Clinician Perceptions on the Use of Free-Text Communication Orders

Objective  The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. Methods  We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes. Results  Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. Discussion  Clinicians'' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR''s structured order entry must be redesigned to support clinicians'' cognitive and workflow needs that are currently being addressed via the use of free-text orders. Conclusion  Clinicians'' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.     

The Impact of Adolescent Chronic Pain on Functioning: Disentangling the Complex Role of Anxiety

A number of adolescents with chronic pain have clinically significant disability across physical, social, and academic activities, and pain severity only explains a portion of the variance in functioning. Thus, it is important to identify therapeutic options to improve adolescents' functioning. In contrast to studies with adults with chronic pain, research in pediatric pain has not consistently found anxiety to be a good predictor of pain-related disability. The present study evaluated pain, anxiety, and functioning in 222 adolescents with chronic pain. Results indicated that pain was consistently and linearly related to disability across measures of physical and social functioning, school attendance, and physician visits. The relation between anxiety and functioning was complex; increased anxiety was related to poorer physical and social functioning and was related to fewer physician visits, although it was not associated with school attendance. Additional analyses revealed that anxiety serves to moderate the relation between pain and functioning. Specifically, at high anxiety, pain was not related to functioning, but at low anxiety, pain consistently predicted disability. In other words, highly anxious adolescents were functioning poorly regardless of the level of pain. The moderating role of anxiety highlights a number of research and clinical possibilities to explore with adolescents with chronic pain-related disability.     

Exploring the Impact of the Coronavirus Pandemic on Pediatric Palliative Care Clinician Personal and Professional Well-Being: A Qualitative Analysis of U.S. Survey Data

ContextThe COVID-19 pandemic has had a dramatic impact on palliative care delivery and patient experiences. Less is known about the experiences and responses of palliative care clinicians.ObjectiveWe aimed to describe the pandemic's impact on pediatric palliative care clinicians' personal and professional well-being.MethodsThe Palliative Assessment of Needed DEvelopments & Modifications In the Era of Coronavirus (PANDEMIC) cross-sectional online survey was posted on 7 professional listservs between May and June 2020. We conducted a conventional content analysis of written responses to three open-ended questions regarding the lasting impact of COVID-19.ResultsOf 207 multidisciplinary respondents from 80 US cities, 148 (71%) provided written responses to open-ended questions, and 62 responses (42%) were related to personal, professional, or existential well-being. These responses were sorted into 4 major categories: personal burdens, professional burdens, personal benefits, and professional benefits. Respondents described burdens more commonly than they did benefits (67% vs. 33% of comments, respectively). Personal burdens related to increased fear and uncertainty, fear of bringing the virus home, and a sense of collective grief. Professional burdens included a sense of exhaustion, a challenge with work-life balance, personal experiences with colleagues infected with the virus, and considerations of leaving health care altogether. Personal benefits included lessons learned, an evolving sense of what matters, and improved work-life balance. Professional benefits included opportunities for professional development and a sense of professional purpose.ConclusionPediatric palliative care clinicians perceive a breadth of impacts from the COVID-19 pandemic. Ongoing clinician assessment is important as the pandemic continues.     

Adolescent Health Concerns: A Comparison of Adolescent and Health Care Provider Perceptions

The purpose of this study was to ascertain adolescent perceptions of health concerns and to contrast the health care provider perceptions of adolescent concerns. The student sample consisted of 179 students from the 9th, 10th, and 11th grade in a 2,000-student suburban high school. The health care provider sample consisted of 74 physicians, nurse practitioners, and school nurses. The largest number of students reported concerns about AIDS, schoolwork, making friends, sex, discrimination, and dental problems. Additionally, menstruation, violence, rape, abuse, pregnancy, sadness, and obesity were of concern to a greater number of female than male students. Homosexuality, sex, auto accidents, and low weight were of concern to a greater number of male than female students. The findings of this study support the following conclusions: (a) Adolescents have more diverse health concerns with greater magnitude than expected by health care providers; (b) health care providers underestimate adolescent psychological and social health concerns; (c) female adolescents were more concerned about their health and more concerned about gender-specific and violent issues than males; (d) women's health care providers are unaware of female adolescent concern about violent acts against women.     

Social Anxiety Dimensions, Neuroticism, and the Contours of Positive Psychological Functioning

Although decades of research have examined relationships between social anxiety and negative outcomes, this study examined relations with indices of positive psychological functioning. In college students (n = 204), a factor analysis on self-report measures of positive psychological functioning derived 3 conceptually meaningful broad domains: Positive Subjective Experiences, Curiosity, and Appetitive Motivations. Analyses were conducted to test whether social interaction anxiety demonstrated unique relationships with positive psychological domains after controlling for shared variance with social observation anxiety (e.g., eating in public, public speaking) and neuroticism. Social interaction anxiety explained unique variance in all 3 domains after separately controlling for social observation anxiety and neuroticism. In contrast, social observation anxiety demonstrated near-zero relationships with all 3 domains, and neuroticism predicted Positive Subjective Experiences, and to a lesser degree, Curiosity. These data provide evidence for the unique association between social interaction anxiety and positive psychological functioning, with implications for future basic and applied research.     

Literature Review of Social Support and Caregiver Burden, 1980 to 1995

Purpose: To critique social support and caregiver burden studies for (a) explication of constructs, (b) associations between constructs, (c) statistical conclusion validity, and (d) generalizability. Social support moderates caregiver burden, yet studies using different conceptualizations raise questions about validity.
Framework and Scope: Cooper's (1984) methodology for an integrated literature review was used to examine 50 studies (1980-1995) involving adult caregivers of older family members.
Findings: Inadequate explication of social support, potential spuriousness and reverse causation, threats to statistical conclusion validity, and lack of generalizability were found.
Conclusions and Implications: Progress has been made in caregiving and social support research, yet many problems remain. Future research should include multiple measures of support, controls for spuriousness and reverse causation, valid and reliable instruments, and samples of diverse populations.     

“Look,Your Muscles Are Firing!”: A Qualitative Study of Clinician Perspectives on the Use of Surface Electromyography in Neurorehabilitation

Objective

To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives.

Interpretation and Impact of Real-World Clinical Data for the Practicing Clinician

Real-world studies have become increasingly important in providing evidence of treatment effectiveness in clinical practice. While randomized clinical trials (RCTs) are the “gold standard” for evaluating the safety and efficacy of new therapeutic agents, necessarily strict inclusion and exclusion criteria mean that trial populations are often not representative of the patient populations encountered in clinical practice. Real-world studies may use information from electronic health and claims databases, which provide large datasets from diverse patient populations, and/or may be observational, collecting prospective or retrospective data over a long period of time. They can therefore provide information on the long-term safety, particularly pertaining to rare events, and effectiveness of drugs in large heterogeneous populations, as well as information on utilization patterns and health and economic outcomes. This review focuses on how evidence from real-world studies can be utilized to complement data from RCTs to gain a more complete picture of the advantages and disadvantages of medications as they are used in practice.Funding: Sanofi US, Inc.     

Exploring Perceptions and Experiences of Maternal Depression in Latinas: A Qualitative Study

Understanding how depression is conceptualized is key to designing effective screening and treatment procedures. Of particular concern is maternal depression in Latinas, given the high Latina birthrate. We conducted two focus groups of pregnant Latinas to elicit their perceptions of and experiences with maternal depression. Women reported familiarity with the concept of maternal depression and that their experiences with depression were linked to social support from family and friends. Women also indicated that they felt responsible for coping and recovering from depression independently. How experiences with depression interact with traditional Latino idioms of distress, needs further investigation.