RESUMEN
Physician categorizations of electronic health record (EHR) data (e.g., depression) into sensitive data categories (e.g., Mental Health) and their perspectives on the adequacy of the categories to classify medical record data were assessed. One thousand data items from patient EHR were classified by 20 physicians (10 psychiatrists paired with ten non-psychiatrist physicians) into data categories via a survey. Cluster-adjusted chi square tests and mixed models were used for analysis. 10 items were selected per each physician pair (100 items in total) for discussion during 20 follow-up interviews. Interviews were thematically analyzed. Survey item categorization yielded 500 (50.0%) agreements, 175 (17.5%) disagreements, 325 (32.5%) partial agreements. Categorization disagreements were associated with physician specialty and implied patient history. Non-psychiatrists selected significantly (p = .016) more data categories than psychiatrists when classifying data items. The endorsement of Mental Health and Substance Use categories were significantly (p = .001) related for both provider types. During thematic analysis, Encounter Diagnosis (100%), Problems (95%), Health Concerns (90%), and Medications (85%) were discussed the most when deciding the sensitivity of medical information. Most (90.0%) interview participants suggested adding additional data categories. Study findings may guide the evolution of digital patient-controlled granular data sharing technology and processes.
Asunto(s)
Registros de Salud Personal , Médicos , Humanos , Registros Electrónicos de Salud , Médicos/psicología , Pacientes , Investigación CualitativaRESUMEN
PURPOSE: Although routine adolescent depression and suicide risk assessment (ADSRA) is recommended, primary care physician (PCP) ADSRA training is needed for successful ADSRA implementation. This study examined the effect of an intervention using standardized patients (SPs) on PCP ADSRA confidence, knowledge, and practices. METHODS: The intervention consisted of a 60-minute seminar followed by a 60-minute SP session to practice ADSRA skills in simulated clinical situations. INTERVENTION: PCPs (n = 46) completed pre- and postintervention assessments. Untrained PCPs interested in the intervention (n = 58) also completed assessments. Assessments evaluated ADSRA self-reported confidence and practices and objectively assessed knowledge. The main outcomes were (1) changes in pre-/postintervention PCP ADSRA confidence and knowledge, and (2) ADSRA practices in untrained versus postintervention PCPs. RESULTS: Compared with untrained PCPs, PCPs 5-10 months postintervention were more likely to screen most adolescents for depression (40% vs. 22%, p = .05), to use a depression screening tool (50% vs. 19%, p = .001), to have diagnosed at least one adolescent with depression in the past 3 months (96% vs. 78%, p = .013), and to have screened depressed adolescents for suicide risk factors, including access to weapons (51% vs. 25%; p = .007) or an impulsive violence history (27% vs. 11%; p = .037). PCP confidence and knowledge about depression assessment and treatment also significantly improved postintervention. CONCLUSIONS: This study supports the use of an SP intervention to improve PCP ADSRA confidence, knowledge, and practices. Widespread implementation of similar educational efforts has the potential to dramatically improve adolescent morbidity and mortality.
Asunto(s)
Competencia Clínica , Depresión/diagnóstico , Atención Primaria de Salud/normas , Medición de Riesgo/métodos , Prevención del Suicidio , Suicidio/estadística & datos numéricos , Adolescente , Servicios de Salud del Adolescente/normas , Depresión/psicología , Femenino , Humanos , Masculino , Suicidio/psicologíaRESUMEN
In rod-shaped bacteria, certain proteins are specifically localized to the cell poles. The nature of the positional information that leads to the proper localization of these proteins is unclear. In a screen for factors required for the localization of the Shigella sp. actin assembly protein IcsA to the bacterial pole, a mutant carrying a transposon insertion in mreB displayed altered targeting of IcsA. The phenotype of cells containing a transposon insertion in mreB was indistinguishable from that of cells containing a nonpolar mutation in mreB or that of wild-type cells treated with the MreB inhibitor A22. In cells lacking MreB, a green fluorescent protein (GFP) fusion to a cytoplasmic derivative of IcsA localized to multiple sites. Secreted full-length native IcsA was present in multiple faint patches on the surfaces of these cells in a pattern similar to that seen for the cytoplasmic IcsA-GFP fusion. EpsM, the polar Vibrio cholerae inner membrane protein, also localized to multiple sites in mreB cells and colocalized with IcsA, indicating that localization to multiple sites is not unique to IcsA. Our results are consistent with the requirement, either direct or indirect, for MreB in the restriction of certain polar material to defined sites within the cell and, in the absence of MreB, with the formation of ectopic sites containing polar material.