Adoption of Electronic Dental Records: Examining the Influence of Practice Characteristics on Adoption in One State.

OBJECTIVE: Compared with medicine, less research has focused on adoption rates and factors contributing to the adoption of electronic dental records (EDRs) and certified electronic health records (EHRs) in the field of dentistry. We ran two multivariate models on EDR adoption and certification-capable EHR adoption to determine environmental and organizational factors associated with adoption. METHODS: We conducted telephone survey of a 10-item questionnaire using disproportionate stratified sampling procedure of 149 dental clinics in Tennessee in 2017 measuring adoption of dental information technology (IT) (EDRs and certification-capable EHRs) and practice characteristics, including region, rurality, specialty, and practice size. We used binomial logistic regression models to determine associations of adoption with predictor variables. RESULTS: A total of 77% of surveyed dental clinics in Tennessee had adopted some type of EDR system. When the definitions of certification capable were applied, the adoption rates in dental clinics dropped to 58%. A binomial logistic regression model for the effects of rurality, specialization, and practice size on the likelihood that a clinic would adopt an EHR product was statistically significant (chi-square (3) = 12.41, p = 0.0061). Of the three predictor variables, specialization and practice size were significant: Odds of adopting an EHR is 67% lower for specialists than for general dentists; and clinics with two or more practicing dentists were associated with a much greater likelihood of adopting an EHR-capable system (adjusted odds ratio = 3.09, p = 0.009). CONCLUSION: Findings from this study indicate moderate to high levels of overall dental IT adoption. However, adoption rates in dental clinics do remain lower than those observed in office-based physician practices in medicine. Specialization and practice size were significant predictors of EHR-capable system adoption. Efforts to increase EHR adoption in dentistry should be mindful of potential disparities in smaller practices and between dental specialties and generalists.

Using multiple data sets for public health tracking of work-related injuries and illnesses in California.

BACKGROUND: Research suggests the U.S. Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses underestimates the magnitude of workplace injuries and illnesses. Enumerating workplace injuries and illnesses may be improved by utilizing multiple state-based data sources. METHODS: Using California-based datasets (workers' compensation claims, health care facility data, and physician reports), we enumerated unique cases of amputations and carpal tunnel syndrome (2007-2008), and evaluated the datasets for usefulness in occupational health tracking by performing record linkage across all datasets and calculating match rates between them. RESULTS: 6,862 amputation and 39,589 carpal tunnel syndrome (CTS) cases were identified. Match rates between the datasets ranged from 34.0% to 45.6% (amputations) and 3.0% to 43.5% (CTS). Enumerated amputation and CTS cases from state-based sources were about five and ten times greater than the BLS SOII estimates (1,390 and 3,720). CONCLUSIONS: Successful demonstration of this state level approach has broad implications for improving federal and state efforts to track and prevent work-related injuries and illnesses.

Up-regulation of hepatic ABCC2, ABCG2, CYP1A1 and GST in multixenobiotic-resistant killifish (Fundulus heteroclitus) from the Sydney Tar Ponds, Nova Scotia, Canada.

Cellular defence against accumulation of toxic xenobiotics includes metabolism by phase I and II enzymes and export of toxicants and their metabolites via ATP-binding cassette (ABC) transporters. Liver gene expression of representatives of these three protein groups was examined in a population of multixenobiotic-resistant killifish (Fundulus heteroclitus) from the Sydney Tar Ponds, Nova Scotia, Canada. The Tar Ponds are heavily polluted with polycyclic aromatic hydrocarbons, polychlorinated biphenyls and heavy metals. The relationship among ABC transporters ABCB1, ABCB11, ABCC2, ABCG2, phase I enzyme cytochrome P4501A1 (CYP1A1) and phase II enzyme glutathione-S-transferase (GST-mu) was investigated by quantifying hepatic transcript abundance. In Tar Pond killifish, hepatic mRNA expression levels of ABCC2, ABCG2, CYP1A1 and GST-mu were elevated compared to reference sites, suggesting that hydrophobic contaminants undergo phase I and II metabolism and are then excreted into the bile of these fish. Hepatic ABCB1 and ABCB11 mRNA were not up-regulated in Tar Pond fish compared to two reference sites, indicating that these two proteins are not involved in conferring multixenobiotic resistance to Tar Pond killifish. The results suggest instead that liver up-regulation of phase I and II enzymes and complementary ABC transporters ABCC2 and ABCG2 may confer contaminant resistance to Tar Pond fish.

Evaluation of calcium and vitamin D supplementation in bisphosphonate therapy.

OBJECTIVE: To assess the calcium and vitamin D intake of osteoporosis patients on bisphosphonate therapy. DESIGN: Prospective study. SETTING: Two independent pharmacies (Futrell Pharmacy Services, Jackson N.C., and McDowell's Pharmacy, Scotland Neck, N.C.) and one ambulatory care clinic (Scotland Neck Family Medical Center, Scotland Neck, N.C.) in eastern rural North Carolina from December 2005 to February 2006. PATIENTS: 29 osteoporosis patients on bisphosphonate therapy. INTERVENTIONS: Patients were assessed on calcium intake and counseled on the appropriateness of supplementation with bisphosphonate therapy. MAIN OUTCOME MEASURE: Degree to which osteoporosis patients on bisphosphonate therapy use concomitant calcium supplements. RESULTS: Of the 29 patients surveyed, 17 patients were using calcium supplements during bisphosphonate therapy. Reasons cited for not using calcium included constipation (7 patients), polypharmacy (3), forgetfulness (1), and deemed unnecessary (1). Types of calcium supplements used were 71% calcium carbonate (12 patients), 24% calcium citrate (4), and 5% unknown (1). Calcium doses used were 500 mg/day (4 patients), and 1,000 mg/day (3), and 1,200-1,400 mg/day (13). Also, 13 patients were taking vitamin D in addition to their calcium, with 8 patients taking 400 IU and the rest 200 IU. Among the patients surveyed, 8 reported taking a proton-pump inhibitor, and 6 were taking calcium carbonate, which is not absorbed well in those taking agents that increase gastric pH. All patients separated their bisphosphonate dose from other medications and meals. CONCLUSION: Patients do not recognize the need to supplement calcium at the recommended dosage of at least 1,200 mg/day or 1,500 mg/day for postmenopausal women with osteoporosis along with vitamin D 400 IU for osteoporosis treatment while on bisphosphonate therapy.

Primary care of the child with cerebral palsy: a review of systems (part II).

Cerebral palsy (CP) is a disorder of movement and posture with additional potential to affect cognitive status. Thus, the goals for management of the child with CP include the following: to promote optimal function; to maintain general health; to foster acquisition of new skills; to assist and educate parents and caregivers; and to anticipate, prevent, and treat the complications of this disorder. Pediatric management of the child with CP should begin at the time of diagnosis. This article is the second of two articles on CP. The first article focused on the diagnosis of CP, and this article will focus on a review of systems approach for management as well as resources for the family and the nurse practitioner.

Cerebral palsy: introduction and diagnosis (part I).

Cerebral palsy (CP), a static, nonprogressive disorder caused by brain insult or injury in the prenatal, perinatal, and postnatal time period, is the major developmental disability affecting function in children. It is characterized by the inability to normally control motor functions, and it has the potential to have an effect on the overall development of a child by affecting the child's ability to explore, speak, learn, and become independent. Effective management can improve the quality of life for the child and family. The first step for the nurse practitioner is to understand the definition of CP and how to make the diagnosis. This article is part one of two articles on CP. The first article will focus on the diagnosis of CP, and the second will focus on a review of systems approach for management as well as resources for the family and practitioner.

Supine and prone infant positioning: a winning combination.

Since 1992, the optimal sleeping position for infants in the United States has been supine. This position has been shown to greatly reduce the rate of Sudden Infant Death Syndrome (Skadberg, Morild, & Markestad, 1998). However, the supine position may lead to other unintended consequences or complications. Through a review of literature, this article explores some of the complications associated with the "Back to Sleep" campaign in the U.S. and discusses educational strategies for perinatal educators.

Shaping the zebrafish notochord.

Promptly after the notochord domain is specified in the vertebrate dorsal mesoderm, it undergoes dramatic morphogenesis. Beginning during gastrulation, convergence and extension movements change a squat cellular array into a narrow, elongated one that defines the primary axis of the embryo. Convergence and extension might be coupled by a highly organized cellular intermixing known as mediolateral intercalation behavior (MIB). To learn whether MIB drives early morphogenesis of the zebrafish notochord, we made 4D recordings and quantitatively analyzed both local cellular interactions and global changes in the shape of the dorsal mesodermal field. We show that MIB appears to mediate convergence and can account for extension throughout the dorsal mesoderm. Comparing the notochord and adjacent somitic mesoderm reveals that extension can be regulated separately from convergence. Moreover, mutational analysis shows that extension does not require convergence. Hence, a cellular machine separate from MIB that can drive dorsal mesodermal extension exists in the zebrafish gastrula. The likely redundant control of morphogenesis may provide for plasticity at this critical stage of early development.

Methodologic issues in a population-based health survey of Gulf War veterans.

This report describes the principal methods used in the development, conduct, and analysis of the research study "Health Assessment of Persian Gulf War Veterans from Iowa" (Iowa Gulf War Study). The methods presented include an outline of the organizational structure, study timeline, hypotheses, outcome definitions, and study design. Adhering to a strict timeline, the study protocol and instruments were developed, and a stratified sample of 3,695 military personnel (76% participation) was located and surveyed by structured telephone interview. The study tracked personnel from all service branches residing nationally and internationally, including those discharged from service. This study required development and implementation of methods appropriate to analysis of data collected in a complex sampling framework and methodological procedures to ensure scientific rigor in a highly public and politicized environment. Statistical analyses were conducted on a priori health outcomes and required development of methods to compute Cochran-Mantel-Haenszel adjusted rate differences. This environment facilitated rapid implementation, critique by scientific and public advisors, a high participation rate, and rapid publication.