Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.

BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria. METHODS: We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. RESULTS: All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. CONCLUSION: If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.

Clinical decision support capabilities of commercially-available clinical information systems.

BACKGROUND: The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. METHODS: The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. RESULTS: Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. CONCLUSIONS: These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.

Career decision making, stability and actualization of career intentions: The case of entrepreneurial intentions

Career counselors are often concerned with stability and likelihood of implementation of clients’ career intentions. It is often assumed that the status in career decision making (CDM) is one likely indicator, yet empirical support for this assumption is sparse. The present study focused on entrepreneurial career intentions (EI) and showed that German university students (N = 1,221), with high EI can be found in very different empirically derived CDM statuses that range from pre-concern to mature decidedness. Longitudinal analyses (n = 561) showed that career choice foreclosure (high decidedness/low exploration) related to more EI stability and that mature decidedness (high decidedness/high exploration) amplified effects of EI on opportunity identification, a form of EI actualization. The results imply that CDM statuses are useful to estimate stability and actualization of career intentions.

Work values as predictors of entrepreneurial career intentions: A longitudinal analysis of gender effects.

Purpose – Work values are an important characteristic to understand gender differences in career intentions, but how gender affects the relationship between values and career intentions is not well established. The purpose of this paper is to investigate whether gender moderates the effects of work values on level and change of entrepreneurial intentions (EI). Design/methodology/approach – In total, 218 German university students were sampled regarding work values and with EI assessed three times over the course of 12 months. Data were analysed with latent growth modelling. Findings – Self‐enhancement and openness to change values predicted higher levels and conservation values lower levels of EI. Gender moderated the effects of enhancement and conservation values on change in EI. Research limitations/implications – The authors relied on self‐reported measures and the sample was restricted to university students. Future research needs to verify to what extent these results generalize to other samples and different career fields, such as science or nursing. Practical implications – The results imply that men and women are interested in an entrepreneurial career based on the same work values but that values have different effects for men and women regarding individual changes in EI. The results suggest that the prototypical work values of a career domain seem important regarding increasing the career intent for the gender that is underrepresented in that domain. Originality/value – The results enhance understanding of how gender affects the relation of work values and a specific career intention, such as entrepreneurship.

A longitudinal cross-country study of entrepreneurial orientation

As recent research documents, there has been an impressive effort of studying the entrepreneurial orientation construct and its nomological role. However, most research has been very context specific and based on the analyses of cross-sectional information. We study causal performance effects from entrepreneurial orientation and its key dimensions in two economic contexts–developed and emerging markets. Gathering data on a sample of 94 firms in developed market context and 108 in emerging market context at two time-points we explore our hypotheses. The results suggest that in a developed economy entrepreneurial orientation has a positive impact on firm performance, whereas in the emerging market context this effect is negative. Furthermore, we assess the contribution of each dimension to the aggregate construct and reveal the importance of risk-taking in both contexts. Finally, we highlight the role of environmental dynamism and explain its varying effect

Firm-level strategic orientation and performance: a synthesis and extension of the knowledge base on entrepreneurial, market and learning orientation

Should a firm stay focused or should it rather adopt a broader strategic perspective? This dissertation summarizes and extends the existing knowledge base on entrepreneurial, market, and learning orientation. Building on multiple theoretical perspectives, empirical evidence from prior studies, as well as on survey and archival data collected in two economic contexts, performance effects from individual orientations, their dimensions and combinations are explored. Results reveal that the three strategic orientations are highly interrelated and that their relationship to firm performance is more complex than previously assumed.

The capabilities of ROSINA/DFMS to measure argon isotopes at comet 67P/Churyumov–Gerasimenko

Little is known about the noble gas abundances in comets. These highly volatile atoms are possible tracers of the history of cometary matter including the thermal evolution. They can help quantify the contribution of cometary impacts to terrestrial oceans and help elucidate on the formation history of comets and their role in the formation and evolution of planetary atmospheres. This paper focuses on argon and the capabilities to measure this noble gas with in situ mass spectrometry at comet 67P/Churyumov–Gerasimenko, the target of the European Space Agency׳s spacecraft Rosetta. Argon may have been detected by remote sensing in a single Oort cloud comet but to date nothing is known about the isotopic abundances of argon in comets. Furthermore, no detection of argon in a Jupiter-family comet has been reported. Comet 67P/Churyumov–Gerasimenko belongs to the group of Jupiter-family comets and originates most likely in the Kuiper belt. Onboard Rosetta is ROSINA/DFMS (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis/Double Focusing Mass Spectrometer). DFMS has unprecedented mass resolution and high sensitivity and is designed to measure isotopic ratios including argon (Balsiger et al., 2007). Argon measurements using the DFMS lab model (identical to the flight model) demonstrate this capability. At very least, this mass spectrometer has the resolution and sensitivity to reduce the upper limit on the argon outgassing rate relative to water by more than three orders of magnitude (for 38Ar). Most likely, ROSINA/DFMS will provide the first detection of argon in a Jupiter-family comet together with the first determination of the ³⁶Ar/³⁸Ar ratio at a comet.

The imaging and dosimetric capabilities of a CT/MR-suitable, anatomically adaptive, shielded intracavitary brachytherapy applicator for the treatment of cervical cancer

Introduction. Investigations into the shortcomings of current intracavitary brachytherapy (ICBT) technology has lead us to design an Anatomically Adaptive Applicator (A3). The goal of this work was to design and characterize the imaging and dosimetric capabilities of this device. The A3 design incorporates a single shield that can both rotate and translate within the colpostat. We hypothesized that this feature, coupled with specific A3 component construction materials and imaging techniques, would facilitate artifact-free CT and MR image acquisition. In addition, by shaping the delivered dose distribution via the A3 movable shield, dose delivered to the rectum will be less compared to equivalent treatments utilizing current state-of-the-art ICBT applicators. ^ Method and materials. A method was developed to facilitate an artifact-free CT imaging protocol that used a "step-and-shoot" technique: pausing the scanner midway through the scan and moving the A 3 shield out of the path of the beam. The A3 CT imaging capabilities were demonstrated acquiring images of a phantom that positioned the A3 and FW applicators in a clinically-applicable geometry. Artifact-free MRI imaging was achieved by utilizing MRI-compatible ovoid components and pulse-sequences that minimize susceptibility artifacts. Artifacts were qualitatively compared, in a clinical setup. For the dosimetric study, Monte-Carlo (MC) models of the A3 and FW (shielded and unshielded) applicators were validated. These models were incorporated into a MC model of one cervical cancer patient ICBT insertion, using 192Ir (mHDR v2 source). The A3 shield's rotation and translation was adjusted for each dwell position to minimize dose to the rectum. Superposition of dose to rectum for all A3 dwell sources (4 per ovoid) was applied to obtain a comparison of equivalent FW treatments. Rectal dose-volume histograms (absolute and HDR/PDR biologically effective dose (BED)) and BED to 2 cc (BED2cc ) were determined for all applicators and compared. ^ Results. Using a "step-and-shoot" CT scanning method and MR compliant materials and optimized pulse-sequences, images of the A 3 were nearly artifact-free for both modalities. The A3 reduced BED2cc by 18.5% and 7.2% for a PDR treatment and 22.4% and 8.7% for a HDR treatment compared to treatments delivered using an uFW and sFW applicator, respectively. ^ Conclusions. The novel design of the A3 facilitated nearly artifact-free image quality for both CT and MR clinical imaging protocols. The design also facilitated a reduction in BED to the rectum compared to equivalent ICBT treatments delivered using current, state-of-the-art applicators. ^

THE ALCOHOL TREATMENT PROFILE SYSTEM: ITS DEVELOPMENT AND AN EVALUATION OF ITS CAPABILITIES

The development of the Alcohol Treatment Profile System (ATPS) was described and an evaluation of its perceived value by various States was undertaken, The ATPS is a treatment needs assessment tool based on the unification of several large national epidemiologic and treatment data sets. It was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and responsibility for its creation was given to the NIAAA's Alcohol Epidemiologic Data System (AEDS). The ATPS merges county-level measures of alcohol problem prevalence (the specially constructed AEDS Alcohol Problem Indicators), indicating "need" for treatment, and treatment utilization measures (the National Drug and Alcohol Treatment Utilization Survey), indicating treatment "demand." The capabilities of the ATPS in the unique planning and policy-making settings of several States were evaluated.^