A primary care physician perspective survey on the limited use of handwriting and pen computing in the electronic medical record

Empirical research has demonstrated that simple design modifications in the electronic medical record (EMR) can improve user acceptance. Changes, such as pagination, the use of wireless pen slate computers and the use of digital ink (the graphic representation of the pen across the computer screen), can make dramatic differences in user performance, reduce uncertainty and increase acceptability. No survey has asked primary care physicians (PCPs) their preference of computer type for use during a consultation. Neither has any investigation determined whether or not physicians believed they could benefit from the use of handwriting (in the entry form of digital ink) as a supplement to the EMR. A survey was prepared to see if a group of PCPs in private practice was receptive to the use of digital ink, and what type of computer - desktop or wireless pen slate - would be preferred for use during a consultation. A wireless pen slate computer was described as having a screen large enough to display the same image seen on a desktop computer. Screen captures were used to demonstrate digital ink for handwriting and drawing. One-hundred-and-fifty-six of the 411 physicians responded (37.95%). Five physicians (3.2%) used a computer during a consultation. Ninety-nine (63.46%) would be willing to use a computer during a consultation. One-hundred-and-twenty-one (77.56%) indicated that digital ink would be useful as a supplement to the EMR. Of those who would use a computer during a consultation, 91/99 (91.09%) preferred a wireless pen slate computer to a desktop computer. Subgroup analysis indicated that those physicians who had been in practice more than 25 years or those who had low volume practices were less likely to desire a computer for use during a consultation. No subgroup showed less than 73% support for the use of handwriting in the EMR. Lack of standards (47.68%) and costs (40.40%) were chosen as the major reasons for not purchasing an EMR. Sixty-one PCPs (36.42%) indicated that a lack of typing skills was an issue and 39 (25.83%) said they had no time to learn. The use of handwriting in the EMR was broadly supported by this group of PCPs in private practice. Likewise, wireless pen computers were the overwhelming choice of computer for use during a consultation. In this group, older and lower volume physicians were less likely to desire a computer for use during a consultation. User acceptance of the EMR may be related to how closely it resembles the processes that are being automated. More surveys are required to determine the needs and expectations of physicians. The data also support other research studies that demonstrate the preference for handwriting and wireless computers, and the need for a limited, standardised and controlled vocabulary

Anabolic–androgenic steroid dependence: an emerging disorder

Anabolic–androgenic steroids (AAS) are widely used illicitly to gain muscle and lose body fat. Here we review the accumulating human and animal evidence showing that AAS may cause a distinct dependence syndrome, often associated with adverse psychiatric and medical effects.We present an illustrative case of AAS dependence, followed by a summary of the human and animal literature on this topic, based on publications known to us or obtained by searching the PubMed database.About 30% of AAS users appear to develop a dependence syndrome, characterized by chronic AAS use despite adverse effects on physical, psychosocial or occupational functioning. AAS dependence shares many features with classical drug dependence. For example, hamsters will self-administer AAS, even to the point of death, and both humans and animals exhibit a well-documented AAS withdrawal syndrome, mediated by neuroendocrine and cortical neurotransmitter systems. AAS dependence may particularly involve opioidergic mechanisms. However, AAS differ from classical drugs in that they produce little immediate reward of acute intoxication, but instead a delayed effect of muscle gains. Thus standard diagnostic criteria for substance dependence, usually crafted for acutely intoxicating drugs, must be adapted slightly for cumulatively acting drugs such as AAS.AAS dependence is a valid diagnostic entity, and probably a growing public health problem. AAS dependence may share brain mechanisms with other forms of substance dependence, especially opioid dependence. Future studies are needed to characterize AAS dependence more clearly, identify risk factors for this syndrome and develop treatment strategies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78670/1/j.1360-0443.2009.02734.x.pd