On Data Quality and Risk in Guideline Based Clinical Decision Support

Guideline based clinical decision support systems provide patient-specific medical guidance to physicians, often at the point-of-care. A large body of research shows that these systems have the potential to reduce practice variation and human error. However, there is also evidence suggesting that these systems may introduce unintended risk into the medical-decision making process. The poor quality of data in medical records and databases poses one such risk. As a result, appropriately assessing the magnitude of the risk posed by data quality is an important, but difficult problem. The nature of this risk depends on several complex and interrelated factors. To analyze the extent of this problem, we provide a novel framework that explicitly models the nature of data, errors, and how guideline based clinical decisions support systems process information and produce guidance. Our framework gives the decision-maker the ability to assess how uncertainty about data quality translates into the risk of negative medical consequences and determine which data elements are most critical for minimizing this risk. The results of our framework can inform both efficient data-quality improvement and risk minimization strategies

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment

Getting Users to Pay Attention to Anti-Phishing Education: Evaluation of Retention and Transfer

Educational materials designed to teach users not to fall for phishing attacks are widely available but are often ignored by users. In this paper, we extend an embedded training methodology using learning science principles in which phishing education is made part of a primary task for users. The goal is to motivate users to pay attention to the training materials. In embedded training, users are sent simulated phishing attacks and trained after they fall for the attacks. Prior studies tested users immediately after training and demonstrated that embedded training improved users’ ability to identify phishing emails and websites. In the present study, we tested users to determine how well they retained knowledge gained through embedded training and how well they transferred this knowledge to identify other types of phishing emails. We also compared the effectiveness of the same training materials delivered via embedded training and delivered as regular email messages. In our experiments, we found that: (a) users learn more effectively when the training materials are presented after users fall for the attack (embedded) than when the same training materials are sent by email (non-embedded); (b) users retain and transfer more knowledge after embedded training than after nonembedded training; and (c) users with higher Cognitive Reflection Test (CRT) scores are more likely than users with lower CRT scores to click on the links in the phishing emails from companies with which they have no account