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https://www.readbyqxmd.com/read/29028276/enhancing-antibiotic-stewardship-by-tackling-spurious-penicillin-allergy
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/29023337/recommendations-for-a-clinical-decision-support-system-for-work-related-asthma-in-primary-care-settings
#7
Philip Harber, Carrie A Redlich, Stella Hines, Margaret Filios, Eileen Storey
OBJECTIVE: Describe a recommended clinical decision support approach for work-related asthma for incorporation in electronic health records for primary care health care providers. METHODS: Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. RESULTS: It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma...
October 11, 2017: Journal of Occupational and Environmental Medicine
https://www.readbyqxmd.com/read/29021983/an-integrated-framework-for-process-driven-model-construction-in-disease-ecology-and-animal-health
#8
REVIEW
Rebecca Mancy, Patrick M Brock, Rowland R Kao
Process models that focus on explicitly representing biological mechanisms are increasingly important in disease ecology and animal health research. However, the large number of process modelling approaches makes it difficult to decide which is most appropriate for a given disease system and research question. Here, we discuss different motivations for using process models and present an integrated conceptual analysis that can be used to guide the construction of infectious disease process models and comparisons between them...
2017: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/29021746/lever-insertion-as-a-salient-stimulus-promoting-insensitivity-to-outcome-devaluation
#9
Youna Vandaele, Heather J Pribut, Patricia H Janak
Flexible and efficient decision-making in complex environments can be achieved through constant interactions between the goal-directed and habitual systems. While goal-directed behavior is considered dependent upon Response-Outcome (R-O) associations, habits instead rely on Stimulus-Response (S-R) associations. However, the stimuli that support the S-R association underlying habitual responding in typical instrumental procedures are poorly defined. To resolve this issue, we designed a discrete-trials procedure, in which rats must wait for lever insertion and complete a sequence of five lever presses to obtain a reward (20% sucrose or grain-based pellets)...
2017: Frontiers in Integrative Neuroscience
https://www.readbyqxmd.com/read/29021126/healthydads-ca-what-do-men-want-in-a-website-designed-to-promote-emotional-wellness-and-healthy-behaviors-during-the-transition-to-parenthood
#10
Deborah Da Costa, Phyllis Zelkowitz, Nicole Letourneau, Andrew Howlett, Cindy-Lee Dennis, Brian Russell, Steven Grover, Ilka Lowensteyn, Peter Chan, Samir Khalifé
BACKGROUND: Up to 18% of men experience depression and/or anxiety during the transition to parenthood. Interventions designed specifically to promote the mental health of men during the transition to parenthood are scarce. Internet-delivered interventions may be acceptable and far-reaching in enhancing mental health, parenting knowledge, and healthy behaviors in expectant or new fathers. OBJECTIVE: To guide the development of Healthydads.ca, a website designed to enhance mental health and healthy behaviors in expectant fathers, a needs assessment was conducted to identify fathers' perspectives of barriers to seeking help for emotional wellness, informational needs, and factors affecting the decision to visit such a website...
October 11, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/29020953/-layers-of-translation-evidence-literacy-in-public-health-practice-a-qualitative-secondary-analysis
#11
Wanda Martin, Joan Wharf Higgins, Bernadette Bernie Pauly, Marjorie MacDonald
BACKGROUND: Strengthening public health systems has been a concern in Canada in the wake of public health emergencies. In one Canadian province, British Columbia, a high priority has been placed on the role of evidence to guide decision making; however, there are numerous challenges to using evidence in practice. The National Collaborating Centre for Methods and Tools therefore developed the Evidence Informed Public Health Framework (EIPH), a seven step guide to assist public health practitioners to use evidence in practice...
October 11, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29019524/-budget-impact-of-the-incorporation-of-genexpert-mtb-rif-for-diagnosis-of-pulmonary-tuberculosis-from-the-perspective-of-the-brazilian-unified-national-health-system-brazil-2013-2017
#12
Márcia Ferreira Teixeira Pinto, Ricardo Steffen, Aline Entringer, Ana Carolina Carioca da Costa, Anete Trajman
The study aimed to estimate the budget impact of GeneXpert MTB/RIF for diagnosis of tuberculosis from the perspective of the Brazilian National Program for Tuberculosis Control, drawing on a static model using the epidemiological method, from 2013 to 2017. GeneXpert MTB/RIF was compared with two diagnostic sputum smear tests. The study used epidemiological, population, and cost data, exchange rates, and databases from the Brazilian Unified National Health System. Sensitivity analysis of scenarios was performed...
October 9, 2017: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/29018643/case-reports-case-series-from-clinical-practice-to-evidence-based-medicine-in-graduate-medical-education
#13
EDITORIAL
Jerry W Sayre, Hale Z Toklu, Fan Ye, Joseph Mazza, Steven Yale
Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education...
August 7, 2017: Curēus
https://www.readbyqxmd.com/read/29017192/-horizon-scanning-in-health-care-a-german-perspective
#14
Laura Krabbe, Barbara Buchberger
Background Decision makers in health care act in an area in which expectations increase to make beneficial new technologies available as soon as possible, to protect patients from unsafe or ineffective technologies, and to expedite or decelerate technology diffusion. Horizon Scanning (HS) is a process to identify early new and emerging technologies and to inform about their potential consequences concerning the health care system. Objectives Methods of HS, worldwide existing activities and the status quo in Germany are described...
October 10, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/29016969/implementation-of-a-scalable-web-based-automated-clinical-decision-support-risk-prediction-tool-for-chronic-kidney-disease-using-c-cda-and-application-programming-interfaces
#15
Lipika Samal, John D D'Amore, David W Bates, Adam Wright
Background and Objective: Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices...
November 1, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28994307/alert-workplace-from-healthcare-workers-perspective-behavioral-and-environmental-strategies-to-improve-vigilance-and-alertness-in-healthcare-settings
#16
Rana Sagah Zadeh, Mardelle Shepley, Hessam Sadatsafavi, Arthur Hamie Owora, Ana C Krieger
OBJECTIVE: This study aims to identify the behavioral and environmental strategies that healthcare workers view as helpful for managing sleepiness, improving alertness, and therefore optimizing workplace safety. BACKGROUND: Reduced alertness is a common issue in healthcare work environments and is associated with impaired cognitive performance and decision-making ability as well as increased errors and injuries. METHOD: We surveyed 136 healthcare professionals at a primary care clinic, an acute care hospital, and a mental health clinic...
January 1, 2017: HERD
https://www.readbyqxmd.com/read/28993124/learning-ensemble-classifiers-for-diabetic-retinopathy-assessment
#17
Emran Saleh, Jerzy Błaszczyński, Antonio Moreno, Aida Valls, Pedro Romero-Aroca, Sofia de la Riva-Fernández, Roman Słowiński
Diabetic retinopathy is one of the most common comorbidities of diabetes. Unfortunately, the recommended annual screening of the eye fundus of diabetic patients is too resource-consuming. Therefore, it is necessary to develop tools that may help doctors to determine the risk of each patient to attain this condition, so that patients with a low risk may be screened less frequently and the use of resources can be improved. This paper explores the use of two kinds of ensemble classifiers learned from data: fuzzy random forest and dominance-based rough set balanced rule ensemble...
October 6, 2017: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/28993099/recognising-older-frail-patients-near-the-end-of-life-what-next
#18
Magnolia Cardona-Morrell, Ebony Lewis, Sanjay Suman, Cilla Haywood, Marcella Williams, Audrey-Anne Brousseau, Sally Greenaway, Ken Hillman, Elsa Dent
Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may be controlled and can be slowed down and its precursor -pre-frailty- can be treated with multidisciplinary intervention. The aim of this narrative review is to provide an overview of the different ways of measuring frailty in community settings, hospital, emergency, general practice and residential aged care; suggest occupational groups who can assess frailty in various services; discuss the feasibility of comprehensive geriatric assessments; and summarise current evidence of its management guidelines...
October 6, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28992561/bridging-the-gap-between-the-randomised-clinical-trial-world-and-the-real-world-by-combination-of-population-based-registry-and-electronic-health-record-data-a-case-study-in-haemato-oncology
#19
REVIEW
R E Kibbelaar, B E Oortgiesen, A M van der Wal-Oost, K Boslooper, J W Coebergh, N J G M Veeger, P Joosten, H Storm, E N van Roon, M Hoogendoorn
Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented...
October 6, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28992075/does-kidney-donor-risk-index-implementation-lead-to-the-transplantation-of-more-and-higher-quality-donor-kidneys
#20
Ester Philipse, Alison P K Lee, Bart Bracke, Vera Hartman, Thierry Chapelle, Geert Roeyen, Kathleen de Greef, Dirk K Ysebaert, Gerda van Beeumen, Marie-Madeleine Couttenye, Amaryllis H Van Craenenbroeck, Rachel Hellemans, Jean-Louis Bosmans, Daniel Abramowicz
Background: The Kidney Donor Risk Index (KDRI) is a quantitative evaluation of the quality of donor organs and is implemented in the US allocation system. This single-centre study investigates whether the implementation of the KDRI in our decision-making process to accept or decline an offered deceased donor kidney, increases our acceptance rate. Methods: From April 2015 until December 2016, we prospectively calculated the KDRI for all deceased donor kidney offers allocated by Eurotransplant to our centre...
August 21, 2017: Nephrology, Dialysis, Transplantation
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