Decision-Making With and Without Information Technology in Acute Care Hospitals: Survey in the United States

These survey results are from a national survey of acute care hospitals. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect addresses resulting in a 15% response rate. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. Decision making with and without information technology is explored based upon the survey data. The results indicate why and how meetings are held. Necessary changes in the decision-making environment are identified for decision making utilizing information technology to be successful. These results will provide a benchmark for hospitals to determine their technology transfer position and to set goals for computer assisted decision-making.     

Computerized Physician Order Entry in U.S. Hospitals: Results of a 2002 Survey

Objective: To determine the availability of inpatient computerized physician order entry in U.S. hospitals and the degree to which physicians are using it.Design: Combined mail and telephone survey of 964 randomly selected hospitals, contrasting 2002 data and results of a survey conducted in 1997.Measurements: Availability: computerized order entry has been installed and is available for use by physicians; inducement: the degree to which use of computers to enter orders is required of physicians; participation: the proportion of physicians at an institution who enter orders by computer; and saturation: the proportion of total orders at an institution entered by a physician using a computer.Results: The response rate was 65%. Computerized order entry was not available to physicians at 524 (83.7%) of 626 hospitals responding, whereas 60 (9.6%) reported complete availability and 41 (6.5%) reported partial availability. Of 91 hospitals providing data about inducement/requirement to use the system, it was optional at 31 (34.1%), encouraged at 18 (19.8%), and required at 42 (46.2%). At 36 hospitals (45.6%), more than 90% of physicians on staff use the system, whereas six (7.6%) reported 51–90% participation and 37 (46.8%) reported participation by fewer than half of physicians. Saturation was bimodal, with 25 (35%) hospitals reporting that more than 90% of all orders are entered by physicians using a computer and 20 (28.2%) reporting that less than 10% of all orders are entered this way.Conclusion: Despite increasing consensus about the desirability of computerized physician order entry (CPOE) use, these data indicate that only 9.6% of U.S. hospitals presently have CPOE completely available. In those hospitals that have CPOE, its use is frequently required. In approximately half of those hospitals, more than 90% of physicians use CPOE; in one-third of them, more than 90% of orders are entered via CPOE.In an editorial in American Medical News, legibility, remote access, and the potential “to make users better doctors” were described as the upsides of computerized physician order entry (CPOE) use, but the downsides of typing, system rigidity, and time were cited as making implementation of CPOE systems a highly controversial topic.¹ We define CPOE as a process that allows a physician to use a computer to directly enter medical orders. Physicians are not the only members of the health care team who might enter orders into a computerized system, but they are the focus of this particular study. Hospitals are being encouraged by outside forces to implement CPOE in an effort to reduce medical errors. We conducted a survey in 1997, with results published in 1998,² to discover what percentage of U.S. hospitals had CPOE at that time and to determine how heavily used it was in hospitals that had it. We found that one-third of hospitals claimed to have CPOE available but that it was little used at these sites. An earlier survey with a small response rate had found that 20% of surveyed institutions had CPOE,³ and a study published in 2000 that was limited to inpatient medication ordering by physicians reported that less than 10% of hospitals or health systems had such systems.⁴ A survey of hospital information systems in Japan discovered that order-entry systems for laboratory, imaging, and pharmacy were available at fewer than 20% of reporting hospitals, but this was not necessarily physician order entry.⁵ A 2003 report by the Leapfrog Group (a coalition of public and private organizations founded by the Business Roundtable, which is an association of chief executive officers of Fortune 500 companies) stated that 4.1% of the reporting hospitals in a recent survey had CPOE fully implemented,⁶ but the sample was primarily limited to certain demographics. During the five years since the results of our last survey were published, there have been numerous publications about the benefits of CPOE^7,8,9,10 and about some of the difficulties encountered by hospitals implementing it.^11,12,13 Several governmental agencies and other bodies such as the Leapfrog Group have made efforts to encourage CPOE use.^14,15,16 To aid organizations during planning and implementation, a number of guides and manuals have been published as well.^{17,18,19,20,21} Although much attention is being focused on CPOE, no recent nationwide figures on hospital installations have been published. Therefore, we decided to send the same survey to the same sample population in 2002 that we did in 1997. The questions to be addressed here are: how widespread is the implementation of CPOE in hospitals across the United States, where is it available, and how much is it used?     

The teaching of child psychiatry in U.S. medical schools: results of a survey.

The major results of this survey are that most schools have special programs in child psychiatry and that these are distinct from the adult psychiatry course. The course content involves clinical evaluation of children, information on child development and psychopathology, assigned reading, and liaison with pediatrics. Most schools have full-time psychiatrists on their faculty, and the child psychiatry course is taught by child psychiatrists; but less than 20 percent of the psychiatric faculty are child psychiatrists in a majority of the schools in the country. Finally, although evaluation by students and faculty is common in most of the schools, only slightly more than one-third of the institutions gave grades in child psychiatry and slightly fewer than one-third gave examinations in this subject.     

临床/口腔医学博士专业学位论文质量现状分析

目的　进一步提高临床/口腔医学博士专业学位论文质量。方法　从论文选题、文献综述、论文创新、写作规范等方面,对某高校2016至2018年临床/口腔医学专业学位博士的1 122份学位论文评阅意见进行统计分析。采用SPSS 20.0进行描述性统计分析。结果　61.0%（614/1 006）临床/口腔医学博士专业学位论文选题来源为应用型研究,30.0%（302/1 006）为非立项研究;83.9%(941/1 122)的博士专业学位论文总评为良好及优秀,评价较差的前3项分别是：论文创新3.3%（37/1 122）、论文内容2.2%（25/1 122）、写作规范0.9%（10/1 122）。结论　学校及导师应明确临床/口腔医学博士专业学位研究生培养定位,加强其科研能力及论文撰写能力的训练,在注重临床实践训练的同时不能降低其学术性要求。     

Medicine in a Neurocentric World: About the Explanatory Power of Neuroscientific Models in Medical Research and Practice

Explanatory models in the neurosciences are seen to have a growing impact on medical regimes of research and practice. At this stage, new diagnostic tools and therapeutic interventions have altered the shape of clinical disciplines such as neurology and psychiatry. This development is driven by specific modes of operationalisation, which immediately call for new standardisation procedures. In the long run, neuroscientific models are expected to follow the reconceptualisation of classification systems, hence contributing to a change in the understanding of somatic and mental disease entities. Medicine in a neurocentric world is dedicated to the analysis of how current regimes of medical research and practice are influenced by neuroscientific approaches to brain and mind. At least three major issues could be identified: how particular explanatory models have evolved, how they are introduced to the medical field and how they are transforming medical research and practice. Anthropological, ethical and cultural challenges arising from the alignment of neuroscience and medicine are addressed. Historical studies concerning the methodological preconditions of neuroscientific research on the one hand and strategies of intervening in the brain and mind in clinical practice on the other are rounding off this themed issue.     

美国FDA批准新药十年（2007～2016）纵观分析

《国际药学研究杂志》发表年度美国FDA批准药物简介已有10年。每种药物自首次获批后,随着临床实践和治疗患者累计数量的增加,必然出现新的问题。如适应证变化;补充修改疗效和临床数据;新适应证的增补;剂量、剂型和给药方式的不断完善;出现新的、严重甚至致命性不良反应时,需要补充禁忌症、警告和注意事项,甚至增加黑框警告等。总之,说明书的所有条目都有可能被修改、补充或删除。更重要的是,10年纵观分析也会发现一些突出的事件,如批准新分子实体（NME）和新生物制品的数量在2015年出现一个明显的高峰。为此,本文从纵向研究10年间发生的突出历史事件,以期对新药研发提供指导和借鉴。     

EPR adoption and dual record maintenance in the U.S.: assessing variation in medical systems infrastructure

The growing adoption of evidence-based medicine in the United States is acting to cause fundamental changes in the delivery of healthcare management services. With the increasing incorporation of electronic patient records (EPRs) into the day-to-day practice of medicine, it necessitates greater dependence on adequate functioning of such resources, as they become more frequently used as a clinical complement in the practice of medicine. Assessing the patterns of adoption of EPRs is likewise of increasing importance, with the recent imposition of uniform government data collection and management requirements. The medium of data storage and maintenance within many organizations is a critical factor in the ultimate delivery of service, with a like need for an integrated, designated medium for the management of data becoming paramount. This study examines, on a nationwide basis, variation in reported adoption of EPRs within U.S. healthcare organizations, and the related maintenance of dual electronic/paper record systems.