How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care

Temporal discrimination: Mechanisms and relevance to adult-onset dystonia

Temporal discrimination is the ability to determine that two sequential sensory stimuli are separated in time. For any individual, the temporal discrimination threshold (TDT) is the minimum interval at which paired sequential stimuli are perceived as being asynchronous; this can be assessed, with high test-retest and inter-rater reliability, using a simple psychophysical test. Temporal discrimination is disordered in a number of basal ganglia diseases including adult-onset dystonia, of which the two most common phenotypes are cervical dystonia and blepharospasm. The causes of adult-onset focal dystonia are unknown; genetic, epigenetic, and environmental factors are relevant. Abnormal TDTs in adult-onset dystonia are associated with structural and neurophysiological changes considered to reflect defective inhibitory interneuronal processing within a network which includes the superior colliculus, basal ganglia, and primary somatosensory cortex. It is hypothesized that abnormal temporal discrimination is a mediational endophenotype and, when present in unaffected relatives of patients with adult-onset dystonia, indicates non-manifesting gene carriage. Using the mediational endophenotype concept, etiological factors in adult-onset dystonia may be examined including (i) the role of environmental exposures in disease penetrance and expression; (ii) sexual dimorphism in sex ratios at age of onset; (iii) the pathogenesis of non-motor symptoms of adult-onset dystonia; and (iv) subcortical mechanisms in disease pathogenesis

Rule-Based Reasoning For Medical Diagnosis

Medical diagnosis is a major part of health care services. Clinicians are always looking for a way to better the services and quality of healthcare. This project purpose is to develop a knowledge based system in order to assist clinicians in medical diagnosis. The use of such system is expected to increase the quality of medical and healthcare. The system main purpose is to act as a reminder system to the clinicians. Ultimately, the clinicians themselves are the one who will be making the diagnose decision. The system is there to assist them, by giving timeliness medical information, and to help refresh their memory and reduce the error that could happen during diagnosis. Methodology used in developing the system is phased development of the Rapid Application Development methodology. Several versions of the system will be developed. The result will be an expert system that takes input, which are clinical symptoms from user and then list several disease that the patient might have suffered according to the symptoms. Besides that, suggested treatment will also be display for each listed disease. The system also acts as repository system where it has patient records functions. 11

Helping Medical Students Write: Genre Analysis of Medical Case Reports

This study uses structural move analysis method of English for Specific Purposes (ESP) genre research in order to examine medical case reports published in on-line medical journals. Specific textual aspects deemed important for the investigation have been selected such as biomedical rhetorical features and conventionalized lexis characteristic of this written medical discourse. The study also explains the key differences between the three established genre research traditions. In addition, important pedagogical applications are briefly discussed

A survey study of steering wheel vibration and sound in automobiles at idle

Copyright @ 2009 Engineering Integrity SocietyThis work is supported by Shell Global Solutions UK for their sponsorship of this research as part of the activities of the EFII3 project

Swivelling the spotlight: stardom, celebrity and ‘me’

Celebrity studies critiques the ways in which celebrity culture constructs discourses of authenticity and disclosure, offering the cultural and economic circulation of the ‘private’ self. Rarely, however, do we turn the spotlight on ourselves as not only scholars of stardom and celebrity, but also part of the audience. Autoethnography has become increasingly important across different disciplines, although its status within media and cultural studies is less visible and secure, not least because the emphasis on personal attachments to media forms may threaten the discipline’s still contested claim to cultural legitimacy. The study of stars and celebrities has often found itself at the ‘lower’ end of this already debased continuum, perhaps making such tensions particularly acute. Based on three personal narratives of engagements with stars and celebrities, this co-authored article explores the potential relationships between autoethnography and celebrity studies, and considers the personal, intellectual, and political implications of bringing the scholar into the celebrity frame

From ABCs to ADHD: the role of schooling in the construction of behaviour disorder and production of disorderly objects

Discussion of Attention-Deficit/Hyperactivity Disorder (ADHD) in the media, and thus much popular discourse, typically revolves around the possible causes of disruptive behaviour and the “behaviourally disordered” child. The usual suspects - too much television and video games, food additives, bad parenting, lack of discipline and single mothers – feature prominently as potential contributors to the spiralling rate of ADHD diagnosis in Western industrialised nations, especially the United States and Australia. Conspicuously absent from the field of investigation, however, is the scene of schooling and the influence that the discourses and practices of schooling might bring to bear upon the constitution of “disorderly behaviour” and subsequent recognition of particular children as a particular kind of “disorderly”. This paper reviews a sample of the literature surrounding ADHD, in order to question the function of this absence and, ultimately, make an argument for an interrogation of the school as a site for the production of disorderly objects