Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds

Background: Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician–EHR interaction. Objective: To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns. Method: We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection. Results: We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5–12), spending a mean of 3:05 minutes per patient (range = 1:34–5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1–16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%. Conclusion: We observed the physician–EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of “information sprawl” in physicians’ digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns. Implications: From the study findings, we suggest recommendations towards improved EHR design

Effect of an antepartum Pap smear on the coverage of a cervical cancer screening programme: a population-based prospective study

BACKGROUND: Almost one-third of Norwegian women aged 25–69 years invited to have a Pap smear do not attend during the recommended period, and thus constitute a population with high-risk of cervical cancer (CC). Since the incidence of precancerous lesions of the cervix peak with occurrence of pregnancies within the same decade in women aged 25 to 35 years of age, antepartum care presents an opportunity to offer a Pap smear thereby increasing the coverage of the programme. The study objective was to describe the effect of the antepartum Pap smear on the coverage of a cytological CC screening programme. METHODS: Among 2 175 762 women resident in Norway in 31.12.1996, all women who gave birth in 1996–7 were identified from the Medical Birth Registry of Norway. Attendance to the cervical cancer screening was assessed by linkage to the Cytology Registry separately for the pregnant and non-pregnant women cohorts. The results were stratified by age, history of previous Pap smear and history of invitation to the CC screening programme. Logistic regression was used to estimate the relative probabilities of having a Pap smear adjusted for age, screening history, and time since invitation, for pregnant and non-pregnant women, respectively. RESULTS: 69% of the pregnant women had a Pap smear during one year of follow-up since beginning of the pregnancy with the majority taken during the antepartum period. Irrespectively of age or history of having a Pap smear, pregnant women were 4.3 times more likely to have a Pap smear during follow-up compared to non-pregnant women. 63.2% of the pregnant women had a smear as response to the invitation letter compared to 28.7% of the non-pregnant women, OR = 2.1 (95% CI 1.9 to 2.4). As an indication of "over-screening", 5397 pregnant women (57.8%) with a smear shortly before the start of follow-up also had a new Papsmear, compared to 83 023 (32.3%) in non-pregnant. CONCLUSION: Pap smear screening during pregnancy increases the coverage of the CC screening programme. The contribution of the antepartum Pap smear to "over-screening" exists but its effect is modest in countries where women on average become pregnant after the start of recommended age of screening

Attractor states and infrared scaling in de Sitter space

The renormalized expectation value of the energy-momentum tensor for a scalar field with any mass m and curvature coupling xi is studied for an arbitrary homogeneous and isotropic physical initial state in de Sitter spacetime. We prove quite generally that has a fixed point attractor behavior at late times, which depends only on m and xi, for any fourth order adiabatic state that is infrared finite. Specifically, when m^2 + xi R > 0, approaches the Bunch-Davies de Sitter invariant value at late times, independently of the initial state. When m = xi = 0, it approaches instead the de Sitter invariant Allen-Folacci value. When m = 0 and xi \ge 0 we show that this state independent asymptotic value of the energy-momentum tensor is proportional to the conserved geometrical tensor (3)H_{ab}, which is related to the behavior of the quantum effective action of the scalar field under global Weyl rescaling. This relationship serves to generalize the definition of the trace anomaly in the infrared for massless, non-conformal fields. In the case m^2 + xi R = 0, but m and xi separately different from zero, grows linearly with cosmic time at late times. For most values of m and xi in the tachyonic cases, m^2 + xi R grows exponentially at late cosmic times for all physically admissable initial states.Comment: 30 pages, 6 figures, 46 kB tar.gz fil

Scratch lottery tickets are a poor incentive to respond to mailed questionnaires

BACKGROUND: It has been demonstrated that the enclosure of money with a mailed questionnaire increases the response rate significantly. We evaluated scratch lottery tickets as an alternative to cash. METHODS: 1500 randomly selected Norwegians between the ages of 40 and 65 years were sent a short questionnaire. 250 received one lottery scratch ticket worth 20 Norwegian kroner (approximately 3 US$) together with the questionnaire, 250 received two scratch tickets, and 250 were promised two scratch tickets if they replied within one week. A fourth group of 250 persons received a 50 kroner banknote with the questionnaire. The remaining 500 letters served as controls. RESULTS: The overall response rate after 6 weeks was 77%. Logistic regression analysis showed that only the 50 kroner group had a response rate that was statistically significantly higher than the controls (p < 0.0001). It was also significantly higher than that in any of the other incentive groups (p < 0.0001, p < 0.004 and p < 0.0001 respectively). Female sex (p < 0.001) and age (p < 0.002) increased the response rate significantly. CONCLUSION: It is possible that the recipients scratched their cards before completing the questionnaire, and that it was a disincentive for the majority that they did not win anything. Lottery scratch tickets are no substitute for cash as an incentive to respond to a questionnaire

A novel online food recall checklist for use in an undergraduate student population : a comparison with diet diaries

Peer reviewedPublisher PD

Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories

BACKGROUND: The Malaysian Ministry of Health promotes breast self-examination (BSE) for all women, and Pap smear screening every three years for all sexually active women ages 20 years and above. The objectives of this paper were to examine the practice of these two screening tests among women production workers in electronics factories, and to identify factors related to practice. METHODS: This was a cross-sectional survey of women production workers from ten electronics factories. Data was collected by a self-administered questionnaire from a total of 1,720 women. The chi-square test, odds ratio and binomial logistic regression were used in bivariate and multivariate analysis. RESULTS: Prevalence rates were 24.4% for BSE once a month, and 18.4% for Pap smear examination within the last three years. Women who were significantly more likely to perform BSE every month were 30 years and older, Malays, with upper secondary education and above, answered the BSE question correctly, and had a Pap smear within the last three years. The proportion of women who had a Pap smear within the last three years were significantly higher among those who were older, married, with young children, on the contraceptive pill or intra-uterine device, had a medical examination within the last five years, answered the Pap smear question correctly, and performed BSE monthly. CONCLUSION: Screening practice rates in this study were low when compared to national rates. Socio-demographic and health care factors significantly associated with screening practice are indicative of barriers which should be further understood so that more effective educational and promotional strategies could be developed

Performance of health-status scales when used selectively or within multi-scale questionnaire

BACKGROUND: Little work has been done to investigate the suggestion that the use of selected scales from a multi-scale health-status questionnaire would compromise reliability and validity. The aim of this study was to compare the performance of three scales selected from the SF-36 generic health questionnaire when administered in isolation or within the entire SF-36 to patients with musculoskeletal disorders. METHODS: Two groups of patients referred to an orthopedic department completed a mailed questionnaire within 4 weeks prior to and a second questionnaire during their visit. The first group completed three SF-36 scales related to physical health (physical functioning, bodily pain, and general health perceptions) on one occasion and all eight SF-36 scales on the other occasion. The second group completed the entire SF-36 on two occasions. Results for patients who reported unchanged health status and had complete scores were analyzed; 80 patients in the first and 62 patients in the second group. RESULTS: The Cronbach alpha reliability and intraclass correlation coefficients exceeded 0.7 for all three scales for both groups. For the first group the mean difference between the scores was 0.4 point for physical functioning, 2.5 points for bodily pain, and 0.5 point for general health perceptions, which did not differ significantly from the corresponding differences for the second group (0.1, 1.9 and 1 point, respectively). CONCLUSION: The use of selected scales from a multi-scale health-status questionnaire seems to yield similar results compared to their use within the entire questionnaire

Comparison of risk factors for squamous cell and adenocarcinomas of the cervix: a meta-analysis

While most cancers of the uterine cervix are squamous cell carcinomas, the relative and absolute incidence of adenocarcinoma of the uterine cervix has risen in recent years. It is not clear to what extent risk factors identified for squamous cell carcinoma of the cervix are shared by cervical adenocarcinomas. We used data from six case-control studies to compare directly risk factors for cervical adenocarcinoma (910 cases) and squamous cell carcinoma (5649 cases) in a published data meta-analysis. The summary odds ratios and tests for differences between these summaries for the two histological types were estimated using empirically weighted least squares. A higher lifetime number of sexual partners, earlier age at first intercourse, higher parity and long duration of oral contraceptive use were risk factors for both histological types. Current smoking was associated with a significantly increased risk of squamous cell carcinoma, with a summary odds ratio of 1.47 (95% confidence interval: 1.15-1.88), but not of adenocarcinoma (summary odds ratio=0.82 (0.60-1.11); test for heterogeneity between squamous cell and adenocarcinoma for current smoking: P=0.001). The results of this meta-analysis of published data suggest that squamous cell and adenocarcinomas of the uterine cervix, while sharing many risk factors, may differ in relation to smoking. Further evidence is needed to confirm this in view of the limited data available

The Thermal Ion Dynamics Experiment and Plasma Source Instrument

The Thermal Ion Dynamics Experiment (TIDE) and the Plasma Source Instrument (PSI) have been developed in response to the requirements of the ISTP Program for three-dimensional (3D) plasma composition measurements capable of tracking the circulation of low-energy (0-500 eV) plasma through the polar magnetosphere. This plasma is composed of penetrating magnetosheath and escaping ionospheric components. It is in part lost to the downstream solar wind and in part recirculated within the magnetosphere, participating in the formation of the diamagnetic hot plasma sheet and ring current plasma populations. Significant obstacles which have previously made this task impossible include the low density and energy of the outflowing ionospheric plasma plume and the positive spacecraft floating potentials which exclude the lowest-energy plasma from detection on ordinary spacecraft. Based on a unique combination of focusing electrostatic ion optics and time of flight detection and mass analysis, TIDE provides the sensitivity (seven apertures of about 1 cm squared effective area each) and angular resolution (6 x 18 degrees) required for this purpose. PSI produces a low energy plasma locally at the POLAR spacecraft that provides the ion current required to balance the photoelectron current, along with a low temperature electron population, regulating the spacecraft potential slightly positive relative to the space plasma. TIDE/PSI will: (a) measure the density and flow fields of the solar and terrestrial plasmas within the high polar cap and magnetospheric lobes; (b) quantify the extent to which ionospheric and solar ions are recirculated within the distant magnetotail neutral sheet or lost to the distant tail and solar wind; (c) investigate the mass-dependent degree energization of these plasmas by measuring their thermodynamic properties; (d) investigate the relative roles of ionosphere and solar wind as sources of plasma to the plasma sheet and ring current