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Clinical decision support system

Arash Shaban-Nejad, Maxime Lavigne, Anya Okhmatovskaia, David L Buckeridge
Population health decision makers must consider complex relationships between multiple concepts measured with differential accuracy from heterogeneous data sources. Population health information systems are currently limited in their ability to integrate data and present a coherent portrait of population health. Consequentially, these systems can provide only basic support for decision makers. The Population Health Record (PopHR) is a semantic web application that automates the integration and extraction of massive amounts of heterogeneous data from multiple distributed sources (e...
October 17, 2016: Annals of the New York Academy of Sciences
Andriy Temko, Gordon Lightbody
It is now generally accepted that EEG is the only reliable way to accurately detect newborn seizures and, as such, prolonged EEG monitoring is increasingly being adopted in neonatal intensive care units. Long EEG recordings may last from several hours to a few days. With neurophysiologists not always available to review the EEG during unsociable hours, there is a pressing need to develop a reliable and robust automatic seizure detection method-a computer algorithm that can take the EEG signal, process it, and output information that supports clinical decision making...
October 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Emma Suggett, John Marriott
BACKGROUND: A number of methods exist for the risk assessment of hospital inpatients to determine the likelihood of patients experiencing drug-related problems (DRPs), including manual review of a patient's medication (medication reviews) and more complex electronic assessment using decision support alerts in electronic prescribing systems. A systematic review was conducted to determine the evidence base for potential risks associated with adult hospital inpatients that could not only lead to medication-related issues but might also be directly associated with pharmacist intervention...
September 2016: Drugs—Real World Outcomes
Jaclyn Yoong, Aleece MacPhail, Gael Trytel, Prashanti Yalini Rajendram, Margaret Winbolt, Joseph E Ibrahim
Objective Limitation of Medical Treatment (LMT) forms are an essential element of end-of-life care. Decision making around LMT is complex and often involves patients with dementia. Despite the complexity, junior doctors frequently play a central role in completing LMT forms. The present study sought perspectives from a range of stakeholders (hospital clinicians, medical education personnel, legal and advocacy staff) about junior doctors' roles in completing LMT forms in general and for patients with dementia...
October 14, 2016: Australian Health Review: a Publication of the Australian Hospital Association
G I Nazarenko, E B Kleimenova, S A Payushchik, V A Otdelenov, D A Sychev
AIM: To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital. MATERIAL AND METHODS: A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry...
2016: Terapevticheskiĭ Arkhiv
Rianne A Weersink, Margriet Bouma, David M Burger, Joost P H Drenth, Nicole G M Hunfeld, Minke Kranenborg, Margje H Monster-Simons, Sandra A W van Putten, Herold J Metselaar, Katja Taxis, Sander D Borgsteede
INTRODUCTION: Liver cirrhosis can have a major impact on drug pharmacokinetics and pharmacodynamics. Patients with cirrhosis often suffer from potentially preventable adverse drug reactions. Guidelines on safe prescribing for these patients are lacking. The aim of this study is to develop a systematic method for evaluating the safety and optimal dosage of drugs in patients with liver cirrhosis. METHODS AND ANALYSIS: For each drug, a six-step evaluation process will be followed...
October 12, 2016: BMJ Open
Pallab K Maulik, Abha Tewari, Siddhardha Devarapalli, Sudha Kallakuri, Anushka Patel
INTRODUCTION: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications...
2016: PloS One
Martin Dawes, Martin N Aloise, J Sidney Ang, Pieter Cullis, Diana Dawes, Robert Fraser, Gideon Liknaitzky, Andrea Paterson, Paul Stanley, Adriana Suarez-Gonzalez, Hagit Katzov-Eckert
BACKGROUND: Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics. METHODS: We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases...
July 2016: CMAJ Open
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Raymond Zakhari, Susan E Sterrett
BACKGROUND AND PURPOSE: A large degree of variation in clinical practice exists among clinicians evaluating and treating individuals with minor head injuries. Noncontrast head computerized tomography (CT) scans are commonly used to assess for intracranial damage in patients presenting with head injury. This practice is not supported by the evidence and poses harm to patients by increasing exposure to ionizing radiation. This form of radiation exposure increases the risk of developing cancers over the course of the individual's life, and further strains the limited resources of the healthcare system...
September 22, 2016: Journal of the American Association of Nurse Practitioners
Amelia Barwise, Lisbeth Garcia-Arguello, Yue Dong, Manasi Hulyalkar, Marija Vukoja, Marcus J Schultz, Neill K J Adhikari, Benjamin Bonneton, Oguz Kilickaya, Rahul Kashyap, Ognjen Gajic, Christopher N Schmickl
BACKGROUND: The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of CERTAIN's key features is clinical decision support providing point-of-care information about common acute illness syndromes, procedures, and medications in an index card format...
October 3, 2016: BMC Medical Informatics and Decision Making
Nicholas Waldron, Claire E Johnson, Peter Saul, Heidi Waldron, Jeffrey C Chong, Anne-Marie Hill, Barbara Hayes
BACKGROUND: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature...
October 6, 2016: BMC Health Services Research
Kathrin M Cresswell, Lisa Lee, Hajar Mozaffar, Robin Williams, Aziz Sheikh
OBJECTIVE: To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING: Six hospitals in England, United Kingdom. STUDY DESIGN: Qualitative case study. DATA COLLECTION: We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals...
October 7, 2016: Health Services Research
Jacques Theitler, Daniella Dassa, Revital Gandelman-Marton
BACKGROUND: The electroencephalogram (EEG) can support the diagnosis of epilepsy, diagnose nonconvulsive status epilepticus, and aid in the classification of epileptic seizures. Its contribution to the diagnosis of other medical conditions or to decision making in other clinical situations was not established. Practically, EEG labs frequently encounter EEG referrals that are not based on current recommendations. OBJECTIVES: To assess the value of inpatient EEG in medical decision making...
October 6, 2016: European Journal of Clinical Investigation
Melanie C Wright, Sherry Dunbar, Brekk C Macpherson, Eugene W Moretti, Guillherme Del Fiol, Jean Bolte, Jeffrey M Taekman, Noa Segall
OBJECTIVES: Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information. METHODS: We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians' information use activities in critical care settings...
October 5, 2016: Applied Clinical Informatics
John Ovretveit, Eugene Nelson, Brent James
Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants' experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research...
October 10, 2016: Journal of Health Organization and Management
Christopher L Bowlus, James T Kenney, Gary Rice, Robert Navarro
BACKGROUND: Chronic liver disease and cirrhosis are a leading cause of morbidity and mortality in the United States. Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis and which has been designated an orphan condition, is a chronic autoimmune disease resulting in the destruction of the small bile ducts in the liver. Without effective treatment, disease progression frequently leads to liver failure and death. Until May 2016, the only FDA-approved treatment for PBC was ursodiol (UDCA), an oral hydrophilic bile acid, which can slow progression of liver damage due to PBC...
October 2016: Journal of Managed Care & Specialty Pharmacy
Marsha Michie, Stephanie A Kraft, Mollie A Minear, Roberta R Ryan, Megan A Allyse
OBJECTIVES: The introduction of prenatal cfDNA screening for fetal aneuploidy and other genetic conditions has exacerbated concerns about informed decision-making in clinical prenatal testing. To assess the information provided to patients to facilitate decisions about cfDNA screening, we collected written patient education and consent documents created by laboratories and clinics. METHODS: Informed consent documents (IC) were coded by two independent coders. Each IC was assessed for readability, attention to elements of informed consent, and completeness of information about the test and the screened conditions...
July 2016: Ethics Med Public Health
Jacob Calvert, Qingqing Mao, Jana L Hoffman, Melissa Jay, Thomas Desautels, Hamid Mohamadlou, Uli Chettipally, Ritankar Das
BACKGROUND: Clinical decision support systems are used to help predict patient stability and mortality in the Intensive Care Unit (ICU). Accurate patient information can assist clinicians with patient management and in allocating finite resources. However, systems currently in common use have limited predictive value in the clinical setting. The increasing availability of Electronic Health Records (EHR) provides an opportunity to use medical information for more accurate patient stability and mortality prediction in the ICU...
November 2016: Annals of Medicine and Surgery
Tiago Ventura, Maria do Carmo Lopes, Brigida Costa Ferreira, Leila Khouri
AIM: In this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems. BACKGROUND: Optimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options...
November 2016: Reports of Practical Oncology and Radiotherapy
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