Open notes sounds great, but will a provider’s documentation change? An exploratory study of the effect of open notes on oncology documentation
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ABSTRACT: Objective
The effects of shared clinical notes on patients, care partners, and
SUBMITTER: Rahimian M
PROVIDER: S-EPMC8518311 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionNew legislation allows patients (with permitted exceptions) to read their clinical notes, leading to both benefits and ethical dilemmas. Medical students need a robust curriculum to learn documentation skills within this challenging context. We aimed to teach note-writing skills through a patient-centered lens with special consideration for the impact on patients and providers. We developed this session for first-year medical students within their foundational clinical skills course to place bias-free language at the forefront of how they learn to construct a medical note.MethodsOne hundred seventy-three first-year medical and dental students participated in this curriculum. They completed an asynchronous presession module first, followed by a 2-hour synchronous workshop including a didactic, student-led discussion and sample patient note exercise. Students were subsequently responsible throughout the year for constructing patient-centered notes, graded by faculty with a newly developed rubric and checklist of best practices.ResultsOn postworkshop surveys, learners reported increased preparedness in their ability to document in a patient-centered manner (presession M = 2.2, midyear M = 3.9, p < .001), as rated on a 5-point Likert scale (1 = not prepared at all, 5 = very prepared), and also found this topic valuable to learn early in their training.DiscussionThis curriculum utilizes a multipart approach to prepare learners to employ clinical notes to communicate with patients and providers, with special attention to how patients and their care partners receive a note. Future directions include expanding the curriculum to higher levels of learning and validating the developed materials.
| S-EPMC10963659 | biostudies-literature
Project description:There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems. We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients' subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients' subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker. A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary. This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients' complex disease and medication profiles in their documentation.
| S-EPMC9333531 | biostudies-literature
Project description:BackgroundIn a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes.ObjectiveThis study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries.MethodsWe administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions.ResultsSeventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches.ConclusionsSharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.
| S-EPMC10981219 | biostudies-literature
Project description:Objects and events in the sensory environment are generally predictable, making most of the energy impinging upon sensory transducers redundant. Given this fact, efficient sensory systems should detect, extract, and exploit predictability in order to optimize sensitivity to less predictable inputs that are, by definition, more informative. Not only are perceptual systems sensitive to changes in physical stimulus properties, but growing evidence reveals sensitivity both to relative predictability of stimuli and to co-occurrence of stimulus attributes within stimuli. Recent results revealed that auditory perception rapidly reorganizes to efficiently capture covariance among stimulus attributes. Acoustic properties per se were perceptually abandoned, and sounds were instead processed relative to patterns of co-occurrence. Here, we show that listeners' ability to distinguish sounds from one another is driven primarily by the extent to which they are consistent or inconsistent with patterns of covariation among stimulus attributes and, to a lesser extent, whether they are heard frequently or infrequently. When sounds were heard frequently and deviated minimally from the prevailing pattern of covariance among attributes, they were poorly discriminated from one another. In stark contrast, when sounds were heard rarely and markedly violated the pattern of covariance, they became hyperdiscriminable with discrimination performance beyond apparent limits of the auditory system. Plausible cortical candidates underlying these dramatic changes in perceptual organization are discussed. These findings support efficient coding of stimulus statistical structure as a model for both perceptual and neural organization.
| S-EPMC4979885 | biostudies-literature
Project description:Mental body-representations are highly plastic and can be modified after brief exposure to unexpected sensory feedback. While the role of vision, touch and proprioception in shaping body-representations has been highlighted by many studies, the auditory influences on mental body-representations remain poorly understood. Changes in body-representations by the manipulation of natural sounds produced when one's body impacts on surfaces have recently been evidenced. But will these changes also occur with non-naturalistic sounds, which provide no information about the impact produced by or on the body? Drawing on the well-documented capacity of dynamic changes in pitch to elicit impressions of motion along the vertical plane and of changes in object size, we asked participants to pull on their right index fingertip with their left hand while they were presented with brief sounds of rising, falling or constant pitches, and in the absence of visual information of their hands. Results show an "auditory Pinocchio" effect, with participants feeling and estimating their finger to be longer after the rising pitch condition. These results provide the first evidence that sounds that are not indicative of veridical movement, such as non-naturalistic sounds, can induce a Pinocchio-like change in body-representation when arbitrarily paired with a bodily action.
| S-EPMC5515978 | biostudies-literature
Project description:This paper aims examines the role of hierarchical inference in sound change. Through hierarchical inference, a language learner can distribute credit for a pronunciation between the intended phone and the larger units in which it is embedded, such as triphones, morphemes, words and larger syntactic constructions and collocations. In this way, hierarchical inference resolves the longstanding debate about the unit of sound change: it is not necessary for change to affect only sounds, or only words. Instead, both can be assigned their proper amount of credit for a particular pronunciation of a phone. Hierarchical inference is shown to generate novel predictions for the emergence of stable variation. Under standard assumptions about linguistic generalization, it also generates a counterintuitive prediction of a U-shaped frequency effect in an advanced articulatorily-motivated sound change. Once the change has progressed far enough for the phone to become associated with the reduced pronunciation, novel words will be more reduced than existing words that, for any reason, have become associated with the unreduced variant. Avoiding this prediction requires learners to not consider novel words to be representative of the experienced lexicon. Instead, learners should generalize to novel words from other words that are likely to exhibit similar behavior: rare words, and the words that occur in similar contexts. Directions for future work are outlined.
| S-EPMC8387583 | biostudies-literature
Project description: Not available
| S-EPMC8441746 | biostudies-literature
Project description:The effect of sound on the behaviour of sharks has not been investigated since the 1970s. Sound is, however, an important sensory stimulus underwater, as it can spread in all directions quickly and propagate further than any other sensory cue. We used a baited underwater camera rig to record the behavioural responses of eight species of sharks (seven reef and coastal shark species and the white shark, Carcharodon carcharias) to the playback of two distinct sound stimuli in the wild: an orca call sequence and an artificially generated sound. When sounds were playing, reef and coastal sharks were less numerous in the area, were responsible for fewer interactions with the baited test rigs, and displayed less 'inquisitive' behaviour, compared to during silent control trials. White sharks spent less time around the baited camera rig when the artificial sound was presented, but showed no significant difference in behaviour in response to orca calls. The use of the presented acoustic stimuli alone is not an effective deterrent for C. carcharias. The behavioural response of reef sharks to sound raises concern about the effects of anthropogenic noise on these taxa.
| S-EPMC6502882 | biostudies-literature
Project description:BackgroundThe past few years have seen an increase in interest in sharing visit notes with patients. Sharing visit notes with patients is also known as "open notes." Shared notes are seen as beneficial for patient empowerment and communication, but concerns have also been raised about potential negative effects. Understanding barriers is essential to successful organizational change, but most published studies on the topic come from countries where shared notes are incentivized or legally required.ObjectiveWe aim to gather opinions about sharing outpatient clinic visit notes from patients and hospital physicians in the Netherlands, where there is currently no policy or incentive plan for shared visit notes.MethodsThis multimethodological study was conducted in an academic and a nonacademic hospital in the Netherlands. We conducted a survey of patients and doctors in March-April 2019. In addition to the survey, we conducted think-aloud interviews to gather more insight into the reasons behind participants' answers. We surveyed 350 physicians and 99 patients, and think-aloud interviews were conducted with an additional 13 physicians and 6 patients.ResultsMost patients (81/98, 77%) were interested in viewing their visit notes, whereas most physicians (262/345, 75.9%) were opposed to allowing patients to view their visit notes. Most patients (54/90, 60%) expected the notes to be written in layman's terms, but most physicians (193/321, 60.1%) did not want to change their writing style to make it more understandable for patients. Doctors raised concerns that reading the note would make patients feel confused and anxious, that the patient would not understand the note, and that shared notes would result in more documentation time or losing a way to communicate with colleagues. Interviews also revealed concerns about documenting sensitive topics such as suspected abuse and unlikely but worrisome differential diagnoses. Physicians also raised concerns that documenting worrisome thoughts elsewhere in the record would result in fragmentation of the patient record. Patients were uncertain if they would understand the notes (46/90, 51%) and, in interviews, raised questions about security and privacy. Physicians did anticipate some benefits, such as the patients remembering the visit better, shared decision-making, and keeping patients informed, but 24% (84/350) indicated that they saw no benefit. Patients anticipated that they would remember the visit better, feel more in control, and better understand their health.ConclusionsDutch patients are interested in shared visit notes, but physicians have many concerns that should be addressed if shared notes are pursued. Physicians' concerns should be addressed before shared notes are implemented. In hospitals where shared notes are implemented, the effects should be monitored (objectively, if possible) to determine whether the concerns raised by our participants have actualized into problems and whether the anticipated benefits are being realized.
| S-EPMC8387887 | biostudies-literature
Project description:Our study details the creation of a series of national open source low-level geographical measures of accessibility to health-related features for Great Britain. We create 14 measures across three domains: retail environment (fast food outlets, gambling outlets, pubs/bars/nightclubs, off-licences, tobacconists), health services (General Practitioners, pharmacies, dentists, hospitals, leisure centres) and the physical environment (green space and air quality). Using the network analysis process of Routino, postcode accessibility (km) to each of these features were calculated for the whole of Great Britain. An average score for each domain was calculated and subsequently combined to form an overall Index highlighting 'Access to Healthy Assets and Hazards'. We find the most accessible healthy areas are concentrated in the periphery of the urban cores, whilst the least accessible healthy areas are located in the urban cores and the rural areas. The open data resource is important for researchers and policy makers alike with an interest in measuring the role of spatial features on health.
| S-EPMC6602943 | biostudies-literature