Better Health While You Wait: A Controlled Trial of a Computer-Based Intervention for Screening and Health Promotion in the Emergency Department

Study objective: We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice. Methods: This controlled clinical trial, with alternating assignment of patients to a computer intervention (prevention group) or usual care, was conducted in a university hospital ED. The study group consisted of 542 adult patients with nonurgent conditions. The study intervention was a self-administered computer survey generating individualized health information. Outcome measures were (1) patient willingness to take a computerized health risk assessment, (2) disclosure of behavioral risk factors, (3) requests for health information, and (4) remembered health advice. Results: Eighty-nine percent (470/542) of eligible patients participated. Ninety percent were black. Eighty-five percent (210/248) of patients in the prevention group disclosed 1 or more major behavioral risk factors including current smoking (79/248; 32%), untreated hypertension (28/248; 13%), problem drinking (46/248; 19%), use of street drugs (33/248; 13%), major depression (87/248; 35%), unsafe sexual behavior (84/248; 33%), and several other injury-prone behaviors. Ninety-five percent of patients in the prevention group requested health information. On follow-up at 1 week, 62% (133/216) of the prevention group patients compared with 27% (48/180) of the control subjects remembered receiving advice on what they could do to improve their health (relative risk 2.3, 95% confidence interval 1.77 to 3.01). Conclusion: Using a self-administered computer-based health risk assessment, the majority of patients in our urban ED disclosed important health risks and requested information. They were more likely than a control group to remember receiving advice on what they could do to improve their health. Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions

Would Physicians Override a Do-Not-Resuscitate Order When a Cardiac Arrest Is Iatrogenic?

OBJECTIVE: To assess whether physicians would be more likely to override a do-not-resuscitate (DNR) order when a hypothetical cardiac arrest is iatrogenic. DESIGN: Mailed survey of 358 practicing physicians. SETTING: A university-affiliated community teaching hospital. PARTICIPANTS: Of 358 physicians surveyed, 285 (80%) responded. MEASUREMENTS AND MAIN RESULTS: Each survey included three case descriptions in which a patient negotiates a DNR order, and then suffers a cardiac arrest. The arrests were caused by the patient’s underlying disease, by an unexpected complication of treatment, and by the physician’s error. Physicians were asked to rate the likelihood that they would attempt cardiopulmonary resuscitation for each case description. Physicians indicated that they would be unlikely to override a DNR order when the arrest was caused by the patient’s underlying disease (mean score 2.55 on a scale from 1 “certainly would not” to 7 “certainly would”). Physicians reported they would be much more likely to resuscitate when the arrest was due to a complication of treatment (5.24 vs 2.55; difference 95% confidence interval [CI] 2.44, 2.91; p < .001), and that they would be even more likely to resuscitate when the arrest was due to physician error (6.32 vs 5.24; difference 95% CI 0.88, 1.20; p < .001). Eight percent, 29%, and 69% of physicians, respectively, said that they “certainly would” resuscitate in these three vignettes (p < .001). CONCLUSIONS: Physicians may believe that DNR orders do not apply to iatrogenic cardiac arrests and that patients do not consider the possibility of an iatrogenic arrest when they negotiate a DNR order. Physicians may also believe that there is a greater obligation to treat when an illness is iatrogenic, and particularly when an illness results from the physician’s error. This response to iatrogenic cardiac arrests, and its possible generalization to other iatrogenic complications, deserves further consideration and discussion

Another history of museums: from the discourse to the museum-piece

The history of museums could get inspired on the procedures of material studies and of Anthropology in order to take a new stand and move away from the institutional approach and consider the approach of objects traditionally labelled as museum objects. The socalled “museum pieces” are supposed to have a number of characteristics, particularly some great historical and artistic qualities, sometimes an heritage quality, but above all the ability to make “friends” around the community or around the world. In all these respects, it is proposed here a number of research procedures that may supplement or enrich the directions usually assigned to the history of institutions