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Clinical decision support system

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https://www.readbyqxmd.com/read/28336504/mhealth-for-clinical-decision-making-in-sub-saharan-africa-a-scoping-review
#1
Ibukun-Oluwa Omolade Adepoju, Bregje Joanna Antonia Albersen, Vincent De Brouwere, Jos van Roosmalen, Marjolein Zweekhorst
BACKGROUND: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established...
March 23, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28333829/acute-traumatic-coagulopathy-the-elephant-in-a-room-of-blind-scientists
#2
Michael A Meledeo, Maryanne C Herzig, James A Bynum, Xiaowu Wu, Anand K Ramasubramanian, Daniel N Darlington, Kristin M Reddoch, Andrew P Cap
Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. ATC has historically been defined by a prolonged prothrombin time (PT), although newer, more informative measurements of hemostatic function have been employed to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333302/outcomes-of-multisite-antimicrobial-stewardship-programme-implementation-with-a-shared-clinical-decision-support-system
#3
Stuart E Bond, Adriana J Chubaty, Suman Adhikari, Spiros Miyakis, Craig S Boutlis, Wilfred W Yeo, Marijka J Batterham, Cara Dickson, Brendan J McMullan, Mona Mostaghim, Samantha Li-Yan Hui, Kate R Clezy, Pamela Konecny
Background: Studies evaluating antimicrobial stewardship programmes (ASPs) supported by computerized clinical decision support systems (CDSSs) have predominantly been conducted in single site metropolitan hospitals. Objectives: To examine outcomes of multisite ASP implementation supported by a centrally deployed CDSS. Methods: An interrupted time series study was conducted across five hospitals in New South Wales, Australia, from 2010 to 2014...
March 14, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28331566/person-centered-prediction-of-survival-in-population-based-screening-program-by-an-intelligent-clinical-decision-support-system
#4
Reza Safdari, Elham Maserat, Hamid Asadzadeh Aghdaei, Amir Hossein Javan Amoli, Hamid Mohaghegh Shalmani
AIM: To survey person centered survival rate in population based screening program by an intelligent clinical decision support system. BACKGROUND: Colorectal cancer is the most common malignancy and major cause of morbidity and mortality throughout the world. Colorectal cancer is the sixth leading cause of cancer death in Iran. In this survey, we used cosine similarity as data mining technique and intelligent system for estimating survival of at risk groups in the screening plan...
2017: Gastroenterology and Hepatology From Bed to Bench
https://www.readbyqxmd.com/read/28326347/the-insufficiencies-of-risk-analysis-of-impending-pathological-fractures-in-patients-with-femoral-metastases-a-literature-review
#5
Emir Benca, Janina M Patsch, Winfried Mayr, Dieter H Pahr, Reinhard Windhager
PURPOSE: Pathologic fractures in patients with bone metastases are a common problem in clinical orthopaedic routine. On one hand recognition of metastatic lesions, which are at a high risk of fracture, is essential for timely prophylactic fixation, while on the other hand patients with a low risk of pathologic fractures should be spared from overtreatment. The purpose of this review is to identify all methods for fracture risk evaluation in patients with femoral metastases in the literature and to evaluate their predictive values in clinical applications...
December 2016: Bone Reports
https://www.readbyqxmd.com/read/28321120/decision-analysis-of-allogeneic-hematopoietic-stem-cell-transplantation-for-patients-with-myelodysplastic-syndrome-stratified-according-to-the-revised-international-prognostic-scoring-system-ipss-r
#6
M G Della Porta, C H Jackson, E P Alessandrino, M Rossi, A Bacigalupo, M T van Lint, M Bernardi, B Allione, A Bosi, S Guidi, V Santini, L Malcovati, M Ubezio, C Milanesi, E Todisco, M T Voso, P Musto, F Onida, A P Iori, R Cerretti, G Grillo, A Molteni, P Pioltelli, L Borin, E Angelucci, E Oldani, S Sica, C Pascutto, V Ferretti, A Santoro, F Bonifazi, M Cazzola, A Rambaldi
Allogeneic hematopoietic stem cell transplantation (allo-SCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Crucial questions in clinical decision making include the definition of optimal timing of the procedure and the benefit of cytoreduction before transplant in high risk patients. We carried out a decision analysis on 1728 MDS who received supportive care, transplantation or hypomethylating agents (HMAs). Risk assessment was based on the revised International Prognostic Scoring System (IPSS-R)...
March 21, 2017: Leukemia: Official Journal of the Leukemia Society of America, Leukemia Research Fund, U.K
https://www.readbyqxmd.com/read/28314191/robust-detection-and-segmentation-of-cell-nuclei-in-biomedical-images-based-on-a-computational-topology-framework
#7
Rodrigo Rojas-Moraleda, Wei Xiong, Niels Halama, Katja Breitkopf-Heinlein, Steven Dooley, Luis Salinas, Dieter W Heermann, Nektarios A Valous
The segmentation of cell nuclei is an important step towards the automated analysis of histological images. The presence of a large number of nuclei in whole-slide images necessitates methods that are computationally tractable in addition to being effective. In this work, a method is developed for the robust segmentation of cell nuclei in histological images based on the principles of persistent homology. More specifically, an abstract simplicial homology approach for image segmentation is established. Essentially, the approach deals with the persistence of disconnected sets in the image, thus identifying salient regions that express patterns of persistence...
March 6, 2017: Medical Image Analysis
https://www.readbyqxmd.com/read/28302112/automation-bias-in-electronic-prescribing
#8
David Lyell, Farah Magrabi, Magdalena Z Raban, L G Pont, Melissa T Baysari, Richard O Day, Enrico Coiera
BACKGROUND: Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. METHODS: One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system...
March 16, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28299667/runx3-and-cell-fate-decisions-in-pancreas-cancer
#9
Martin C Whittle, Sunil R Hingorani
The RUNX family transcription factors are critical regulators of development and frequently dysregulated in cancer. RUNX3, the least well characterized of the three family members, has been variously described as a tumor promoter or suppressor, sometimes with conflicting results and opinions in the same cancer and likely reflecting a complex role in oncogenesis. We recently identified RUNX3 expression as a crucial determinant of the predilection for pancreatic ductal adenocarcinoma (PDA) cells to proliferate locally or promulgate throughout the body...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28297010/computerized-clinical-decision-support-systems-for-prevention-of-venous-thromboembolism-why-can-t-my-electronic-health-record-be-more-like-netflix-amazon-google-and-apple
#10
https://www.readbyqxmd.com/read/28297002/use-of-computerized-clinical-decision-support-systems-to-prevent-venous-thromboembolism-in-surgical-patients-a-systematic-review-and-meta-analysis
#11
Zachary M Borab, Michael A Lanni, Michael G Tecce, Christopher J Pannucci, John P Fischer
Importance: Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE. Objective: To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE. Data Sources: PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials...
March 15, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28296456/improving-patient-safety-through-the-use-of-nursing-surveillance
#12
Karen K Giuliano
Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of rapid, appropriate interventions. Through use of an illustrative clinical example based on Early Warning System scoring and rapid response teams, this article seeks to distinguish between nurse monitoring and surveillance to demonstrate the impact of surveillance on improving both care processes and patient care...
February 2017: Biomedical Instrumentation & Technology
https://www.readbyqxmd.com/read/28292502/opioid-overdose-education-and-naloxone-distribution-development-of-the-veterans-health-administration-s-national-program
#13
Elizabeth M Oliva, Melissa L D Christopher, Daina Wells, Mark Bounthavong, Michael Harvey, Julianne Himstreet, Thomas Emmendorfer, Michael Valentino, Mariano Franchi, Francine Goodman, Jodie A Trafton
OBJECTIVES: To prevent opioid-related mortality, the Veterans Health Administration (VHA) developed a national Opioid Overdose Education and Naloxone Distribution (OEND) program. SETTING: VHA's OEND program sought national implementation of OEND across all medical facilities (n = 142). PRACTICE DESCRIPTION: This paper describes VHA's efforts to facilitate nationwide health care system-based OEND implementation, including the critical roles of VHA's national pharmacy services and academic detailing services...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28292304/design-and-implementation-of-electronic-health-record-integrated-clinical-prediction-rules-icpr-a-randomized-trial-in-diverse-primary-care-settings
#14
David A Feldstein, Rachel Hess, Thomas McGinn, Rebecca G Mishuris, Lauren McCullagh, Paul D Smith, Michael Flynn, Joseph Palmisano, Gheorghe Doros, Devin Mann
BACKGROUND: Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems...
March 14, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28291766/sepsis-3-on-the-block-what-does-it-mean-for-pre-clinical-sepsis-modeling
#15
Marcin F Osuchowski, Christoph Thiemermann, Daniel G Remick
To effectively improve outcomes of septic patients, we first need to elucidate the multifaceted pathogenesis of sepsis syndromes and related inflammatory conditions. In fulfillment of such needs, in February 2016, new definitions for sepsis and septic shock were published under the acronym Sepsis-3. Although aimed at the clinical area, Sepsis-3 will have an inevitable influence upon the field of translational research as well. Sepsis-3 brings a considerable shift regarding the experimental focal point: from inflammatory states (SIRS/CARS) to organ failure (single and multiple) as the decisive factor...
October 25, 2016: Shock
https://www.readbyqxmd.com/read/28291496/public-health-surveillance-via-template-management-in-electronic-health-records-tri-service-workflow-s-rapid-response-to-an-infectious-disease-crisis
#16
Holly Berkley, Matthew Barnes, David Carnahan, Janet Hayhurst, Archie Bockhorst, James Neville
OBJECTIVE: To describe the use of template-based screening for risk of infectious disease exposure of patients presenting to primary care medical facilities during the 2014 West African Ebola virus outbreak. METHODS: The Military Health System implemented an Ebola risk-screening tool in primary care settings in order to create early notifications and early responses to potentially infected persons. Three time-sensitive, evidence-based screening questions were developed and posted to Tri-Service Workflow (TSWF) AHLTA templates in conjunction with appropriate training...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290067/expert-system-classifier-for-adaptive-radiation-therapy-in-prostate-cancer
#17
Gabriele Guidi, Nicola Maffei, Claudio Vecchi, Giovanni Gottardi, Alberto Ciarmatori, Grazia Maria Mistretta, Ercole Mazzeo, Patrizia Giacobazzi, Frank Lohr, Tiziana Costi
A classifier-based expert system was developed to compare delivered and planned radiation therapy in prostate cancer patients. Its aim is to automatically identify patients that can benefit from an adaptive treatment strategy. The study predominantly addresses dosimetric uncertainties and critical issues caused by motion of hollow organs. 1200 MVCT images of 38 prostate adenocarcinoma cases were analyzed. An automatic daily re-contouring of structures (i.e. rectum, bladder and femoral heads), rigid/deformable registration and dose warping was carried out to simulate dose and volume variations during therapy...
March 13, 2017: Australasian Physical & Engineering Sciences in Medicine
https://www.readbyqxmd.com/read/28289051/paediatric-early-warning-systems-for-detecting-and-responding-to-clinical-deterioration-in-children-a-systematic-review
#18
Veronica Lambert, Anne Matthews, Rachel MacDonell, John Fitzsimons
OBJECTIVE: To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children. METHOD: The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments)...
March 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28287850/five-challenges-to-ethical-communication-for-interprofessional-paediatric-practice-a-social-work-perspective
#19
Clare Delany, Angela Richards, Helen Stewart, Lauren Kosta
In paediatric clinical care, what is said to a parent or carer as well as when, where, and how it is said, directly advances or diminishes parents' capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia...
March 13, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28283997/decision-support-system-for-detection-of-papilledema-through-fundus-retinal-images
#20
Shahzad Akbar, Muhammad Usman Akram, Muhammad Sharif, Anam Tariq, Ubaid Ullah Yasin
A condition in which the optic nerve inside the eye is swelled due to increased intracranial pressure is known as papilledema. The abnormalities due to papilledema such as opacification of Retinal Nerve Fiber Layer (RNFL), dilated optic disc capillaries, blurred disc margins, absence of venous pulsations, elevation of optic disc, obscuration of optic disc vessels, dilation of optic disc veins, optic disc splinter hemorrhages, cotton wool spots and hard exudates may result in complete vision loss. The ophthalmologists detect papilledema by means of an ophthalmoscope, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and ultrasound...
April 2017: Journal of Medical Systems
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