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Decision Support Systems, Clinical

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https://www.readbyqxmd.com/read/28642108/investing-in-new-technology-in-pulmonary-medicine-navigating-the-tortuous-path-to-success
#1
REVIEW
Robert Kruklitis, Kim French, Michael Joseph Cangelosi, Kevin L Kovitz
The introduction of new technologies offer the promise to advance medicine. This occurs alongside improved efforts to control costs of healthcare by hospital administrators, Center for Medicare and Medicaid Services' (CMS) pivot to value programs, and commercial payers' efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technologies. Healthcare providers are turning toward value assessments, while simultaneously tasked with a mission of offering state-of-the art technologies and services...
June 19, 2017: Chest
https://www.readbyqxmd.com/read/28638933/-implementation-status-of-regulation-eu-536-2014-in-the-member-states
#2
REVIEW
Elke Stahl
The upcoming Regulation EU 536/2014 for clinical trials of medicinal products for human use requires multinational cooperation in the assessment of clinical trial applications by the member states concerned as well as one single decision per member state concerned, supported by the new EU Portal and database system. The implementation makes national reorganisation of the processes necessary, especially coordination and cooperation between the national competent authorities and the ethics committees, necessary...
June 21, 2017: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/28638239/using-transfer-learning-for-improved-mortality-prediction-in-a-data-scarce-hospital-setting
#3
Thomas Desautels, Jacob Calvert, Jana Hoffman, Qingqing Mao, Melissa Jay, Grant Fletcher, Chris Barton, Uli Chettipally, Yaniv Kerem, Ritankar Das
Algorithm-based clinical decision support (CDS) systems associate patient-derived health data with outcomes of interest, such as in-hospital mortality. However, the quality of such associations often depends on the availability of site-specific training data. Without sufficient quantities of data, the underlying statistical apparatus cannot differentiate useful patterns from noise and, as a result, may underperform. This initial training data burden limits the widespread, out-of-the-box, use of machine learning-based risk scoring systems...
2017: Biomedical Informatics Insights
https://www.readbyqxmd.com/read/28637667/thrombocytopenia-in-pregnancy
#4
Douglas B Cines, Lisa D Levine
Thrombocytopenia develops in 5-10% of women during pregnancy or in the immediate post-partum period. A low platelet count is often an incidental feature, but it can also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances in understanding and managing the more common causes of thrombocytopenia in pregnancy made over the past 5-10 years...
June 21, 2017: Blood
https://www.readbyqxmd.com/read/28637576/antimicrobial-use-and-resistance-in-australia-aura-surveillance-system-coordinating-national-data-on-antimicrobial-use-and-resistance-for-australia
#5
John D Turnidge, Kathy T Meleady
Objective The aim of the present study was to describe the process of establishment and coordination of the national Antimicrobial Use and Resistance in Australia (AURA) surveillance system.Methods Existing surveillance programs conducted by health organisations at state or multi-jurisdictional levels were reviewed, and gaps and opportunities identified for the development of a national system. In view of the time frame available as part of the Australian Government Department of Health funding agreement, the strategy used by the Australian Commission on Safety and Quality in Health Care was to commence work with existing surveillance programs, expanding and enhancing them and developing new systems where gaps were identified...
June 22, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28636981/development-and-validation-of-nomogram-based-on-mir-203-and-clinicopathological-characteristics-predicting-survival-after-neoadjuvant-chemotherapy-and-surgery-for-patients-with-non-metastatic-osteosarcoma
#6
Dong Cheng, Xubin Qiu, Ming Zhuang, Chenlei Zhu, Hongjun Zou, Ailiang Zhang
BACKGROUND: Recently, nomograms have been used as models for risk prediction in malignant tumor because they can predict the outcome of interest for a certain individual based on many variables. This study aimed to establish an effective prognostic nomogram for osteosarcoma based on the clinicopathological factors and microRNA-203. RESULTS: The results showed that miR-203 expression was significantly lower in osteosarcoma tissues compared with the corresponding adjacent tissues (P < 0...
June 17, 2017: Oncotarget
https://www.readbyqxmd.com/read/28636060/developing-mobile-clinical-decision-support-for-nursing-home-staff-assessment-of-urinary-tract-infection-using-goal-directed-design
#7
Wallace Jones, Cynthia Drake, David Mack, Blaine Reeder, Barbara Trautner, Heidi Wald
BACKGROUND: Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. OBJECTIVES: We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff...
June 20, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28633483/an-informatics-research-agenda-to-support-patient-and-family-empowerment-and-engagement-in-care-and-recovery-during-and-after-hospitalization
#8
Sarah Collins, Patricia Dykes, David W Bates, Brittany Couture, Ronen Rozenblum, Jennifer Prey, Kristin O'Reilly, Patricia Q Bourie, Cindy Dwyer, S Ryan Greysen, Jeffery Smith, Michael Gropper, Anuj K Dalal
As part of an interdisciplinary acute care patient portal task force with members from 10 academic medical centers and professional organizations, we held a national workshop with 71 attendees representing over 30 health systems, professional organizations, and technology companies. Our consensus approach identified 7 key sociotechnical and evaluation research focus areas related to the consumption and capture of information from patients, care partners (eg, family, friends), and clinicians through portals in the acute and post-acute care settings...
June 17, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28631809/anabolic-steroids-for-treating-pressure-ulcers
#9
REVIEW
Cho Naing, Maxine A Whittaker
BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers...
June 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28627737/caries-treatment-decisions-among-undergraduate-and-postgraduate-students-supported-by-visual-detection-systems
#10
Vinícius Krieger Costa Nogueira, Diego Girotto Bussaneli, Manuel Restrepo Restrepo, Rubens Spin-Neto, Lourdes Aparecida Martins Dos Santos-Pinto, Thalita Boldieri, Rita de Cássia Loiola Cordeiro
BACKGROUND: The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention. AIM: This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria. DESIGN: Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment...
June 19, 2017: International Journal of Paediatric Dentistry
https://www.readbyqxmd.com/read/28627235/translating-guidelines-into-practice-interpreting-the-2016-acc-expert-consensus-decision-pathway-on-the-role-of-non-statin-therapies-for-ldl-cholesterol-lowering-in-the-management-of-atherosclerotic-cardiovascular-disease-risk
#11
Laura H Waite, Yvonne L Phan, Sarah A Spinler
OBJECTIVE: In 2016, the American College of Cardiology released a decision pathway, based on expert consensus, to guide use of non-statin agents in the management of atherosclerotic cardiovascular disease risk. The purpose of this article is to assist practitioners, health systems and managed care entities with interpreting this consensus statement in order to simplify implementation of the recommendations into patient care. METHODS: Major themes from the consensus statement are briefly summarized and explained...
June 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28625857/validation-of-the-visible-occlusal-plaque-index-vopi-in-estimating-caries-lesion-activity
#12
J C Carvalho, H D Mestrinho, L S Oliveira, M M Varjão, N Aimée, V Qvist
OBJECTIVE: The present study appraises the construct validity of the Visible Occlusal Plaque Index (VOPI) along with its sub-types, convergent and discriminant validity. METHODS: 618 10-15year old Brazilian adolescents were included. The VOPI has a four-point ordinal scale ranging from no plaque to heavy plaque. VOPI scores and caries status on permanent molars were mapped and recorded at individual anatomical sites of the groove-fossa-system and at surface level...
June 15, 2017: Journal of Dentistry
https://www.readbyqxmd.com/read/28623557/proving-value-in-radiology-experience-developing-and-implementing-a-shareable-open-source-registry-platform-driven-by-radiology-workflow
#13
Judy Wawira Gichoya, Marc D Kohli, Paul Haste, Elizabeth Mills Abigail, Matthew S Johnson
Numerous initiatives are in place to support value based care in radiology including decision support using appropriateness criteria, quality metrics like radiation dose monitoring, and efforts to improve the quality of the radiology report for consumption by referring providers. These initiatives are largely data driven. Organizations can choose to purchase proprietary registry systems, pay for software as a service solution, or deploy/build their own registry systems. Traditionally, registries are created for a single purpose like radiation dosage or specific disease tracking like diabetes registry...
June 16, 2017: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/28621297/endoscopic-ultrasound-with-or-without-fine-needle-aspiration-has-a-meaningful-impact-on-clinical-care-in-the-pediatric-population
#14
Amit Raina, Maire A Conrad, Benjamin Sahn, Alireza Sedarat, Gregory G Ginsberg, Nuzhat A Ahmad, Vinay Chandrasekhara, Petar Mamula, Michael L Kochman
BACKGROUND AND OBJECTIVES: The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes...
May 2017: Endoscopic Ultrasound
https://www.readbyqxmd.com/read/28621247/-aria-2016-executive-summary-integrated-care-pathways-for-predictive-medicine-across-the-life-cycle
#15
Ayşe Arzu Yorgancıoğlu, Ömer Kalaycı, Cemal Cingi, Bilun Gemicioğlu, Ali Fuat Kalyoncu, Iogana Agache, Claus Bachert, Anna Bedbrook, George Walter Canonica, Thomas Casale, Alvaro Cruz, Wytsk Ej Fokkens, Peter Hellings, Boleslaw Samolinski, Jean Bousquet
The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA- disseminated and implemented in over 70 countries globally- is now focusing on the implementation of emerging technologies for individualized and predictive medicine...
March 2017: Tüberküloz Ve Toraks
https://www.readbyqxmd.com/read/28620998/a-survey-of-speech-language-therapy-provision-for-people-with-post-stroke-dysarthria-in-the-uk
#16
Nick Miller, Steven Bloch
BACKGROUND: A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate management, little is known currently about UK service delivery issues relating to speech and language therapy (SLT) assessment and treatment for this group...
June 16, 2017: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/28620094/an-interrupted-time-series-analysis-to-determine-the-effect-of-an-electronic-health-record-based-intervention-on-appropriate-screening-for-type-2-diabetes-in-urban-primary-care-clinics-in-new-york-city
#17
Jeanine B Albu, Nancy Sohler, Rui Li, Xuan Li, Edwin Young, Edward W Gregg, Dennis Ross-Degnan
OBJECTIVE: To determine the impact of a health system-wide primary care diabetes management system, which included targeted guidelines for type 2 diabetes (T2DM) and prediabetes (dysglycemia) screening, on detection of previously undiagnosed dysglycemia cases. RESEARCH DESIGN AND METHODS: Intervention included electronic health record (EHR)-based decision support and standardized providers and staff training for using the American Diabetes Association guidelines for dysglycemia screening...
June 15, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28619604/clinical-implementation-of-pharmacogenomics-for-personalized-precision-medicine-barriers-and-solutions
#18
REVIEW
Michelle Elizabeth Klein, Md Masud Parvez, Jae-Gook Shin
Clinical implementation of pharmacogenomics (PGx) leads to personalized medicine, which improves the efficacy, safety, and cost-effectiveness of treatments. Although PGx-based research has been conducted for more than a decade, several barriers have slowed down its widespread implementation in clinical practice. Globally, there is an imbalance in programs and solutions required to empower the clinical implementation of PGx between countries. Therefore, we aimed to review these issues comprehensively, determine the major barriers, and find the best solutions...
June 12, 2017: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28617187/retrospective-analysis-of-continuous-glucose-monitoring-data-with-the-surveillance-error-grid-supports-nonadjunctive-dosing-decisions
#19
John B Welsh, Tomas Walker, David Price
OBJECTIVE: The objective was to assess clinical risks of inaccurate continuous glucose monitoring (CGM) system readings as estimated by the surveillance error grid (SEG). METHODS: Values from Dexcom G4 Platinum system with an advanced algorithm (Software 505) were plotted on the SEG with temporally matched reference venous (YSI) values collected during clinic visits on days 1, 4, and 7 of sensor wear. Data from a pediatric study (N = 79, age [mean ± SD] 12.2 ± 4...
February 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28615793/classification-of-clinical-significance-of-mri-prostate-findings-using-3d-convolutional-neural-networks
#20
Alireza Mehrtash, Alireza Sedghi, Mohsen Ghafoorian, Mehdi Taghipour, Clare M Tempany, William M Wells, Tina Kapur, Parvin Mousavi, Purang Abolmaesumi, Andriy Fedorov
Prostate cancer (PCa) remains a leading cause of cancer mortality among American men. Multi-parametric magnetic resonance imaging (mpMRI) is widely used to assist with detection of PCa and characterization of its aggressiveness. Computer-aided diagnosis (CADx) of PCa in MRI can be used as clinical decision support system to aid radiologists in interpretation and reporting of mpMRI. We report on the development of a convolution neural network (CNN) model to support CADx in PCa based on the appearance of prostate tissue in mpMRI, conducted as part of the SPIE-AAPM-NCI PROSTATEx challenge...
February 11, 2017: Proceedings of SPIE
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