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Clinical Decision Support

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https://www.readbyqxmd.com/read/28239219/higher-quality-and-lower-cost-from-improving-hospital-discharge-decision-making
#1
James C Cox, Vjollca Sadiraj, Kurt E Schnier, John F Sweeney
This paper reports research on improving decisions about hospital discharges - decisions that are now made by physicians based on mainly subjective evaluations of patients' discharge status. We report an experiment on uptake of our clinical decision support software (CDSS) which presents physicians with evidence-based discharge criteria that can be effectively utilized at the point of care where the discharge decision is made. One experimental treatment we report prompts physician attentiveness to the CDSS by replacing the default option of universal "opt in" to patient discharge with the alternative default option of "opt out" from the CDSS recommendations to discharge or not to discharge the patient on each day of hospital stay...
November 2016: Journal of Economic Behavior & Organization
https://www.readbyqxmd.com/read/28238561/magnetic-resonance-imaging-of-the-inferior-alveolar-nerve-with-special-regard-to-metal-artifact-reduction
#2
Monika Probst, Vivien Richter, Jochen Weitz, Jan Stefan Kirschke, Carl Ganter, Matthias Troeltzsch, Mathias Nittka, Carl-Peter Cornelius, Claus Zimmer, Florian Andreas Probst
PURPOSE: Magnetic resonance imaging (MRI) is an excellent imaging modality for displaying peripheral nerves. Since the knowledge about MRI of the inferior alveolar nerve (IAN) is limited, this pilot study aims to identify the prospects and limitations of MRI of the IAN, with special consideration of metal artifacts. MATERIALS AND METHODS: Initially, in vitro MRI of a dental implant was performed to establish an optimized protocol for metal artifact reduction using WARP sequences (a software package provided by Siemens Healthcare, Erlangen, Germany) including view angle tilting (VAT) and slice-encoding metal artifact correction (SEMAC) techniques...
January 25, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28238344/implications-of-inaccurate-clinical-nodal-staging-in-pancreatic-adenocarcinoma
#3
Douglas S Swords, Matthew A Firpo, Kirsten M Johnson, Kenneth M Boucher, Courtney L Scaife, Sean J Mulvihill
BACKGROUND: Many patients with stage I-II pancreatic adenocarcinoma do not undergo resection. We hypothesized that (1) clinical staging underestimates nodal involvement, causing stage IIB to have a greater percent of resected patients and (2) this stage-shift causes discrepancies in observed survival. METHODS: The Surveillance, Epidemiology, and End Results (SEER) research database was used to evaluate cause-specific survival in patients with pancreatic adenocarcinoma from 2004-2012...
February 18, 2017: Surgery
https://www.readbyqxmd.com/read/28237694/analysis-of-clinical-and-microbiological-data-on-acinetobacter-baumannii-strains-assist-the-preauthorization-of-antibiotics-at-the-patient-level-for-an-effective-antibiotic-stewardship-program
#4
Khine Swe Swe-Han, Koleka P Mlisana, Manormoney Pillay
Drug resistant Acinetobacter baumannii (A. baumannii) poses serious treatment challenges and is on the rise worldwide. The Infectious Diseases Society of America/Society for Healthcare Epidemiology of America recommends preauthorization of antibiotics to ensure successful antibiotic stewardship programs (ASWPs). This study estimates and analyzes the microbiological and clinical characteristics of A. baumanii strains with differentiating criteria for sepsis versus colonization, in order to support preauthorization and assist ASWPs at the patient level...
February 22, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28237287/single-antiplatelet-therapy-in-patients-with-contraindication-to-dual-antiplatelet-therapy-after-transcatheter-aortic-valve-implantation
#5
Antonio Mangieri, Richard J Jabbour, Claudio Montalto, Matteo Pagnesi, Damiano Regazzoli, Marco B Ancona, Francesco Giannini, Akihito Tanaka, Letizia Bertoldi, Fabrizio Monaco, Eustachio Agricola, Manuela Giglio, Roberto Mattioli, Luca Ferri, Matteo Montorfano, Alaide Chieffo, Ottavio Alfieri, Antonio Colombo, Azeem Latib
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis...
January 6, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28236087/gastrointestinal-pharmacology
#6
Miguel Saps, Adrian Miranda
: There is little evidence for most of the medications currently used to treat functional abdominal pain disorders (FAPDs) in children. Not only are there very few clinical trials, but also most have significant variability in the methods used and outcomes measured. Thus, the decision on the most appropriate pharmacological treatment is frequently based on adult studies or empirical data. In children, peppermint oil, trimebutine, and drotaverine have shown significant benefit compared with placebo, each of them in a single randomized clinical trial...
February 25, 2017: Handbook of Experimental Pharmacology
https://www.readbyqxmd.com/read/28235017/development-of-a-clinical-decision-support-system-for-diabetes-care-a-pilot-study
#7
Livvi Li Wei Sim, Kenneth Hon Kim Ban, Tin Wee Tan, Sunil Kumar Sethi, Tze Ping Loh
Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines...
2017: PloS One
https://www.readbyqxmd.com/read/28234783/is-there-still-a-role-for-hypothermia-in-neurocritical-care
#8
Florian Frank, Gregor Broessner
PURPOSE OF REVIEW: Therapeutic hypothermia (i.e. induced body core temperature ≈ 33-35°C) in neurological patients with cerebrovascular disease and traumatic brain injury is a controversially discussed issue in the literature. In this review, we have included the most recently published research covering the use of therapeutic hypothermia and targeted temperature management in neurologic diseases and translated the results into a clinical decision support for the professional healthcare community...
February 23, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28232597/multidisciplinary-management-of-breast-cancer-during-pregnancy
#9
Shlomit Strulov Shachar, Kristalyn Gallagher, Kandace McGuire, Timothy M Zagar, Aimee Faso, Hyman B Muss, Raeshall Sweeting, Carey K Anders
BACKGROUND: Although breast cancer during pregnancy (BCDP) is rare (occurring with only 0.4% of all BC diagnoses in female patients aged 16-49 years), management decisions are challenging to both the patient and the multidisciplinary team. MATERIALS AND METHODS: Experts in breast cancer at the University of North Carolina conducted a targeted literature search regarding the multidisciplinary treatment approaches to BCDP: medical, surgical, and radiation oncology...
February 23, 2017: Oncologist
https://www.readbyqxmd.com/read/28232035/cognitive-systems-at-the-point-of-care-the-credo-program
#10
John Fox
CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das, Fox et al [9] and Fox and Das [26]...
February 13, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28231334/prevalence-of-hpv-16-and-18-and-attitudes-toward-hpv-vaccination-trials-in-patients-with-cervical-cancer-in-mali
#11
Ibrahima Téguété, Amadou Dolo, Kotou Sangare, Abdoulaye Sissoko, Mali Rochas, Sarah Beseme, Karamoko Tounkara, Shahla Yekta, Anne S De Groot, Ousmane A Koita
BACKGROUND: Cervical cancer is one of the most common and lethal cancers in West Africa. Even though vaccines that protect against the most common Human papillomavirus (HPV) strains, 16 and 18, are currently in use in developed countries, the implementation of these vaccines in developing countries has been painfully slow, considering the pre-eminence of HPV-associated cervical cancer among women in those countries. AIM: We performed serological and PCR-based assessment of blood and tissue specimens obtained from women undergoing cervical cancer-related surgery at a major urban hospital in Bamako...
2017: PloS One
https://www.readbyqxmd.com/read/28230457/comparative-effectiveness-of-rapid-acting-insulins-in-adults-with-diabetes
#12
Patrick N Racsa, Yunus Meah, Jeffrey J Ellis, Kimberly R Saverno
BACKGROUND: Although there are a variety of insulin products and new delivery modalities available, the absence of direct clinical and economic comparisons can make treatment planning and formulary decision making difficult. Direct comparisons between insulin aspart and insulin lispro from a large heterogeneous population are not available. OBJECTIVE: To assess differences in clinical outcomes, medication adherence, utilization, and total health care costs between aspart and lispro and vial versus pen modalities for administering these short-acting insulin analogs...
March 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28230438/the-influence-of-placements-on-adult-nursing-graduates-choice-of-first-post
#13
Mark Wareing, Renate Taylor, Aileen Wilson, Adrienne Sharples
BACKGROUND: This article presents findings from a study that sought to explore the extent to which clinical placements have an impact on nursing students' decisions regarding their first staff nurse post. Within the UK, nursing is facing a recruitment crisis with particular difficulty recruiting to areas such as primary care and care of older people. Transitioning into a new role is challenging in any occupation, but it is a particular problem in nursing where the realities of professional practice often differ from students' perception of the staff nurse role as shaped by their clinical placements...
February 23, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28227784/an-analytics-based-clinical-decision-support-system-for-cvd-risk-assessment-and-management
#14
Shreya Anand, Ravindra B Patil, P Krishnamoorthy, Shreya Anand, Ravindra B Patil, P Krishnamoorthy, Shreya Anand, Ravindra B Patil, P Krishnamoorthy
Cardiovascular disease (CVD) is a major cause of disability and premature death throughout the world. Acute coronary events and other cardiovascular events frequently occur suddenly, and are often fatal before medical care can be given. Risk factor modification can reduce clinical events and premature death in people with established cardiovascular disease as well as in those who are at high cardiovascular risk due to one or more risk factors. In this work, India specific World Health Organization-International Society of Hypertension (WHO-ISH) guidelines has been implemented to stratify the subjects by their risk profile...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28227143/csdc-a-nationwide-screening-platform-for-stroke-control-and-prevention-in-china
#15
Jinghui Yu, Huajian Mao, Mei Li, Dan Ye, Dongsheng Zhao, Jinghui Yu, Huajian Mao, Mei Li, Dan Ye, Dongsheng Zhao, Dan Ye, Huajian Mao, Mei Li, Dongsheng Zhao, Jinghui Yu
As a leading cause of severe disability and death, stroke places an enormous burden on Chinese society. A nationwide stroke screening platform called CSDC (China Stoke Data Center) has been built to support the national stroke prevention program and stroke clinical research since 2011. This platform is composed of a data integration system and a big data analysis system. The data integration system is used to collect information on risk factors, diagnosis history, treatment, and sociodemographic characteristics and stroke patients' EMR...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28227051/optimal-decision-support-rules-improve-personalize-warfarin-treatment-outcomes
#16
Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato, Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato, Chih-Lin Chi, Kourosh Ravvaz, John Weissert, Peter J Tonellato
We tested optimization-based approaches to generate decision support rules used to improve personalized warfarin treatment based on clinical and genetic characteristics. Our approach simulated warfarin treatment outcomes using five existing treatment plans for clinical avatars (virtual patients). We used individual clinical avatar Time-in-Therapeutic-Range to represent the two-sided adverse risk to bleeding (over dosed - above therapeutic range) and thrombosis (under dosed - below therapeutic range) and as the objective function in the optimization to minimize overall risk...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28227048/anticoagulation-manager-development-of-a-clinical-decision-support-mobile-application-for-management-of-anticoagulants
#17
Chih-Wen Cheng, Hang Wu, Pamela J Thompson, Julie R Taylor, Barbara A Zehnbauer, Karlyn K Wilson, May D Wang, Chih-Wen Cheng, Hang Wu, Pamela J Thompson, Julie R Taylor, Barbara A Zehnbauer, Karlyn K Wilson, May D Wang, Karlyn K Wilson, Pamela J Thompson, Barbara A Zehnbauer, Hang Wu, Julie R Taylor, Chih-Wen Cheng, May D Wang
Patients with certain clotting disorders or conditions have a greater risk of developing arterial or venous clots and downstream embolisms, strokes, and arterial insufficiency. These patients need prescription anticoagulant drugs to reduce the possibility of clot formation. However, historically, the clinical decision making workflow in determining the correct type and dosage of anticoagulant(s) is part science and part art. To address this problem, we developed Anticoagulation Manager, an intelligent clinical decision workflow management system on iOS-based mobile devices to help clinicians effectively choose the most appropriate and helpful follow-up clotting tests for patients with a common clotting profile...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28227033/advanced-analytics-for-outcome-prediction-in-intensive-care-units
#18
Ali Jalali, Dieter Bender, Mohamed Rehman, Vinay Nadkanri, C Nataraj, Ali Jalali, Dieter Bender, Mohamed Rehman, Vinay Nadkanri, C Nataraj, Mohamed Rehman, Ali Jalali, Vinay Nadkanri, Dieter Bender, C Nataraj
In this paper we present a new expert knowledge based clinical decision support system for prediction of intensive care units outcome based on the physiological measurements collected during the first 48 hours of the patient's admission to the ICU. The developed CDSS algorithm is composed of several stages. First, we categorize the collected data based on the physiological organ that they represent. We then extract clinically relevant features from each data category and then rank these features based on their mutual information with the outcome...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28225511/treatment-satisfaction-in-systemic-lupus-erythematosus-development-of-a-patient-reported-outcome-measure
#19
Susan D Mathias, Pamela Berry, Katie Pascoe, Jane de Vries, Anca D Askanase, Hilary H Colwell, David J Chang
OBJECTIVE: The aim of this study was to develop a patient-reported outcome measure specific for systemic lupus erythematosus (SLE) to assess patient satisfaction with treatment, treatment options, and medical care. METHODS: Patients with SLE were recruited from four US rheumatology practices. Concept elicitation interviews identified aspects that patients considered important and relevant regarding satisfaction with treatment and medical care. Concept elicitation interviews and clinical input were used to draft the Lupus Satisfaction Questionnaire (LSQ)...
March 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/28225312/perspectives-on-learning-and-clinical-practice-improvement-for-diabetes-in-the-hospital-a-review-of-educational-interventions-for-providers
#20
Ariana Pichardo-Lowden, Paul Haidet, Guillermo E Umpierrez
BACKGROUND: The management inpatient hyperglycemia and diabetes requires expertise among many healthcare providers. There is limited evidence about how education for healthcare providers can result in optimization of clinical outcomes. The purpose of this critical review of the literature is to examine methods and outcomes related to educational interventions regarding the management of diabetes and dysglycemia in the hospital setting. This report provides recommendations to advance learning, curricular planning and clinical practice...
February 22, 2017: Endocrine Practice
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