Predictors of tool usage in the military health system's electronic health record, the Armed Forces Health Longitudinal Technology Application.

OBJECTIVE: To assess the association between key predictor variables and use of advanced features for the Armed Forces Health Longitudinal Technology Application (AHLTA), the electronic health record (EHR) for the Military Health System (MHS). METHODS: Secondary analysis of a web-based volunteer survey of 520 Navy AHLTA users. chi2 and logistic regression methods were used to assess the strength of relationship between three predictor variables and the use of several advanced AHLTA features. RESULTS: Adequacy of initial training was associated with increased use of the template management module (adjusted OR = 2.34, 95% CI 1.64-3.61) and order sets (adjusted OR = 1.64, 95% CI 1.07-2.51). Duration of AHLTA usage was associated with use of all advanced features (adjusted OR = 1.69-6.12, p < or = 0.001-0.045). Physicians use most of the advanced features more than nonphysicians (adjusted OR = 1.95-7.07, p < or = 0.001-0.030). Seventy percent of users cited a slow screen refresh rate as a problem. CONCLUSIONS: Training, duration of usage, and provider role are associated with use of advanced features.

Ossifying fibromyxoid tumor of soft parts--a clinicopathologic and immunohistochemical study of 104 cases with long-term follow-up and a critical review of the literature.

Ossifying fibromyxoid tumor (OFT) is a unique soft tissue tumor of uncertain histogenesis. The majority of reported cases (approximately 220) have pursued a benign clinical course. However, recent literature has emphasized the existence of morphologically atypical and clinically malignant examples of this tumor and proposed guidelines for assessment of biologic potential. In the present study, we evaluated 104 cases of OFT from the Armed Forces Institute of Pathology, accessioned between the years 1970 and 2007. Herein, OFT was strictly defined as a tumor with lobular architecture, predominantly epithelioid cell morphology, a low level of atypia, corded and trabecular growth patterns, moderate amounts of myxocollagenous matrix, and often, focal peripheral metaplastic bone formation. Tumors that lacked conventional morphology were excluded. The exclusion group included cutaneous mixed tumors, low-grade fibromyxoid sarcomas, and extraskeletal osteosarcomas. The OFTs occurred in 64 men and 40 women with a median age of 50 years (range, 21 to 81 y). The tumor size ranged from 0.7 to 17 cm (median, 3 cm). The mitotic rate varied from 0 to 41 mitotic figures per 50 HPFs (median, 2/50 HPFs). Tumor cell nuclei typically contained small, distinct nucleoli, and necrosis was infrequent (11/104). The great majority of tumors (67/71, 94%) were positive for S100 protein, whereas only occasional examples had (focal) positivity for desmin, glial fibrillary acidic protein, and an AE1/AE3 keratin cocktail. Local recurrences were documented in 9 of 41(22%) living patients, usually 10 or more years after primary surgery, but there were no metastases. A mitotic rate of >2 mitotic figures/50 HPFs was a risk factor for local recurrence, but necrosis, tumor size, the presence of satellite nodules, and positive margins were not. When OFT is strictly defined by the criteria noted above, there is potential for local recurrence, but there seems to be little or no risk for metastasis.