gathered valid data from a total of 164 physicians for analysis in the model. The empirical results support the validity of the proposed model and identified shared vision as the most significant factor of influence on knowledge-sharing attitudes, followed in descending order by knowledge-sharing self-efficacy, reputation, and altruism. © The Author(s) 2015.

Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter?

PubMed

Raymond, Louis; Paré, Guy; Marchand, Marie

2017-04-01

The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact 'does matter', its clinical functionalities explaining why certain physicians make more extended use of their system than others.

Implementing EHRs: An Exploratory Study to Examine Current Practices in Migrating Physician Practice

PubMed Central

Dolezel, Diane; Moczygemba, Jackie

2015-01-01

Implementation of electronic health record (EHR) systems in physician practices is challenging and complex. In the past, physicians had little incentive to move from paper-based records. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, Medicare and Medicaid incentive payments are now available for physicians who implement EHRs for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) has ample detail on clinical data needed for meaningful use in order to assess the quality of patient care. Details are lacking, however, on how much clinical data, if any, should be transferred from the old paper records during an EHR implementation project. The purpose of this exploratory study was to investigate and document the elements of longitudinal clinical data that are essential for inclusion in the EHR of physicians in a clinical practice setting, as reported by the office managers of the physicians in the study group. PMID:26807077

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine.

PubMed

Tai-Seale, Ming; Olson, Cliff W; Li, Jinnan; Chan, Albert S; Morikawa, Criss; Durbin, Meg; Wang, Wei; Luft, Harold S

2017-04-01

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts. Project HOPE—The People-to-People Health Foundation, Inc.

Physician communication about adolescent vaccination: How is human papillomavirus vaccine different?

PubMed

Gilkey, Melissa B; Moss, Jennifer L; Coyne-Beasley, Tamera; Hall, Megan E; Shah, Parth D; Brewer, Noel T

2015-08-01

Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type. A national sample of 776 U.S. physicians (53% pediatricians, 47% family medicine physicians) completed our online survey in 2014. We assessed physicians' perceptions and communication practices related to recommending adolescent vaccines for 11- and 12-year-old patients. About three-quarters of physicians (73%) reported recommending HPV vaccine as highly important for patients, ages 11-12. More physicians recommended tetanus, diphtheria, and acellular pertussis (Tdap) (95%) and meningococcal vaccines (87%, both p<0.001) as highly important for this age group. Only 13% of physicians perceived HPV vaccine as being highly important to parents, which was far fewer than perceived parental support for Tdap (74%) and meningococcal vaccines (62%, both p<0.001). Physicians reported that discussing HPV vaccine took almost twice as long as discussing Tdap. Among physicians with a preferred order for discussing adolescent vaccines, most (70%) discussed HPV vaccine last. Our findings suggest that primary care physicians perceived HPV vaccine discussions to be burdensome, requiring more time and engendering less parental support than other adolescent vaccines. Perhaps for this reason, physicians in our national study recommended HPV vaccine less strongly than other adolescent vaccines, and often chose to discuss it last. Communication strategies are needed to support physicians in recommending HPV vaccine with greater confidence and efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

The cost and quality of hospitalists.

PubMed

Gipe, B T

2000-03-01

The Hospitalist concept is becoming the standard of practice as managed care penetration grows. It is increasingly difficult to do a good job in the outpatient arena and this makes the old "double threat" model in which the physician speeds through inpatient rounds in the morning before clinic, during lunch, and again at night after his office closes, obsolete. There is simply too much at stake in the inpatient arena to have large periods of time in which physician coverage is minimal. Controversy exists as to whether or not the services should be "outsourced" to a Hospitalist management company or developed internally, using physicians who historically have had a significant presence in the hospital. If the services are outsourced, then it is essential that they be built around a strong local physician leader who remains active in patient care. The French author, Anais Nin wrote: "There are very few human beings who receive the truth, complete and staggering, by instant illumination. Most of them acquire it fragment by fragment, on a small scale, by successive developments, cellularly, like a laborious mosaic." Inpatient care in the United States is adequately described as a laborious mosaic in which providers of many different services surround patients with many different problems. Hospitalist programs can help to bring order to the mosaic by consistently combining the correct physician talent with the system's sickest and most expensive patients in order to achieve the best possible outcomes.

Fighting antibiotic resistance in Portuguese hospitals: Understanding antibiotic prescription behaviours to better design antibiotic stewardship programmes.

PubMed

Simões, Alexandra S; Alves, Daniela A; Gregório, João; Couto, Isabel; Dias, Sónia; Póvoa, Pedro; Viveiros, Miguel; Gonçalves, Luzia; Lapão, Luís V

2018-06-01

Since physicians play an important role in antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge and to understand prescription behaviours, difficulties and barriers in their antibiotic prescription process in order to promote better and well-adapted antibiotic stewardship policies. This study was conducted in 2016 using a self-administered questionnaire to physicians in two tertiary public hospitals from two different regions in Portugal. Participating physicians [response rate 47.6% (30/63)] identified antibiotic resistance as a global problem; however, one-third did not recognise antibiotic resistance as a major problem on their own hospital. Factors that most influenced antibiotic prescription were 'microbiology laboratory results', 'patient clinical situation' and patient 'co-morbidities'. On the other hand, 'colleagues' opinion' and 'costs control' were considered as less determining factors. Regarding difficulties and bottlenecks in the antibiotic prescription process, participant physicians reported 'lack of (or delayed) microbiological results' and 'no access to antibiotic susceptibility patterns' as major barriers. 'Education and training' was considered the most effective intervention to improve antibiotic prescription. These results suggest that the design and implementation of antibiotic stewardship interventions should provide better data management and sharing tools between physicians and the microbiology laboratory, especially through the creation of antimicrobial prescribing guidelines according to hospital epidemiology, and easy access to hospital antibiotic susceptibility patterns and epidemiological data. Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

A study of renal function influence by integrating cloud-based manometers and physician order entry systems.

PubMed

Lin, Yuh-Feng; Sheng, Li-Huei; Wu, Mei-Yi; Zheng, Cai-Mei; Chang, Tian-Jong; Li, Yu-Chuan; Huang, Yu-Hui; Lu, Hsi-Peng

2014-12-01

No evidence exists from randomized trials to support using cloud-based manometers integrated with available physician order entry systems for tracking patient blood pressure (BP) to assist in the control of renal function deterioration. We investigated how integrating cloud-based manometers with physician order entry systems benefits our outpatient chronic kidney disease patients compared with typical BP tracking systems. We randomly assigned 36 chronic kidney disease patients to use cloud-based manometers integrated with physician order entry systems or typical BP recording sheets, and followed the patients for 6 months. The composite outcome was that the patients saw improvement both in BP and renal function. We compared the systolic and diastolic BP (SBP and DBP), and renal function of our patients at 0 months, 3 months, and 6 months after using the integrated manometers and typical BP monitoring sheets. Nighttime SBP and DBP were significantly lower in the study group compared with the control group. Serum creatinine level in the study group improved significantly compared with the control group after the end of Month 6 (2.83 ± 2.0 vs. 4.38 ± 3.0, p = 0.018). Proteinuria improved nonsignificantly in Month 6 in the study group compared with the control group (1.05 ± 0.9 vs. 1.90 ± 1.3, p = 0.09). Both SBP and DBP during the nighttime hours improved significantly in the study group compared with the baseline. In pre-end-stage renal disease patients, regularly monitoring BP by integrating cloud-based manometers appears to result in a significant decrease in creatinine and improvement in nighttime BP control. Estimated glomerular filtration rate and proteinuria were found to be improved nonsignificantly, and thus, larger population and longer follow-up studies may be needed.

Family physician perceptions of working with LGBTQ patients: physician training needs.

PubMed

Beagan, Brenda; Fredericks, Erin; Bryson, Mary

2015-01-01

Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

Implementing a Commercial Rule Base as a Medication Order Safety Net

PubMed Central

Reichley, Richard M.; Seaton, Terry L.; Resetar, Ervina; Micek, Scott T.; Scott, Karen L.; Fraser, Victoria J.; Dunagan, W. Claiborne; Bailey, Thomas C.

2005-01-01

A commercial rule base (Cerner Multum) was used to identify medication orders exceeding recommended dosage limits at five hospitals within BJC HealthCare, an integrated health care system. During initial testing, clinical pharmacists determined that there was an excessive number of nuisance and clinically insignificant alerts, with an overall alert rate of 9.2%. A method for customizing the commercial rule base was implemented to increase rule specificity for problematic rules. The system was subsequently deployed at two facilities and achieved alert rates of less than 1%. Pharmacists screened these alerts and contacted ordering physicians in 21% of cases. Physicians made therapeutic changes in response to 38% of alerts presented to them. By applying simple techniques to customize rules, commercial rule bases can be used to rapidly deploy a safety net to screen drug orders for excessive dosages, while preserving the rule architecture for later implementations of more finely tuned clinical decision support. PMID:15802481

Pain, sympathy and the medical encounter between the mid eighteenth and the mid twentieth centuries

PubMed Central

Bourke, Joanna

2014-01-01

Witnessing people in pain inevitably elicits anxiety in physicians and other caregivers. Physicians are often required to inflict certain types of discomforts in order to alleviate other, more destructive, pains. Accusations that physicians lacked sympathy can be heard throughout the centuries. This article explores the diverse medical responses to such claims between the eighteenth and twentieth centuries. It interrogates changing definitions of clinical sympathy. The concept of sympathy was continually being reworked for each generation of medical professional. Crucially, in this reworking, philosophers (such as Adam Smith) and physicians came into dialogue. Cultures of sympathy were understood in both physiological and metaphorical terms, and were tied to changing notions of professionalization PMID:24489439

The physician-administrator as patient: distinctive aspects of medical care.

PubMed

Cappell, Mitchell S

2011-01-01

This article examines distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital. The article describes eight distinctive aspects of administrator-physicians as patients, including special patient treatment; exalted patient expectations by hospital personnel; patient suppression of emotions; patient denial; self-doctoring; job stress contributing to disease; self-sacrifice to achieve better health; and rational medical decisions when not under stress. Health-care workers should recognize how these distinctive aspects of medical care and behavior affect administrator-physicians as patients, in order to mitigate their negative effects, potentiate their positive effects, and optimize the care of these patients.

Assessing the Validity of Using Serious Game Technology to Analyze Physician Decision Making

PubMed Central

Mohan, Deepika; Angus, Derek C.; Ricketts, Daniel; Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R.; Yealy, Donald M.; Barnato, Amber E.

2014-01-01

Background Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. Methods We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. Findings We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). Conclusions We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory. PMID:25153149

Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards

PubMed Central

2013-01-01

Background Poor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care. Methods Qualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofesional contexts. Results Physicians in GIM wards communicated with other professions mainly in structured rounds. Physicians’ communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians. Conclusion Without interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care. Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions. PMID:24274052

Development and Validation of a Measure of Intention to Stay in Academia for Physician Assistant Faculty

ERIC Educational Resources Information Center

Graham, Karen

2012-01-01

This study attempted development and validation of a measure of "intention to stay in academia" for physician assistant (PA) faculty in order to determine if the construct could be measured in way that had both quantitative and qualitative meaning. Adopting both the methodologic framework of the Rasch model and the theoretical framework…

Form reconciles meds, but doctor buy-in difficult.

PubMed

2006-02-01

One ED has developed a medication reconciliation form to meet the National Patient Safety Goal of reconciling medications across the continuum of care. The form does require additional staff time to complete. Staff and physicians need training so they understand the importance of meeting the safety goal. Physicians may resist giving orders on previously prescribed meds and may see the form as redundant.

75 FR 7266 - Roaring Fork Valley Physicians I.P.A.; Analysis of the Agreement Containing Consent Order to Aid...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-18

... FEDERAL TRADE COMMISSION [File No. 061 0172] Roaring Fork Valley Physicians I.P.A.; Analysis of... attached Analysis to Aid Public Comment describes both the allegations in the draft complaint and the terms... Commission, has been placed on the public record for a period of thirty (30) days. The following Analysis to...

The use of ambulatory blood pressure monitoring to confirm a diagnosis of high blood pressure by primary-care physicians in Oregon.

PubMed

Carter, Brittany U; Kaylor, Mary Beth

2016-04-01

Hypertension is the most commonly diagnosed medical condition in the USA. Unfortunately, patients are misdiagnosed in primary care because of inaccurate office-based blood pressure measurements. Several US healthcare organizations currently recommend confirming an office-based hypertension diagnosis with ambulatory blood pressure monitoring to avoid overtreatment; however, its use for the purpose of confirming an office-based hypertension diagnosis is relatively unknown. This descriptive study surveyed 143 primary-care physicians in Oregon with regard to their current use of ambulatory blood pressure monitoring. Nineteen percent of the physicians reported that they would use ambulatory blood pressure monitoring to confirm an office-based hypertension diagnosis, although over half had never ordered it. The most frequent indication for ordering ambulatory blood pressure monitoring was to investigate suspected white-coat hypertension (37.3%). In addition, many of the practices did not own an ambulatory blood pressure monitoring device (79.7%) and, therefore, had to refer patients to other clinics or departments for testing. Many primary-care physicians will need to change their current clinical practice to align with the shift toward a confirmation process for office-based hypertension diagnoses to improve population health.

Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

PubMed

Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

2014-11-01

To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Dutch physicians on the role of the family in continuous sedation.

PubMed

van Tol, Donald G; Kouwenhoven, Pauline; van der Vegt, Bea; Weyers, Heleen

2015-03-01

In order to relieve intractable suffering of a terminal patient, doctors may decide to continuously sedate a patient until the end of life. Little research is done on the role the family plays during the process of continuous sedation. This study aims to get a view of doctors' experiences with continuous sedation, and the role of the family throughout that process. We held in-depth interviews with 48 doctors (19 general practitioners, 16 nursing home doctors and 18 medical specialists). Participants were selected varying in experience and opinions concerning end-of-life decisions. Dutch physicians experience the role of family in continuous sedation as important and potentially difficult. Difficulties may rise especially during the final stages when the patient is no longer conscious and family members are waiting for death to come. Disagreement may arise between physician and family, concerning the dignity of the dying process or the question whether the sedated patient is suffering or not. Some physicians report they hastened the dying process, in order to relieve the families' suffering. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integrating nutrition services into primary care

PubMed Central

Crustolo, Anne Marie; Kates, Nick; Ackerman, Sari; Schamehorn, Sherri

2005-01-01

PROBLEM BEING ADDRESSED Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians’ activities. CONCLUSION Registered dietitians can augment and complement family physicians’ activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices. PMID:16805083

Plastic Surgery Overseas: How Much Should a Physician Risk in the Pursuit of Higher-Quality Continuity of Care?

PubMed

Schweikart, Scott

2018-04-01

In this article I discuss medical tourism, whereby patients go overseas for plastic surgery treatment in order to save money. However, if malpractice occurs abroad, there are several barriers that make it difficult for patients to recover damages. I explain these legal barriers and then discuss the possible causes of action patients can have over their "domestic physician" (their personal physician who might have referred surgery abroad or who gives postoperative follow-up care) and how these causes of action can create avenues of legal recovery not otherwise available. The possible liability of the domestic physician in the context of surgical malpractice abroad creates an ethical tension in the pursuit of higher-quality continuity of care, as the more involved the physician becomes in the process, the more likely he or she will assume liability. © 2018 American Medical Association. All Rights Reserved.

Pediatric caregiver involvement in the assessment of physicians.

PubMed

Moreau, Katherine A; Pound, Catherine M; Eady, Kaylee

2015-08-01

Given the growth and benefits of consumerist and family-centred approaches to pediatric health care, there is a need to involve pediatric caregivers in the assessment of their children's physicians. We present interconnected questions that are important to address in order to facilitate pediatric caregiver involvement in the assessment of their children's physicians. Pediatric caregivers can be valuable assessors of physicians' non-technical skills. It is important to conduct additional research on caregiver involvement in assessment activities and create a reflective discourse on this topic. To ensure that pediatric caregivers' assessments of physicians are formally recognized and advantageous, it is important to understand: (a) what pediatric caregivers can assess; (b) what assessment tools exist for pediatric caregivers; (c) how to create appropriate assessment tools for pediatric caregivers; (d) how to collect pediatric caregivers' assessments; (e) how to increase the legitimacy, use, and effectiveness of pediatric caregivers' assessments; and (f) the consequences of pediatric caregiver assessment.

Professionalism in the digital age.

PubMed

Mostaghimi, Arash; Crotty, Bradley H

2011-04-19

The increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in this digital age in order to maintain confidentiality, honesty, and trust in the medical profession. Although the ability of physicians to use online social networks, blogs, and media sites for personal and professional reasons should be preserved, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a "dual-citizenship" approach to online social media that separates public and private personae would allow physicians to both leverage networks for professional connections and maintain privacy in other aspects. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary.

Knowledge, Practices, and Perceived Barriers Regarding Cancer Pain Management Among Physicians and Nurses In Korea: A Nationwide Multicenter Survey

PubMed Central

Jho, Hyun Jung; Kim, Yeol; Kong, Kyung Ae; Kim, Dae Hyun; Choi, Jin Young; Nam, Eun Jeong; Choi, Jin Young; Koh, Sujin; Hwang, Kwan Ok; Baek, Sun Kyung; Park, Eun Jung

2014-01-01

Purpose Medical professionals’ practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. Methods A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pain management, the perceived barriers to cancer pain control, and processes perceived as the major causes of delay in opioid administration. Results A total of 333 questionnaires (149 physicians and 284 nurses) were analyzed. Nurses performed pain assessment and documentation more regularly than physicians did. Although physicians had better knowledge of pain management than did nurses, both groups lacked knowledge regarding the side effects and pharmacology of opioids. Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge. Physicians perceived patients’ reluctance to take opioids as a barrier to pain control, more so than did nurses, while nurses perceived patients’ tendency to under-report of pain as a barrier, more so than did physicians. Physicians and nurses held different perceptions regarding major cause of delay during opioid administration. Conclusions There were differences between physicians and nurses in knowledge and practices for cancer pain management. An effective educational strategy for cancer pain management is needed in order to improve medical professionals’ knowledge and clinical practices. PMID:25144641

The trend and features of physician workforce supply in China: after national medical licensing system reform.

PubMed

Tang, Chengxiang; Tang, Daisheng

2018-04-03

The annual number of newly licensed physicians is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health care market over a period. In order to both regulate medical professions and improve the quality of health care services, China established its medical licensing system from the point of the implementation of 'Law on Practising Doctors' in 1999. The objective of this study is to depict the trend and structure of newly licensed physicians thereafter. This study analyses a unique census data set that provides the headcount of newly licensed physicians from 2005 to 2015 in China. We also review a short history of medical licensing system reform in China since the 1990s. The annual number of first-time licensed physicians in China increased from 159 489 in 2005 to 221 639 in 2015. Up to 2015, over half of newly licensed physicians had not received a medical education equivalent to a bachelor degree or higher. Around 51% of China's newly licensed physicians were female in 2005, while the same ratio for females in 2015 was 56%. This article first provides an exploratory analysis of physician inflow into health care market in China using physician licensing data. The medical licensing system in China allows entering physicians with a broad range of educational levels. Moreover, the feminisation of the physician supply in China has become increasingly apparent and its impacts on health care provision still require more rigorous examination.

The migration of physicians and the local supply of practitioners: a five-year comparison.

PubMed

Ricketts, Thomas C

2013-12-01

The overall distribution of physicians in the United States is uneven, with concentrations in urban areas while some rural places have proportionately very few. This report examines the movement of physicians who have completed their training and choose to move from one location to another. The analysis linked the locations of practice of physicians practicing in the 50 U.S. states in 2006 and 2011 using data from the American Medical Association Physician Masterfile. Age, gender, location practice, activity status, and specialty were included in the data. Physicians who changed address in the five-year period were identified and were compared with nonmovers using descriptive statistics. A summary logistic regression of movers compared with nonmovers was performed to assess the most important correlates of migration. The overall rate of county-to-county relocation for physicians was 19.8% for the five-year period 2006-2011. Analyses indicated that older, male, and urban physicians were less likely to move; that physicians with osteopathic training were more likely to move; and that surgeons and primary care physicians were less likely to move compared with other specialists. The physician workforce in the United States migrates from place to place, and this movement determines the local supply of practitioners at any given time. Programs that intend to influence the local supply of doctors should account for this background tendency to relocate practice in order to achieve goals of more equal geographic distribution.

Blood bank on-call physician's experiences at a large university medical center.

PubMed

Bryant, Barbara J; Alperin, Jack B; Indrikovs, Alexander J

2005-01-01

The responsibilities of the blood bank on-call physician (blood bank physician from here on) encompass many aspects of transfusion medicine and physician education. This physician is available 24 hours a day to address any issues concerning the collection and transfusion of blood and blood components. The purpose of this study was to identify and categorize the issues that may confront a blood bank physician. Each call received over a 4-month period was logged and the resolution documented. The calls were grouped into five categories: donor issues, therapeutic procedure issues, patient issues, physician education issues, and requests for blood components not meeting previously defined transfusion guidelines. The blood bank physician received 224 calls during the study period. To resolve each issue, an additional 1 to 14 telephone calls were needed to gather further information. Number of calls by category were donor issues, 20 (8.9%); therapeutic procedure issues, 9 (4.0%); patient issues, 4 (1.8%); physician education issues, 33 (14.7%); and requests for blood components not meeting previously defined transfusion guidelines, 158 (70.6%). Requests for blood components were denied in 39.8 percent of the cases not meeting guidelines. Other forms of therapy were warranted in 20.9 percent of the cases. This study revealed that 85.3 percent of the calls referred to the blood bank physician related to physician education and the appropriateness of blood component orders. These results emphasize the need for ongoing education of medical staff in transfusion medicine issues.

Reduction in chemotherapy order errors with computerized physician order entry.

PubMed

Meisenberg, Barry R; Wright, Robert R; Brady-Copertino, Catherine J

2014-01-01

To measure the number and type of errors associated with chemotherapy order composition associated with three sequential methods of ordering: handwritten orders, preprinted orders, and computerized physician order entry (CPOE) embedded in the electronic health record. From 2008 to 2012, a sample of completed chemotherapy orders were reviewed by a pharmacist for the number and type of errors as part of routine performance improvement monitoring. Error frequencies for each of the three distinct methods of composing chemotherapy orders were compared using statistical methods. The rate of problematic order sets-those requiring significant rework for clarification-was reduced from 30.6% with handwritten orders to 12.6% with preprinted orders (preprinted v handwritten, P < .001) to 2.2% with CPOE (preprinted v CPOE, P < .001). The incidence of errors capable of causing harm was reduced from 4.2% with handwritten orders to 1.5% with preprinted orders (preprinted v handwritten, P < .001) to 0.1% with CPOE (CPOE v preprinted, P < .001). The number of problem- and error-containing chemotherapy orders was reduced sequentially by preprinted order sets and then by CPOE. CPOE is associated with low error rates, but it did not eliminate all errors, and the technology can introduce novel types of errors not seen with traditional handwritten or preprinted orders. Vigilance even with CPOE is still required to avoid patient harm.

Maternal and infant characteristics by mode of vitamin K prophylaxis administration.

PubMed

Khambalia, Amina Z; Roberts, Christine L; Bowen, Jennifer R; Nassar, Natasha

2012-08-01

  The aim of this study was to compare maternal and infant characteristics by mode of VK administration.   De-identified computerised birth files of all babies born in New South Wales (NSW), Australia between January 2007 and December 2009 (when VK prophylaxis was measured) were included in the present study. The outcome variable, mode of VK prophylaxis, was recorded by checkbox as oral, IM injection, none or not stated.   We analysed population-based birth data from 2007 to 2009 in NSW, Australia and found that IM injection was the most prevalent mode of administration (96.3%, n = 263, 555), followed by oral (2.6%, n = 7023) and none (1.2%, n = 3136). Compared to neonates receiving IM VK, those with oral or none were more likely to have vaginal births without medical interventions at birth centres or planned home births and were less likely to receive hepatitis B vaccination. Among neonates administered oral VK, a larger proportion were preterm births and breastfed at discharge compared to neonates administered VK as an IM injection. Neonates with no VK recorded were more likely to be admitted to neonatal intensive care, but may have received VK later in the birth admission.   A small proportion of the Australian neonates may be at risk of inadequate protection from VKBD due to parental concerns about the safety of IM injection of VK to neonates. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Pet ownership and adolescent health: cross-sectional population study.

PubMed

Mathers, Megan; Canterford, Louise; Olds, Tim; Waters, Elizabeth; Wake, Melissa

2010-12-01

To determine whether adolescent health and well-being are associated with having a pet in the household (any pet, or specifically dogs, cats or horses/ponies) or average daily time spent caring for/playing with pet(s). Design, setting and participants--Cross-sectional data from the third wave of the Health of Young Victorians Study (HOYVS), a school-based population study in Victoria, Australia. Predictors--Adolescent-reported pet ownership and average daily time spent caring for/playing with pet(s). Outcomes--Self-reported quality of life (KIDSCREEN); average 4-day daily physical activity level from a computerised diary; parent-proxy and self-reported physical and psychosocial health status (PedsQL); measured BMI status (not overweight, overweight, obese) and blood pressure. Statistical Analysis--Regression methods, adjusted for socio-demographic factors, and non-parametric methods. Household pet data were available for 928 adolescents (466 boys; mean age of 15.9 (SD 1.2) years). Most adolescents (88.7%) reported having a pet in their household. Of these, 75.1% reported no activity involving pets over the surveyed days. It appeared that neither owning a pet nor time spent caring for/playing with a pet was related, positively or negatively, to adolescent health or well-being. Despite high rates of pet ownership, adolescents had little interaction with pets. It appears that owning a pet and time spent caring for/playing with a pet was not clearly associated with adolescents' health or well-being. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Evaluating hyperglycaemia in the hospitalised patient: towards an improved system for classification and treatment.

PubMed

O'Sullivan, E P; Duignan, J; O'Shea, P; Griffin, D; Dinneen, S F

2014-03-01

Hyperglycaemia is common amongst hospitalised patients. Some of this is due to pre-existing diabetes (either previously diagnosed or not), but a proportion is due to stress hyperglycaemia, a transient state of high blood sugars related to the underlying illness. We aimed to estimate the prevalence of hyperglycaemia in an Irish hospital setting, including an assessment of what contribution is made by cases of stress hyperglycaemia. Over a 9-day period, all bedside glucometer-measured point of care blood glucoses performed in medical and surgical wards in University Hospital Galway were examined. Medical case notes and our diabetes computerised database were analysed to identify individuals with pre-existing diabetes. Glycosylated haemoglobin (HbA1c) was measured on the remainder of patients, to differentiate between pre-existing diabetes (HbA1c ≥ 48 mmol/mol) and stress hyperglycaemia (HbA1c < 48 mmol/mol). A total of 1,637 glucose readings were performed on 262 in-patients, of which 164 (63 %) were in the hyperglycaemic range. Of the 126 eligible for study inclusion, 92 (73 %) had pre-existing diabetes and 11 (9 %) had previously undiagnosed diabetes. The remaining 20 patients (16 %) had stress hyperglycaemia. We report a high prevalence of hyperglycaemia (including stress hyperglycaemia) in an in-patient cohort in whom testing was undertaken at the discretion of the treating physician. Our data illustrate the utility of HbA1c measurement in this setting to help differentiate between pre-existing diabetes and stress hyperglycaemia. Much work remains to be done on how to best identify and treat in-patient hyperglycaemia.

Analysis of Suicidal Behaviour in Israeli Veterans and Terror Victims with Post-Traumatic Stress Disorder by Using the Computerised Gottschalk-Gleser Scales

ERIC Educational Resources Information Center

Galor, Sharon; Hentschel, Uwe

2009-01-01

The primary objective of this study was to identify the vulnerability factors for suicide attempts in an Israeli sample, with the help of the Gottschalk-Gleser content analysis scales. The respondents were divided into four groups: suicide attempters; controls; post-traumatic stress disorder and depressed patients who did not report suicidal…

The Development and Empowerment of Mathematical Abilities: The Impact of Pencil and Paper and Computerised Interventions for Preschool Children

ERIC Educational Resources Information Center

Mascia, Maria Lidia; Agus, Mirian; Fastame, Maria Chiara; Penna, Maria Pietronilla; Sale, Eliana; Pessa, Eliano

2015-01-01

The development of numerical abilities was examined in three groups of 5 year-olds: one including 13 children accomplishing a numerical training in pencil-and-paper format (EG1); another group including 21 children accomplished a homologous training in computerized format; the remaining 24 children were assigned to the control group (CG). The…

Catching the Early Walker: An Examination of Potential Antecedents of Rapid Student Exit from Business-Related Undergraduate Degree Programmes in a Post-1992 University

ERIC Educational Resources Information Center

Bennett, Roger; Kottasz, Rita; Nocciolino, Julia

2007-01-01

Outputs from a computerised touch pad turnstile security system that recorded business students' entries into and exits from a university's buildings revealed that a significant number of the institution's first-year intake withdrew from their (business) degree programmes within a few weeks of enrolment. Accordingly, a sample of these "early…

US primary care physicians' opinions about conscientious refusal: a national vignette experiment.

PubMed

Brauer, Simon G; Yoon, John D; Curlin, Farr A

2016-02-01

Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians' beliefs about what responses are appropriate. We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements. Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86). This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Analysis of Low Appropriateness Score Exam Trends in Decision Support-based Radiology Order Entry System.

PubMed

Gupta, Supriya; Klein, Kandace; Singh, Anand H; Thrall, James H

2017-05-01

Awareness of imaging utilization increased after implementation of Radiology Order Entry with decision support systems (ROE-DS). Our hypothesis is few exams with low Clinical Appropriateness Score (CAS) on ROE-DS are performed. Clinical indications of exams with CAS less than 3 (9-point scale) were re-reviewed and reports analyzed. Structured Query Language-based query retrieved exams with CAS less than 3 in ROE-DS from January 2007 to December 2011. Reasons provided by physicians for ordering these exams and reports of exams performed were analyzed. For each indication, number of exams ordered and performed was calculated. Statistical significance was assessed using Student's t test and χ 2 analysis (P < .05). From 445,984 exams, 12,615 exams (2.8%) had CAS less than 3, and 7,956 exams (63%) were performed. Reasons for ordering of 12,615 low CAS exams were as follows: Requests by physician specialists without further explanation (4,516 = 35.8%), notation of special clinical circumstances (2,877 = 22.8%), requests by nonphysician staff without further explanation (1,383 = 10.9%), absence of suspected finding on previous modality (1,099 = 8.7%), patient preference (737 = 5.8%), and requests based on radiologists' recommendations (706 = 5.6%). Difference between male and female (male < female) preferences for low CAS exams was statistically significant (P < .01). Imaging outcome was highest for extremity MRI cases (66.7%; P < .01). Less than 3% of exams ordered had low CAS and about two-thirds of these were performed. Most common indication for ordering these exams was physician specialist request based on opinion of medical necessity without specification. Extremity MRI constituted the highest positive findings for low CAS exams performed. Published by Elsevier Inc.

Avoidance of anticipated regret: the ordering of prostate-specific antigen tests.

PubMed

Sorum, Paul C; Mullet, Etienne; Shim, Junseop; Bonnin-Scaon, Sylvie; Chasseigne, Gérard; Cogneau, Joël

2004-01-01

When making decisions, people are known to try to minimize the regret that would be provoked by unwanted consequences of these decisions. The authors explored the strength and determinants of such anticipated regret in a study of physicians' decisions to order prostate-specific antigen (PSA) tests. 32 US and 33 French primary care physicians indicated the likelihood they would order a PSA for 32 hypothetical men presenting for routine physical exams. They then indicated how much regret they would feel if they found advanced prostate cancer in 12 other patients for whom they had chosen not to order PSAs several years before. The latter patients differed according to age (55, 65, or 75 years), a prior request or not for PSA testing, and no or some irregularity of the prostate on the earlier rectal exam. ANOVA found that regret was higher when the patient had requested a PSA, the prostate was irregular, and the patient was younger. Shape had less effect when the patient had requested a PSA. US physicians had more regret than the French, patient request had a greater impact on the Americans, and increasing patient age reduced regret more among the French. In a 1-way correlation, the regret score was associated with the likelihood of ordering PSAs for both the French (r = 0.64, P < 0.005) and the Americans (r = 0.42, P< 0.02). In a regression analysis too, the regret score was the most important predictor of the likelihood of ordering a PSA (beta = 0.37, P < 0.0001). Regret over failing to diagnose aggressive prostate cancer is associated with a policy of ordering PSAs. This regret appears to be culturally sensitive.

Decision tools in health care: focus on the problem, not the solution.

PubMed

Liu, Joseph; Wyatt, Jeremy C; Altman, Douglas G

2006-01-20

Systematic reviews or randomised-controlled trials usually help to establish the effectiveness of drugs and other health technologies, but are rarely sufficient by themselves to ensure actual clinical use of the technology. The process from innovation to routine clinical use is complex. Numerous computerised decision support systems (DSS) have been developed, but many fail to be taken up into actual use. Some developers construct technologically advanced systems with little relevance to the real world. Others did not determine whether a clinical need exists. With NHS investing 5 billion pounds sterling in computer systems, also occurring in other countries, there is an urgent need to shift from a technology-driven approach to one that identifies and employs the most cost-effective method to manage knowledge, regardless of the technology. The generic term, 'decision tool' (DT), is therefore suggested to demonstrate that these aids, which seem different technically, are conceptually the same from a clinical viewpoint. Many computerised DSSs failed for various reasons, for example, they were not based on best available knowledge; there was insufficient emphasis on their need for high quality clinical data; their development was technology-led; or evaluation methods were misapplied. We argue that DSSs and other computer-based, paper-based and even mechanical decision aids are members of a wider family of decision tools. A DT is an active knowledge resource that uses patient data to generate case specific advice, which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them. The identification of DTs as a consistent and important category of health technology should encourage the sharing of lessons between DT developers and users and reduce the frequency of decision tool projects focusing only on technology. The focus of evaluation should become more clinical, with the impact of computer-based DTs being evaluated against other computer, paper- or mechanical tools, to identify the most cost effective tool for each clinical problem. We suggested the generic term 'decision tool' to demonstrate that decision-making aids, such as computerised DSSs, paper algorithms, and reminders are conceptually the same, so the methods to evaluate them should be the same.

Clinical and cost effectiveness of computer treatment for aphasia post stroke (Big CACTUS): study protocol for a randomised controlled trial.

PubMed

Palmer, Rebecca; Cooper, Cindy; Enderby, Pam; Brady, Marian; Julious, Steven; Bowen, Audrey; Latimer, Nicholas

2015-01-27

Aphasia affects the ability to speak, comprehend spoken language, read and write. One third of stroke survivors experience aphasia. Evidence suggests that aphasia can continue to improve after the first few months with intensive speech and language therapy, which is frequently beyond what resources allow. The development of computer software for language practice provides an opportunity for self-managed therapy. This pragmatic randomised controlled trial will investigate the clinical and cost effectiveness of a computerised approach to long-term aphasia therapy post stroke. A total of 285 adults with aphasia at least four months post stroke will be randomly allocated to either usual care, computerised intervention in addition to usual care or attention and activity control in addition to usual care. Those in the intervention group will receive six months of self-managed word finding practice on their home computer with monthly face-to-face support from a volunteer/assistant. Those in the attention control group will receive puzzle activities, supplemented by monthly telephone calls. Study delivery will be coordinated by 20 speech and language therapy departments across the United Kingdom. Outcome measures will be made at baseline, six, nine and 12 months after randomisation by blinded speech and language therapist assessors. Primary outcomes are the change in number of words (of personal relevance) named correctly at six months and improvement in functional conversation. Primary outcomes will be analysed using a Hochberg testing procedure. Significance will be declared if differences in both word retrieval and functional conversation at six months are significant at the 5% level, or if either comparison is significant at 2.5%. A cost utility analysis will be undertaken from the NHS and personal social service perspective. Differences between costs and quality-adjusted life years in the three groups will be described and the incremental cost effectiveness ratio will be calculated. Treatment fidelity will be monitored. This is the first fully powered trial of the clinical and cost effectiveness of computerised aphasia therapy. Specific challenges in designing the protocol are considered. Registered with Current Controlled Trials ISRCTN68798818 on 18 February 2014.

Evaluation of an interactive case simulation system in dermatology and venereology for medical students

PubMed Central

Wahlgren, Carl-Fredrik; Edelbring, Samuel; Fors, Uno; Hindbeck, Hans; Ståhle, Mona

2006-01-01

Background Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning. Methods Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination. Results The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination. Conclusion We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination. PMID:16907972

Demonstrating the effectiveness of body armour: a pilot prospective computerised surface wound mapping trial performed at the Role 3 hospital in Afghanistan.

PubMed

Breeze, Johno; Allanson-Bailey, L S; Hepper, A E; Midwinter, M J

2015-03-01

Modern body armour clearly reduces injury incidence and severity, but evidence to actually objectively demonstrate this effect is scarce. Although the Joint Theatre Trauma Registry (JTTR) alone cannot relate injury pattern to body armour coverage, the addition of computerised Surface Wound Mapping (SWM) may enable this utility. Surface wound locations of all UK and NATO coalition soldiers, Afghan National Army and Police and local nationals injured by explosively propelled fragments and treated in the Role 3 UK-led Field Hospital in Camp Bastion, Afghanistan, between 8 July and 20 October 2012 were prospectively recorded. The Abbreviated Injury Scores (AIS) and relative risk of casualties sustaining injuries under a type of body armour were compared with those that did not wear that armour. Casualties wearing a combat helmet were 2.7 times less likely to sustain a fragmentation wound to the head than those that were unprotected (mean AIS of 2.9 compared with 4.1). Casualties wearing a body armour vest were 4.1 times less likely to sustain a fragmentation wound to the chest or abdomen than those that were unprotected (mean AIS of 2.9 compared with 3.9). Casualties wearing pelvic protection were 10 times less likely to sustain a fragmentation wound to the pelvis compared with those that were unprotected (mean AIS of 3.4 compared with 3.9). Computerised SWM has objectively demonstrated the ability of body armour worn on current operations in Afghanistan to reduce wound incidence and severity. We recognise this technique is limited in that it only records the surface wound location and may be specific to this conflict. However, gathering electronic SWM at the same time as recording injuries for the JTTR was simple, required little extra time and therefore we would recommend its collection during future conflicts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

42 CFR 447.520 - FFP: Conditions relating to physician-administered drugs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... using Healthcare Common Procedure Coding System codes or NDC numbers in order to secure rebates. (2) As... Medicaid Program using NDC numbers in order to secure rebates. (b) As of January 1, 2007, a State must...

42 CFR 447.520 - FFP: Conditions relating to physician-administered drugs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... using Healthcare Common Procedure Coding System codes or NDC numbers in order to secure rebates. (2) As... Medicaid Program using NDC numbers in order to secure rebates. (b) As of January 1, 2007, a State must...

42 CFR 447.520 - FFP: Conditions relating to physician-administered drugs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... using Healthcare Common Procedure Coding System codes or NDC numbers in order to secure rebates. (2) As... Medicaid Program using NDC numbers in order to secure rebates. (b) As of January 1, 2007, a State must...

42 CFR 447.520 - FFP: Conditions relating to physician-administered drugs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... using Healthcare Common Procedure Coding System codes or NDC numbers in order to secure rebates. (2) As... Medicaid Program using NDC numbers in order to secure rebates. (b) As of January 1, 2007, a State must...

42 CFR 447.520 - FFP: Conditions relating to physician-administered drugs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... using Healthcare Common Procedure Coding System codes or NDC numbers in order to secure rebates. (2) As... Medicaid Program using NDC numbers in order to secure rebates. (b) As of January 1, 2007, a State must...

Medicinal Behavior in Persian Literature by Emphasis on Ibn-Sina Popular Literature

PubMed Central

Kolahdouzan, Akbar; Vahabi, Fataneh

2013-01-01

Content of Persian literature comes from innocents, has special effect on social and individual people life. We understand worth of medical science, physician and sick people relationship in society and impact of religion behavior in treatment. Persian literature contains some recommendation that improve belief, trust, and secretary in medical society. In this article we chose some Persian literature about medicinal behavior and discuss trough: physician relationship with GOD and its impact on treatment, and sick people with others. We hope by studying this article physician can work better and sick people obey their orders more. PMID:23687466

Learning the preferences of physicians for the organization of result lists of medical evidence articles.

PubMed

O'Sullivan, D; Wilk, S; Michalowski, W; Slowinski, R; Thomas, R; Kadzinski, M; Farion, K

2014-01-01

Online medical knowledge repositories such as MEDLINE and The Cochrane Library are increasingly used by physicians to retrieve articles to aid with clinical decision making. The prevailing approach for organizing retrieved articles is in the form of a rank-ordered list, with the assumption that the higher an article is presented on a list, the more relevant it is. Despite this common list-based organization, it is seldom studied how physicians perceive the association between the relevance of articles and the order in which articles are presented. In this paper we describe a case study that captured physician preferences for 3-element lists of medical articles in order to learn how to organize medical knowledge for decision-making. Comprehensive relevance evaluations were developed to represent 3-element lists of hypothetical articles that may be retrieved from an online medical knowledge source such as MEDLINE or The Cochrane Library. Comprehensive relevance evaluations asses not only an article's relevance for a query, but also whether it has been placed on the correct list position. In other words an article may be relevant and correctly placed on a result list (e.g. the most relevant article appears first in the result list), an article may be relevant for a query but placed on an incorrect list position (e.g. the most relevant article appears second in a result list), or an article may be irrelevant for a query yet still appear in the result list. The relevance evaluations were presented to six senior physicians who were asked to express their preferences for an article's relevance and its position on a list by pairwise comparisons representing different combinations of 3-element lists. The elicited preferences were assessed using a novel GRIP (Generalized Regression with Intensities of Preference) method and represented as an additive value function. Value functions were derived for individual physicians as well as the group of physicians. The results show that physicians assign significant value to the 1st position on a list and they expect that the most relevant article is presented first. Whilst physicians still prefer obtaining a correctly placed article on position 2, they are also quite satisfied with misplaced relevant article. Low consideration of the 3rd position was uniformly confirmed. Our findings confirm the importance of placing the most relevant article on the 1st position on a list and the importance paid to position on a list significantly diminishes after the 2nd position. The derived value functions may be used by developers of clinical decision support applications to decide how best to organize medical knowledge for decision making and to create personalized evaluation measures that can augment typical measures used to evaluate information retrieval systems.

Acute knee injuries: use of decision rules for selective radiograph ordering.

PubMed

Tandeter, H B; Shvartzman, P; Stevens, Max A

1999-12-01

Family physicians often encounter patients with acute knee trauma. Radiographs of injured knees are commonly ordered, even though fractures are found in only 6 percent of such patients and emergency department physicians can usually discriminate clinically between fracture and nonfracture. Decision rules have been developed to reduce the unnecessary use of radiologic studies in patients with acute knee injury. The Ottawa knee rules and the Pittsburgh decision rules are the latest guidelines for the selective use of radiographs in knee trauma. Application of these rules may lead to a more efficient evaluation of knee injuries and a reduction in health costs without an increase in adverse outcomes.

Saving a Drug Poisoning Victim: A Kinetics Simulation

NASA Astrophysics Data System (ADS)

Selco, Jodye I.; Beery, Janet

2002-05-01

In this project, students, posing as hospital emergency room physicians, must save the life of a child who has accidentally overdosed on the asthma medication, theophylline. The progress of the drug through the child's body can be modeled as a chemical kinetics problem involving first-order consecutive reactions. Students begin by setting up a system of linear first-order differential equations describing the medication's absorption into and elimination from the child's bloodstream using half-lives obtained from the Physician's Desk Reference. By using a computer to solve the differential equations numerically, students discover that the child will almost certainly die if they, as physicians, do not intervene. The students then determine by how much they need to increase the drug's elimination rate in order to save the child. This dictates the appropriate medical action. Students discover that they need to use the more drastic treatment of extracorporeal filtering of the blood through charcoal, rather than simply administering oral doses of charcoal. We've found that this project appeals to a broad range of students; many students are interested in careers in the health professions and all are intrigued by the child's grave situation.

A Cross-site Qualitative Study of Physician Order Entry

PubMed Central

Ash, Joan S.; Gorman, Paul N.; Lavelle, Mary; Payne, Thomas H.; Massaro, Thomas A.; Frantz, Gerri L.; Lyman, Jason A.

2003-01-01

Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. Measurements: Patterns and themes concerning perceptions of POE were identified. Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied. PMID:12595408

[Another profession in the Ottoman period dealing with pharmaceutics: surgery].

PubMed

Altintaş, Ayten

2004-01-01

We have realized in many documents that in the Ottoman period surgeons were involved in pharmaceutics as much as physicians and herbalists. Surgeons employed by the state ordered more drugs than physicians, and it is interesting that in their order list there were mostly singular drugs instead of ready-made ones. In addition to drugs used by surgeons in preparing ointments and plasters, pans and filters were utilized in the process of production, and earthenware pots, tin and wooden boxes with various kinds of paper were ordered for the purpose of packaging. We have determined that most of the single drugs placed onto the lists of surgeons were "ointment of rust" that dries the pus, and "red ointment" that is good for all kinds of pus. The preparation of the ointments were specified in detail in books of surgery (Cerrahnames)We have observed that parallel to the Regulation of 1826, surgeons were given the title of pharmacist when they were appointed to military bodies. 100 kurus (piaster) were paid to surgeons for performing surgery and 50 kurus for preparing drugs, which is another important document indicating that surgeons were more responsible than physicians in preparing drugs.

Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor?

PubMed

Street, Richard L; Gordon, Howard; Haidet, Paul

2007-08-01

Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

"It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals.

PubMed

Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L

2017-06-30

nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness.

PubMed

Fries, Christopher J

2008-11-01

ABSTRACTOBJECTIVETo develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSIONThis study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.

Physician self-referral and physician-owned specialty facilities.

PubMed

Casalino, Lawrence P

2008-06-01

Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

Qualitative study of employment of physician assistants by physicians

PubMed Central

Taylor, Maureen T.; Wayne Taylor, D.; Burrows, Kristen; Cunnington, John; Lombardi, Andrea; Liou, Michelle

2013-01-01

Abstract Objective To explore the experiences and perceptions of Ontario physician assistant (PA) employers about the barriers to and benefits of hiring PAs. Design A qualitative design using semistructured interviews. Setting Rural and urban eastern and southwestern Ontario. Participants Seven family physicians and 7 other specialists. Methods The 14 physicians participated in semistructured interviews, which were audiorecorded and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis. Main findings Physician-specific benefits to hiring PAs included increased flexibility, the opportunity to expand practice, the ability to focus more time on complex patients, overall reduction in work hours and stress, and an opportunity for professional fellowship. Physicians who hired PAs without government financial support said PAs were affordable as long as they were able to retain them. Barriers to hiring PAs included uncertainty about funding, the initial need for intensive supervision and training, and a lack of clarity around delegation of acts. Conclusion Physicians are motivated to hire PAs to help deal with long wait times and long hours, but few are expecting to increase their income by taking on PAs. Governments, medical colleges, educators, and regulators must address the perceived barriers to PA hiring in order to expand and optimize this profession. PMID:24235209

Reflective Practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States

ERIC Educational Resources Information Center

Miller Juve, Amy Katrina

2012-01-01

The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge…

Trials, settlements, and arbitration. The defendant's perspective.

PubMed

Martello, J

1999-01-01

Knowledge, preparation, and planning can greatly increase a physician's chances of success in a medical malpractice trial. In this article, the author presents an overview of the many questions that must be addressed in any medical negligence case in order to determine the many possible strategies that the physician and his or her defense attorney must consider. The author addresses the strategies of mediation, arbitration, settlements, and trial.

Seeking greener pastures? The relationship between career satisfaction and the intention to emigrate: a survey of Ghanaian physicians.

PubMed

Opoku, Samuel T; Apenteng, Bettye A

2014-09-01

A significant number of physicians from developing nations emigrate to developed nations in search of better career opportunities. In addition to crippling the health systems of developing nations, the emigration of physicians from sub-Saharan African (SSA) countries results in a loss of return on investment to these nations. The purpose of this study was to identify the relationship between career satisfaction and the intention of active Ghanaian physicians to leave the country within the next 5 years. This study was a cross-sectional correlational study using data from a survey of practicing physicians in Ghana. The primary independent variables examined were dimensions of career satisfaction, assessed using an abridged form of the Physician Work Life Survey. Data from the multivariate ordered logistic regression model indicated that physicians who were house officers or medical officers and those who reported dissatisfaction with their compensation were more likely to report that they were thinking about leaving Ghana within the next 5 years. Health policies aimed at increasing monetary compensation and providing junior physicians with the resources needed to excel in their careers may improve the retention of physicians in Ghana. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Physician and nurse relationships, a key to patient safety.

PubMed

Benner, Annalisa B

2007-04-01

A negative or intimidating relationship between a physician and a nurse can create a situation that puts the patient at risk. There are four areas in which communication between these groups affect patient safety and physician liability. Multiple studies have revealed that nurses who are intimidated by physicians do not contact the care provider as quickly for a patient condition change or consult with the physician as readily to clarify a medication order. Patients will be put at risk if there are not enough nurses to staff hospitals. The nursing shortage will become a greater issue as the current nursing workforce ages. The average age of a nurse in Kentucky is 44 years old. To avoid a serious nursing shortage there is a need to fill the open positions left by retiring nursing staff. Attracting the new graduates will require a positive, healthy working environment. If a course of treatment is challenged by the courts, a solid partner relationship between a physician and a nurse puts the physician in a stronger position. There are multiple organizations that have developed suggested actions that will encourage a healthy working relationship with better communication between physicians and nurses. Collaboration between physicians, nurses, and hospital administrators is the only way a healthy work environment will be attained. It is the responsibility of each group to begin the conversations that will improve this patient safety barrier.

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal

PubMed Central

Hinkelmann, Jürgen; Volkert, Thomas; Rodde, Sibyll; Hahnenkamp, Klaus

2016-01-01

Background University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. Objective In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Methods Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production (“industry 4.0”) because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts’ scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. Results We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). Conclusions All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals. PMID:28003176

Exploring the impact of word-of-mouth about Physicians' service quality on patient choice based on online health communities.

PubMed

Lu, Naiji; Wu, Hong

2016-11-26

Health care service is a high-credence service and patients may face difficulties ascertaining service quality in order to make choices about their available treatment options. Online health communities (OHCs) provide a convenient channel for patients to search for physicians' information, such as Word-of-Mouth (WOM), particularly on physicians' service quality evaluated by other patients. Existing studies from other service domains have proved that WOM impacts consumer choice. However, how patients make a choice based on physicians' WOM has not been studied, particularly with reference to different patient characteristics and by using real data. One thousand eight hundred fifty three physicians' real data were collected from a Chinese online health community. The data were analyzed using ordinary least squares (OLS) method. The study found that functional quality negatively moderated the relationship between technical quality and patient choice, and disease risk moderated the relationship between physicians' service quality and patient choice. Our study recommends that hospital managers need to consider the roles of both technical quality and functional quality seriously. Physicians should improve their medical skills and bedside manners based on the severity and type of disease to provide better service.

Effects of Compensation Methods and Physician Group Structure on Physicians' Perceived Incentives to Alter Services to Patients

PubMed Central

Reschovsky, James D; Hadley, J ack; Landon, Bruce E

2006-01-01

Objective To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Data Source Nationally representative data on physicians are from the 2000–2001 Community Tracking Study Physician Survey (N = 12,406). Study Design Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Principal Findings Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Conclusions Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage. PMID:16899003

Family physician perceptions of working with LGBTQ patients: physician training needs

PubMed Central

Beagan, Brenda; Fredericks, Erin; Bryson, Mary

2015-01-01

Background Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. Method In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women. PMID:26451226

Physician perspectives on legal processes for resolving end-of-life disputes.

PubMed

Chidwick, Paula; Sibbald, Robert

2011-01-01

In order to understand how to effectively approach end-of-life disputes, this study surveyed physicians' attitudes towards one process for resolving end-of-life disputes, namely, the Consent and Capacity Board of Ontario. In this case, the process involved examining interpretation of best interests between substitute decision-makers and medical teams. Physicians who made "Form G" applications to the Consent and Capacity Board of Ontario that resulted in a decision posted on the open-access database, Canadian Legal Information Institute (CanLii), were identified and surveyed. This purposive sample led to 13 invitations to participate and 12 interviews (92% response rate). Interviews were conducted using a prescribed interview guide. No barriers to the Consent and Capacity Board process were reported. Applications were made when physicians reached an impasse with the family and further treatment was perceived to be "unethical." The most significant challenge reported was the delay when appeals were launched. Appeals extended the process for an indefinite period of time making it so lengthy it negated any perceived benefits of the process. Benefits included that a neutral third party, namely the Consent and Capacity Board, was able to assess best interests. Also, when decisions were timely, further harm to the patient was minimized. Physicians reported this particular approach, namely the Consent and Capacity Board has a mechanism that is worthwhile, patient centred, process oriented, orderly and efficient for resolving end-of-life disputes and, in particular, determining best interests. However, unless the appeal process can be adjusted to respond to the ICU context there is a risk of not serving the best interest of patients. Physicians would recommend framing end-of-life treatment plans in the positive instead of negative, for example, propose palliative care and no escalation of treatment as opposed to withdrawal.

[The disgrace of Antoine Daquin, first physician of Louis XIV (1693)].

PubMed

Peumery, J J

1996-12-01

Antoine Daquin, Principal Physician of Louis XIV and Earl of Jouy-en-Josas, was born in Paris. He was the son of Louis-Henri Daquin, Physician to Queen Marie de Médicis; his paternal grandfather, born in the Jewish religion, became converted to catholicism at Aquino, in Italy, whence his name d'Aquin, then Daquin. A. Daquin studied to be a doctor at Montpellier and graduated on 18 May 1648. He married Marguerite Gayant, Antoine Vallot's niece, Antoine Vallot being the Principal Physician of Louis XIV. This relationship permitted him to get the position of Principal Physician of the Queen, then, after Vallot's death, to succeed him, on 18 April 1672, as Principal Physician of the King. The kindliness of the King's mistress, Mme de Montespan, helped him in that appointment. Daquin was a good doctor, he turned out awkward: "great courtier, but rich, miser, grasping, wanting to establish his family anyway" said the Duc de Saint-Simon. He dared ask the King for the Archbishopric of Tours for his son: "it was the rock on which he broke up" said again Saint-Simon. On 2 November 1693, the comte de Pontchartrain came to his home by order of the King, to tell him, he was ordered to retire from Court without delay. It was forbidden him to come back or to write to the King. Guy-Crescent Fagon was designated "Premier Médecin" instead of him; but Fagon had worked at the undoing of Daquin, with a view to robbing him of his position, with the complicity of the King's new mistress, Mme de Maintenon. After his disgrace, Daquin retired probably to Moulins; he died obscurely in Vichy, on 17 May 1696. Today, Daquin is regarded as a victim of intrigues of Court, which explains his celebrity.

Portuguese Family Physicians’ Awareness of Diagnostic and Laboratory Test Costs: A Cross-Sectional Study

PubMed Central

Sá, Luísa; Costa-Santos, Cristina; Teixeira, Andreia; Couto, Luciana; Costa-Pereira, Altamiro; Hespanhol, Alberto; Santos, Paulo; Martins, Carlos

2015-01-01

Background Physicians’ ability to make cost-effective decisions has been shown to be affected by their knowledge of health care costs. This study assessed whether Portuguese family physicians are aware of the costs of the most frequently prescribed diagnostic and laboratory tests. Methods A cross-sectional study was conducted in a representative sample of Portuguese family physicians, using computer-assisted telephone interviews for data collection. A Likert scale was used to assess physician’s level of agreement with four statements about health care costs. Family physicians were also asked to estimate the costs of diagnostic and laboratory tests. Each physician’s cost estimate was compared with the true cost and the absolute error was calculated. Results One-quarter (24%; 95% confidence interval: 23%–25%) of all cost estimates were accurate to within 25% of the true cost, with 55% (95% IC: 53–56) overestimating and 21% (95% IC: 20–22) underestimating the true actual cost. The majority (76%) of family physicians thought they did not have or were uncertain as to whether they had adequate knowledge of diagnostic and laboratory test costs, and only 7% reported receiving adequate education. The majority of the family physicians (82%) said that they had adequate access to information about the diagnostic and laboratory test costs. Thirty-three percent thought that costs did not influence their decision to order tests, while 27% were uncertain. Conclusions Portuguese family physicians have limited awareness of diagnostic and laboratory test costs, and our results demonstrate a need for improved education in this area. Further research should focus on identifying whether interventions in cost knowledge actually change ordering behavior, in identifying optimal methods to disseminate cost information, and on improving the cost-effectiveness of care. PMID:26356625

Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients

PubMed Central

Hunderfund, Andrea N. Leep; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, LeAnn M.; Britton, Jeffrey W.

2011-01-01

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls. PMID:21193651

Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences With Cost-Conscious Care.

PubMed

Leep Hunderfund, Andrea N; Dyrbye, Liselotte N; Starr, Stephanie R; Mandrekar, Jay; Naessens, James M; Tilburt, Jon C; George, Paul; Baxley, Elizabeth G; Gonzalo, Jed D; Moriates, Christopher; Goold, Susan D; Carney, Patricia A; Miller, Bonnie M; Grethlein, Sara J; Fancher, Tonya L; Reed, Darcy A

2017-05-01

To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0.82 and 0.81, respectively). Regional health care intensity was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data: ratio of physician visits per decedent compared with the U.S. average, ratio of specialty to primary care physician visits per decedent, and hospital care intensity index. Of 5,992 students invited, 3,395 (57%) responded. Ninety percent (2,640/2,932) agreed physicians have a responsibility to contain costs. However, 48% (1,1416/2,960) thought ordering a test is easier than explaining why it is unnecessary, and 58% (1,685/2,928) agreed ordering fewer tests will increase the risk of malpractice litigation. In adjusted linear regression analyses, students in higher-health-care-intensity regions reported observing significantly fewer cost-conscious role-modeling behaviors: For each one-unit increase in the three health care intensity measures, scores on the 21-point cost-conscious role-modeling scale decreased by 4.4 (SE 0.7), 3.2 (0.6), and 3.9 (0.6) points, respectively (all P < .001). Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.

Modelling the degree of porosity of the ceramic surface intended for implants.

PubMed

Stach, Sebastian; Kędzia, Olga; Garczyk, Żaneta; Wróbel, Zygmunt

2018-05-18

The main goal of the study was to develop a model of the degree of surface porosity of a biomaterial intended for implants. The model was implemented using MATLAB. A computer simulation was carried out based on the developed model, which resulted in a two-dimensional image of the modelled surface. Then, an algorithm for computerised image analysis of the surface of the actual oxide bioceramic layer was developed, which enabled determining its degree of porosity. In order to obtain the confocal micrographs of a few areas of the biomaterial, measurements were performed using the LEXT OLS4000 confocal laser microscope. The image analysis was carried out using MountainsMap Premium and SPIP. The obtained results allowed determining the input parameters of the program, on the basis of which porous biomaterial surface images were generated. The last part of the study involved verification of the developed model. The modelling method was tested by comparing the obtained results with the experimental data obtained from the analysis of surface images of the test material.

Future perspectives toward the early definition of a multivariate decision-support scheme employed in clinical decision making for senior citizens.

PubMed

Frantzidis, Christos A; Gilou, Sotiria; Billis, Antonis; Karagianni, Maria; Bratsas, Charalampos D; Bamidis, Panagiotis

2016-03-01

Recent neuroscientific studies focused on the identification of pathological neurophysiological patterns (emotions, geriatric depression, memory impairment and sleep disturbances) through computerised clinical decision-support systems. Almost all these research attempts employed either resting-state condition (e.g. eyes-closed) or event-related potentials extracted during a cognitive task known to be affected by the disease under consideration. This Letter reviews existing data mining techniques and aims to enhance their robustness by proposing a holistic decision framework dealing with comorbidities and early symptoms' identification, while it could be applied in realistic occasions. Multivariate features are elicited and fused in order to be compared with average activities characteristic of each neuropathology group. A proposed model of the specific cognitive function which may be based on previous findings (a priori information) and/or validated by current experimental data should be then formed. So, the proposed scheme facilitates the early identification and prevention of neurodegenerative phenomena. Neurophysiological semantic annotation is hypothesised to enhance the importance of the proposed framework in facilitating the personalised healthcare of the information society and medical informatics research community.

The protection of the patient's private life: the computer challenge. Second part.

PubMed

Van Overstraeten, M; Michel, Luc

2002-12-01

Today, medical practice is invaded by a growing number of technologies of all kinds, among which computer techniques have an important place. Although they have significant advantages, for instance in terms of medical record management, they give rise to several problems, particularly concerning the confidentiality of the patient's data with regards to third party. A great number of specific provisions, complementary to the general texts protecting private life (examined in the first part of this two parts article), endeavour to solve these problems. It is true that these provisions are recent, have various origins and often appear as rules difficult to understand. Yet, they are partially inspired by a common logic. Relying on these common features, the authors make two suggestions for the future, in order to avoid that the growing computerisation of medical practice eventually destabilises the health care relationship: a) Any dictatorship of confidentiality must be rejected b) Stimulating a sense of professionalism is most likely the way to avoid an anarchic and unrealistic development of rules aimed at regulating the health care relationship.

Randomised sham-controlled study of high-frequency bilateral deep transcranial magnetic stimulation (dTMS) to treat adult attention hyperactive disorder (ADHD): Negative results.

PubMed

Paz, Yaniv; Friedwald, Keren; Levkovitz, Yeheal; Zangen, Abraham; Alyagon, Uri; Nitzan, Uri; Segev, Aviv; Maoz, Hagai; Koubi, May; Bloch, Yuval

2017-01-31

Recent studies support the possible effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a treatment for attention deficit hyperactivity disorder (ADHD). The objective of this study was to evaluate the safety and possible efficacy of bilateral prefrontal deep rTMS for the treatment of adult ADHD. Twenty-six adult ADHD patients were randomised blindly to sham or actual deep TMS (dTMS). Twenty daily sessions were conducted using the bilateral H5 dTMS coil (Brainsway, IL) in order to stimulate the prefrontal cortex at 120% of the motor threshold at high frequency. For assessment, Conners' Adult ADHD Rating Scale questionnaire and a computerised continuous performance test, Test of Variables of Attention, were used. No differences in clinical outcomes were detected between the actual dTMS and sham groups. The presented evidence does not support the utility of bilateral prefrontal stimulation to treat adult ADHD. Due to the small sample size, caution must be exercised in interpreting our preliminary findings.

Diagnostic precision of mentally estimated home blood pressure means.

PubMed

Ouattara, Franck Olivier; Laskine, Mikhael; Cheong, Nathalie Ng; Birnbaum, Leora; Wistaff, Robert; Bertrand, Michel; van Nguyen, Paul; Kolan, Christophe; Durand, Madeleine; Rinfret, Felix; Lamarre-Cliche, Maxime

2018-05-07

Paper home blood pressure (HBP) charts are commonly brought to physicians at office visits. The precision and accuracy of mental calculations of blood pressure (BP) means are not known. A total of 109 hypertensive patients were instructed to measure and record their HBP for 1 week and to bring their paper charts to their office visit. Study section 1: HBP means were calculated electronically and compared to corresponding in-office BP estimates made by physicians. Study section 2: 100 randomly ordered HBP charts were re-examined repetitively by 11 evaluators. Each evaluator estimated BP means four times in 5, 15, 30, and 60 s (random order) allocated for the task. BP means and diagnostic performance (determination of therapeutic systolic and diastolic BP goals attained or not) were compared between physician estimates and electronically calculated results. Overall, electronically and mentally calculated BP means were not different. Individual analysis showed that 83% of in-office physician estimates were within a 5-mmHg systolic BP range. There was diagnostic disagreement in 15% of cases. Performance improved consistently when the time allocated for BP estimation was increased from 5 to 15 s and from 15 to 30 s, but not when it exceeded 30 s. Mentally calculating HBP means from paper charts can cause a number of diagnostic errors. Chart evaluation exceeding 30 s does not significantly improve accuracy. BP-measuring devices with modern analytical capacities could be useful to physicians.

Deficits in knowledge, attitude, and practice towards blood culture sampling: results of a nationwide mixed-methods study among inpatient care physicians in Germany.

PubMed

Raupach-Rosin, Heike; Duddeck, Arne; Gehrlich, Maike; Helmke, Charlotte; Huebner, Johannes; Pletz, Mathias W; Mikolajczyk, Rafael; Karch, André

2017-08-01

Blood culture (BC) sampling rates in Germany are considerably lower than recommended. Aim of our study was to assess knowledge, attitudes, and practice of physicians in Germany regarding BC diagnostics. We conducted a cross-sectional mixed-methods study among physicians working in inpatient care in Germany. Based on the results of qualitative focus groups, a questionnaire-based quantitative study was conducted in 2015-2016. In total, 706 medical doctors and final-year medical students from 11 out of 16 federal states in Germany participated. BC sampling was considered an important diagnostic tool by 95% of the participants. However, only 23% of them would collect BCs in three scenarios for which BC ordering is recommended by present guidelines in Germany; almost one out of ten physicians would not have taken blood cultures in any of the three scenarios. The majority of participants (74%) reported not to adhere to the guideline recommendation that blood culture sampling should include at least two blood culture sets from two different injection sites. High routine in blood culture sampling, perceived importance of blood culture diagnostics, the availability of an in-house microbiological lab, and the department the physician worked in were identified as predictors for good blood culture practice. Our study suggests that there are substantial deficits in BC ordering and the application of guidelines for good BC practice in Germany. Based on these findings, multimodal interventions appear necessary for improving BC diagnostics.

The management of health care service quality. A physician perspective.

PubMed

Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

2016-01-01

Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

Internet (WWW) based system of ultrasonic image processing tools for remote image analysis.

PubMed

Zeng, Hong; Fei, Ding-Yu; Fu, Cai-Ting; Kraft, Kenneth A

2003-07-01

Ultrasonic Doppler color imaging can provide anatomic information and simultaneously render flow information within blood vessels for diagnostic purpose. Many researchers are currently developing ultrasound image processing algorithms in order to provide physicians with accurate clinical parameters from the images. Because researchers use a variety of computer languages and work on different computer platforms to implement their algorithms, it is difficult for other researchers and physicians to access those programs. A system has been developed using World Wide Web (WWW) technologies and HTTP communication protocols to publish our ultrasonic Angle Independent Doppler Color Image (AIDCI) processing algorithm and several general measurement tools on the Internet, where authorized researchers and physicians can easily access the program using web browsers to carry out remote analysis of their local ultrasonic images or images provided from the database. In order to overcome potential incompatibility between programs and users' computer platforms, ActiveX technology was used in this project. The technique developed may also be used for other research fields.

Of mugs, meals and more: the intricate relations between physicians and the medical industry.

PubMed

Sahm, Stephan

2013-05-01

Empirical research has proven the influence exerted by the medical industry on physicians' decision-making. Physicians are the gatekeepers who determine how money is spent within the healthcare system. Hence, they are the target group of powerful lobbies in the field, i.e. the manufacturers of medical devices and the pharmaceutical industry. As clinical research lies in the hands of physicians, they play an exclusive and central role in launching new medical products. There are many ethical problems involved here: physicians may develop a mindset of entitlement; biased decisions may put patients at risk; academic interests and research activities will no longer be free if they are influenced considerably by financial incentives; fair resource allocation may be restricted. An aspect that has been neglected so far is the administrators' involvement as they not rarely expect physicians to acquire external financial resources from industry as benefits often lie with the institutions. To "protect" physicians from undue sway may be in the best interest of patients in order to guarantee a fair allocation of resources and to prevent the application of technologies (and medications) that would not have been used according to current standards of care. The latter may and obviously does put patients at risk. On the other hand, medico-industrial relations are of great importance. A considerable part of medical progress is driven by private industry. Yet, any co-operation between those who care for patients and industry ultimately has to serve the patient. Hence, strong policies to guide conduct are sorely needed. The following points are held to be pivotal in order to secure ethical conduct: (1) professional codes of ethics; (2) a stronger academic attitude amongst medical staff, (3) rules of transparency for medico-industrial relations including online disclosure and limiting scale of payments, (4) establishing rules (and laws) that ban unethical conduct and mandate vigorous surveillance of adherence to guidelines.

Physicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed.

PubMed

Hsu, Chia-Chen; Chou, Chia-Lin; Chen, Tzeng-Ji; Ho, Chin-Chin; Lee, Chung-Yuan; Chou, Yueh-Ching

2015-05-01

Clinical care has become increasingly dependent on computerized physician order entry (CPOE) systems. No study has reported the adverse effect of CPOE on physicians' ability to handwrite prescriptions. This study took advantage of an extensive crash of the CPOE system at a large hospital to assess the completeness, legibility, and accuracy of physicians' handwritten prescriptions. The CPOE system had operated at the outpatient department of an academic medical center in Taiwan since 1993. During an unintentional shutdown that lasted 3.5 hours in 2010, physicians were forced to write prescriptions manually. These handwritten prescriptions, together with clinical medical records, were later audited by clinical pharmacists with respect to 16 fields of the patient's, prescriber's, and drug data. A total of 1418 prescriptions with 3805 drug items were handwritten by 114 to 1369 patients. Not a single prescription had all necessary fields filled in. Although the field of age was most frequently omitted (1282 [90.4%] of 1418 prescriptions) among the patient's data, the field of dosage form was most frequently omitted (3480 [91.5%] of 3805 items) among the drug data. In contrast, the scale of illegibility was rather small. The highest percentage reached only 1.5% (n = 57) in the field of drug frequency. Inaccuracies of strength, dose, and drug name were observed in 745 (19.6%), 517 (13.6%), and 435 (11.4%) prescribed drug items, respectively. The unintentional shutdown of a long-running CPOE system revealed that physicians fail to handwrite flawless prescriptions in the digital era. The contingency plans for computer disasters at health care facilities might include preparation of stand-alone e-prescribing software so that the service delay could be kept to the minimum. However, guidance on prescribing should remain an essential part of medical education. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Informed consent and nudging.

PubMed

Simkulet, William

2018-06-19

In order to avoid patient abuse, under normal situations before performing a medical intervention on a patient, a physician must obtain informed consent from that patient, where to give genuine informed consent a patient must be competent, understand her condition, her options and their expected risks and benefits, and must expressly consent to one of those options. However, many patients refrain from the option that their physician believes to be best, and many physicians worry that their patients make irrational healthcare decisions, hindering their ability to provide efficient healthcare for their patients. Some philosophers have proposed a solution to this problem: they advocate that physicians nudge their patients to steer them towards their physician's preferred option. A nudge is any influence designed to predictably alter a person's behavior without limiting their options or giving them reasons to act. Proponents of nudging contend that nudges are consistent with obtaining informed consent. Here I argue that nudging is incompatible with genuine informed consent, as it violates a physician's obligation to tell their patients the truth, the whole truth, and nothing but the truth during adequate disclosure. © 2018 John Wiley & Sons Ltd.

Design and implementation of an automated email notification system for results of tests pending at discharge.

PubMed

Dalal, Anuj K; Schnipper, Jeffrey L; Poon, Eric G; Williams, Deborah H; Rossi-Roh, Kathleen; Macleay, Allison; Liang, Catherine L; Nolido, Nyryan; Budris, Jonas; Bates, David W; Roy, Christopher L

2012-01-01

Physicians are often unaware of the results of tests pending at discharge (TPADs). The authors designed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure, network email. The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available. A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility. Logic was incorporated to suppress selected tests and to limit notification volume. The system was activated for patients with TPADs discharged by randomly selected inpatient-attending physicians during a 6-month pilot. They received approximately 1.6 email notifications per discharged patient with TPADs. Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey (59% survey response rate). Automated email notification is a useful strategy for managing results of TPADs.

Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives.

PubMed

Bateman, Lori Brand; Clair, Jeffrey Michael

2015-01-01

Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.

PubMed

Estryn-Behar, M; Doppia, M-A; Guetarni, K; Fry, C; Machet, G; Pelloux, P; Aune, I; Muster, D; Lassaunière, J-M; Prudhomme, C

2011-05-01

France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence. The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% < 35 years old, 33.8% 35-44 years old, 34.5% 45-54 years old and 23.6% ≥ 55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality. The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work-family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis. In order to prevent the premature departure of French doctors, it is important to improve work-family balance, working processes through collaboration, multidisciplinary teamwork and to develop team training approaches and ward design to facilitate teamwork.

Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive.

PubMed

Richter, Astrid; Kostova, Petya; Baur, Xaver; Wegner, Ralf

2014-02-01

The present study is a 10-year comparison (1997 vs. 2007) of occupational and health aspects before and after the implementation of the European Working Time Directive on German hospital physicians. A major focus is whether the changes in working conditions are accompanied by a lower risk for burnout. Three hundred and twenty-eight physicians from the Medical Register of the city of Hamburg completed the survey in 1997 and 994 physicians in 2007. The response rates were 55.4 and 46.5 %, respectively. All participants filled in a 22-item version of the German translation of the Maslach Burnout Inventory. Results of multivariate covariance analyses are reported. The work of physicians has changed significantly within the 10-year period, for example, work time decreased by 4.5 h on average to 55.8 h per week in 2007. Junior physicians profited more from this development, but on-call duties increased for senior physicians in particular. The reduced hours were at the expense of fewer rests. Junior, as well as senior, physicians reported significantly higher rates on the burnout scale for emotional exhaustion (mean 21.8, SD 10.7) in the latter survey and senior physicians also on the depersonalization scale (mean 9.7, SD 6.3). Changes in working conditions in accordance with the European Working Time Directive are not accompanied by reduced strain and risk of burnout for physicians. Rather, our data argue for greater intensification in work, especially for senior physicians. Further studies are suggested in order to explore interventions for a sustainable improvement in the working conditions of physicians.