Factors Affecting Stress Levels in Attendants Accompanying Patients to Emergency Department.

Introduction: Staff in emergency departments work in an environment where they are continuously exposed to situations with aggressive patients and their caretakers. With increasing incidents of reported violence, the present study was conducted to identify factors associated with stress levels among patients' attendants.

Methods: A prospective, cross-sectional, observational study was conducted among 256 attendants of patients presenting to Emergency Department (ED).

Bladder cancer with pioglitazone: A case-control study.

Background: Varied reports suggest a contentious relationship of bladder malignancy with pioglitazone in patients with type 2 diabetes.

Aim: To study an association (prevalence and predictors) of bladder malignancy with pioglitazone therapy in Asian-Indian type 2 diabetes patients.

Method: In this observational multicenter study, type 2 diabetic patients attending out-patient diabetes-clinic were evaluated.

Algorithmic Detection of Boolean Logic Errors in Clinical Decision Support Statements.

Objective: Clinical decision support (CDS) can contribute to quality and safety. Prior work has shown that errors in CDS systems are common and can lead to unintended consequences. Many CDS systems use Boolean logic, which can be difficult for CDS analysts to specify accurately.

Structured override reasons for drug-drug interaction alerts in electronic health records.

Objective: The study sought to determine availability and use of structured override reasons for drug-drug interaction (DDI) alerts in electronic health records.

Materials And Methods: We collected data on DDI alerts and override reasons from 10 clinical sites across the United States using a variety of electronic health records. We used a multistage iterative card sort method to categorize the override reasons from all sites and identified best practices.

Integrity of clinical information in computerized order requisitions for diagnostic imaging.

Objective: Assess information integrity (concordance and completeness of documented exam indications from the electronic health record [EHR] imaging order requisition, compared to EHR provider notes), and assess potential impact of indication inaccuracies on exam planning and interpretation.

Methods: This retrospective study, approved by the Institutional Review Board, was conducted at a tertiary academic medical center. There were 139 MRI lumbar spine (LS-MRI) and 176 CT abdomen/pelvis orders performed 4/1/2016-5/31/2016 randomly selected and reviewed by 4 radiologists for concordance and completeness of relevant exam indications in order requisitions compared to provider notes, and potential impact of indication inaccuracies on exam planning and interpretation.

Pharmacokinetics of colistin in patients with multidrug-resistant Gram-negative infections: A pilot study.

Background & Objectives: There is little information concerning intravenously (i.v.) administered colistin in patients with multidrug-resistant (MDR) Gram-negative infections.

Medicare Imaging Demonstration: Assessing Attributes of Appropriate Use Criteria and Their Influence on Ordering Behavior.

Objective: Persistent concern exists about the variable and possibly inappropriate utilization of high-cost imaging tests. The purpose of this study is to assess the influence of appropriate use criteria attributes on altering ambulatory imaging orders deemed inappropriate.

Materials And Methods: This secondary analysis included Medicare Imaging Demonstration data collected from three health care systems in 2011-2013 via the use of clinical decision support (CDS) during ambulatory imaging order entry.

JOURNAL CLUB: Predictors of Provider Response to Clinical Decision Support: Lessons Learned From the Medicare Imaging Demonstration.

Objective: The efficacy of imaging clinical decision support (CDS) varies. Our objective was to identify CDS factors contributing to imaging order cancellation or modification.

Subjects And Methods: This pre-post study was performed across four institutions participating in the Medicare Imaging Demonstration.

Variation in high-priority drug-drug interaction alerts across institutions and electronic health records.

Objective: The United States Office of the National Coordinator for Health Information Technology sponsored the development of a "high-priority" list of drug-drug interactions (DDIs) to be used for clinical decision support. We assessed current adoption of this list and current alerting practice for these DDIs with regard to alert implementation (presence or absence of an alert) and display (alert appearance as interruptive or passive).

Materials And Methods: We conducted evaluations of electronic health records (EHRs) at a convenience sample of health care organizations across the United States using a standardized testing protocol with simulated orders.

Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options.

Objective: Increasing the use of generic medications could help control medical costs. However, educational interventions have limited impact on prescriber behavior, and e-prescribing alerts are associated with high override rates and alert fatigue. Our objective was to evaluate the effect of a less intrusive intervention, a redesign of an e-prescribing interface that provides default options intended to "nudge" prescribers towards prescribing generic drugs.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers.

Aim: To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists.

Materials And Methods: Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS).

Results: The study included 1494 patients recruited from 15 centers.

Multimodal monitoring in the pediatric intensive care unit: new modalities and informatics challenges.

We review several newer modalities to monitor the brain in children with acute neurologic disease in the pediatric intensive care unit, such as partial brain tissue oxygen tension (PbtO2), jugular venous oxygen saturation (SjvO2), near infrared spectroscopy (NIRS), thermal diffusion measurement of cerebral blood flow, cerebral microdialysis, and EEG. We then discuss the informatics challenges to acquire, consolidate, analyze, and display the data. Acquisition includes multiple data types: discrete, waveform, and continuous.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses.

Aim: To assess the health-care needs of the patients with severe mental disorders.

Materials And Methods: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS).

Results: The study included 1494 patients recruited from 15 centers.

A long-term follow-up evaluation of electronic health record prescribing safety.

Objective: To be eligible for incentives through the Electronic Health Record (EHR) Incentive Program, many providers using older or locally developed EHRs will be transitioning to new, commercial EHRs. We previously evaluated prescribing errors made by providers in the first year following transition from a locally developed EHR with minimal prescribing clinical decision support (CDS) to a commercial EHR with robust CDS. Following system refinements, we conducted this study to assess the rates and types of errors 2 years after transition and determine the evolution of errors.

Accuracy of electronically reported "meaningful use" clinical quality measures: a cross-sectional study.

Background: The federal Electronic Health Record Incentive Program requires electronic reporting of quality from electronic health records, beginning in 2014. Whether electronic reports of quality are accurate is unclear.

Objective: To measure the accuracy of electronic reporting compared with manual review.

Promoting generic medication prescribing by order interface redesign: small change, large impact.

Prescription drugs are a significant component of the ever increasing health care costs. We describe the effects on generic medication prescribing behavior achieved through redesign of the order entry interface of our institutions ambulatory electronic health record. The redesign involved custom programming that automatically substituted brand medications with their generic equivalents and only allowed continuation with the brand medication if the clinician made an extra mouse click selecting "dispense as written".

Physician experiences transitioning between an older versus newer electronic health record for electronic prescribing.

Purpose: Federal incentives to adopt interoperable, certified electronic health records (EHRs) with electronic prescribing (e-prescribing) are motivating providers using older EHRs to transition to newer EHRs. The objective of this study was to describe, from the perspective of experienced EHR users, the transition from an older, locally developed EHR with minimal clinical decision support (CDS) for e-prescribing to a newer, commercial EHR with more robust CDS for e-prescribing.

Methods: This qualitative, case study consisted of observations and semi-structured interviews of adult internal medicine faculty members (n=19) at an academic-affiliated ambulatory care clinic from January through November 2009.

A tri-marker proliferation index predicts biochemical recurrence after surgery for prostate cancer.

Prostate cancer exhibits tremendous variability in clinical behavior, ranging from indolent to lethal disease. Better prognostic markers are needed to stratify patients for appropriately aggressive therapy. By expression profiling, we can identify a proliferation signature variably expressed in prostate cancers.

Transitioning between electronic health records: effects on ambulatory prescribing safety.

Background: Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems.

Objective: To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety.

Physicians' potential use and preferences related to health information exchange.

Purpose: To characterize physician attitudes and preferences towards health information exchange (HIE), which is the ability to transmit health information electronically across institutions, and identify factors that influence physicians' interest in using HIE for their clinical work.

Methods: A survey was conducted of physicians affiliated with institutions that are stakeholders of a regional health information organization in the United States (U.S.

Is lymphadenectomy indicated in patients with T1 moderately differentiated penile cancer?

Objective: In patients with penile squamous cell carcinomas (SCCs), lymphadenectomy can be curative and should be considered in cases deemed high risk for metastatic spread to regional lymph nodes. Management of patients without palpable lymphadenopathy remains controversial. Current guidelines for T1 penile SCCs based on previous studies have suggested that moderately differentiated tumors are at low risk for metastatic disease; however given our experience with such patients we sought to examine whether such tumors were truly observable or should be treated more aggressively.

Needs of Indian schizophrenia patients: an exploratory study from India.

Background: Although there are many studies from the West, no study has evaluated the needs of schizophrenia patients in Indian setting.

Methodology: 100 consecutive patients of schizophrenia were assessed on Camberwell Assessment of Needs questionnaire. Same questionnaire was also administered to the caregiver to assess their perception about the needs of the patients.

Clinical presentation and urachal remnant pathology: implications for treatment.

Purpose: Symptomatic pediatric urachal remnants are frequently excised but to our knowledge it is unknown whether incidentally identified urachal remnants require removal. Urachal remnant excision in childhood is advocated to avoid future malignancy. Urachal anomalies that contain fibrostromal tissue without epithelium may have lower malignant potential and not require excision.

hCAP-D3 expression marks a prostate cancer subtype with favorable clinical behavior and androgen signaling signature.

Growing evidence suggests that only a fraction of prostate cancers detected clinically are potentially lethal. An important clinical issue is identifying men with indolent cancer who might be spared aggressive therapies with associated morbidities. Previously, using microarray analysis we defined 3 molecular subtypes of prostate cancer with different gene-expression patterns.