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Clinical decision support system

Linda A Dimeff, David A Jobes, Samantha A Chalker, Brian M Piehl, Leticia Lobo Duvivier, Benjamin C Lok, Mohan S Zalake, Julie Chung, Kelly Koerner
OBJECTIVE: A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. METHOD: Using iterative user-centered design with 24 suicidal patients, an avatar prototype, "Dr...
May 20, 2018: General Hospital Psychiatry
Traci D Yates, Marion E Davis, Yhenneko J Taylor, Lisa Davidson, Crystal D Connor, Katherine Buehler, Melanie D Spencer
BACKGROUND: Inappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. The goals of this study were to explore elements influencing provider decisions to prescribe antibiotics, identify provider recommendations for interventions to reduce inappropriate antibiotic use, and inform the clinical management of patients in the outpatient environment for infections that do not require antibiotics...
June 23, 2018: BMC Family Practice
Lori A Ramkissoon, Nicholas Britt, Alexander Guevara, Emily Whitt, Eric Severson, Pratheesh Sathyan, Laurie Gay, Julia Elvin, Jeffrey S Ross, Charlotte Brown, Kimberly Stogner-Underwood, Ryan Mott, David Kram, Roy Strowd, Glenn J Lesser, Shakti H Ramkissoon
In recent years, large-scale genomic studies have expanded our knowledge regarding genomic drivers in tumors of the central nervous system. While histopathologic analysis of brain tumors remains the primary method for tumor classification, the clinical utility of molecular and genomic testing to support and/or complement tumor classification continues to expand. This approach enhances diagnostic accuracy and provides clinicians with objective data to facilitate discussions regarding prognosis and treatment decisions, including selection of clinical trials...
June 21, 2018: Current Treatment Options in Oncology
Michael M Segal, Alanna K Rahm, Nathan C Hulse, Grant Wood, Janet L Williams, Lynn Feldman, Gregory J Moore, David Gehrum, Michelle Yefko, Steven Mayernick, Roger Gildersleeve, Margie C Sunderland, Steven B Bleyl, Peter Haug, Marc S Williams
Introduction: Reducing misdiagnosis has long been a goal of medical informatics. Current thinking has focused on achieving this goal by integrating diagnostic decision support into electronic health records. Methods: A diagnostic decision support system already in clinical use was integrated into electronic health record systems at two large health systems, after clinician input on desired capabilities. The decision support provided three outputs: editable text for use in a clinical note, a summary including the suggested differential diagnosis with a graphical representation of probability, and a list of pertinent positive and pertinent negative findings (with onsets)...
December 6, 2017: EGEMS
Barbara Nussbaumer-Streit, Ludwig Grillich, Anna Glechner, Lisa Affengruber, Gerald Gartlehner, Johannes Morche, Jörg J Meerpohl
In healthcare, the processes, criteria, and evidence that decision makers use to reach their judgments often remain unclear. Decision makers sometimes neglect important criteria, give undue weight to criteria, or do not use the best available evidence to inform their judgments. Thus, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group developed a system, to support transparent decision making. The purpose of the Evidence-to-Decision (EtD) framework is to help people use evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, coverage decisions, and health system, or public health recommendations and decisions...
June 18, 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
Vandenberk Bert, Vandael Eline, Robyns Tomas, Vandenberghe Joris, Garweg Christophe, Foulon Veerle, Ector Joris, Willems Rik
BACKGROUND: Incorporation of QTc in clinical decision support systems requires accurate QT-interval correction, also during common ECG abnormalities as ventricular conduction defects (VCD). We compared the performance and predictive value of QT correction formulas to design a patient-specific QT correction algorithm (QTcA). METHODS: The first ECG in adult patients with sinus rhythm (SR), atrial fibrillation (AF) and ventricular pacing (VP) was collected retrospectively...
June 21, 2018: Pacing and Clinical Electrophysiology: PACE
Antti Tolonen, Hanneke F M Rhodius-Meester, Marie Bruun, Juha Koikkalainen, Frederik Barkhof, Afina W Lemstra, Teddy Koene, Philip Scheltens, Charlotte E Teunissen, Tong Tong, Ricardo Guerrero, Andreas Schuh, Christian Ledig, Marta Baroni, Daniel Rueckert, Hilkka Soininen, Anne M Remes, Gunhild Waldemar, Steen G Hasselbalch, Patrizia Mecocci, Wiesje M van der Flier, Jyrki Lötjönen
Clinical decision support systems (CDSSs) hold potential for the differential diagnosis of neurodegenerative diseases. We developed a novel CDSS, the PredictND tool, designed for differential diagnosis of different types of dementia. It combines information obtained from multiple diagnostic tests such as neuropsychological tests, MRI and cerebrospinal fluid samples. Here we evaluated how the classifier used in it performs in differentiating between controls with subjective cognitive decline, dementia due to Alzheimer's disease, vascular dementia, frontotemporal lobar degeneration and dementia with Lewy bodies...
2018: Frontiers in Aging Neuroscience
Jürg Blaser
Challenges of Digital Medicine Abstract. Digitization is increasingly covering more and more sectors, including medicine. To ensure medical operation 365 × 24 hours, progressively more human and financial resources are necessary. The transformation of patient histories from paper into electronic patient records focused initially on documentation. Today, hospital information systems are increasingly used as a platform for the communication of all professionals involved in the patient process - in Switzerland, however, so far without providing patients direct access to their data...
June 2018: Praxis
Stephen W Reddel, Michael H Barnett, Sean Riminton, Tej Dugal, Katherine Buzzard, Chenu Tim Wang, Fiona Fitzgerald, Heidi N Beadnall, Diane Erickson, David Gahan, Daniel Wang, Toby Ackland, Richard Thompson
BACKGROUND: Alemtuzumab is a highly effective treatment for relapsing-remitting multiple sclerosis (MS) but requires ongoing pathology monitoring for autoimmune adverse effects. The Alemtuzumab in MS Safety Systems (AMS3) study evaluated the implementation of an automated pathology-monitoring system. OBJECTIVES: To develop an efficient automated clinical decision support system (CDSS) to electronically prompt and track pathology collection and to provide prescribers and patients with customised alerts of abnormal results for identified risks...
June 1, 2018: Multiple Sclerosis: Clinical and Laboratory Research
S K L Chia
Early-stage hormone receptor-positive breast cancer is the most common subtype and stage presenting in countries with organized screening programs. Standard clinical and pathologic factors are routinely used to support prognosis and decisions about adjuvant therapies. Hormone receptor and her2 status are essential for decision-making about the use of adjuvant hormonal and anti-her2 therapies respectively. Genomic assays are now commercially available to aid in either further prognostication or in refining the potential benefit of adjuvant chemotherapy...
June 2018: Current Oncology
B Melosky
Background: Neuroendocrine tumours (nets) are classified by site of origin, with lung being the second most common primary site after the gastrointestinal tract. Lung nets are rare and heterogeneous, with varied pathologic and clinical features. Typical and atypical carcinoid tumours are low-grade lung nets which, compared with the more common high-grade nets, are associated with a more favourable prognosis. Still, optimal treatment strategies are lacking. Methods: This review concentrates on classification and treatment strategies for metastatic low-grade lung nets, considering both typical and atypical carcinoids...
June 2018: Current Oncology
Meghan R Cain, Dimitrios Arkilo, Amy M Linabery, Anupam B Kharbanda
OBJECTIVES: To evaluate emergency department use and outcomes of neuroimaging for headache in a free-standing children's hospital system. STUDY DESIGN: We prospectively enrolled children aged 6-18 years who presented to the emergency department with a chief complaint of headache from September 2015 to September 2016. Standardized data collection was performed in real time, including telephone follow-up as needed, and imaging outcome was determined through a chart review...
June 14, 2018: Journal of Pediatrics
Alessandro Orlando, A Stewart Levy, Benjamin A Rubin, Allen Tanner, Matthew M Carrick, Mark Lieser, David Hamilton, Charles W Mains, David Bar-Or
OBJECTIVE A paucity of studies have examined neurosurgical interventions in the mild traumatic brain injury (mTBI) population with intracranial hemorrhage (ICH). Furthermore, it is not understood how the dimensions of an ICH relate to the risk of a neurosurgical intervention. These limitations contribute to a lack of treatment guidelines. Isolated subdural hematomas (iSDHs) are the most prevalent ICH in mTBI, carry the highest neurosurgical intervention rate, and account for an overwhelming majority of all neurosurgical interventions...
June 15, 2018: Journal of Neurosurgery
Marc Gutenstein, John W Pickering, Martin Than
Clinical pathways are used to support the management of patients in emergency departments. An existing document-based clinical pathway was used as the foundation on which to design and build a digital clinical pathway for acute chest pain, with the aim of improving clinical calculations, clinician decision-making, documentation, and data collection. Established principles of decision support system design were used to build an application within the existing electronic health record, before testing with a multidisciplinary team of doctors using a think-aloud protocol...
June 1, 2018: Health Informatics Journal
Robin Blythe, David Cook, Nicholas Graves
BACKGROUND: A sepsis care bundle of intravenous vitamin C, thiamine, and hydrocortisone was reported to improve treatment outcomes. The data to support it are uncertain and decision makers are likely to be cautious about adopting it. The objective of this study was to model the opportunity costs in dollars and lives of waiting for better information before adopting the bundle. METHODS: A decision tree was built using information from the literature. We modelled the impact of bundle adoption under three scenarios using a simulation in which the bundle was effective as reported in the primary trial, less effective based on other information, and ineffective...
2018: F1000Research
Karin Nordin, Anna-Lena Brorsson, Kerstin Ekbom
BACKGROUND: The positive effects of behavioural treatment and weight management in adolescents with severe obesity are modest. Obesity surgery can be an option for adolescents, but is not the first-hand choice of treatment. The knowledge about adolescents' own experiences of having undergone surgery and their thoughts and feelings of the follow-up period are limited. OBJECTIVES: To describe adolescents' decision to go through obesity surgery as teenager and their experiences of the follow-up period...
April 26, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Deborah Davies
Primary Health Networks (PHNs) are tasked to enhance the efficiency and effectiveness of general practice. Gold Coast Primary Health Network (GCPHN) has been collecting de-identified aggregated clinical data from general practices and reporting back on areas for improvement on data coding and some clinical metrics, such as blood pressure not being recorded. However, aggregated data cannot be used to intervene at the individual patient level, and because of the collection-to-reporting time-lag, the data cannot help facilitate immediate action in the general practice...
June 14, 2018: Australian Journal of Primary Health
Anna Janssen, Tracy Robinson, Melissa Brunner, Paul Harnett, Kylie E Museth, Tim Shaw
BACKGROUND: Multidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research...
June 13, 2018: BMC Health Services Research
Jaak Ph Janssens, Klaus Schuster, Andreas Voss
Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system...
June 2018: EPMA Journal
Brett E Youngerman, Hojjat Salmasian, Eileen J Carter, Michael L Loftus, Rimma Perotte, Barbara G Ross, E Yoko Furuya, Robert A Green, David K Vawdrey
OBJECTIVE: To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).Design, Setting, and ParticipantsThis 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.InterventionsPhase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration...
June 13, 2018: Infection Control and Hospital Epidemiology
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