University of Oregon Libraries Statistical Abstract for Fiscal Year 2011-2012

20 page

A Narrative Review of Medication-Related Clinical Decision Support

Objectives: A key element of the implementation and on-going use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods: We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature (CINAHL), Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key Findings: Our search of ‘all training’ approaches returned 1,155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions: A number of methods are used to train prescribers; however the lack of papers retrieved suggests a need for additional studies to inform training methods

Sarcoidosis: the disease and its ocular manifestations

Sarcoidosis is a systemic disease that has ocular manifestations. For many patients there is a long course of treatment both topical and systemic. This article describes sarcoidosis both systemic and ocular and some of the treatment modalities used

Understanding physicians’ behavior toward alerts about nephrotoxic medications in outpatients: a cross-sectional analysis

Background: Although most outpatients are relatively healthy, many have chronic renal insufficiency, and high override rates for suggestions on renal dosing have been observed. To better understand the override of renal dosing alerts in an outpatient setting, we conducted a study to evaluate which patients were more frequently prescribed contraindicated medications, to assess providers’ responses to suggestions, and to examine the drugs involved and the reasons for overrides. Methods: We obtained data on renal alert overrides and the coded reasons for overrides cited by providers at the time of prescription from outpatient clinics and ambulatory hospital-based practices at a large academic health care center over a period of 3 years, from January 2009 to December 2011. For detailed chart review, a group of 6 trained clinicians developed the appropriateness criteria with excellent inter-rater reliability (κ = 0.93). We stratified providers by override frequency and then drew samples from the high- and low-frequency groups. We measured the rate of total overrides, rate of appropriate overrides, medications overridden, and the reason(s) for override. Results: A total of 4120 renal alerts were triggered by 584 prescribers in the study period, among which 78.2% (3,221) were overridden. Almost half of the alerts were triggered by 40 providers and one-third was triggered by high-frequency overriders. The appropriateness rates were fairly similar, at 28.4% and 31.6% for high- and low-frequency overriders, respectively. Metformin, glyburide, hydrochlorothiazide, and nitrofurantoin were the most common drugs overridden. Physicians’ appropriateness rates were higher than the rates for nurse practitioners (32.9% vs. 22.1%). Physicians with low frequency override rates had higher levels of appropriateness for metformin than the high frequency overriders (P = 0.005). Conclusion: A small number of providers accounted for a large fraction of overrides, as was the case with a small number of drugs. These data suggest that a focused intervention targeting primarily these providers and medications has the potential to improve medication safety

Asymptotic solvers for ordinary differential equations with multiple frequencies

We construct asymptotic expansions for ordinary differential equations with highly oscillatory forcing terms, focusing on the case of multiple, non-commensurate frequencies. We derive an asymptotic expansion in inverse powers of the oscillatory parameter and use its truncation as an exceedingly effective means to discretize the differential equation in question. Numerical examples illustrate the effectiveness of the method

A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?

Objectives A key element of the implementation and ongoing use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature, Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key findings Our search of ‘all training’ approaches returned 1155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions A number of methods are used to train prescribers; however, the lack of papers retrieved suggests a need for additional studies to inform training methods

Variation in education doctoral students’ conceptions of university teaching

The development of doctoral students as university teachers has received substantially less attention compared with their development as researchers, with a similar deficit extending to research on how they experience and understand university teaching. This article reports the results of a phenomenographic study of education doctoral students’ conceptions of teaching in higher education. Using samples from two education departments in England and Sweden, we conducted interviews to identify variation in doctoral students’ experiences of university teaching. Analysis of the transcripts produced six qualitatively different conceptions of teaching: doctoral students conceptualised university teaching as a means of (A) transmitting knowledge, (B) presenting contrasting concepts of education, (C) communicating and engaging with students, (D) enabling students to apply knowledge and skills, (E) enabling students to interpret and compare concepts of education, and (F) promoting personal, professional and societal development and change. While in broad agreement with previous studies on university teachers’ conceptions of teaching, the study offers a unique insight into how the subject of education is understood by doctoral students who teach. The findings also underline the need to introduce common frameworks of academic development for academics and doctoral students alike that prioritise ways of representing and engaging with the structure of the subject, rather than the acquisition of teaching skills

Structure of the mirror nuclei 9^9Be and 9^9B in a microscopic cluster model

The structure of the mirror nuclei $^9$Be and $^9$B is studied in a microscopic $\alpha+ \alpha+ n$ and $\alpha+ \alpha+ p$ three-cluster model using a fully antisymmetrized 9-nucleon wave function. The two-nucleon interaction includes central and spin-orbit components and the Coulomb potential. The ground state of $^9$Be is obtained accurately with the stochastic variational method, while several particle-unbound states of both $^9$Be and $^9$B are investigated with the complex scaling method.The calculation for $^9$Be supports the recent identification for the existence of two broad states around 6.5 MeV, and predicts the $\frac{3}{2}^{-}_2$ and $\frac{5}{2}^{-}_2$ states at about 4.5 MeV and 8 MeV, respectively. The similarity of the calculated spectra of $^9$Be and $^9$B enables one to identify unknown spins and parities of the $^9$B states. Available data on electromagnetic moments and elastic electron scatterings are reproduced very well. The enhancement of the $E$1 transition of the first excited state in $^9$Be is well accounted for. The calculated density of $^9$Be is found to reproduce the reaction cross section on a Carbon target. The analysis of the beta decay of $^9$Li to $^9$Be clearly shows that the wave function of $^9$Be must contain a small component that cannot be described by the simple $\alpha+ \alpha+ n$ model. This small component can be well accounted for by extending a configuration space to include the distortion of the $\alpha$-particle to $t+p$ and $h+n$ partitions.Comment: 24 page

Wt1 is required for cardiovascular progenitor cell formation through transcriptional control of Snail and E-cadherin

Epicardial epithelial-mesenchymal transition (EMT) is hypothesized to generate cardiovascular progenitor cells that differentiate into various cell types, including coronary smooth muscle and endothelial cells, perivascular and cardiac interstitial fibroblasts and cardiomyocytes. Here we show that an epicardial-specific knockout of Wt1 leads to a reduction of mesenchymal progenitor cells and their derivatives. We demonstrate that Wt1 is essential for repression of the epithelial phenotype in epicardial cells and during Embryonic Stem (ES) cell differentiation, through direct transcriptional regulation of Snail (Snai1) and E-cadherin (Cdh1), two of the major mediators of EMT. Some mesodermal lineages fail to form in Wt1 null embryoid bodies but this effect is rescued by the expression of Snai1, underlining the importance of EMT in generating these differentiated cells. These new insights into the molecular mechanisms regulating cardiovascular progenitor cells and EMT will shed light on the pathogenesis of heart diseases and may help the development of cell based therapies