Understanding the management of electronic test result notifications in the outpatient setting

<p>Abstract</p> <p>Background</p> <p>Notifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.</p> <p>Methods</p> <p>We conducted a qualitative study consisting of six 6-8 member focus groups (N = 44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow.</p> <p>Results</p> <p>Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification.</p> <p>Conclusion</p> <p>Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.</p

Micro-CT screening of old shell collections helps to understand the distribution of viviparity in the highly diversifed clausiliid clade of land snails

Current zoological research may benefit in many ways from the study of old collections of shells. These collections may provide materials for the verification of broad zoogeographical and ecological hypotheses on the reproduction of molluscs, as they include records from many areas where sampling is currently impossible or very difficult due to political circumstances. In the present paper we present data on viviparous and embryo-retention reproductive modes in clausiliid land snails (subfamily Phaedusinae) acquired from specimens collected since the nineteenth century in the Pontic, Hyrcanian, and East and Southeast Asian regions. X-ray imaging (micro-CT) enabled relatively quick screening of more than 1,000 individuals classified within 141 taxa, among which we discovered 205 shells containing embryos or eggs. Gravid individuals were found to belong to 55 species, representing, for some of these species, the first indication of brooding reproductive strategy

Selection system orientations as an explanation for the differences between dual leaders of the same organization in their perception of organizational performance

We investigate to what extent individual managers operating in a dual leadership structure have different perceptions of how well his/her organization is performing. Using selection system theory we develop hypotheses on the relationships between a leader&#039;s selection system orientation and his/her perception of performance along multiple dimensions: market performance, expert performance and peer performance. The hypotheses are tested using dyadic data from 59 organizations in the performing arts led by two-hierarchically equivalent-managers. Our results show that dual leaders&#039; differences in terms of market orientation and expert orientation relate positively to perceived performance differences along the same dimensions. This relationship is not found with respect to peer selection orientation. Generally, the relationship between orientation differences and perceived performance differences is stronger if the process of interpreting signals to construct a perception of organizational performance leaves more room for equivocality and uncertainty

Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008 Condições periodontais e desigualdades sociais, raciais e de gênero no Brasil: revisão sistemática da literatura do período de 1999 a 2008

The objective of this study was to review the Brazilian epidemiologic literature on periodontal outcomes and socio-demographic factors, assessing bibliographic and methodological characteristics of this scientific production, as well as the consistency and statistical significance of the examined associations. A systematic review was carried out in six bibliographic sources. The review was limited to the period between 1999 and 2008, without any other type of restriction. Among the 410 papers identified, 29 were included in the review. An increasing number of articles, specifically in the last four years of study, was observed. However, there is a concentration of studies in the South and Southeast regions of Brazil, and many of them are not closely connected to theoretical formulations in the field. In spite of these shortcomings, the review findings corroborate the idea that poor socioeconomic conditions are associated with periodontal outcomes, as demonstrated primarily by income and schooling indicators.<br>O objetivo deste trabalho foi revisar a literatura epidemiológica brasileira sobre condições periodontais e aspectos sociodemográficos, avaliando características bibliográficas e metodológicas dessa produção, bem como a consistência e a significância estatística das associações examinadas. Foi conduzida uma revisão sistemática, por meio de consulta eletrônica, a seis fontes bibliográficas. A revisão foi restrita ao período de 1999 a 2008, sem a imposição de quaisquer outros limites de pesquisa. Entre os 410 artigos identificados, 29 foram incluídos na revisão. Observa-se crescimento da produção, especialmente no último quadriênio. Entretanto, há uma concentração dos estudos nas regiões Sul e Sudeste do país, e os trabalhos não se apoiam explicitamente em elaborações teóricas pertinentes ao tema. Apesar dessas limitações, os resultados dessa revisão sugerem que há uma relação inversa entre indicadores socioeconômicos e desfechos periodontais, demonstrada especialmente por indicadores de renda e escolaridade