Impact of integrating public health clinical decision support alerts into electronic health records on testing for gastrointestinal illness

Laboratory testing by clinicians is essential to outbreak investigations. Electronic health records may increase testing through clinical decision support that alerts providers about existing outbreaks and facilitates laboratory ordering. The impact on laboratory testing was evaluated for foodborne disease outbreaks between 2006 and 2009. After controlling for standard public health messaging and season, decision support resulted in a significant increase in laboratory testing and may be useful in enhancing public health messaging and provider action.     

Factors related to self-efficacy in persons with scleroderma

Purpose: Scleroderma (SSc) is rare, and few studies have examined self‐efficacy in persons with the disease. Self‐efficacy is one precursor that has been shown to initiate changes in behaviour when managing chronic disease. The objective of this study was to explore the levels of self‐efficacy in persons with SSc, compare self‐efficacy in persons with limited or diffuse SSc and determine correlations between self‐efficacy, physical function and psychological variables. Methods: Sixty‐two participants with SSc completed measures assessing self‐efficacy, depression, fatigue, pain, hand function and activity limitations. The mean age of participants was 52.9 years. The mean educational level was 15.8 years. Sixty‐seven per cent were married and 87.1% were women. Thirty participants had diffuse SSc, 27 had limited SSc and five were unclassified. Results: The only significant differences between the two disease subtypes were in hand function and self‐efficacy function subscale scores. Total self‐efficacy scores significantly correlated with marital status, employment, self‐reported health, depression, functional ability, fatigue, pain and hand function. Similarly, self‐efficacy function scale scores correlated significantly with employment, self‐reported health, functional ability, pain and hand function. Self‐efficacy pain scale scores correlated significantly with fatigability. The self‐efficacy other scale scores correlated significantly with depression and fatigability. Participants with higher levels of pain and depression, more fatigue, more general disability and more hand disability had lower self‐efficacy. Conclusion: Self‐efficacy correlates with physical function and psychological variables, and could predict how patients manage their health. Self‐efficacy may increase through participation in educational programmes focusing on self‐management of these variables. Copyright © 2010 John Wiley & Sons, Ltd.