Analyzing Medication Documentation in Electronic Health Records: Dental Students’ Self-Reported Behaviors and Charting Practices

The aim of this two-part study was to assess third- and fourth-year dental students’ perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients’ medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents’ most frequently cited perceived barriers to medication documentation were patients’ not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low

Topological superconducting phases in disordered quantum wires with strong spin-orbit coupling

Zeeman fields can drive semiconductor quantum wires with strong spin-orbit coupling and in proximity to s-wave superconductors into a topological phase which supports end Majorana fermions and offers an attractive platform for realizing topological quantum information processing. Here, we investigate how potential disorder affects the topological phase by a combination of analytical and numerical approaches. Most prominently, we find that the robustness of the topological phase against disorder depends sensitively and non-monotonously on the Zeeman field applied to the wire.Comment: 6 pages, 3 figures; published versio

Assessment of Left Atrial Deformation and Function by 2-Dimensional Speckle Tracking Echocardiography in Healthy Dogs and Dogs With Myxomatous Mitral Valve Disease

open7noBackground: The assessment of left atrial (LA) function by 2-dimensional speckle tracking echocardiography (STE) holds important clinical implications in human medicine. Few similar data are available in dogs. Objectives: To assess LA function by STE in dogs with and without myxomatous mitral valve disease (MMVD), analyzing LA areas, systolic function, and strain. Animals: One hundred and fifty dogs were divided according to the American College of Veterinary Internal Medicine classification of heart failure: 23 dogs in class A, 52 in class B1, 36 in class B2, and 39 in class C + D. Methods: Prospective observational study. Conventional morphologic and Doppler variables, LA areas, and STE-based LA strain analysis were performed in all dogs and results were compared among groups. Correlation analysis was carried out between LA STE variables and other echocardiographic variables. Results: Variability study showed good reproducibility for all the tested variables (coefficient of variation <16%). Left atrial areas, fractional area change, peak atrial longitudinal strain (PALS), peak atrial contraction strain, and contraction strain index (CSI) differed significantly between groups B2 and C + D and all the other groups (overall P < .001), whereas only PALS differed between groups B1 and A (P = .01). Left atrial areas increased with progression of the disease, whereas LA functional parameters decreased. Only CSI increased nonsignificantly from group A to group B1 and then progressively decreased. Thirty-one significant correlations (P < .001, r > .3) were found between conventional left heart echocardiographic variables and LA areas and strain variables. Conclusions and Clinical Importance: Left atrial STE analysis provides useful information on atrial function in the dog, highlighting a progressive decline in atrial function with worsening of MMVD.openBaron Toaldo, M; Romito, G.; Guglielmini, C.; Diana, A.; Pelle, N.G.; Contiero, B.; Cipone, M.Baron Toaldo, M; Romito, G.; Guglielmini, C.; Diana, A.; Pelle, N.G.; Contiero, B.; Cipone, M

TOBACCO CESSATION: COMPARING SMOKERS WITH AND WITHOUT SUB-STANCE ABUSE HISTORY

poster abstractSmoking cessation has been suggested to be more difficult for individuals with a history of chemical dependence. Previous research suggests a higher intensity of nicotine addiction, greater negative affect, and unfavorable psy-chometric assessment scores during cessation. The Indiana University Nico-tine Dependence Program (IUNDP) treated over 1200 patients using a Mayo Clinic-based approach which assesses the behavioral, social, and physiologi-cal aspects of tobacco and nicotine dependence. The IUNDP was also insti-tuted at FB. Participant charts (1992-2011) were selected from IUSD and FB for retrospective analysis. Chart selection criteria consisted of complete, pre-and post quit measures for a minimum of four appointments, and two post-quit appointments. 107 charts from patients without history of chemical de-pendence (ND) and 123 from those with a chemical dependence (CD) history were reviewed. Student researchers, trained to a standardized protocol, cap-tured 16 tobacco use and demographic variables, and 12 post-quit treatment measures. Analyses were made using Pearson chi-square tests for binary da-ta, Wilcoxon rank sum tests for all other data, and Wilcoxon signed rank tests for changes between time periods. Comparatively, smokers in the CD group were likely to be male, and displayed an increase in the following: sensorimotor handling scores of the Horn psychological test of nicotine de-pendence, negative mood, anxiety, restlessness, and average withdrawal scores (p<0.05). Additionally, CD smokers had less decrease in anger, but a greater decrease in frustration (p<0.05). Despite some differences, smokers with and without a history of substance abuse were similar in their tobacco-related addiction parameters. Results suggest that smokers with a history of chemical dependence have greater difficulty during smoking cessation with respect to addiction-related sensorimotor manipulation and psychological withdrawal symptoms

Chaotic dynamics in superconducting nanocircuits

The quantum kicked rotator can be realized in a periodically driven superconducting nanocircuit. A study of the fidelity allows the experimental investigation of exponential instability of quantum motion inside the Ehrenfest time scale, chaotic diffusion and quantum dynamical localization. The role of noise and the experimental setup to measure the fidelity is discussed as well.Comment: 4 pages, 4 figure

Standard and Null Weak Values

Weak value (WV) is a quantum mechanical measurement protocol, proposed by Aharonov, Albert, and Vaidman. It consists of a weak measurement, which is weighed in, conditional on the outcome of a later, strong measurement. Here we define another two-step measurement protocol, null weak value (NVW), and point out its advantages as compared to WV. We present two alternative derivations of NWVs and compare them to the corresponding derivations of WVs.Comment: 11 pages, 2 figures. To appear in Quantum Theory: A Two-Time Success Story: Yakir Aharonov Festschrif

Probability distribution of Majorana end-state energies in disordered wires

One-dimensional topological superconductors harbor Majorana bound states at their ends. For superconducting wires of finite length L, these Majorana states combine into fermionic excitations with an energy $\epsilon_0$ that is exponentially small in L. Weak disorder leaves the energy splitting exponentially small, but affects its typical value and causes large sample-to-sample fluctuations. We show that the probability distribution of $\epsilon_0$ is log normal in the limit of large L, whereas the distribution of the lowest-lying bulk energy level $\epsilon_1$ has an algebraic tail at small $\epsilon_1$. Our findings have implications for the speed at which a topological quantum computer can be operated.Comment: 4 pages, 2 figure

Diagnostics of entanglement dynamics in noisy and disordered spin chains via the measurement-induced steady-state entanglement transition

We utilize the concept of a measurement-induced entanglement transition to analyze the interplay and competition of processes that generate and destroy entanglement in a one-dimensional quantum spin chain evolving under a locally noisy and disordered Hamiltonian. We employ continuous measurements of variable strength to induce a transition from volume to area-law scaling of the steady-state entanglement entropy. While static background disorder systematically reduces the critical measurement strength, this critical value depends nonmonotonically on the strength of nonstatic noise. According to the extracted finite-size scaling exponents, the universality class of the transition is independent of the noise and disorder strength. We interpret the results in terms of the effect of static and nonstatic disorder on the intricate dynamics of the entanglement generation rate due to the Hamiltonian in the absence of measurement, which is fully reflected in the behavior of the critical measurement strength. Our results establish a firm connection between this entanglement growth and the steady-state behavior of the measurement-controlled systems, which therefore can serve as a tool to quantify and investigate features of transient entanglement dynamics in complex many-body systems via a steady-state phase transition

Topological transition in measurement-induced geometric phases

The state of a quantum system, adiabatically driven in a cycle, may acquire a measurable phase depending only on the closed trajectory in parameter space. Such geometric phases are ubiquitous and also underline the physics of robust topological phenomena such as the quantum Hall effect. Equivalently, a geometric phase may be induced through a cyclic sequence of quantum measurements. We show that the application of a sequence of weak measurements renders the closed trajectories, hence the geometric phase, stochastic. We study the concomitant probability distribution and show that, when varying the measurement strength, the mapping between the measurement sequence and the geometric phase undergoes a topological transition. Our finding may impact measurement-induced control and manipulation of quantum states-a promising approach to quantum information processing. It also has repercussions on understanding the foundations of quantum measurement

Subthalamic neural activity patterns anticipate economic risk decisions in gambling

Economic decision-making is disrupted in individuals with gambling disorder, an addictive behavior observed in Parkinson’s Disease (PD) patients receiving dopaminergic therapy. The subthalamic nucleus (STN) is involved in the inhibition of impulsive behaviors; however its role in impulse control disorders and addiction is still unclear. Here, we recorded STN local field potentials (LFPs) in PD patients with and without gambling disorder during an economic decision-making task. Reaction times analysis showed that for all patients the decision whether to risk preceded task onset. We compared then for both groups the STN LFP preceding high and low risk economic decisions. We found that risk avoidance in gamblers correlated with larger STN LFP low frequency (<12 Hz) fluctuations preceding task onset. In particular, the amplitude of low frequency LFP fluctuations carried significant information about future decisions. Decisions of patients not affected by gambling disorder were instead not correlated with pre-task STN LFP. Our results suggest that STN activity preceding task onset affects risk decisions by pre-emptively inhibiting attraction to high but unlikely rewards in favor of a long-term payoff