Clinicians Of Different Specialties Research Articles

International Classification of Functioning as a tool for assessing the degree of disability, rehabilitation potential and prospects for its implementation in the educational process

The article presents the provisions of the International Classification of Functioning (ICF), disability, the relationship of changes in health, personal and social factors of a person with therapeutic pathology in order to determine the criteria of disability, substantiate the need and scope of rehabilitation measures in the field of health and social protection. The purpose of this work was to analyze the data, means, methods and conditions of using ICF to organize the effective work of rehabilitation centers for patients, as well as to evaluate its results. The World Health Organization approved the systematization of international classifications necessary for epidemiological control and coordination of public health efforts during medical and social expertise. ICF, disability and health is becoming increasingly important in the work of clinicians of different specialties. Acting as a classifier of health characteristics and all related circumstances, the ICF can be used in many areas of public life: healthcare, social protection, insurance, social employment, education, economics, social policy, legislation. Comprehensive diagnostic and functional information allows giving a broader and more meaningful description of the state of health of a particular person or group of people. In this context, the definition of a disability group has medical, legal and social significance, as it is associated with specific relations in society: the availability of benefits for a disabled person, payment of a disability pension, disability restrictions. The practical significance of the results lies in the fact that the developed method of applying the ICF classification makes it possible to evaluate the effectiveness of medical rehabilitation of patients in the conditions of the modern healthcare system.

Person-centered care for diverse women: Narrative review of foundational research.

Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.

The perceived association of oral diseases and general pathology among doctors of different specialties.

This study aimed to highlight the perceived associations between general and oral pathology, among clinicians of different specialties. Data was collected through a questionnaire with 22 questions, with single or multiple answers, to 88 dentists, general practitioners, or pediatricians. The majority of participants were women (89.8%), aged between 30 and 39 years (52.3%), with a professional experience mostly under 10 years (61.3%). Many doctors considered that there was an association between oral and general pathologies (39.8%). The most common general pathologies associated with oral pathology were digestive disorders (n=21, 23.9%), followed by cardiovascular, genetic, endocrine and metabolic, neuropsychiatric, respiratory, hematological, immunological, and oncological pathologies. Tooth decay was mainly found in patients with digestive, respiratory, or neuropsychiatric disorders, and periodontal disease was more common in patients with obstetric disorders. Diseases of the oral mucosa, such as canker sores and gingivostomatitis, were more common in patients with digestive pathology, endocrine and metabolic, or reproductive disorders. The study pointed out that physicians, regardless of their medical training, often observed a relatively rich general pathology associated with oral conditions. It is important to differentiate between primary and secondary oral pathology, associated with general pathology and medication, establishing a correct diagnosis of the disease and treatment according to general or oral diseases and their manifestations.

Treatment of inflammatory diseases of the nose and paranasal sinuses from the standpoint of bioregulatory systemic medicine

One of the most frequent otorhinolaryngological pathologies is inflammatory diseases of the nose and paranasal sinuses. In Russia, according to the Ministry of Health and Social Development, 15% of adults and 5% of children suffer from chronic rhinosinusitis. According to analysis of medical records, indicators of ENT diseases do not decrease, and long-established treatment regimens prove to be ineffective, despite the large number of different medications. One of the hypotheses existing at the present stage attributes this tendency to the underestimation of the complexity of regulatory systems in the era of reductionism, when the organism is unable to fully adapt to the influence of the environment. In this connection, the concept of bioregulatory systems medicine (BrSM), developed by an international group of scientific experts and clinicians of different specialties, whose underlying principles are the perception of the human being as a complex and integrated system, acquires particular significance. The development of any process is carried out through multilevel interaction between the various systems of the body, the so-called intra-network interactions. According to the views accepted in BrSM, multipurpose therapy is justified to influence different links of pathogenesis. Thus, the bioregulatory approach is multitargeted, i.e., it involves the use of multicomponent drugs affecting the body as a single system. The purpose of this study is to consider treatment regimens for inflammatory diseases of the nose and paranasal sinuses from the perspective of bioregulatory systems medicine. It is concluded that bioregulatory nasal spray therapy is safe and well tolerated, has anti-inflammatory, antiviral, moisturizing effects, and stimulates mucosal regeneration, is combined with other medicines, and is an excellent alternative to traditional methods of treatment, has no side effects and limitations typical of them.

Inter-rater agreement in pPOSSUM scores of geriatric trauma patients: a prospective evaluation.

Risk prediction models are widely used in the perioperative setting to identify high-risk patients who may benefit from additional care and to aid clinical decision-making. pPOSSUM is such a prediction model, however, little is known about the inter-rater agreement when scoring subjective parameters. This study assessed the inter-rater agreement between clinicians of different specialties and work-level when scoring 30 clinical case reports of geriatric hip fracture patients with pPOSSUM. Eighteen clinicians of the department of Surgery (three specialists, four residents), Anaesthesiology (four specialists, two residents) and Emergency Medicine (three specialists, two residents) who were familiar with the pPOSSUM scoring system were asked to calculate the scores. The kappa statistic and the statistical method of Fleiss were used to analyse inter-rater agreement. The response rate was 100%. Among surgeons, Anaesthesiologists and Emergency department doctors (ED), the overall mean kappa values were 0.42, 0.08 and 0.20, respectively. Among surgery, anaesthesiology and ED residents the overall mean kappa values were 0.21, 0.33 and 0.37, respectively. Within the department of Surgery, Anaesthesiology and Emergency Medicine the overall mean kappa values were 0.23, 0.12 and 0.22, respectively. An overall mean kappa value of 0.19 was seen among all specialists. All residents had an overall mean kappa value of 0.21 and all clinicians had an overall mean kappa value of 0.21. The overall inter-rater agreement of clinicians and interdisciplinary agreement when scoring geriatric hip fracture patients with pPOSSUM was low and prone to subjectivity in our study. A higher work-experience level did not lead to better agreement. When pPOSSUM is calculated without clinical assessment by the same clinician, caution is advised to prevent over-reliance on the pPOSSUM risk prediction model. III.

To confront sexual violence, we must train non-forensic experts to perform medico-legal evaluations.

Sexual violence is a global crisis. Forensic evaluations are critical for obtaining evidence and increasing the likelihood of accessing justice, as many cases fail due to lack of evidence or poor evidence. In some countries, only board-certified forensic specialists are authorized to conduct forensic evaluations. However, the high number of sexual violence cases coupled with the shortage of forensic physicians make that restriction a fundamental impediment to a rights-based response to sexual violence crimes. Governments and regulatory bodies should expand the pool of those capable of conducting forensic sexual violence evaluations by partnering with clinicians of different specialties and facilitating their training.

Melioidosis presenting with periorbital cellulitis and rhinosinusitis

Melioidosis is an infectious disease caused by the bacteria Burkholderia pseudomallei. It has a variety of clinical manifestations ranging from localized abscess, to severe pneumonia to fatal septicaemia. Sinonasal and orbital manifestations of Melioidosis are rare [1]. This is the first reported case of Melioidosis presenting with orbital cellulitis and rhinosinusitis in Sri Lanka. A 42-year-old patient with diabetes mellitus presented with pyrexia of unknown origin, multiple abscesses in the leg, periorbital cellulitis and rhinosinusitis. Initial investigations did not reveal a diagnosis. Eventually it was diagnosed as Melioidosis with a positive blood culture and successfully managed with long term antibiotics. ConclusionEarly identification and aggressive management is needed to reduce the morbidity and mortality of Melioidosis. Awareness amongst clinicians of different specialties is important as this disease has variety of manifestations.

Clinicians' Behavior Toward Radiology Reports: A Cross-Sectional Study.

BackgroundThe radiology report is the way of communication between the radiologists and the clinicians of different specialties. Each part of the report is important and significant in the patient management plan. Therefore, knowledge of interpretation and behavior in understanding the final report is a variable crucial skill.MethodsThis is a cross-sectional survey study to explore the behavior and attitude of clinicians toward radiology reports in relation to their professional clinical demographic. A total of 107 physicians participated, including consultants, specialists, and residents among different specialties.ResultsAmong the 107 responses, 58.9% were male and 41.1% were female. The majority of the physicians (78.5%) read the radiology report for every requested study for each patient, while 21.5% of participants didn’t read the radiology report for the studies they requested, instead, they only read it occasionally. Gender played a significant factor, as female practitioners were more likely to read the complete radiology report (P = 0.033). In addition, the age of the practitioner was also significant as clinicians in the age group 40-60 years old were more likely to check the requested radiology image prior to reading the report compared to age groups 20-39 and >60 years (P = 0.035). Lastly, specialists were significantly more likely to read the entire radiology report compared to consultants and residents (P = 0.006).ConclusionMore emphasis and awareness should be provided to clinicians on the importance of reading the entire radiology report as some information can be missed if not being read completely.

Late diagnosis of chronic granulomatous disease.

Modern era advancements in medical care, with improved treatment of infections, can result in delayed diagnosis of congenital immunodeficiencies. In this study we present a retrospective cohort of 16patients diagnosed with Chronic Granulomatous Disease (CGD) at adulthood. Some of the patients had a milder clinical phenotype, but others had a classic phenotype with severe infectious and inflammatory complications reflecting a profoundly impaired neutrophil function. It is therefore of great importance to investigate the individual journey of each patient through different misdiagnoses and the threads which led to the correct diagnosis. Currently the recommended definitive treatment for CGD is hematopoietic stem cell transplantation (HSCT). Although survival of our patients to adulthood might argue against the need for early HSCT during infancy, we claim that the opposite is correct, as most of them grew to be severely ill and diagnosed at a stage when HSCT is debatable with potentially an unfavorable outcome. This cohort stresses the need to increase awareness of this severe congenital immunodeficiency among clinicians of different specialties who might be treating undiagnosed adult patients with CGD.

The Heart Failure Association Atlas: rationale, objectives, and methods.

Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence-based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF.

Assessment of the epidemic situation in the diagnosis of Epstein-Barr virus infection in persons 15 years and older with a description of the clinical case

In order to assess the epidemic situation in the diagnosis of infection caused by the Epstein-Barr virus, a retrospective epidemiological analysis of the incidence of infectious mononucleosis for the period from 1990 to 2018 was conducted in the Moscow region using generally accepted methods of statistical data processing. The description of the clinical case was based on the results of dynamic observation of the patient reflected in the outpatient chart. It is shown that against the background of increasing morbidity rates, there is an epidemiological problem with infectious mononucleosis. Despite the fact that children 0–14 years old are traditionally at risk for infectious mononucleosis, the epidemic process involves the adult population, whose incidence rates also tend to increase. The growth rate of in dicators in the age groups 0–14 and 15 years and older is comparable. The active form of EBV infection in adults can occur in the form of reactivation, which is illustrated by the clinical case described in the article. This case of reactivation of EB infection in an adult clearly illustrates the need to assess the current epidemic situation in differential diagnosis and inform clinicians of different specialties on the epidemiology of EB infection.

Recognition of Palliative Care in Chinese Clinicians: How They Feel and What They Know.

Objective To investigate doctors' feelings when providing medical care to end-stage patients, and their understanding as well as reflection about theoretical concepts of palliative medicine. Methods Questionnaires were delivered through a social networking platform to 1500 clinicians of different specialties in 10 proviences of China. It covered issues of background information, self-assessment of familiarity to palliative care, prior training history, emotional attitude toward end-stage patients, and the reflections on clinical practice. Logistic regression analysis and chi-square test were used to analyse the categorical variables. Results There were 379 clinicians who completed the questionnaires and submitted successfully. Among them, 66.8% (253/379) had attended palliative care training courses more than twice; 66.8% (253/379) clinicians percieved powerless feeling when facing end-stage patients. We found that the education on palliative medicine was significantly associated to doctors' better comprehension on the concept of palliative care (OR=6.923, P=0.002). Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings (χ 2=13.015, P<0.001), and would be more likely to concern about patients and their family members in their clinical work (χ 2=28.754, P<0.001, χ 2=24.406, P<0.001). Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients. Palliative care help them overcome the negative feelings and act more caring in clinic. More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors' cognition on palliative care.

INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST’S PRACTICE: ISSUES OF ITS CLINICAL PRESENTATION AND DIAGNOSIS

At present, the problem of infective endocarditis (IE) remains relevant for clinicians of different specialties, including rheumatologists. The distinctive feature of present-day IE is its polyetiological pattern due to a broad spectrum of pathogens. The lecture highlights in detail clinical picture of the disease, laboratory and instrumental findings. It presents current international diagnostic criteria for IE. The obvious clinical polymorphism, subtle symptoms, and monosyndromic onset as masks, all increases the significance of differential diagnosis of IE, in early disease stages in particular. Main approaches to differentiating IE from diseases posing the greatest differentially diagnostic challenges are set forth.

Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges.

ObjectiveAnti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is a new autoimmune disorder, often paraneoplastic in nature, presenting with complex neuropsychiatric symptoms. Diagnosed serologically, this disorder is often responsive to immunosuppressant treatment. The objective of this review is to educate clinicians on the challenges of diagnosis and management of this disorder.Materials and methodsA review of the relevant literature on clinical presentation, pathophysiology, and recommended management was conducted using a PubMed search. Examination of the results identified articles published between 2007 and 2014.ResultsThe literature highlights the importance of recognizing early common signs and symptoms, which include hallucinations, seizures, altered mental status, and movement disorders, often in the absence of fever. Although the presence of blood and/or cerebrospinal fluid autoantibodies confirms diagnosis, approximately 15% of patients have only positive cerebrospinal fluid titers. Antibody detection should prompt a search for an underlying teratoma or other underlying neoplasm and the initiation of first-line immunosuppressant therapy: intravenous methylprednisolone, intravenous immunoglobulin, or plasmapheresis, or a combination thereof. Second-line treatment with rituximab or cyclophosphamide should be implemented if no improvement is noted after 10 days. Complications can include behavioral problems (eg, aggression and insomnia), hypoventilation, catatonia, and autonomic instability. Those patients who can be managed outside an intensive care unit and whose tumors are identified and removed typically have better rates of remission and functional outcomes.ConclusionThere is an increasing need for clinicians of different specialties, including psychiatrists, neurologists, oncologists, neurooncologists, immunologists, and intensivists to become familiar with this disorder and its potential complications. Remission can be optimized with prompt detection and aggressive, collaborative treatment within a multidisciplinary team.

Defining Cancer Care Quality or Delivering Quality Cancer Care?

Many in the oncology world see as accepted that quality and value are difficult to define and that no specialty-wide consensus is likely to be reached in the short term about how to measure and report success at improving either. Others find the definition just beyond their grasp and suggest that, like pornography, they know it when they see it. Large organizations, publications, conferences, and processes have sprung up around the concept, and various attempts have been made to develop “measures of quality” that can characterize a practice or physician in this area. This work includes ongoing efforts within and among the National Quality Forum, NCCN, ASCO, The US Oncology Network (The Network), the Community Oncology Alliance, and Ontario Cancer Care to identify quality measures—many of which focus on surrogate processes or activities that should lead to quality. Instead, however, we believe this effort and investment should focus on outcomebased measures, and we offer a paradigm for measuring interventions: •� Quality is the efficient delivery of evidence-based care by trained clinicians in an accessible setting. •� In this context, value is providing higher quality care at the same cost, or the same quality at a lower cost. We believe these concepts are at the core of cancer care delivery, whether in the community or academic setting and across specialties, including medical oncology, radiation oncology, gynecologic oncology, urology, and surgery. Achieving quality will require integrated, coordinated care with clinical teams spanning these professionals and settings. It requires not only coordination among clinicians of different specialties but also investment in infrastructure resources to facilitate the integration of process development and clinical decision support tools that support evidence-based practices that optimize practice efficiency and care delivery. If the right investments have been made and communications highways created, these definitions are measurable, reportable, and comparable (without significant manual effort). Just as important, these definitions allow quality and value to evolve over time as the evidence evolves. Consequently, the highest-quality treatment pathways, and even the best modalities of treatment, may be vastly different in the future. For example, advance care planning and palliative care services would likely not have been included in the concept of evidence-based care 10 years ago. Today, however, the data suggest that palliative care concurrent with disease-directed care can improve outcomes and patient experiences while reducing costs. This view is also supported by a decade of hypothesis, consensus-building, technology investment, data collection, and analysis by physicians and supporting clinicians and staff of The Network, who we believe pioneered the concepts of narrowly drawn, evidence-based pathways for care in oncology. Nearly a decade ago, physicians in The Network decided to develop Level I Pathways, evidence-based guidelines that redirect the wide range of treatments in oncology care into more precise, clinically proven treatment options. (More information is available at http://www.usoncology.com/cancercareadvocates/ AdvancingCancerCare/DeliverHigh-QualityCare/LevelIPathways.) The Level I Pathways program helps physicians eliminate disparities in care by refining potential

Current Staging Systems for Pancreatic Cancer

Accurate pretreatment staging of pancreatic cancer is a crucial initial step in the development of a stage-specific treatment plan, either on- or off-protocol for any patient with pancreatic cancer. Importantly, current American Joint Committee on Cancer staging utilizes the maximal information available; if surgery has been performed, then pathological information from the resected specimen will provide additional information for both T and N staging. If surgery has not been performed, then staging is based on information from available cross-sectional imaging studies. Although American Joint Committee on Cancer staging was modified in the sixth edition to reflect the survival difference between patients with operable/resectable versus nonoperable/unresectable disease, the precise definitions of resectability continue to evolve. It is essential for clinicians of different specialties to understand the definitions of resectability to facilitate optimal patient care and to allow for accurate interpretation of the literature. This review focuses on important aspects of the pretreatment assessment of patients with particular attention to definitions of resectability. Computed tomography has become the optimal imaging modality for pancreatic cancer staging, but other adjunct studies, including endoscopic ultrasound and laparoscopy, may provide additional staging information especially in circumstances where computed tomography technology is limited. In addition, the process of a standardized pathological review is summarized, with emphasis on assessment of the superior mesenteric artery margin and the definitions of R0, R1, and R2. Finally, the prognostic importance of key components of the pathological report such as lymph node status, lymph node ratio, and treatment effect is reviewed.

Sonoelastography: the method of choice for evaluation of tissue elasticity

Ultrasound devices and methodologies have been continuously evolving and becoming more important as tools in diagnostic medicine. Recently a new ultrasound diagnostic technique has been developed. Named sonoelastography, the technique enables evaluation of tissue elasticity and is based on differences in stiffness (hardness, compressibility, elasticity) of pathological changes and normal adjacent tissue. Sonoelastography (SE) is also known as Real-time tissue elastography (RTE), Real-time sonoelastography (RTSE), Tissue type imaging (TTI) and Ultrasound Strain Imaging Technology. It has been found useful in many medicine elds and adopted readily by clinicians of different specialties. It gives more information than conventional ultrasound in evaluation of tumors, liver disease, skeletal muscles, rheumatoid nodules and other pathological changes. This review covers the basics of elastography, its applications, instruments, techniques, the scoring system and the indications for elastography.

A taxonomy of reasons for not prescribing guideline-recommended medications for patients with heart failure

Background: Performance-measurement systems may work best when they account for the reasons why physicians do not provide guideline-recommended interventions. Objective: This article develops a conceptual framework for understanding the proximate, patient-centered reasons why physicians do not prescribe angiotensin-converting enzyme (ACE) inhibitors or β-blockers to patients with heart failure and reduced systolic function. Methods: This was a focus group study using a 2-stage design. Academically affiliated clinicians of different specialties and levels of training were recruited by e-mailed invitations sent to clinicians within each target group. To be included, candidates needed to be currently practicing in an ambulatory care setting in which they encountered patients with heart failure. In the first part of each group, participants were asked to describe reasons for not prescribing ACE inhibitors or â-blockers for patients with heart failure. Next, participants were asked to develop concept maps that organized these reasons into categories and described the relationships between these categories. The concept maps from each group were synthesized to develop a consensus scheme for categorizing reasons for nonprescribing. Results: There were 31 participants in 7 focus groups; median age was 31 years and 55% (17/31) were women. Two broad themes emerged. First, clinicians hinted at their own attitude-related barriers to prescribing. However, they framed their comments largely in terms of patient-centered reasons for nonprescribing that arose in individual patient encounters. Second, decision making about heart failure drug therapy often involved a complex and overlapping series of considerations. Five categories of reasons for not prescribing ACE inhibitors or â-blockers emerged: (1) adverse effects of drug therapy; (2) nonadherence to therapeutic and monitoring plan; (3) patients' preferences and beliefs; (4) comanagement and transitions of care; and (5) prioritization and patient benefit. Conclusions: Physicians' reasons for not prescribing guideline-recommended drugs for heart failure are complex but can be organized into a useful taxonomy. This taxonomy may be helpful for performance-measurement and quality-improvement programs that seek to understand reasons for physicians' nonadherence to guidelines.

Overrides of Medication Alerts in Ambulatory Care

Electronic prescribing systems with decision support may improve patient safety in ambulatory care by offering drug allergy and drug interaction alerts. However, preliminary studies show that clinicians override most of these alerts. We performed a retrospective analysis of 233 537 medication safety alerts generated by 2872 clinicians in Massachusetts, New Jersey, and Pennsylvania who used a common electronic prescribing system from January 1, 2006, through September 30, 2006. We used multivariate techniques to examine factors associated with alert acceptance. A total of 6.6% of electronic prescription attempts generated alerts. Clinicians accepted 9.2% of drug interaction alerts and 23.0% of allergy alerts. High-severity interactions accounted for most alerts (61.6%); clinicians accepted high-severity alerts slightly more often than moderate- or low-severity interaction alerts (10.4%, 7.3%, and 7.1%, respectively; P < .001). Clinicians accepted 2.2% to 43.1% of high-severity interaction alerts, depending on the classes of interacting medications. In multivariable analyses, we found no difference in alert acceptance among clinicians of different specialties (P = .16). Clinicians were less likely to accept a drug interaction alert if the patient had previously received the alerted medication (odds ratio, 0.03; 95% confidence interval, 0.03-0.03). Clinicians override most medication alerts, suggesting that current medication safety alerts may be inadequate to protect patient safety.

Do depressed patients in different treatment settings have different levels of well-being and functioning?

Differences in the functioning and well-being of adult patients with current or past depressive disorder who visited clinicians of different specialties in health maintenance organizations, solo practices, or large multispecialty group practices were examined. For patients in different systems, there were no significant differences in functioning and well-being across 12 domains tested. Patients of mental health specialists had worse mental health and more limitations in social activities, whereas patients of medical clinicians had worse physical functioning, more pain, more physical/psychophysiologic symptoms, and worse health perceptions. Thus, each system of care had depressed patients with a similar functioning and well-being "burden" but specialty sectors had patients with slightly different functioning and well-being profiles, probably reflecting patient selection of type of provider.