Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry System

Objective: Many hospitals are investing in computer-based provider order-entry (POE) systems, and providers’ evaluations have proved important for the success of the systems. The authors assessed how physicians and nurses viewed the effects of one modified commercial POE system on time spent patients, resource utilization, errors with orders, and overall quality of care. Design: Survey. Measurements: Opinions of 271 POE users on medicine wards of an urban teaching hospital: 96 medical house officers, 49 attending physicians, 19 clinical fellows with heavy inpatient loads, and 107 nurses. Results: Responses were received from 85 percent of the sample. Most physicians and nurses agreed that orders were executed faster under POE. About 30 percent of house officers and attendings or fellows, compared with 56 percent of nurses, reported improvement in overall quality of care with POE. Forty-four percent of house officers and 34 percent of attendings/fellows reported that their time with patients decreased, whereas 56 percent of nurses indicated that their time with patients increased (P \u3c 0.001). Sixty percent of house officers and 41 percent of attendings/fellows indicated that order errors increased, whereas 69 percent of nurses indicated a decrease or no change in errors. Although most nurses reported no change in the frequency of ordering tests and medications with POE, 61 percent of house officers reported an increased frequency. Conclusion: Physicians and nurses had markedly different views about effects of a POE system on patient care, highlighting the need to consider both perspectives when assessing the impact of POE. With this POE system, most nurses saw beneficial effects, whereas many physicians saw negative effects

Physicians' knowledge, attitudes, and perceptions concerning antibiotic resistance:a survey in a Ghanaian tertiary care hospital

Abstract Background Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians’ knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana. Methods We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives. Results The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE. Conclusions Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians

Continuity of information and care : a pilot study in a health centre

Introduction: Family medicine is the first level of contact of individuals, the family and the community with the national health.1 Quality of continuity is the degree of which a series of discrete encounters with health care professionals is coherent, connected, and consistent with the patient's medical needs and personal context.2 Objective: The aim of this study was to assess continuity of care in patients attending for General Practitioner consultations in Floriana Health Centre (FHC). Method: The study focused on all the physician- patient encounters occurring in the GP consultation rooms between 8 a.m. and 5 p.m, which accounts for the overall majority of patient contacts in health centres over a 24 hour period. This was a pilot study and consequently the study was carried out in only one health centre. The field work was carried out on five working days, including a Sunday. The number of medical records which were given to patients was noted together with the total number of patients attending for a consultation. This data was then divided in morning (8a.m. – noon) and afternoon (noon – 5p.m) sessions. Medical records given to GPs were assessed to see whether an entry was actually made and the quality of the entry. Results: A total of 529 patient encounters were included in the study. There were 411 patients attending the FHC for a GP consultation between 8a.m. and 5p.m. in four weekdays and 118 patients attending a consultation on Sunday. 23% of patients attending for a GP consultation during weekdays were given a file while 77% were not. A higher percentage of medical records were not given in the afternoons. 75% of GPs wrote a note in the patient’s file when it was provided to them. Conclusion: Continuity of care is an important and essential element in delivering good quality healthcare service to the patient. Continuity of care is not occurring to the desired degree in FHC and is possibly leading to sub-optimal care being provided to our patients. The intention is that in the future, this pilot study will be implemented on a larger scale in other health centres for a greater representation of the work being done at primary care level.peer-reviewe

2003-2007 Report on Hate Crimes and Discrimination Against Arab Americans

Analyzes rates, patterns, and sources of anti-Arab-American hate crimes and discrimination, including detainee abuse, delays in naturalization, and threats; civil liberties concerns; bias in schools; and defamation in the media. Includes case summaries

Rape Messaging

When feminists began advocating for rape reform in the 1970s, the rape message was clear: rape was not a crime to be taken seriously because women lie. After decades of criminal law reform, the legal requirement that a woman vigorously resist a man’s sexual advances to prove that she was raped has largely disappeared from the statute books, and, in theory, rape shield laws make a woman’s prior sexual history irrelevant. Yet, despite what the law dictates, rape law reforms have not had a “trickle-down” effect, where changes in law lead to changes in attitude. Women are still believed to be vindictive shrews so police continue to code rape allegations as “unfounded,” and prosecutors continue to elect not to prosecute many rape cases. To many, “no” can sometimes still mean “yes.” In short, criminal law reforms have only marginally succeeded at deterring rape and increasing conviction rates for rape. At the same time, criminal law reforms have entrenched gender norms and endorsed the message that acquaintance rapes are less worthy of harsh punishment. This Article argues against further ex post criminal law reforms and posits that efforts should shift to ex ante public health interventions. This Article draws from recent successful experiences with public health interventions in destigmatizing AIDS and denormalizing tobacco and advocates for a robust public health campaign to denormalize rape. It presents a detailed proposal for changing rape messaging, denormalizing rape, and ensuring better outcomes for victims

‘Out of bed, but not yet abroad’: spatial experiences of recovery from illness in Early Modern England

In early modern England, patients tracked their transition from sickness to health according to where they were in domestic space. During severe illness, the sick were usually confined to bed, unable to stir; but as health returned, they gradually expanded their spatial horizons, until eventually they could leave the house – known as ‘going abroad’. Recovery was thus a state of spatial liminality – between the sickbed and the outdoors, or more specifically, the threshold of the front door. The present study asks what it was like to make this transition, exploring the patient’s physical, emotional, sensory and spiritual experience of the return to normal spatial life. Through these discussions, the chapter seeks to rebalance and brighten our overall picture of early modern health, which has hitherto focused mainly on disease and death. In so doing, it challenges the fairly widespread assumption that recovery was rare in this period

The Third Plague Pandemic and British India: A Transformation of Science, Policy, and Indian Society

This paper seeks to understand the role of the Third Plague Pandemic\u27s overwhelming devastation in colonial India, specifically through the new advancements in scientific understanding, unheard of proactive prevention measures, and increased separation between the colonial powers of Great Britain and the common people of India