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Clinical decision support system

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https://www.readbyqxmd.com/read/29046028/-aria-2016-executive-summary-integrated-care-pathways-for-predictive-medicine-throughout-the-life-cycle-in-argentina
#1
Juan Carlos Ivancevich, Hugo Neffen, Mario E Zernotti, Estrella Asayag, Ariel Blua, Alberto Cicerán, Edgardo J Jares, Alberto J Lavrut, Jorge F Máspero, Ioana Agache, Claus Bachert, Anna Bedbrook, Giorgio W Canonica, Thomas B Casale, Álvaro A Cruz, Wytske J Fokkens, Peter W Hellings, Boleslaw Samolinski, Jean Bousquet
The ARIA initiative was started during a World Health Organization workshop in 1999. The initial goals were to propose a new classification for allergic rhinitis, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with stakeholders for world-wide use. ARIA is now focused on the implementation of emerging technologies for individualized and predictive medicine. MASK: MACVIA-Aria Sentinel Network uses mobile technology to develop care pathways that enable management by a multidisciplinary group or by patients themselves...
July 2017: Revista Alergia Mexico: Organo Oficial de la Sociedad Mexicana de Alergia e Inmunología, A.C
https://www.readbyqxmd.com/read/29045651/clinical-decision-support-alert-malfunctions-analysis-and-empirically-derived-taxonomy
#2
Adam Wright, Angela Ai, Joan Ash, Jane F Wiesen, Thu-Trang T Hickman, Skye Aaron, Dustin McEvoy, Shane Borkowsky, Pavithra I Dissanayake, Peter Embi, William Galanter, Jeremy Harper, Steve Z Kassakian, Rachel Ramoni, Richard Schreiber, Anwar Sirajuddin, David W Bates, Dean F Sittig
Objective: To develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions. Materials and Methods: We identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions...
October 16, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29045355/complexity-of-chronic-conditions-impact-on-end-of-life-expense-trajectories-of-medicare-decedents
#3
Suzanne S Sullivan, Junxin Li, Yow-Wu Bill Wu, Sharon Hewner
OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling...
October 17, 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/29043247/clinic-based-mobile-health-decision-support-to-enhance-adult-epilepsy-self-management-an-intervention-mapping-approach
#4
Ross Shegog, Charles E Begley
INTRODUCTION: Epilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/29042521/-transition-of-children-with-epilepsy-to-adult-care-current-status-and-challenge
#5
Hidemoto Kubota
Thirty percent of the patients consulting a pediatric neurologist have already reached adulthood as patients and their families do not like transfer to the adult clinics; moreover, there are no suitable clinics. Pediatric neurologists find it difficult to examine adult patients with childhood-onset epilepsy as they are unfamiliar with the psychiatric and psychological symptoms manifested in adulthood, and the common diseases of adulthood. On the other hand, adult neurologists have difficulty obtaining a complete picture of the patient's clinical history since childhood, and are unfamiliar with childhood-specific epilepsy syndrome...
October 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/29039778/comparison-of-two-sources-of-clinical-audit-data-to-assess-the-delivery-of-diabetes-care-in-aboriginal-communities
#6
Timothy Regan, Christine Paul, Paul Ishiguchi, Catherine D'Este, Claudia Koller, Kristy Forshaw, Natasha Noble, Christopher Oldmeadow, Alessandra Bisquera, Sandra Eades
The objective of this study was to determine the concordance between data extracted from two Clinical Decision Support Systems regarding diabetes testing and monitoring at Aboriginal Community Controlled Health Services in Australia. De-identified PenCAT and Communicare Systems data were extracted from the services allocated to the intervention arm of a diabetes care trial, and intra-class correlations for each extracted item were derived at a service level. Strong to very strong correlations between the two data sources were found regarding the total number of patients with diabetes per service (Intra-class correlation [ICC] = 0...
October 17, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29039372/weighting-experience-based-decision-support-on-the-basis-of-clinical-outcomes-assessment
#7
Naiara Muro, Nekane Larburu, Jacques Bouaud, Brigitte Seroussi
Technologies such as decision support systems are expected to help clinicians implement clinical practice guidelines (CPGs) with the aim of decreasing practice variations and improving clinical outcomes. However, if CPGs provide recommendations to improve patient care, they may fail to take into account actual clinical outcomes associated to the recommended treatment, such as adverse events or secondary effects. In this paper, we present a novel experience-based decision support approach applied to the management of breast cancer, the most commonly diagnosed cancer among women worldwide...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29038186/incidence-duration-and-cost-of-futile-treatment-in-end-of-life-hospital-admissions-to-three-australian-public-sector-tertiary-hospitals-a-retrospective-multicentre-cohort-study
#8
Hannah E Carter, Sarah Winch, Adrian G Barnett, Malcolm Parker, Cindy Gallois, Lindy Willmott, Ben P White, Mary Anne Patton, Letitia Burridge, Gayle Salkield, Eliana Close, Leonie Callaway, Nicholas Graves
OBJECTIVES: To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions. DESIGN: Retrospective multicentre cohort study involving a clinical audit of hospital admissions. SETTING: Three Australian public-sector tertiary hospitals. PARTICIPANTS: Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012. MAIN OUTCOME MEASURES: Incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment...
October 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29036894/how-can-data-drive-policy-and-practice-in-child-welfare-making-the-link-in-canada
#9
Barbara Fallon, Joanne Filippelli, Tara Black, Nico Trocmé, Tonino Esposito
Formal university-child welfare partnerships offer a unique opportunity to begin to fill the gaps in the child welfare knowledge base and link child welfare services to the realities of practice. With resources from a knowledge mobilization grant, a formal partnership was developed between the University of Toronto, clinicians, policy analysts, and researchers from child welfare agencies across Ontario. The key objectives of the grant included: (1) enhancing the capacity of service providers to access and analyze child welfare data to inform service and policy decisions; (2) integrating clinical expertise in service and policy decisions; and (3) developing a joint research agenda addressing high-priority knowledge gaps...
October 14, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29036406/effects-of-computerized-decision-support-system-implementations-on-patient-outcomes-in-inpatient-care-a-systematic-review
#10
Julian Varghese, Maren Kleine, Sophia Isabella Gessner, Sarah Sandmann, Martin Dugas
Objectives: To systematically classify the clinical impact of computerized clinical decision support systems (CDSSs) in inpatient care. Materials and Methods: Medline, Cochrane Trials, and Cochrane Reviews were searched for CDSS studies that assessed patient outcomes in inpatient settings. For each study, 2 physicians independently mapped patient outcome effects to a predefined medical effect score to assess the clinical impact of reported outcome effects. Disagreements were measured by using weighted kappa and solved by consensus...
September 23, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29036296/unintended-adverse-consequences-of-a-clinical-decision-support-system-two-cases
#11
Erin G Stone
Many institutions have implemented clinical decision support systems (CDSSs). While CDSS research papers have focused on benefits of these systems, there is a smaller body of literature showing that CDSSs may also produce unintended adverse consequences (UACs). Detailed here are 2 cases of UACs resulting from a CDSS. Both of these cases were related to external systems that fed data into the CDSS. In the first case, lack of knowledge of data categorization in an external pharmacy system produced a UAC; in the second case, the change of a clinical laboratory instrument produced the UAC...
September 23, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29034685/improving-performance-on-preventive-health-quality-measures-using-clinical-decision-support-to-capture-care-done-elsewhere-and-patient-exceptions
#12
Michael E Bowen, Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D Persell, Ethan A Halm
Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < ...
October 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29034482/deep-reinforcement-learning-for-automated-radiation-adaptation-in-lung-cancer
#13
Huan-Hsin Tseng, Yi Luo, Sunan Cui, Jen-Tzung Chien, Randall K Ten Haken, Issam El Naqa
PURPOSE: To investigate deep reinforcement learning (DRL) based on historical treatment plans for developing automated radiation adaptation protocols for non-small cell lung cancer (NSCLC) patients that aim to maximize tumor local control at reduced rates of radiation pneumonitis grade 2 (RP2). METHODS: In a retrospective population of 114 NSCLC patients who received radiotherapy, a 3-component neural networks framework was developed for deep reinforcement learning (DRL) of dose fractionation adaptation...
October 16, 2017: Medical Physics
https://www.readbyqxmd.com/read/29029694/prescriber-response-to-computerized-drug-alerts-for-electronic-prescriptions-among-hospitalized-patients
#14
Yael Zenziper Straichman, Daniel Kurnik, Ilan Matok, Hillel Halkin, Noa Markovits, Amitai Ziv, Ari Shamiss, Ronen Loebstein
BACKGROUND: Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, "alert fatigue", and indiscriminate rejection. OBJECTIVES: To compare acceptance rates of alerts generated by the SafeRx(®) prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified. METHODS: In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel's largest tertiary care center...
November 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29028276/enhancing-antibiotic-stewardship-by-tackling-spurious-penicillin-allergy
#15
Mamidipudi Thirumala Krishna, Aarnoud P Huissoon, Mark Li, Alex Richter, Devadas Ganesh Pillay, Dhinakaran Sambanthan, Sumanth C Raman, Shuaib Nasser, Siraj A Misbah
Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications - longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, meticillin-resistant Staphylococcus aureus infections and vancomycin resistant enterococcus...
October 13, 2017: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29026458/safe-opioid-prescription-a-smart-on-fhir-approach-to-clinical-decision-support
#16
Shyamashree Sinha, Mark Jensen, Sarah Mullin, Peter L Elkin
Background Prescription opioid pain medication overuse, misuse and abuse have been a significant contributing factor in the opioid epidemic. The rising death rates from opioid overdose have caused healthcare practitioners and researchers to work on optimizing pain therapy and limiting the prescriptions for pain medications. The state of New York has implemented a prescription drug monitoring program(PDMP), amended public health law to limit the prescription of opioids for acute pain and utilized the resources of the state and county health departments to help in curbing this epidemic...
2017: Online Journal of Public Health Informatics
https://www.readbyqxmd.com/read/29026454/opportunities-and-obstacles-using-a-clinical-decision-support-system-for-maternal-care-in-burkina-faso
#17
S Alphonse Zakane, Lars L Gustafsson, Ali Sie, Göran Tomson, Svetla Loukanova, Pia Bastholm-Rahmner
OBJECTIVE: Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare Workers (HCWs), a computerized decision support system (CDSS) was piloted at six rural maternal care units in Burkina Faso. During the two years of the study period, it was apparent from reports that the CDSS was not used regularly in clinical practice. This study aimed to explore the reasons why HCWs failed to use the CDSS. METHODS: A workshop, organized as group discussions and a plenary session, was performed with 13 participants to understand their experience with the CDSS and suggest improvements if pertinent...
2017: Online Journal of Public Health Informatics
https://www.readbyqxmd.com/read/29025839/family-attitudes-actions-decisions-and-experiences-following-implementation-of-deemed-consent-and-the-human-transplantation-wales-act-2013-mixed-method-study-protocol
#18
Jane Noyes, Karen Morgan, Phillip Walton, Abigail Roberts, Leah Mclaughlin, Michael Stephens
INTRODUCTION: The Human Transplantation (Wales) Act 2013 (the Act) introduced a 'soft opt-out' system of organ donation on 1 December 2015. Citizens are encouraged to make their organ donation decision known during their lifetime. In order to work, the Act and media campaign need to create a context, whereby organ donation becomes the norm, and create a mechanism for people to behave as intended (formally register their decision; consider appointing a representative; convey their donation decision to their families and friends or do nothing-deemed consent)...
October 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/29025114/comprehensive-process-model-of-clinical-information-interaction-in-primary-care-results-of-a-best-fit-framework-synthesis
#19
Tiffany C Veinot, Charles R Senteio, David Hanauer, Julie C Lowery
Objective: To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. Materials and Methods: We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village...
September 2, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29025024/implementing-prescription-drug-monitoring-and-other-clinical-decision-support-for-opioid-risk-mitigation-in-a-military-health-care-setting-a-qualitative-feasibility-study
#20
Erin P Finley, Suyen Schneegans, Claudina Tami, Mary Jo Pugh, Don McGeary, Lauren Penney, Jennifer Sharpe Potter
Objective: Chronic noncancer pain is a highly prevalent condition among service members returning from deployment overseas. The US Army has a higher rate of opioid misuse than the civilian population. Although most states and many health care systems have implemented prescription drug monitoring programs (PDMPs) or other clinician decision support (CDS) to aid providers in delivering guideline-recommended opioid therapy, similar tools are lacking in military health settings. Materials and Methods: We conducted a pre-implementation feasibility and needs assessment guided by the Promoting Action Research in Health Services framework...
August 21, 2017: Journal of the American Medical Informatics Association: JAMIA
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