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Clinical decision support system

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https://www.readbyqxmd.com/read/28823018/prevalence-and-nature-of-potential-drug-drug-interactions-among-kidney-transplant-patients-in-a-german-intensive-care-unit
#1
Julia Amkreutz, Alexander Koch, Lukas Buendgens, Anja Muehlfeld, Christian Trautwein, Albrecht Eisert
Background Complex polypharmacotherapy makes kidney transplant patients vulnerable to drug-drug interactions (DDIs). Objective To study prevalence and nature of potential DDIs (pDDIs) in kidney transplant patients. Setting Internal medicine ICU, University Hospital RWTH Aachen. Method In this retrospective observational study, pDDIs were identified in the first week after transplant from 1999 to 2010. Patients aged at least 18 years with prescription of at least two drugs were included. Patients with incomplete data were excluded...
August 19, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28822900/supportive-care-pathway-functionalities-of-ehr-system-in-a-saudi-arabian-hospital
#2
Bakheet Aldosari
BACKGROUND: Electronic health record (EHR) is a data management system used in healthcare services. The stored medical information in EHR can be accessed and utilized by authorized users, which helps clinicians in making clinical decisions. Therefore, this study aims at comparing the embedded clinical guidelines or the supportive pathway functions as well as their compliance level in the two EMR systems, i.e. QuadraMed (QCPR) and BestCare. METHODS: A test vignette was used to evaluate the features, functions, performance, and output to assess the EHR clinical path way functionality of the QCPR and BestCare...
August 12, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28822594/-grade-evidence-to-decision-etd-frameworks-a-systematic-and-transparent-approach-to-making-well-informed-healthcare-choices-1-introduction
#3
Pablo Alonso-Coello, Holger J Schünemann, Jenny Moberg, Romina Brignardello-Petersen, Elie A Akl, Marina Davoli, Shaun Treweek, Reem A Mustafa, Gabriel Rada, Sarah Rosenbaum, Angela Morelli, Gordon H Guyatt, Andrew D Oxman
Clinicians, guideline developers, and policymakers sometimes neglect important criteria, give undue weight to criteria, and do not use the best available evidence to inform their judgments. Explicit and transparent systems for decision making can help to ensure that all important criteria are considered and that decisions are informed by the best available research evidence. The GRADE Working Group has developed Evidence to Decision (EtD) frameworks for the different type of recommendations or decisions. The purpose of EtD frameworks 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...
August 16, 2017: Gaceta Sanitaria
https://www.readbyqxmd.com/read/28821264/impact-of-early-initiation-versus-national-standard-of-care-of-antiretroviral-therapy-in-swaziland-s-public-sector-health-system-study-protocol-for-a-stepped-wedge-randomized-trial
#4
Fiona J Walsh, Till Bärnighausen, Wim Delva, Yvette Fleming, Gavin Khumalo, Charlotte L Lejeune, Sikhathele Mazibuko, Charmaine Khudzie Mlambo, Ria Reis, Donna Spiegelman, Mandisa Zwane, Velephi Okello
BACKGROUND: There is robust clinical evidence to support offering early access to antiretroviral treatment (ART) to all HIV-positive individuals, irrespective of disease stage, to both improve patient health outcomes and reduce HIV incidence. However, as the global treatment guidelines shift to meet this evidence, it is still largely unknown if early access to ART for all (also referred to as "treatment as prevention" or "universal test and treat") is a feasible intervention in the resource-limited countries where this approach could have the biggest impact on the course of the HIV epidemics...
August 18, 2017: Trials
https://www.readbyqxmd.com/read/28820010/diagnosing-asthma-and-chronic-obstructive-pulmonary-disease-with-machine-learning
#5
Dimitris Spathis, Panayiotis Vlamos
This study examines the clinical decision support systems in healthcare, in particular about the prevention, diagnosis and treatment of respiratory diseases, such as Asthma and chronic obstructive pulmonary disease. The empirical pulmonology study of a representative sample (n = 132) attempts to identify the major factors that contribute to the diagnosis of these diseases. Machine learning results show that in chronic obstructive pulmonary disease's case, Random Forest classifier outperforms other techniques with 97...
August 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/28818317/reconsidering-the-gatekeeper-paradigm-for-percutaneous-coronary-intervention-in-stable-coronary-disease-management
#6
EDITORIAL
Joshua Schulman-Marcus, William S Weintraub, William E Boden
Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes...
July 24, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28817861/population-health-management-and-cancer-screening
#7
Bradley Kamstra, Mark K Huntington
Population health management (PHM) is a new health care model being implemented. It has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." This includes health outcomes and patterns of health determinants, and policies and interventions that link these two. Moving from a fee-for-service payment system to a quality- or value-based system, this model places on the clinician more responsibility for the costs of health care and its reimbursements...
2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28817655/assessing-experience-in-the-deliberate-practice-of-running-using-a-fuzzy-decision-support-system
#8
Maria Isabel Roveri, Edison de Jesus Manoel, Andrea Naomi Onodera, Neli R S Ortega, Vitor Daniel Tessutti, Emerson Vilela, Nelson Evêncio, Isabel C N Sacco
The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches' knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time...
2017: PloS One
https://www.readbyqxmd.com/read/28816912/distance-learning-adhd-quality-improvement-in-primary-care-a-cluster-randomized-trial
#9
Alexander G Fiks, Stephanie L Mayne, Jeremy J Michel, Jeffrey Miller, Manju Abraham, Andrew Suh, Abbas F Jawad, James P Guevara, Robert W Grundmeier, Nathan J Blum, Thomas J Power
OBJECTIVE: To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. METHODS: Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control...
August 9, 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/28815153/high-risk-drug-drug-interactions-between-clinical-practice-guidelines-for-management-of-chronic-conditions
#10
Geoffrey J Tso, Samson W Tu, Mark A Musen, Mary K Goldstein
Clinicians and clinical decision-support systems often follow pharmacotherapy recommendations for patients based on clinical practice guidelines (CPGs). In multimorbid patients, these recommendations can potentially have clinically significant drug-drug interactions (DDIs). In this study, we describe and validate a method for programmatically detecting DDIs among CPG recommendations. The system extracts pharmacotherapy intervention recommendations from narrative CPGs, normalizes the terms, creates a mapping of drugs and drug classes, and then identifies occurrences of DDIs between CPG pairs...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815151/eye-tracking-for-clinical-decision-support-a-method-to-capture-automatically-what-physicians-are-viewing-in-the-emr
#11
Andrew J King, Harry Hochheiser, Shyam Visweswaran, Gilles Clermont, Gregory F Cooper
Eye-tracking is a valuable research tool that is used in laboratory and limited field environments. We take steps toward developing methods that enable widespread adoption of eye-tracking and its real-time application in clinical decision support. Eye-tracking will enhance awareness and enable intelligent views, more precise alerts, and other forms of decision support in the Electronic Medical Record (EMR). We evaluated a low-cost eye-tracking device and found the device's accuracy to be non-inferior to a more expensive device...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815144/a-clinical-decision-support-system-for-monitoring-post-colonoscopy-patient-follow-up-and-scheduling
#12
Roxanne Wadia, Mark Shifman, Forrest L Levin, Luis Marenco, Cynthia A Brandt, Kei-Hoi Cheung, Tamar Taddei, Michael Krauthammer
This paper describes a natural language processing (NLP)-based clinical decision support (CDS) system that is geared towards colon cancer care coordinators as the end users. The system is implemented using a metadata- driven Structured Query Language (SQL) function (discriminant function). For our pilot study, we have developed a training corpus consisting of 2,085 pathology reports from the VA Connecticut Health Care System (VACHS). We categorized reports as "actionable"- requiring close follow up, or "non-actionable"- requiring standard or no follow up...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815136/design-recommendations-for-pharmacogenomics-clinical-decision-support-systems
#13
Maher Khelifi, Peter Tarczy-Hornoch, Emily B Devine, Wanda Pratt
The use of pharmacogenomics (PGx) in clinical practice still faces challenges to fully adopt genetic information in targeting drug therapy. To incorporate genetics into clinical practice, many support the use of Pharmacogenomics Clinical Decision Support Systems (PGx-CDS) for medication prescriptions. This support was fueled by new guidelines to incorporate genetics for optimizing drug dosage and reducing adverse events. In addition, the complexity of PGx led to exploring CDS outside the paradigm of the basic CDS tools embedded in commercial electronic health records...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815131/integrating-medication-alert-data-into-a-clinical-data-repository-to-enable-retrospective-study-of-drug-interaction-alerts-in-clinical-practice
#14
Mei Liu, Brittany L Melton, Gregory Ator, Lemuel R Waitman
Current clinical data repositories primarily extract data from multiple administrative and electronic medical record (EMR) data resources (e.g., hospital and physician billing records) containing specific patient-level data including demographics, medications, laboratory results, diagnoses, and procedure codes. It overlooks the importance of EMR system-level data (e.g., medication alerts that are routinely used by physicians, nurses, and pharmacists for decision support) for the surveillance of EMR decision support tools...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815127/a-knowledge-based-system-for-intelligent-support-in-pharmacogenomics-evidence-assessment-ontology-driven-evidence-representation-and-retrieval
#15
Chia-Ju Lee, Beth Devine, Peter Tarczy-Hornoch
Pharmacogenomics holds promise as a critical component of precision medicine. Yet, the use of pharmacogenomics in routine clinical care is minimal, partly due to the lack of efficient and effective use of existing evidence. This paper describes the design, development, implementation and evaluation of a knowledge-based system that fulfills three critical features: a) providing clinically relevant evidence, b) applying an evidence-based approach, and c) using semantically computable formalism, to facilitate efficient evidence assessment to support timely decisions on adoption of pharmacogenomics in clinical care...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28812013/intelligent-techniques-using-molecular-data-analysis-in-leukaemia-an-opportunity-for-personalized-medicine-support-system
#16
REVIEW
Haneen Banjar, David Adelson, Fred Brown, Naeem Chaudhri
The use of intelligent techniques in medicine has brought a ray of hope in terms of treating leukaemia patients. Personalized treatment uses patient's genetic profile to select a mode of treatment. This process makes use of molecular technology and machine learning, to determine the most suitable approach to treating a leukaemia patient. Until now, no reviews have been published from a computational perspective concerning the development of personalized medicine intelligent techniques for leukaemia patients using molecular data analysis...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28807617/measurement-of-peripheral-venous-catheter-related-phlebitis-a-cross-sectional-study
#17
Katarina Göransson, Ulrika Förberg, Eva Johansson, Maria Unbeck
BACKGROUND: Many instruments for measurement of peripheral venous catheter (PVC)-related phlebitis are available, but no consensus exists on their applicability in clinical practice. This absence of consensus affects the ability to identify and compare proportions of PVCs causing phlebitis within and across hospitals as the range varies between 2% and 62% in previous studies. We hypothesised that the instruments' ability to identify phlebitis varies. The aim of this study is to illustrate the complexity of application of phlebitis instruments to a clinical dataset...
August 11, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28807317/validation-of-the-famacha%C3%A2-system-in-south-american-camelids
#18
Bobby E Storey, Lisa H Williamson, Sue B Howell, Thomas H Terrill, Roy Berghaus, Anand N Vidyashankar, Ray M Kaplan
Haemonchus contortus resistant to multiple anthelmintics threaten the viability of the small ruminant industry in areas where this parasite is prevalent. In response to this situation, the FAMACHA© system was developed and validated for use with small ruminants as a way to detect clinical anemia associated with haemonchosis. Given that H. contortus and multiple anthelmintic resistance is a similar problem in camelids, the FAMACHA© system might also provide the same benefits. To address this need, a validation study of the FAMACHA© system was conducted on 21 alpaca and llama farms over a 2-year period...
August 30, 2017: Veterinary Parasitology
https://www.readbyqxmd.com/read/28805695/infants-investigated-by-the-child-welfare-system-exploring-a-distinct-profile-of-risks-service-needs-and-referrals-for-support-in-ontario
#19
Joanne Filippelli, Barbara Fallon, Esme Fuller-Thomson, Nico Trocmé
The science of early childhood development underscores that maltreatment and other adversities experienced during infancy heightens the risk for poor developmental and socio-emotional outcomes. Referrals to supportive services by the child welfare system are particularly critical during infancy given the rapidity of brain development and infants' sensitivity to their environment. The main objectives of the current study are to: (1) examine age-specific differences in clinical and case characteristics; (2) determine the factors associated with the service referral decision involving infants; and (3) explore the types of services families have been referred to at the conclusion of a maltreatment-related investigation...
August 12, 2017: Brain Sciences
https://www.readbyqxmd.com/read/28804870/effect-of-the-tool-to-reduce-inappropriate-medications-on-medication-communication-and-deprescribing
#20
Terri R Fried, Kristina M Niehoff, Richard L Street, Peter A Charpentier, Nallakkandi Rajeevan, Perry L Miller, Mary K Goldstein, John R O'Leary, Brenda T Fenton
OBJECTIVES: To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. DESIGN: Randomized clinical trial. SETTING: Primary care clinics at a Veterans Affairs Medical Center. PARTICIPANTS: Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128)...
August 14, 2017: Journal of the American Geriatrics Society
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