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The “Emergency Department Pathology Order Support Tool” (EDPOST) is an electronic laboratory test ordering decision support tool that aims to decrease variation in test ordering practices. As part of a larger project on the codesign, development, and evaluation of ED-POST, this study aimed to explore the workflow nuances that might affect the intended use of the digital decision support tool. Semi-structured, in-depth interviews were conducted with 15 ED clinicians involved in the laboratory test ordering process across the development and evaluation phases of ED-POST. Participants identified the expanded role of registered nurses in test ordering and the practice of ordering tests that are outside the ED’s scope as contextual characteristics that can affect the use and perceived utility of the proposed ED-POST tool. Reconciling “work-as-imagined” with “work-as-done” in the design and development of electronic interventions is important in achieving interventions to improve the safe and effective use of pathology tests. [ABSTRACT FROM AUTHOR]

Introduction: Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation. Methods: This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents' demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models. Results: Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14; 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72; 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41; 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge. Discussion: Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital divide may imply potential healthcare disparities in socially disadvantaged patients. [ABSTRACT FROM AUTHOR]

Purpose: Although research on how the downstream calculations of a patent's profit potential influence invention renewal decisions is extensive, the impact of the upstream knowledge creation stages is overlooked. The purpose of this study is to address this theoretical vacuum by examining the intra-organizational configuration of knowledge networks and collaboration networks. Design/methodology/approach: The data consist of 491 global pharmaceutical firms that patent in the USA. Drawing on patent records, the authors simultaneously construct intra-organizational knowledge networks and collaboration networks and identify network cohesion features (i.e. local and global). The authors employ panel fixed-effects models to test the hypotheses. Findings: The results show that local knowledge cohesion and local social cohesion decrease invention renewals, while global knowledge cohesion and global social cohesion increase renewals. Moreover, the marginal effects of local and global social cohesion are stronger than those of local and global knowledge cohesion, respectively. Research limitations/implications: The hypotheses are tested using the pharmaceutical industry as a research setting, which limits the generalizability of our findings. In addition, potential formal and informal contingencies are not considered. Practical implications: Despite its limitations, this study provides valuable implications. First, managers are cautioned against the adverse effects of local cohesion structures on invention renewal. Second, firms can dynamically adjust their local and global network configuration strategies to harmonize the generation of valuable inventions and the retention of good ideas. Originality/value: Complementary to previous research that focused on inventions' performance feedback, this study delves into upstream knowledge creation stages to understand invention renewals. [ABSTRACT FROM AUTHOR]

Laboratory tests play an integral role in the delivery of quality health care. However, evidence indicates variations in diagnostic testing, which can lead to patient safety risks. Electronic decision support systems are often identified as key to reducing diagnostic error. However, such tools are often introduced into a clinical setting with little understanding of clinician workflow and how tools are likely to impact this. This study reports a qualitative co-design methodology and results from the first phase in the design and development of an analytics-driven, dashboard approach to supporting clinician test ordering in the Emergency Department. [ABSTRACT FROM AUTHOR]

Plasmablastic myeloma (PBM) is an uncommon and aggressive morphologic variant of multiple myeloma (MM). The neoplastic immature cells exhibit diverse morphology, posing a diagnostic challenge. The diagnostic criteria for PBM include the identification of ≥ 2% plasmablasts in the bone marrow aspirate. This case describes the incidental finding of a light-chain multiple myeloma (LCMM) transformed into PBM, a phenomenon not previously reported.

The Intensive Care Unit (ICU) is an information-intense environment where more patient data points are recorded than in other wards. The electronic Record for Intensive Care (eRIC) is an ICU information system that integrates patient data every minute from multiple systems. Once implemented across New South Wales (NSW), eRIC will be one of the largest system-wide ICU clinical information systems in the world. This study explored experiences with the use of eRIC by ICU clinicians at an Australian metropolitan teaching hospital. Semi-structured, in-depth interviews relating to physician electronic test management processes were conducted with 11 ICU clinicians and one clinical information system manager was observed in their use of the system. The introduction of eRIC resulted in an additional patient record, which was perceived to hold implications for workflow and patient safety. Study findings are valuable for informing implementation as the rollout of eRIC continues.