Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis. Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health record (EHR) reminding providers of the recommended treatment of sinusitis. The advisory included a link to national guidelines and a note template was installed to assist providers in documentation. The BPA appeared on the providers’ screen when an ICD-9 code of acute or bacterial sinusitis was entered during the patient visit. Results: After adjusting for select patient and provider factors, the computer-assisted guidelines effectively reduced the overall antibiotic prescribing among these patients by 31% (relative risk: 0.69, 95% confidence interval: 0.51–0.95) and reduced incorrect prescribing from 88.5% to 78.7% (P = 0.02). Conclusions: Clinical reminders within the EHR can be an effective tool to reduce inappropriate antibiotic use and improve providers’ decisions regarding the correct antibiotic choices for patients with acute sinusitis

Los comportamientos de control en la pareja en la era digital: la aceptación de la violencia de género, el sexismo y los mitos del amor

Young people have incorporated information and communication technology (ICT) and its influence on socialization as a new instrument to exercise controlling behaviors in their relationships. The present research aims to analyse the influence of some variables that affect social perception of those controlling behaviors, such as the adopted role on the scene (i.e., protagonist vs. observer) and means of control that is used (i.e., face-to-face vs. WhatsApp) while considering the effect of attitudinal variables: acceptability of intimate partner violence against women (IPVAW), ambivalent sexism, and myths about romantic love. Two studies were implemented: Study 1 included women (n = 224) and Study 2 included men (n = 120), all of them college students. The main results revealed that both women and men perceive controlling behaviors amongst other peer couples; however, few of them recognize suffering or the exercise of these behaviors within their relationships. In addition, data pointed out the adopted role on the scene and the ideological variables (ambivalent sexism, acceptability of IPVAW, and myths about romantic love) that influenced social perception of dating violence; however, there was no influence of means of control. This research contributes to the previous literature, evidencing that controlling behaviors through technological means are accepted and normalized among young people. Additionally, it shows novel data about young people’s social perception of controlling behaviors in their relationships, depending on whether they adopt the role of observer or the role of protagonist in a violent situation.Con las tecnologías de la información y la comunicación (TIC) y su influencia en la socialización, los jóvenes han incorporado un instrumento más para ejercer comportamientos controladores en sus relaciones de pareja. Esta investigación pretende analizar la influencia de algunas variables que afectan a la percepción social de estos comportamientos controladores, como el rol del participante en el escenario (protagonista vs. observador u observadora) y el medio de control utilizado (cara a cara vs. WhatsApp), considerando el efecto de las variables ideológicas: aceptabilidad de la violencia, sexismo y mitos del amor romántico. Se llevaron a cabo dos estudios: un primer estudio con mujeres (n = 224) y uno segundo con hombres (n = 120), todos ellos estudiantes universitarios. Los principales resultados indicaron que tanto mujeres como hombres observan comportamientos controladores en otras parejas de su edad, aunque pocos reconocen sufrir o ejercer estos comportamientos en sus relaciones. Asimismo, se encuentra que el rol que se ocupa en el escenario y las variables ideológicas (sexismo ambivalente, aceptabilidad de la violencia y mitos sobre el amor romántico) influyen en la percepción social de la violencia en la pareja, si bien no se encontró influencia del medio de control. Estos hallazgos constituyen una aportación a la literatura existente, poniendo en evidencia que los comportamientos controladores ejercidos a través de los medios tecnológicos son aceptados y normalizados entre los jóvenes y las jóvenes. Asimismo, proporciona datos novedosos sobre la percepción social que esta población tiene de los comportamientos controladores en las relaciones en función de si se adopta el rol de observador o de protagonista de la situación violenta

Examining the effect of residential change on intimate partner violence risk

Abstract Objectives: To examine the relationship between residential change and a woman’s subsequent risk of intimate partner violence (IPV), whether by a past or a new offender, a relationship that has not been prospectively examined to date. Design: A dynamic cohort of women who recently changed residence (movers) was compared with those who did not (non-movers) for 12-month risk of IPV by a past offender and of IPV by a new offender. Participants and methods: Secondary analysis of a linked, longitudinal National Crime Victimization Survey dataset including 10 754 recent movers and 10 236 non-movers among women aged 18–44 years. Results: The risk of IPV by either a past or a new offender was almost double for women who had recently moved compared with those who had not moved. This increased risk proved to be robust, as it persisted when the data were weighted and unweighted, and when the main effect was adjusted by measured covariates. Conclusions: The apparent increase in IPV risk after residential change may be a marker of a pre-existing problem or a precursor of subsequent problems. Unlike past research that has considered residential change after abuse or as a simultaneous exposure, this study focused solely on empirically measuring the risk of IPV after a recent move. This decision has important public health ramifications: determination of IPV exposure is not always possible, whereas soliciting a woman’s history of residence may be more feasible. If transience puts a woman at greater risk for victimisation by an intimate partner, increased awareness may have a vital role in protecting women who move

Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis. Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health record (EHR) reminding providers of the recommended treatment of sinusitis. The advisory included a link to national guidelines and a note template was installed to assist providers in documentation. The BPA appeared on the providers’ screen when an ICD-9 code of acute or bacterial sinusitis was entered during the patient visit. Results: After adjusting for select patient and provider factors, the computer-assisted guidelines effectively reduced the overall antibiotic prescribing among these patients by 31% (relative risk: 0.69, 95% confidence interval: 0.51–0.95) and reduced incorrect prescribing from 88.5% to 78.7% (P = 0.02). Conclusions: Clinical reminders within the EHR can be an effective tool to reduce inappropriate antibiotic use and improve providers’ decisions regarding the correct antibiotic choices for patients with acute sinusitis