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Congressional twitter use revisited on the platform's 10-year anniversary

JOURNAL OF THE ASSOCIATION FOR INFORMATION SCIENCE AND TECHNOLOGY 2018年第8期69卷 1067-1070页

作者： Golbeck, Jennifer Auxier, Brooke Bickford, Abigail Cabrera, Lautaro McHugh, Meaghan Conte Moore, Stephani Hart, Jacquelyn Resti, Justin Rogers, Anthony Zimmerman, Jenna Univ Maryland Coll Informat Studies College Pk MD 20742 USA

The microblogging platform, Twitter, has been an extremely valuable tool for politicians in sharing information, fostering broader communication to constituents, and promoting their political stances. This article follows up on previous research from 2009 on this subject. We reexamined tweets from the US Congress collected in early 2017. We found Congressional tweeting habits and content have changed very little in the last 8 years. Overall, they tended to use Twitter to pass along political information and links in addition to reporting on official and unofficial activities and meetings. We discuss future spaces for research that go beyond content analysis into issues of motivation, communication, and impact.

关键词： GOVERNMENT agencies -- United States LEGISLATION PRACTICAL politics SOCIAL media medical coding

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Perceptions, Attitudes, and Behaviors of Primary Care Providers Toward Obesity Management: A Qualitative Study

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JOURNAL OF COMMUNITY HEALTH NURSING 2018年第3期35卷 85-101页

作者： Bornhoeft, Kathleen Capital Hlth Primary Care Brunswick 832 Brunswck Ave Trenton NJ 08638 USA

Background and Problem Statement: Obesity is a prevalent chronic disease associated with decreased life expectancy, increased morbidity and mortality, and escalating health care ***: To explore perceptions, attitudes, and behaviors toward obesity management by providers in primary ***: Data were collected through a descriptive qualitative design using semi-structured face-to-face interviews at primary care ***: Common barriers to obesity management were identified and three major themes emerged;provider centered obstacles, perceived organizational obstacles, and provider perception of patient ***: Obesity is not being effectively managed in these primary care practices and three common themes/obstacles must be addressed.

关键词： PREVENTION of obesity CINAHL (Information retrieval system) CORPORATE culture HEALTH services accessibility INTERVIEWING RESEARCH methodology MEDLINE NURSE practitioners NURSES' attitudes OBESITY PRIMARY health care SYSTEMATIC reviews (medical research) QUALITATIVE research JUDGMENT sampling THEMATIC analysis PLANNED behavior theory DISEASE prevalence DATA analysis software PHYSICIANS -- Attitudes medical coding DESCRIPTIVE statistics ATTITUDES toward obesity

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Using paradox theory to understand responses to tensions between service and training in general surgery

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medical EDUCATION 2018年第3期52卷 288-301页

作者： Cleland, Jennifer Roberts, Ruby Kitto, Simon Strand, Pia Johnston, Peter Univ Aberdeen Ctr Healthcare Educ Res & Innovat CHERI Sch Med Dent & Nutr Aberdeen Scotland Univ Ottawa Dept Innovat Med Educ Ottawa ON Canada Lund Univ Fac Med Ctr Teaching & Learning Lund Sweden Northern Deanery NHS Educ Scotland Aberdeen Scotland

ContextThe tension between service and training in pressured health care environments can have a detrimental impact on training quality and job satisfaction. Yet the management literature proposes that competing demands are inherent in organisational settings: it is not the demands as such that lead to negative outcomes but how people and organisations react to opposing tensions. We explored how key stakeholders responded to competing service-training demands in a surgical setting that had recently gone through a highly-publicised organisational crisis. MethodsThis was an explanatory case study of a general surgery unit. Public documents informed the research questions and the data were triangulated with semi-structured interviews (n = 14) with key stakeholders. Data coding and analysis were initially inductive but, after the themes emerged, we used a paradox lens to group themes into four contextual dimensions: performing, organising, belonging and learning. ResultsTensions were apparent in the data, with managers, surgeons and trainees or residents in conflict with each other because of different goals or priorities and divergent perspectives on the same issue of balancing service and training (performing). This adversely impacted on relationships across and within groups (belonging, learning) and led to individuals prioritising their own goals rather than working for the greater good' (performing, belonging). Yet although relationships and communication improved, the approach to getting a better balance maintained the compartmentalisation' of training (organising) rather than acknowledging that training and service cannot be separated. DiscussionStakeholder responses to the tensions provided temporary relief but were unlikely to lead to real change if the tension between service and training was considered to be an interdependent and persistent paradox. Reframing the service-training paradox in this way may encourage adjusting responses to create effective workin

关键词： COMMUNICATION HEALTH facilities HOSPITAL medical staff INTERVIEWING LEARNING RESEARCH methodology medical care NEEDS assessment (medical care) medical education PERSONAL property PERSONNEL management PSYCHOLOGY RESEARCH STRESS (Psychology) SURGEONS OPERATIVE surgery THEORY DEPARTMENTS DATA analysis medical coding

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Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery

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TRANSFUSION 2018年第4期58卷 998-1005页

作者： Butwick, Alexander J. Walsh, Eileen M. Kuzniewicz, Michael Li, Sherian X. Escobar, Gabriel J. Stanford Univ Dept Anesthesiol Perioperat & Pain Med Sch Med MC 5640300 Pasteur Dr Stanford CA 94305 USA Kaiser Permanente Northern Calif Div Res Oakland CA USA

BACKGROUNDDetermining the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes for postpartum hemorrhage (PPH) is vital for reaching valid conclusions about the epidemiology of PPH. Our primary objectives were to assess the performance characteristics of ICD-9 PPH codes against a reference standard using estimated blood loss (EBL) among a cohort undergoing Cesarean delivery. STUDY DESIGN AND METHODSWe analyzed maternal discharge and EBL data from women who underwent Cesarean delivery at Kaiser Permanente Northern California facilities between 2010 and 2013. We defined PPH as an EBL of at least 1000mL. In a secondary analysis, ICD-9 performance characteristics were assessed using an EBL of at least 1500 mL to classify severe PPH. RESULTSWe identified 35,614 hospitalizations for Cesarean delivery. Using EBL of at least 1000 mL as the gold standard, PPH codes had a sensitivity of 27.8%, specificity of 97%, positive predictive value (PPV) of 74.5%, and a negative predictive value (NPV) of 80.9%. The prevalence of a PPH code (9%) was lower than the prevalence using a blood loss of at least 1000 mL (24%). Using a reference standard of EBL of at least 1500 mL, PPH codes had a sensitivity of 61.7%, specificity of 93.8%, PPV of 34.2%, and NPV of 97.9%. CONCLUSIONPPH ICD-9 codes have high specificity, moderately high PPVs and NPVs, and low sensitivity. An EBL of at least 1500 mL as a reference standard has higher sensitivity. Our findings suggest that, for women undergoing Cesarean delivery, quality improvement efforts are needed to enhance PPH ICD-9 coding accuracy in administrative data sets.

关键词： BLOOD loss estimation CESAREAN section PREGNANCY complications medical coding

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Home Health Nurses' Perspectives and Care Processes Related to Older Persons with Frailty and Depression: A Mixed Method Pilot Study

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JOURNAL OF COMMUNITY HEALTH NURSING 2018年第3期35卷 118-136页

作者： Wang, Jinjiao Simmons, Sandra F. Maxwell, Cathy A. Schlundt, David G. Mion, Lorraine C. Univ Rochester Med Ctr Sch Nursing Room 2w-319255 Crittenden Blvd Rochester NY 14642 USA Vanderbilt Univ Med Ctr Dept Med Ctr Qual AgingDiv Geriatr Nashville TN USA VA Tennessee Valley Healthcare Syst GRECC Nashville TN USA Vanderbilt Univ Sch Nursing Nashville TN 37240 USA Vanderbilt Univ Dept Psychol Nashville TN 37240 USA Ohio State Univ Coll Nursing Columbus OH 43210 USA

The objectives of this study were (1) to describe home health care (HHC) nurses' perception of and care processes related to geriatric depression and frailty, and (2) to identify barriers to care delivery for older persons with these two conditions. Ten semi-structured interviews were conducted with HHC nurses, and 16 HHC nursing visits to 16 older patients (65years) were observed. Mixed method analysis showed that HHC nurses did not routinely assess for frailty and depression. Major barriers to care delivery included insufficient training, documentation burden, limited reimbursement, and high caseload. Addressing these barriers would facilitate HHC nursing care for frail, depressed elders.

关键词： COMMUNICATION CONCEPTUAL structures (Information theory) CONTENT analysis MENTAL depression DOCUMENTATION FRAIL elderly HOME care services INTERVIEWING MATHEMATICAL models RESEARCH methodology medical care medical informatics NURSES' attitudes OBSERVATION (Scientific method) HEALTH outcome assessment SAMPLING (Statistics) QUALITATIVE research PILOT projects THEORY JUDGMENT sampling THEMATIC analysis DATA analysis software medical coding OLD age

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Challenges, success factors and pitfalls: implementation of distributed medical education

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medical EDUCATION 2018年第11期52卷 1167-1177页

作者： Saxena, Anurag Lawrence, Kathy Desanghere, Loni Smith-Windsor, Tom White, Gill Florizone, Dan McGartland, Sinead Stobart, Kent Univ Saskatchewan Coll Med Saskatoon SK Canada Univ Saskatchewan Johnson Shoyama Sch Publ Policy Saskatoon SK Canada

OBJECTIVES There are only a few descriptive reports on the implementation of distributed medical education (DME) and these provide accounts of successful implementation from the senior leadership perspective. In Saskatchewan, over a period of 4 years (20102014), four family medicine residency sites were established and two additional sites could not be developed. The aim of this study was to identify challenges, success factors and pitfalls in DME implementation based upon experiences of multiple stakeholders with both successful and unsuccessful outcomes. METHODS Data were obtained through document analysis (n = 64, spanning 2009-2016;perspectives of government, senior leadership, management and learners), focus groups of management and operations personnel (n = 10) and interviews of senior leaders (n = 4). Challenges and success factors were ascertained through categorisation. Iterative coding guided by three sensitising frameworks was used to determine themes in organisational dynamics. RESULTS Both challenges and success factors included contextual variables, governance, inter-and intra-organisational relationships (most common success factor), resources (most common challenge), the learning environment and pedagogy. Management and operations were only a challenge. Organisational themes affecting the outcome and the pitfalls included the pace of development across multiple sites, collaborative governance, continuity in senior leadership, operations alignment and reconciliation of competing goals. CONCLUSIONS Emerging opportunities for DME can be leveraged through collaborative governance, aligned operations and resolution of competing goals, even in constrained contexts, to translate political will into success;however, there are pitfalls that need to be avoided. Our findings based upon multi-stakeholder perspectives add to the body of knowledge on deployment, carefully considering the conditions for success and associated pitfalls.

关键词： CLINICAL medicine CURRICULUM planning DOCUMENTATION EXECUTIVES -- Psychology FOCUS groups GOAL (Psychology) INTERPROFESSIONAL relations INTERVIEWING LEADERSHIP medical education SCHOOL environment CLINICAL competence TEACHING methods INSTITUTIONAL cooperation HUMAN services programs EDUCATIONAL outcomes LEADERS PSYCHOLOGY medical coding CLINICAL governance STUDY & teaching

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Rebuttal From Drs Liebovitz and Fahrenbach

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CHEST 2018年第5期153卷 1099-1100页

作者： Liebovitz, David M. Fahrenbach, John Univ Chicago Dept Med Chicago IL 60637 USA Univ Chicago Med Ctr Ctr Healthcare Delivery Sci & Innovat Chicago IL 60637 USA

The author reflects on the editorial published within the issue on three principles to justify continued use of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) terms in the era of big data. It mentions analysis of medical records requires organized data and ICD-10 is a key ingredient. It also mentions ICD-10 is necessary for billing and therefore adds value in the era of big data is incomplete.

关键词： BIG data medical records HEALTH care industry billing medical coding

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Doing More with Less in Health Care: Findings from a Multi-Method Study of Decommissioning in the English National Health Service

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JOURNAL OF SOCIAL POLICY 2018年第3期47卷 543-564页

作者： Harlock, Jenny Williams, Iestyn Robert, Glenn Hall, Kelly Mannion, Russell Brearley, Sally Univ Oxford Nuffield Dept Populat Hlth Hlth Serv Res Unit Richard Doll BldgOld Rd Campus Oxford OX3 7LF England Univ Birmingham Hlth Serv Management Ctr Pk House40 Edgbaston Pk Rd Birmingham B15 2RT W Midlands England Kings Coll London Florence Nightingale Fac Nursing Midwifery & Pall James Clerk Maxwell Bldg57 Waterloo Rd London SE1 8WA England Univ Birmingham Dept Social Policy & Social Work Muirhead Tower Birmingham B15 2TT W Midlands England

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning;a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally;and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships;organisational capacity and resources for decommissioning;the extent and nature of decommissioning;and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to successfully' implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what success' looks like in terms of a decommissioning process.

关键词： NATIONAL health services COST control INTERVIEWING RESEARCH methodology ORGANIZATIONAL change FINANCING of research SURVEYS ORGANIZATIONAL structure GOVERNMENT policy DATA analysis software medical coding

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Message Framing in Vaccine Communication: A Systematic Review of Published Literature

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HEALTH COMMUNICATION 2018年第3期33卷 299-314页

作者： Penta, Marcela A. Baban, Adriana Babes Bolyai Univ Dept Psychol 37 Republicii St Cluj Napoca 400015 Romania

Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O'Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.

关键词： VACCINES medical communication LITERATURE reviews HEALTH services accessibility RISK perception FRAMES (Social sciences) GOAL (Psychology) SYSTEMATIC reviews (medical research) ATTITUDE (Psychology) HEALTH IMMUNIZATION INFLUENZA vaccination PSYCHOLOGY information storage & retrieval systems MEDLINE ONLINE information services PERSUASION (Rhetoric) VACCINATION INFORMATION resources HUMAN Papillomavirus vaccination medical coding SOCIAL aspects

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Rebuttal From Dr Weiner

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CHEST 2018年第5期153卷 1098-1099页

作者： Weiner, Mark G. Temple Univ Lewis Katz Sch Med Dept Clin Sci Philadelphia PA 19122 USA

The article focuses on International Classification of Diseases (ICD) coding is laborious, frustrating, and biased, and automated coding approaches are available and continue to improve and helpful for advancing health care. It mentions success of optical character recognition (OCR), image analysis, driverless vehicles, and the existing use of objective algorithms of clinical data, unbiased by external billing pressures, that assist coders.

关键词： medical coding medical care OPTICAL character recognition IMAGE analysis AUTONOMOUS vehicles HEALTH care industry billing

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