BackgroundThe use of intravenous thrombolysis for stroke is limited by contraindications that may be difficult to identify promptly and accurately. Evidence supports the use of information technology-based clinical decision support (CDS) tools to achieve improvements in care delivery. The objective of this pilot study was to investigate the efficacy of a CDS tool to screen health records for contraindications to intravenous stroke thrombolysis.MethodsA CDS tool was developed to rapidly screen health information in seven affiliated hospitals for contraindications to stroke thrombolysis. A fixed-sequence, 2-period crossover study was conducted to test the efficacy of the CDS tool. Four mock patient records derived from the stroke registry that contained a total of nine contraindication items in two or more of the hospitals were used for testing purposes. The test patients were preset and balanced between groups with and without the CDS tool appearing six times in each group before recruiting the participating physicians. Physicians who were responsible for thrombolytic therapy and willing to sign informed consent were recruited. The participating physicians were asked to check a list of contraindications for two of the patients by using a shared electronic medical record system among the seven hospitals with and without the CDS tool. The test time and missed contraindications were recorded and analyzed statistically.ResultsA total of 14 physicians who were responsible for stroke thrombolysis were approached, and 12 signed informed consent and took the test. By using the CDS tool, the test time was reduced significantly from 14.6 ± 7.4 to 7.3 ± 5.2 min (P = 0.010). In a total of 54 contraindications, the number of missed contraindications was reduced significantly from 23 (42.6 %) to seven (13.0 %) (P = 0.001). The difference of missed contraindication number between the two groups was statistically significant either per physician or per contraindication item.ConclusionsBy screening health records for relevant contraindications, the use of a CDS tool may reduce the time needed to review medical records and reduce the number of missed contraindications for stroke thrombolysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-015-0229-4) contains supplementary material, which is available to authorized users.

This paper reports on an interdisciplinary, collaborative project grounded in linguistic theory on impersonalisation and visual communication theory on wordless visual narratives.The aims of this practice-based research project is to develop an alternative to existing methods of studying impersonalization strategies through interdisciplinary collaboration and to test its usefulness for identifying not only the range of possible linguistic strategies of impersonalization but also the preferred strategies for specific impersonal uses. The group of eighteen collaborators consisted of two linguists, one graphic design lecturer and fifteen final-year graphic design students. The students were responsible for designing visual prompts for the questionnaire that i) should not limit the possible linguistic answers, ii) must be able to accommodate any impersonalisation strategy, iii) should not contain any limiting linguistic clues, and iv) had to comply with the criteria on the basis of which the twelve impersonal uses are distinguished from one another. The questionnaire was piloted in two phases. After each phase, students adjusted and refined their visual prompts. A validation phase indicated that the finalised questionnaire fulfils its functions, since at least sixteen different impersonalisation strategies can be distinguished, and preferable strategies for each impersonal use can be identified.

OPSOMMING Hierdie artikel ondersoek die verskillende strategieë wat Afrikaanse sprekers gebruik om aan te dui dat 'n konstruksie onpersoonlik is. Onpersoonlike konstruksies is konstruksies waar die (soms implisiete) subjek geparafraseer kan word as "mense in die algemeen", " 'n onbekende persoon" of "sommige mense". Hierdie onderwerp het al baie aandag in die taalkundeliteratuur gekry, maar die fokus was meestal op 'n beperkte aantal onverpersoonlikingstrategieë, soos die gebruik van persoonlike voornaamwoorde (bv. Jy leef net een keer), onbepaalde voornaamwoorde (byvoorbeeld Iemand het my beursie gesteel!) en passiewe konstruksies (byvoorbeeld My kar is gesteel). Volgens ons kan dié nou fokus in die literatuur toegeskryf word aan die feit dat die navorsingsmetodes (byvoorbeeld korpusstudies en vraelyste) wat tot op hede gebruik is om onverpersoonlikingstrategieë te ondersoek, navorsers slegs in staat stel om op deduktiewe wyse na die strategieë te kyk. Tot op hede is daar nog nie 'n studie uitgevoer om te bepaal i) watter verskillende moontlike onverpersoonlikingstrategieë deur Afrikaanse sprekers aangewend kan word nie, en ii) of daar bepaalde voorkeure vir sprekers bestaan oor watter strategieë om te gebruik in die verskillende en onderskeibare onpersoonlike kontekste. Hierdie ondersoek beantwoord hierdie twee vrae deur die resultate van 'n visuele vraelys - wat aan ongeveer 450 Afrikaanssprekende respondente gegee is om te beantwoord - te bestudeer. Trefwoorde: onpersoonlik; onverpersoonliking; agenslose passief; menslike onpersoonlike voornaamwoord; universeel; eksistensieel; onverper-soonlikingstrategie. ABSTRACT In this article, we examine impersonal constructions in Afrikaans, i.e. constructions without a referential subject or, put differently, constructions where the (implicit) subject can be paraphrased as "people in general", "someone" or "somepeople". This topic has already received considerable attention in the literature but the focus has generally been on a limited number of strategies, such as human impersonal pronouns (e.g. mens leef net een keer "one only lives once") and the passive construction (e.g. my kar is gesteel "my car has been stolen"). In our view, this narrow focus in the literature is at least partly due to the limitations of the language-based methods (e.g. corpus studies and questionnaires) currently used in the research. These methods essentially facilitate a deductive approach by investigating a predetermined set of more or less established impersonal constructions. The present study, by contrast, adopts a more open-ended approach in order to get a better sense of the range of possible strategies that speakers of Afrikaans can use in different impersonal contexts and of the constructions that they prefer to employ in those various impersonal uses. We therefore draw on a visual questionnaire with few linguistic cues. Each scene in this questionnaire depicts a particular impersonal context - based on the distinguishing criteria found in the existing semantic maps of the domain of impersonalisation (such as quantification, perspective and veridicality) and respondents are encouraged to provide a sentence that captures the situation. The questionnaire was published online, promoted via social media and completed by more than 400 respondents. The findings show first of all that there exist numerous alternatives to the well-known strategies of impersonalisation. In addition to pronouns (e.g. jy "you" in wat gebeur as jy die knoppie druk? "what happens when you press that button?") and passives (e.g. is gepluk "were picked" in terwyl jy geslaap het, is al die appels gepluk "while you were asleep, all the apples were picked"), the types of constructions identified in our study include but are not restricted to: nouns with the meaning "people" and an extra evaluative connotation (e.g. morsjorse "litterbugs" in morsjorse het gister hier gesit en drink "litterbugs were drinking here yesterday"), the generic use of the imperative (e.g. onthou "remember" in onthou om altyd jou sitplekgordel vas te maak! "remember always to fasten your seat belt!"), nominalisations (e.g. koud kry "getting cold" in die winter is vir koud kry gemaak "winter is made for getting cold") and free-choice constructions (e.g. wie ook al "whoever" in wie ook al gister hier sokker gespeel het, het hul bal vergeet "whoever played soccer here yesterday forgot their ball"). Our results are furthermore suggestive of the impersonal constructions that are clearly favoured by speakers of Afrikaans. They indicate, for instance, that the established but still comparatively under-researched strategy of passivisation is used across all impersonal contexts and is even regularly preferred to the better-studied pronouns in certain uses (e.g. daar is al weer terreuraanvalle uitgevoer "terror attacks have again been carried out" instead of hulle het al weer terreuraanvalle uitgevoer "they have again carried out terror attacks"). Indefinite pronouns too are found to be among the most common constructions - especially, though not only, in contexts assuming the existence of a particular unidentified person responsible for some event (e.g. iemand "someone" in iemand het al die appels gepluk "someone has picked all the apples"). Nouns with the meaning "people", finally, also appear to be quite favoured by speakers of Afrikaans and they occur in a variety of impersonal uses, such as statements about people in general that do not, however, include the speaker or the addressee (e.g. mense "people" in in China eet mense rys "in China, people eat rice"). Keywords: impersonal; impersonalisation; agensless passive; human impersonal pronouns; universal; existential; impersonalisation strategy