Massachusetts payers and providers have encouraged clinician usage of e-Prescribing technology to improve patient safety, enhance office practice efficiencies, and reduce medical costs. This report describes three early pilot e-Prescribing projects as case studies. These projects identified the e-Prescribing needs of clinicians, illustrated key issues that made implementation difficult, and clarified the impact of various types of functionality. The authors identified ten key barriers: (1) previous negative technology experiences, (2) initial and long-term cost, (3) lost productivity, (4) competing priorities, (5) change management issues, (6) interoperability limitations, (7) information technology (IT) requirements, (8) standards limitations, (9) waiting for an "all-in-one solution," and (10) confusion about competing product offerings including hospital/Integrated Delivery System (IDN)-sponsored projects. In Massachusetts, regional projects have helped to address these barriers, and e-Prescribing activities are accelerating rapidly within the state.

Observers with brain injury and control participants performed a vigilance task during which they received periodic whiffs of unscented air or air scented with peppermint. Under both fragrance conditions, controls reduced the frequency of commissive errors (false alarms) over the course of the vigil, an adaptive strategy given the low probability of signals employed (0.04). The false alarm rate of observers with brain injury increased precipitously toward the end of the vigil in the unscented air condition. However, exposure to the scent of peppermint rendered the false alarm scores of observers with brain injury similar to that of controls, a result which is consistent with evidence that olfactory stimulation activates brain areas vital for planning and judgment.

No abstract

No abstract

Patients' olfactory functioning is rarely considered by rehabilitation specialists because this capacity is seen as unnecessary for most vocational and academic purposes. However, several recent studies have shown that intermittent exposure to fragrances can help subjects sustain attention more efficiently. As this effect is especially pronounced when subjects report attention-maintenance difficulties, accessory olfactory stimulation may enhance the sustained attention capacities of head-injured subjects. Another study is cited in which subjects who lost their sense of smell following head injuries were found to experience more difficulty in maintaining employment. This effect is probably related to orbital lobe damage, which usually accompanies post-traumatic anosmia. The implications of these studies for rehabilitation professionals are discussed.