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Decision Support Systems, Clinical

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https://www.readbyqxmd.com/read/28108211/user-centered-design-improves-the-usability-of-drug-drug-interaction-alerts-experimental-comparison-of-interfaces
#1
Daniel R Luna, Daniel A Rizzato Lede, Carlos M Otero, Marcelo R Risk, Fernán González Bernaldo de Quirós
Clinical Decision Support Systems can alert health professionals about drug interactions when they prescribe medications. The Hospital Italiano de Buenos Aires in Argentina developed an electronic health record with drug-drug interaction alerts, using traditional software engineering techniques and requirements. Despite enhancing the drug-drug interaction knowledge database, the alert override rate of this system was very high. We redesigned the alert system using user-centered design (UCD) and participatory design techniques to enhance the drug-drug interaction alert interface...
January 17, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28106594/big-data-and-nursing-implications-for-the-future
#2
Maxim Topaz, Lisiane Pruinelli
Big data is becoming increasingly more prevalent and it affects the way nurses learn, practice, conduct research and develop policy. The discipline of nursing needs to maximize the benefits of big data to advance the vision of promoting human health and wellbeing. However, current practicing nurses, educators and nurse scientists often lack the required skills and competencies necessary for meaningful use of big data. Some of the key skills for further development include the ability to mine narrative and structured data for new care or outcome patterns, effective data visualization techniques, and further integration of nursing sensitive data into artificial intelligence systems for better clinical decision support...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28105616/-interpretation-of-the-updates-of-nccn-2017-version-1-0-guideline-for-colorectal-cancer
#3
Gong Chen
The NCCN has recently released its 2017 version 1.0 guideline for colorectal cancer. There are several updates from this new version guideline which are believed to change the current clinical practice. Update one, low-dose aspirin is recommended for patients with colorectal cancer after colectomy for secondary chemoprevention. Update two, biological agents are removed from the neoadjuvant treatment regimen for resectable metastatic colorectal cancer (mCRC). This update is based on lack of evidence to support benefits of biological agents including bevacizumab and cetuximab in the neoadjuvant setting...
January 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28104826/screening-for-medication-errors-using-an-outlier-detection-system
#4
Gordon D Schiff, Lynn A Volk, Mayya Volodarskaya, Deborah H Williams, Lake Walsh, Sara G Myers, David W Bates, Ronen Rozenblum
OBJECTIVE: The study objective was to evaluate the accuracy, validity, and clinical usefulness of medication error alerts generated by an alerting system using outlier detection screening. MATERIALS AND METHODS: Five years of clinical data were extracted from an electronic health record system for 747 985 patients who had at least one visit during 2012-2013 at practices affiliated with 2 academic medical centers. Data were screened using the system to detect outliers suggestive of potential medication errors...
January 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28100524/making-robust-assessments-of-specialist-trainees-workplace-performance
#5
J M Weller, D J Castanelli, Y Chen, B Jolly
BACKGROUND: Workplace-based assessments should provide a reliable measure of trainee performance, but have met with mixed success. We proposed that using an entrustability scale, where supervisors scored trainees on the level of supervision required for the case would improve the utility of compulsory mini-clinical evaluation exercise (CEX) assessments in a large anaesthesia training program. METHODS: We analysed mini-CEX scores from all Australian and New Zealand College of Anaesthetists trainees submitted to an online database over a 12-month period...
February 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28099325/intraoperative-clinical-decision-support-for-anesthesia-a-narrative-review-of-available-systems
#6
Bala G Nair, Eilon Gabel, Ira Hofer, Howard A Schwid, Maxime Cannesson
With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care. Real-time CDS holds the most promise because real-time alerts and guidance can drive provider behavior toward evidence-based standardized care during the ongoing case...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28095934/the-effect-of-ambulance-staffing-models-in-a-metropolitan-fire-based-ems-system
#7
Eric J Cortez, Ashish R Panchal, James E Davis, David P Keseg
: Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]). METHODS: This was a retrospective study conducted from September 17, 2013 through December 31, 2013...
January 18, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28089673/the-value-of-participatory-development-to-support-antimicrobial-stewardship-with-a-clinical-decision-support-system
#8
Nienke Beerlage-de Jong, Jobke Wentzel, Ron Hendrix, Lisette van Gemert-Pijnen
BACKGROUND: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. METHODS: A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians...
January 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28088009/cardiac-output-and-systemic-vascular-resistance-clinical-assessment-compared-with-a-noninvasive-objective-measurement-in-children-with-shock
#9
Asma Razavi, Christopher J L Newth, Robinder G Khemani, Fernando Beltramo, Patrick A Ross
PURPOSE: To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. STUDY DESIGN: Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support...
December 28, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/28079974/findings-from-a-pilot-study-bringing-evidence-based-practice-to-the-bedside
#10
Mary Ann Friesen, Joni M Brady, Renee Milligan, Patricia Christensen
BACKGROUND: To translate research supporting inpatient care outcomes and provide evidence-based care, registered nurses (RNs) need continuing education and mentoring support to adopt evidence-based practice (EBP). AIMS: The aim of this study was to assess a demonstration project intended to pilot and evaluate a structured EBP education with mentoring innovation for nurses in a multihospital system. METHODS: Nurses from five units in five hospitals were included in an education with mentoring innovation to implement the Johns Hopkins Nursing Evidence-Based Practice Model and the Advancing Research and Clinical practice through close Collaboration (ARCC) Model...
January 12, 2017: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/28078665/computerized-pharmacy-surveillance-and-alert-system-for-drug-related-problems
#11
O Ferrández, O Urbina, S Grau, J Mateu-de-Antonio, M Marin-Casino, J Portabella, S Mojal, M Riu, E Salas
WHAT IS KNOWN AND OBJECTIVE: Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment...
January 12, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28077228/levers-for-addressing-medical-underuse-and-overuse-achieving-high-value-health-care
#12
REVIEW
Adam G Elshaug, Meredith B Rosenthal, John N Lavis, Shannon Brownlee, Harald Schmidt, Somil Nagpal, Peter Littlejohns, Divya Srivastava, Sean Tunis, Vikas Saini
The preceding papers in this Series have outlined how underuse and overuse of health-care services occur within a complex system of health-care production, with a multiplicity of causes. Because poor care is ubiquitous and has considerable consequences for the health and wellbeing of billions of people around the world, remedying this problem is a morally and politically urgent task. Universal health coverage is a key step towards achieving the right care. Therefore, full consideration of potential levers of change must include an upstream perspective-ie, an understanding of the system-level factors that drive overuse and underuse, as well as the various incentives at work during a clinical encounter...
January 6, 2017: Lancet
https://www.readbyqxmd.com/read/28076746/characteristics-of-patients-presenting-to-an-after-hours-clinic-results-of-a-magnet-analysis
#13
Lyle R Turner, Christopher Pearce, Madeleine Borg, Adam McLeod, Marianne Shearer, Danielle Mazza
After-hours access to general practice (GP) is critical to supporting accessibility and reducing emergency department demand. To understand who utilises after-hours GP services, this study examined the characteristics of presentations to an Eastern Melbourne after-hours clinic between 2005 and 2014. Descriptive analyses of patient and presentation characteristics, diagnoses, medications and pathology were conducted. Across the study period, 39.1% of presentations to the clinic (N=64,800) were by patients under 18 years of age...
January 12, 2017: Australian Journal of Primary Health
https://www.readbyqxmd.com/read/28075695/lessons-from-launching-the-diabetes-prevention-program-in-a-large-integrated-health-care-delivery-system-a-case-study
#14
Colin D Rehm, Melinda E Marquez, Elizabeth Spurrell-Huss, Nicole Hollingsworth, Amanda S Parsons
There is urgent need for health systems to prevent diabetes. To date, few health systems have implemented the evidence-based Diabetes Prevention Program (DPP), and the few that have mostly partnered with community-based organizations to implement the program. Given the recent decision by the Centers for Medicare & Medicaid Services to reimburse for diabetes prevention, there is likely much interest in how such programs can be implemented within large health systems or how community partnerships can be expanded to support DPP implementation...
January 11, 2017: Population Health Management
https://www.readbyqxmd.com/read/28074750/physician-perceptions-of-consultant-pharmacist-services-associated-with-an-intervention-for-adverse-drug-events-in-the-nursing-facility
#15
Sandra L Kane-Gill, Joseph T Hanlon, Michael J Fine, Subashan Perera, Colleen M Culley, Stephanie A Studenski, Dave A Nace, Richard D Boyce, Nicholas G Castle, Steven M Handler
OBJECTIVE: To assess the importance and performance of consultant pharmacist services delivered before and after an intervention to detect and manage adverse drug events among nursing facility residents. DESIGN: Before and after intervention survey of physicians participating in a randomized, controlled trial. SETTING: Four nonprofit, academically affiliated nursing facilities. PARTICIPANTS: Attending physicians providing nursing facility care who were randomized to intervention or control groups...
December 1, 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28066898/a-quantitative-symmetry-based-analysis-of-hyperacute-ischemic-stroke-lesions-in-noncontrast-computed-tomography
#16
Roman Peter, Panagiotis Korfiatis, Daniel Blezek, A Oscar Beitia, Irena Stepan-Buksakowska, Daniel Horinek, Kelly D Flemming, Bradley J Erickson
PURPOSE: Early identification of ischemic stroke plays a significant role in treatment and potential recovery of damaged brain tissue. In noncontrast CT (ncCT), the differences between ischemic changes and healthy tissue are usually very subtle during the hyperacute phase (< 8 h from the stroke onset). Therefore, visual comparison of both hemispheres is an important step in clinical assessment. A quantitative symmetry-based analysis of texture features of ischemic lesions in noncontrast CT images may provide an important information for differentiation of ischemic and healthy brain tissue in this phase...
January 2017: Medical Physics
https://www.readbyqxmd.com/read/28064261/clinical-effects-of-prebiotics-in-pediatric-population
#17
Rok Orel, Lea Vodušek Reberšak
CONTEXT: Prebiotics are non-digestible components of food that in a selective manner trigger the expansion of microbes in the gut with valuable effects for the health of the host. In our document, current literature pertaining to the clinical effects of the use of prebiotics for the treatment and prevention of some common pediatric pathology such as infantile colic, constipation, absorption of minerals, weight gain, diarrhea, respiratory infections, and eczema is reviewed. EVIDENCE: Data was collected through search of the MEDLINE, PubMed, UpToDate, Cochrane Database of Systemic Reviews, and the Cochrane Controlled Trials Register database as well as through references from relevant articles, all until September 2015...
December 15, 2016: Indian Pediatrics
https://www.readbyqxmd.com/read/28063462/going-digital-a-narrative-overview-of-the-clinical-and-organisational-impacts-of-ehealth-technologies-in-hospital-practice
#18
Justin Keasberry, Ian A Scott, Clair Sullivan, Andrew Staib, Richard Ashby
Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes.Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool...
January 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28057607/the-value-of-electronic-medical-record-implementation-in-mental-health-care-a-case-study
#19
Sanaz Riahi, Ilan Fischler, Melanie I Stuckey, Philip E Klassen, John Chen
BACKGROUND: Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. OBJECTIVE: The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization...
January 5, 2017: JMIR Medical Informatics
https://www.readbyqxmd.com/read/28057024/behavior-change-interventions-and-policies-influencing-primary-healthcare-professionals-practice-an-overview-of-reviews
#20
REVIEW
Bhupendrasinh F Chauhan, Maya Jeyaraman, Amrinder Singh Mann, Justin Lys, Becky Skidmore, Kathryn M Sibley, Ahmed Abou-Setta, Ryan Zarychanksi
BACKGROUND: There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS: Study design: overview of reviews. DATA SOURCE: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015)...
January 5, 2017: Implementation Science: IS
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