Keyboard data entry use among osteopathic medical students and residents.

CONTEXT: Candidates taking the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE) are currently evaluated on their ability to document clinical findings using a handwritten postencounter note. However, keyboard data entry is increasingly used for medical documentation. OBJECTIVE: To determine the use and perception of keyboard data entry among osteopathic medical students and residents in educational and clinical settings. METHODS: A Web-based survey regarding frequency of and preference for keyboard data entry was distributed to 9801 osteopathic medical students, 17,268 osteopathic residents, and 34 clinical deans of colleges of osteopathic medicine (COMs). In addition, 31 COMs' clinical skills center directors were contacted to participate in a telephone survey about the use of keyboard data entry in their centers. RESULTS: A total of 1711 students, 1198 residents, 14 clinical deans, and 17 clinical skills center directors responded to the surveys. The majority of students (872 [51%]) reported using electronic keyboard data entry at their COM's clinical skills center for postencounter notes. Among respondents, 379 students (23%), 77 residents (9%), and 1 clinical dean reported that electronic keyboard data entry is never or rarely used during clinical rotations. Most trainees (1592 students [93%], 864 residents [94%]) reported that they were either comfortable or very comfortable with typing. Given the option of recording methods for SOAP (subjective, objective, assessment, plan) note findings on the COMLEX-USA Level 2-PE, 7 clinical deans were unsure of their students' preferences, while the remaining favored keyboard data entry (5) over handwriting (2). The majority of student and resident respondents would choose keyboard data entry (1009 [60%] and 511 [55%], respectively). CONCLUSION: Osteopathic medical students and residents are comfortable with typing; they are exposed to and would prefer using an electronic form of entry for medical documentation. These results support a conversion from written postencounter notes to keyboard data entry of notes on the COMLEX-USA Level 2-PE.

Persistence and growth of the fecal indicator bacteria enterococci in detritus and natural estuarine plankton communities.

Enterococci are used to evaluate recreational-water quality and health risks in marine environments. In addition to their occurrence in feces of warm blooded animals, they are also common epiphytes. We investigated the contribution of plankton- or particle-associated enterococci in estuarine and coastal water. Seven water and size-fractionated plankton samples were collected monthly between April 2008 and January 2009 in the tidal reaches of the Skidaway River (Georgia, USA). Each size fraction, along with filtered (<30 µm) and bulk estuarine water, was processed according to U.S. Environmental Protection Agency method 1600. Presumptive enterococci were selected and species were identified using carbon substrate utilization patterns. The highest average densities occurred within the 30-, 63-, 105-, and 150-µm size fractions, which also represented the majority (>99%) of the particles within the sampled water. Particle-associated enterococci accounted for as little as 1% of enterococci in bulk water in April to as much as 95% in July. Enterococcus faecalis was the most commonly isolated species from both water and plankton and represented 31% (16/51) and 35% (6/17) of the identified Enterococcus species from water and plankton, respectively. Enterococcus casseliflavus represented 29% of the selected isolates from plankton and 16% from water. Both E. faecalis and E. casseliflavus were able to survive and grow in plankton suspensions significantly longer than in artificial seawater. Enterococcus spp. may be highly concentrated in plankton and associated particles, especially during summer and fall months. These findings could have implications for the effectiveness of enterococci as an indicator of coastal water quality, especially in particle-rich environments.

Risk of fetal mortality after exposure to Listeria monocytogenes based on dose-response data from pregnant guinea pigs and primates.

One-third of the annual cases of listeriosis in the United States occur during pregnancy and can lead to miscarriage or stillbirth, premature delivery, or infection of the newborn. Previous risk assessments completed by the Food and Drug Administration/the Food Safety Inspection Service of the U.S. Department of Agriculture/the Centers for Disease Control and Prevention (FDA/USDA/CDC) and Food and Agricultural Organization/the World Health Organization (FAO/WHO) were based on dose-response data from mice. Recent animal studies using nonhuman primates and guinea pigs have both estimated LD(50)s of approximately 10(7) Listeria monocytogenes colony forming units (cfu). The FAO/WHO estimated a human LD(50) of 1.9 x 10(6) cfu based on data from a pregnant woman consuming contaminated soft cheese. We reevaluated risk based on dose-response curves from pregnant rhesus monkeys and guinea pigs. Using standard risk assessment methodology including hazard identification, exposure assessment, hazard characterization, and risk characterization, risk was calculated based on the new dose-response information. To compare models, we looked at mortality rate per serving at predicted doses ranging from 10(-4) to 10(12) L. monocytogenes cfu. Based on a serving of 10(6) L. monocytogenes cfu, the primate model predicts a death rate of 5.9 x 10(-1) compared to the FDA/USDA/CDC (fig. IV-12) predicted rate of 1.3 x 10(-7). Based on the guinea pig and primate models, the mortality rate calculated by the FDA/USDA/CDC is underestimated for this susceptible population.