Effect of computerized physician order entry on imaging study indication.

PURPOSE: The effect of computerized physician order entry (CPOE) on imaging indication quality had only been measured in one institution's emergency department using a homegrown electronic health record with faculty physicians, and only with one instrument. To better understand how many US hospitals' recent CPOE implementations had affected indication quality, we measured its effect in a generalizable inpatient setting, using one existing and one novel instrument. METHODS: We retrospectively analyzed the indications for 100 randomly selected inpatient abdominal CT studies during 2 calendar months immediately prior to a 3/3/2012 CPOE implementation (1/1/2012-2/29/2012) and during 2 subsequent calendar months (5/1/2012-6/30/2012). We excluded 2 intervening months to avoid behaviors associated with adoption. We measured indication quality using a published 8-point explicit scoring scale and our own, novel, implicit 7-point Likert scale. RESULTS: Explicit scores increased 93% from a pre-CPOE mean ± 95% confidence interval of 1.4 ± 0.2 to a CPOE mean of 2.7 ± 0.3 (P < .01). Implicit scores increased 26% from a pre-CPOE mean of 4.3 ± 0.3 to a CPOE mean of 5.4 ± 0.2 (P < .05). When presented with a statement that an indication was "extremely helpful," and choices ranging from "strongly disagree" = 1 to "strongly agree" = 7, implicit scores of 4 and 5 signified "undecided" and "somewhat agree," respectively. CONCLUSIONS: In an inpatient setting with strong external validity to other US hospitals, CPOE implementation increased indication quality, as measured by 2 independent scoring systems (one pre-existing explicit system and one novel, intuitive implicit system). CPOE thus appears to enhance communication from ordering clinicians to radiologists.

Chronic pain resolution after a lucid dream: a case for neural plasticity?

Chronic pain is often managed using a multidisciplinary, biopsychosocial approach. Interventions targeting the biological, psychological, and social aspects of both the patient and the pain have been demonstrated to provide objective and subjective improvement in chronic pain symptoms. The mechanism by which pain attenuation occurs after these interventions remains to be elucidated. While there is a relatively large body of empirical literature suggesting that functional and structural changes in the peripheral and central nervous systems are key in the development and maintenance of chronic pain states, less is known about changes that take place in the nervous system as a whole after biopsychosocial interventions. Using as a model the unique case of Mr. S, a patient suffering with chronic pain for 22 years who experienced a complete resolution of pain after a lucid dream following 2 years of biopsychosocial treatments, we postulate that central nervous system (CNS) reorganization (i.e., neural plasticity) serves as a possible mechanism for the therapeutic benefit of multidisciplinary treatments, and may set a neural framework for healing, in this case via a lucid dream.