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Clinical decision support systems

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https://www.readbyqxmd.com/read/29332975/enhancing-the-clinical-value-of-medical-laboratory-testing
#1
REVIEW
Kenneth A Sikaris
The value of medical laboratory testing is often directed to the cost of testing however the clinical benefits of these tests are at least as important. Laboratory testing has an acknowledged widespread role in clinical decision making, and therefore a role in determining clinical outcome. Consequently, the value of laboratory testing should be considered in its role in affecting beneficial actions and outcomes. This includes both the requesting phase of choosing tests which will influence clinical decision making as well as the reporting phase in a way that guides clinical decisions and actions...
November 2017: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/29331259/public-and-physician-s-expectations-and-ethical-concerns-about-electronic-health-record-benefits-outweigh-risks-except-for-information-security
#2
Eleni Entzeridou, Evgenia Markopoulou, Vasiliki Mollaki
INTRODUCTION: Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. OBJECTIVES: To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. METHODS: A convenience sample was surveyed for both the public and physicians...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331253/evaluation-of-three-machine-learning-models-for-self-referral-decision-support-on-low-back-pain-in-primary-care
#3
Wendy Oude Nijeweme-d'Hollosy, Lex van Velsen, Mannes Poel, Catharina G M Groothuis-Oudshoorn, Remko Soer, Hermie Hermens
BACKGROUND: Most people experience low back pain (LBP) at least once in their life and for some patients this evolves into a chronic condition. One way to prevent acute LBP from transiting into chronic LBP, is to ensure that patients receive the right interventions at the right moment. We started research in the design of a clinical decision support system (CDSS) to support patients with LBP in their self-referral to primary care. For this, we explored the possibilities of using supervised machine learning...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331072/transcranial-ultrasonographic-image-analysis-system-for-decision-support-in-parkinson-disease
#4
Andrius Sakalauskas, Vita Špečkauskienė, Kristina Laučkaitė, Rytis Jurkonis, Daiva Rastenytė, Arūnas Lukoševičius
OBJECTIVES: Transcranial ultrasonography (US) is a relatively new neuroimaging modality proposed for early diagnostics of Parkinson disease (PD). The main limitation of transcranial US image-based diagnostics is a high degree of subjectivity caused by low quality of the transcranial images. The article presents a developed image analysis system and evaluates the potential of automated image analysis on transcranial US. METHODS: The system consists of algorithms for the segmentation and assessment of informative brain regions (midbrain and substantia nigra) and a decision support subsystem, which is equipped with 64 classification algorithms...
January 13, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29330714/evidence-based-recommendations-to-improve-the-safe-use-of-drugs-in-patients-with-liver-cirrhosis
#5
Rianne A Weersink, Margriet Bouma, David M Burger, Joost P H Drenth, S Froukje Harkes-Idzinga, Nicole G M Hunfeld, Herold J Metselaar, Margje H Monster-Simons, Katja Taxis, Sander D Borgsteede
INTRODUCTION: The presence of liver cirrhosis can have a major impact on pharmacodynamics and pharmacokinetics, but guidance for prescribing is lacking. OBJECTIVE: The aim of this study is to provide an overview of evidence-based recommendations developed for the safe use of drugs in liver cirrhosis. METHODS: Recommendations were based on a systematic literature search combined with expert opinion from a panel of 10 experts. The safety of each drug was classified as safe, no additional risks known, additional risks known, unsafe, unknown or the safety class was dependent on the severity of liver cirrhosis (Child-Pugh classification)...
January 12, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/29324970/watson-for-oncology-and-breast-cancer-treatment-recommendations-agreement-with-an-expert-multidisciplinary-tumor-board
#6
S P Somashekhar, M-J Sepúlveda, S Puglielli, A D Norden, E H Shortliffe, C Rohit Kumar, A Rauthan, N Arun Kumar, P Patil, K Rhee, Y Ramya
Background: Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Artificial intelligence (AI) clinical decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the AI CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer...
January 9, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29321134/efficacy-of-a-chronic-care-based-intervention-on-secondary-stroke-prevention-among-vulnerable-stroke-survivors-a-randomized-controlled-trial
#7
Eric M Cheng, William E Cunningham, Amytis Towfighi, Nerses Sanossian, Robert J Bryg, Thomas L Anderson, Frances Barry, Susan M Douglas, Lillie Hudson, Monica Ayala-Rivera, Jeffrey J Guterman, Sandra Gross-Schulman, Sylvia Beanes, Andrea S Jones, Honghu Liu, Barbara G Vickrey
BACKGROUND: Disparities of care among stroke survivors are well documented. Effective interventions to improve recurrent stroke preventative care in vulnerable populations are lacking. METHODS AND RESULTS: In a randomized controlled trial, we tested the efficacy of components of a chronic care model-based intervention versus usual care among 404 subjects having an ischemic stroke or transient ischemic attack within 90 days of enrollment and receiving care within the Los Angeles public healthcare system...
January 2018: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29320805/success-rate-of-medical-thoracoscopy-and-talc-pleurodesis-in-malignant-pleurisy-a-single-centre-experience
#8
Joke Leemans, Christophe Dooms, Vincent Ninane, Jonas Yserbyt
BACKGROUND AND OBJECTIVE: Malignant pleurisy is associated with advanced oncological disease and dyspnoea is the most common presenting symptom. Pleurodesis is the preferred palliative and supportive treatment option, targeting symptom relief. The identification of clinical and endoscopic features that determine the success of talc pleurodesis in malignant pleurisy could guide clinical decision-making. METHODS: All symptomatic patients with malignant pleurisy subjected to talc pleurodesis through medical thoracoscopy between January 2012 and December 2015 were included...
January 10, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/29317919/impact-on-process-results-of-clinical-decision-support-systems-cdsss-applied-to-medication-use-overview-of-systematic-reviews
#9
Wálleri C Reis, Aline F Bonetti, Wallace E Bottacin, Alcindo S Reis, Thaís T Souza, Roberto Pontarolo, Cassyano J Correr, Fernando Fernandez-Llimos
Objective: The purpose of this overview (systematic review of systematic reviews) is to evaluate the impact of clinical decision support systems (CDSS) applied to medication use in the care process. Methods: A search for systematic reviews that address CDSS was performed on Medline following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. Terms related to CDSS and systematic reviews were used in combination with Boolean operators and search field tags to build the electronic search strategy...
October 2017: Pharmacy Practice
https://www.readbyqxmd.com/read/29316979/the-association-between-mental-health-nursing-and-hospital-admissions-for-people-with-serious-mental-illness-a-protocol-for-a-systematic-review
#10
Matthew J Leach, Martin Jones, Dan Bressington, Fiona Nolan, Adrian Jones, Kuda Muyambi, Marianne Gillam, Richard Gray
BACKGROUND: Relapse in individuals with severe mental illness (SMI) is a frequent occurrence and can add considerably to the burden of disease. As such, relapse prevention is an essential therapeutic outcome for people with SMI. Mental health nurses (MHNs) are well placed to support individuals with SMI and to prevent relapse; notwithstanding, there has been no synthesis of the evidence to date to determine whether MHNs prevent relapse in this population. METHODS: Electronic databases will be systemically searched for observational studies and clinical trials that report the association between mental health nursing and the hospitalisation of persons living with an SMI...
January 9, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29316889/a-systematic-review-of-chronic-disease-management-interventions-in-primary-care
#11
Rebecca Reynolds, Sarah Dennis, Iqbal Hasan, Jan Slewa, Winnie Chen, David Tian, Sangeetha Bobba, Nicholas Zwar
BACKGROUND: Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. METHODS: The methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes...
January 9, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29315023/sepsis-screening-current-evidence-and-available-tools
#12
Natacha Villegas, Laura J Moore
BACKGROUND: Early recognition of sepsis is challenging, especially in the surgical patient. Because of the non-specific nature of the initial signs and symptoms, delays in recognition are all too common. To improve the early identification of sepsis, screening tools have been developed, and several papers have described their results. This article reviews the available sepsis screening tools. METHODS: A PubMed search was performed using the search terms "sepsis" and "shock," "electronic alert," "clinical decision support," and "early warning systems...
January 9, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29313756/data-needs-for-a-serious-illness-care-accountability-system-a-framework-and-recommendations
#13
Tom Valuck, Russ Montgomery
BACKGROUND: Successful implementation of a comprehensive accountability system for community-based serious illness care will require a robust data infrastructure. Data will be needed to support care delivery, quality measurement, value-based payment, and evaluation and monitoring. OBJECTIVE: The specific data needs in these areas need to be identified and understood, so that gaps in currently available data may be addressed. DESIGN: We developed a framework that includes the needed data and data infrastructure to support the features and characteristics of a serious illness care accountability system...
March 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29310963/guidance-on-noncorticosteroid-systemic-immunomodulatory-therapy-in-noninfectious-uveitis-fundamentals-of-care-for-uveitis-focus-initiative
#14
REVIEW
Andrew D Dick, James T Rosenbaum, Hassan A Al-Dhibi, Rubens Belfort, Antoine P Brézin, Soon Phaik Chee, Janet L Davis, Athimalaipet V Ramanan, Koh-Hei Sonoda, Ester Carreño, Heloisa Nascimento, Sawsen Salah, Sherveen Salek, Jay Siak, Laura Steeples
TOPIC: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. CLINICAL RELEVANCE: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. METHODS: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science)...
January 5, 2018: Ophthalmology
https://www.readbyqxmd.com/read/29306956/applying-a-big-data-literature-system-to-recommend-antihypertensive-drugs-for-hypertension-patients-with-diabetes-mellitus
#15
Jing-Xian Shu, Ying Li, Ting He, Ling Chen, Xue Li, Lin-Lin Zou, Lu Yin, Xiao-Hui Li, An-Li Wang, Xing Liu, Hong Yuan
BACKGROUND The explosive increase in medical literature has changed therapeutic strategies, but it is challenging for physicians to keep up-to-date on the medical literature. Scientific literature data mining on a large-scale of can be used to refresh physician knowledge and better improve the quality of disease treatment. MATERIAL AND METHODS This paper reports on a reformulated version of a data mining method called MedRank, which is a network-based algorithm that ranks therapy for a target disease based on the MEDLINE literature database...
January 7, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/29306885/derivation-and-validation-of-different-machine-learning-models-in-mortality-prediction-of-trauma-in-motorcycle-riders-a-cross-sectional-retrospective-study-in-southern-taiwan
#16
Pao-Jen Kuo, Shao-Chun Wu, Peng-Chen Chien, Cheng-Shyuan Rau, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh
OBJECTIVES: This study aimed to build and test the models of machine learning (ML) to predict the mortality of hospitalised motorcycle riders. SETTING: The study was conducted in a level-1 trauma centre in southern Taiwan. PARTICIPANTS: Motorcycle riders who were hospitalised between January 2009 and December 2015 were classified into a training set (n=6306) and test set (n=946). Using the demographic information, injury characteristics and laboratory data of patients, logistic regression (LR), support vector machine (SVM) and decision tree (DT) analyses were performed to determine the mortality of individual motorcycle riders, under different conditions, using all samples or reduced samples, as well as all variables or selected features in the algorithm...
January 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29304039/establishing-ebola-virus-disease-evd-diagnostics-using-genexpert-technology-at-a-mobile-laboratory-in-liberia-impact-on-outbreak-response-case-management-and-laboratory-systems-strengthening
#17
Philomena Raftery, Orla Condell, Christine Wasunna, Jonathan Kpaka, Ruth Zwizwai, Mahmood Nuha, Mosoka Fallah, Maxwell Freeman, Victoria Harris, Mark Miller, April Baller, Moses Massaquoi, Victoria Katawera, John Saindon, Philip Bemah, Esther Hamblion, Evelyn Castle, Desmond Williams, Alex Gasasira, Tolbert Nyenswah
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening...
January 2018: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29302379/change-point-detection-for-monitoring-clinical-decision-support-systems-with-a-multi-process-dynamic-linear-model
#18
Siqi Liu, Adam Wright, Dean F Sittig, Milos Hauskrecht
A clinical decision support system and its components may malfunction due to different reasons. The objective of this work is to develop computational methods that can help us to monitor the system and assure its proper operation by promptly detecting and analyzing changes in its behavior. We develop a new change-point detection method using the Multi-Process Dynamic Linear Model. The experiments on real and simulated data show that our method outperforms existing change-point detection methods, leading to higher accuracy and shorter delay in the detection...
November 2017: Proceedings
https://www.readbyqxmd.com/read/29301713/the-coronary-artery-disease-reporting-and-data-system-cad-rads-prognostic-and-clinical-implications-associated-with-standardized-coronary-computed-tomography-angiography-reporting
#19
Joe X Xie, Ricardo C Cury, Jonathon Leipsic, Matthew T Crim, Daniel S Berman, Heidi Gransar, Matthew J Budoff, Stephan Achenbach, Bríain Ó Hartaigh, Tracy Q Callister, Hugo Marques, Ronen Rubinshtein, Mouaz H Al-Mallah, Daniele Andreini, Gianluca Pontone, Filippo Cademartiri, Erica Maffei, Kavitha Chinnaiyan, Gilbert Raff, Martin Hadamitzky, Joerg Hausleiter, Gudrun Feuchtner, Allison Dunning, Augustin DeLago, Yong-Jin Kim, Philipp A Kaufmann, Todd C Villines, Benjamin J W Chow, Niree Hindoyan, Millie Gomez, Fay Y Lin, Erica Jones, James K Min, Leslee J Shaw
OBJECTIVES: This study sought to assess clinical outcomes associated with the novel Coronary Artery Disease-Reporting and Data System (CAD-RADS) scores used to standardize coronary computed tomography angiography (CTA) reporting and their potential utility in guiding post-coronary CTA care. BACKGROUND: Clinical decision support is a major focus of health care policies aimed at improving guideline-directed care. Recently, CAD-RADS was developed to standardize coronary CTA reporting and includes clinical recommendations to facilitate patient management after coronary CTA...
January 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29297754/impact-of-patient-reminders-on-papanicolaou-test-completion-for-high-risk-patients-identified-by-a-clinical-decision-support-system
#20
Kathy L MacLaughlin, Maya E Kessler, Ravikumar Komandur Elayavilli, Branden C Hickey, Marianne R Scheitel, Kavishwar B Wagholikar, Hongfang Liu, Walter K Kremers, Rajeev Chaudhry
BACKGROUND: A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up...
January 3, 2018: Journal of Women's Health
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