Effect of Computerized Physician Order Entry on Imaging Study Indication

PurposeThe effect of computerized physician order entry (CPOE) on imaging indication quality had only been measured in one institution’s emergency department using a homegrown electronic health record with faculty physicians, and only with one instrument. To better understand how many US hospitals’ recent CPOE implementations had affected indication quality, we measured its effect in a generalizable inpatient setting, using one existing and one novel instrument.MethodsWe retrospectively analyzed the indications for 100 randomly selected inpatient abdominal CT studies during 2 calendar months immediately prior to a 3/3/2012 CPOE implementation (1/1/2012-2/29/2012) and during 2 subsequent calendar months (5/1/2012-6/30/2012). We excluded 2 intervening months to avoid behaviors associated with adoption. We measured indication quality using a published 8-point explicit scoring scale and our own, novel, implicit 7-point Likert scale.ResultsExplicit scores increased 93% from a pre-CPOE mean ± 95% confidence interval of 1.4 ± 0.2 to a CPOE mean of 2.7 ± 0.3 (P < .01). Implicit scores increased 26% from a pre-CPOE mean of 4.3 ± 0.3 to a CPOE mean of 5.4 ± 0.2 (P < .05). When presented with a statement that an indication was “extremely helpful,” and choices ranging from “strongly disagree” = 1 to “strongly agree” = 7, implicit scores of 4 and 5 signified “undecided” and “somewhat agree,” respectively.ConclusionsIn an inpatient setting with strong external validity to other US hospitals, CPOE implementation increased indication quality, as measured by 2 independent scoring systems (one pre-existing explicit system and one novel, intuitive implicit system). CPOE thus appears to enhance communication from ordering clinicians to radiologists.     

Factors related to the presentation of thin and thick nodular melanoma from a population‐based cancer registry in Queensland Australia

BACKGROUND:

Worldwide, the incidence of thick melanoma has not declined, and the nodular melanoma (NM) subtype accounts for nearly 40% of newly diagnosed thick melanoma. To assess differences between patients with thin (≤2.00 mm) and thick (≥2.01 mm) nodular melanoma, the authors evaluated factors such as demographics, melanoma detection patterns, tumor visibility, and physician screening for NM alone and compared clinical presentation and anatomic location of NM with superficial spreading melanoma (SSM).

METHODS:

The authors used data from a large population‐based study of Queensland (Australia) residents diagnosed with melanoma. Queensland residents aged 20 to 75 years with histologically confirmed first primary invasive cutaneous melanoma were eligible for the study, and all questionnaires were conducted by telephone (response rate, 77.9%).

RESULTS:

During this 4‐year period, 369 patients with nodular melanoma were interviewed, of whom 56.7% were diagnosed with tumors ≤2.00 mm. Men, older individuals, and those who had not been screened by a physician in the past 3 years were more likely to have nodular tumors of greater thickness. Thickest nodular melanoma (4 mm+) was also most common in persons who had not been screened by a physician within the past 3 years (odds ratio, 3.75; 95% confidence interval, 1.47‐9.59). Forty‐six percent of patients with thin nodular melanoma (≤2.00 mm) reported a change in color, compared with 64% of patients with thin SSM and 26% of patients with thick nodular melanoma (>2.00 mm).

CONCLUSIONS:

Awareness of factors related to earlier detection of potentially fatal nodular melanomas, including the benefits of a physician examination, should be useful in enhancing public and professional education strategies. Particular awareness of clinical warning signs associated with thin nodular melanoma should allow for more prompt diagnosis and treatment of this subtype. Cancer 2009. © 2009 American Cancer Society.     

Providers Do Not Verify Patient Identity during Computer Order Entry

Introduction:  Improving patient identification (ID), by using two identifiers, is a Joint Commission safety goal. Appropriate identifiers include name, date of birth (DOB), or medical record number (MRN).
Objectives:  The objectives were to determine the frequency of verifying patient ID during computerized provider order entry (CPOE).
Methods:  This was a prospective study using simulated scenarios with an eye-tracking device. Medical providers were asked to review 10 charts (scenarios), select the patient from a computer alphabetical list, and order tests. Two scenarios had embedded ID errors compared to the computer (incorrect DOB or misspelled last name), and a third had a potential error (second patient on alphabetical list with same last name). Providers were not aware the focus was patient ID. Verifying patient ID was defined as looking at name and either DOB or MRN on the computer.
Results:  Twenty-five of 25 providers (100%; 95% confidence interval [CI] = 86% to 100%) selected the correct patient when there was a second patient with the same last name. Two of 25 (8%; 95% CI = 1% to 26%) noted the DOB error; the remaining 23 ordered tests on an incorrect patient. One of 25 (4%, 95% CI = 0% to 20%) noted the last name error; 12 ordered tests on an incorrect patient. No participant (0%, 0/107; 95% CI = 0% to 3%) verified patient ID by looking at MRN prior to selecting a patient from the alphabetical list. Twenty-three percent (45/200; 95% CI = 17% to 29%) verified patient ID prior to ordering tests.
Conclusions:  Medical providers often miss ID errors and infrequently verify patient ID with two identifiers during CPOE.     

15所医院临床医学重点学科人员满意度分析

采用调查问卷、统计分析等方法，从多个角度分别对15所临床医学重点学科的管理者、医师队伍进行了满意度调查分析，分析了存在的问题，提出了加强交流沟通、和谐医患关系、加强交流合作、减轻工作负担、开展技术帮带等对策。     

Is NIH funding predictive of greater research productivity and impact among academic otolaryngologists?

Objectives/Hypothesis:

The h‐index is an accurate and reliable indicator of scholarly productivity that takes into account relevance, significance, and influence of research contributions. As such, it is an effective, objective bibliometric that can be used to evaluate academic otolaryngologists for decisions regarding appointment and advancement. In this study, we evaluate the impact of NIH funding on scholarly productivity in otolaryngology.

Study Design:

Analysis of bibliometric data of academic otolaryngologists.

Methods:

Funding data for the 20 otolaryngology departments with the largest aggregate total of NIH grants for the fiscal years (FY) 2011 and 2012 was obtained using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Reports (RePORTER) Database. H‐indices were calculated using the Scopus online database, and then compared to funding data at both the departmental and individual level.

Results:

Faculty members in otolaryngology departments who received NIH funding had significantly greater research productivity and impact, as measured by the h‐index, than their nonfunded peers. H‐indices increased with greater NIH funding levels, and investigators with MD degrees tended to have higher mean NIH funding levels than those with PhDs. While there was no correlation between average h‐index and NIH funding totals at the level of departments, there was greater correlation upon examination of NIH funding levels of individual investigators.

Conclusions:

The h‐index has a strong relationship with, and may be predictive of, grant awards of NIH‐funded faculty members in otolaryngology departments. This bibliometric may be useful in decisions regarding appointment and advancement of faculty members within academic otolaryngology departments. Laryngoscope, 2013     

放射医务人员压力及相关因素与健康的关系

[目的]探讨放射医务人员知觉压力及相关因素对健康的影响。[方法]采用一般健康量表、中文版知觉压力量表、艾森克人格问卷量表中文版、工作倦怠调查表,对728名放射医务人员进行调查。[结果]不同年龄、不同婚姻状况的放射医务工作人员之间的压力总分差异有统计学意义（F=2.975,P=0.036;F=3.519,P=0.030）;直接接触射线的工作人员压力总分高于间接接触者（t=3.170,P〈0.001）;不同职称之间的工作人员压力总分有统计学意义（F=6.513,P〈0.001）。放射工作人员的知觉压力分值和一般健康量表总分存在正相关（r=0.414,P〈0.01）;多重线性回归显示,知觉压力、神经质、情绪耗竭3个变量对健康均有影响作用（P〈0.05）。[结论]放射医务人员的知觉压力水平可影响其健康状况,应对他们进行有效的健康教育,减轻压力,促进身心健康。     

宁波市基层医生社区康复培训实践与思考

经过岗位培训的基层医生是开展社区康复的一支重要卫生队伍。该文介绍了宁波市基层医生社区康复岗位培训的实践情况,并就如何发展社区康复服务提出了若干建议。