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Clinical decision support systems

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https://www.readbyqxmd.com/read/28917219/reuma-pt-contribution-to-the-knowledge-of-immune-mediated-systemic-rheumatic-diseases
#1
Maria José Santos, Helena Canhão, Ana Filipa Mourão, Filipa Oliveira Ramos, Cristina Ponte, Cátia Duarte, Anabela Barcelos, Fernando Martins, José António Melo Gomes
Patient registries are key instruments aimed at a better understanding of the natural history of diseases, at assessing the effectiveness of therapeutic interventions, as well as identifying rare events or outcomes that are not captured in clinical trials. However, the potential of registries goes far beyond these aspects. For example, registries promote the standardization of clinical practice, can also provide information on domains that are not routinely collected in clinical practice and can support decision-making...
September 14, 2017: Acta Reumatológica Portuguesa
https://www.readbyqxmd.com/read/28915897/development-of-a-complex-intervention-to-promote-appropriate-prescribing-and-medication-intensification-in-poorly-controlled-type-2-diabetes-mellitus-in-irish-general-practice
#2
Mark E Murphy, Molly Byrne, Atieh Zarabzadeh, Derek Corrigan, Tom Fahey, Susan M Smith
BACKGROUND: Poorly controlled type 2 diabetes mellitus (T2DM) can be seen as failure to meet recommended targets for management of key risk factors including glycaemic control, blood pressure and lipids. Poor control of risk factors is associated with significant morbidity, mortality and healthcare costs. Failure to intensify medications for patients with poor control of T2DM when indicated is called clinical inertia and is one contributory factor to poor control of T2DM. We aimed to develop a theory and evidence-based complex intervention to improve appropriate prescribing and medication intensification in poorly controlled T2DM in Irish general practice...
September 16, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28915822/what-hinders-the-uptake-of-computerized-decision-support-systems-in-hospitals-a-qualitative-study-and-framework-for-implementation
#3
Elisa G Liberati, Francesca Ruggiero, Laura Galuppo, Mara Gorli, Marien González-Lorenzo, Marco Maraldi, Pietro Ruggieri, Hernan Polo Friz, Giuseppe Scaratti, Koren H Kwag, Roberto Vespignani, Lorenzo Moja
BACKGROUND: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption...
September 15, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28912165/holistic-care-of-complicated-tuberculosis-in-healthcare-settings-with-limited-resources
#4
Trevor Duke, Sharon Kasa Tom, Harry Poka, Henry Welch
In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries...
September 14, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28911338/organisational-culture-and-trust-as-influences-over-the-implementation-of-equity-oriented-policy-in-two-south-african-case-study-hospitals
#5
Ermin Erasmus, Lucy Gilson, Veloshnee Govender, Moremi Nkosi
BACKGROUND: This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust...
September 15, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28910289/how-tavi-registries-report-clinical-outcomes-a-systematic-review-of-endpoints-based-on-varc-2-definitions
#6
Shixuan Zhang, Peter L Kolominsky-Rabas
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an alternative treatment for severe aortic stenosis in patients considered as high surgical risk. Since its first human implantation by Cribier et al., TAVI has been shown to increase survival rate and quality of life for high surgical risks patients. The objective of this study is to provide an overview of TAVI registries and the reporting clinical outcomes based on the VARC-2 definitions. In addition, the comparability and adherence of VARC-2 reporting within the identified TAVI registries was reviewed...
2017: PloS One
https://www.readbyqxmd.com/read/28905658/decision-support-for-diabetes-in-scotland-implementation-and-evaluation-of-a-clinical-decision-support-system
#7
Nicholas Conway, Karen A Adamson, Scott G Cunningham, Alistair Emslie Smith, Peter Nyberg, Blair H Smith, Ann Wales, Deborah J Wake
BACKGROUND: Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users' reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014...
September 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28905541/the-role-of-new-imaging-methods-in-managing-age-related-macular-degeneration
#8
Stephen James Talks, Akhunzada Muhammad Aftab, Imran Ashfaq, Taha Soomro
The use of imaging for age-related macular degeneration (AMD) depends on how it benefits clinical management and on reimbursement. The latter should relate to the former. This review assesses how different forms of AMD can be imaged and what information this provides. For nonneovascular AMD high-resolution optical coherence tomography (OCT), autofluorescence, and near infrared imaging can identify the type of drusen, such as reticular pseudodrusen, which influences prognosis, and the amount of atrophy, for which phase 3 trials are underway...
September 14, 2017: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/28903733/increasing-confidence-and-changing-behaviors-in-primary-care-providers-engaged-in-genetic-counselling
#9
Michael S Wilkes, Frank C Day, Tonya L Fancher, Haley McDermott, Erik Lehman, Robert A Bell, Michael J Green
BACKGROUND: Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics...
September 13, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28901643/renal-function-monitoring-in-heart-failure-what-is-the-optimal-frequency-a-narrative-review
#10
REVIEW
A Al-Naher, D J Wright, M A J Devonald, M Pirmohamed
The second most common cause of hospitalisation due to adverse drug reactions in the UK is renal dysfunction due to diuretics, particularly in patients with heart failure, where diuretic therapy is a mainstay of treatment regimens. Therefore the optimal frequency for monitoring renal function in these patients is an important consideration for preventing renal failure and hospitalisation. This review looks at the current evidence for optimal monitoring practices of renal function in patients with heart failure according to national and international guidelines on the management of heart failure (AHA/NICE/ESC/SIGN)...
September 13, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28901005/delivery-arrangements-for-health-systems-in-low-income-countries-an-overview-of-systematic-reviews
#11
REVIEW
Agustín Ciapponi, Simon Lewin, Cristian A Herrera, Newton Opiyo, Tomas Pantoja, Elizabeth Paulsen, Gabriel Rada, Charles S Wiysonge, Gabriel Bastías, Lilian Dudley, Signe Flottorp, Marie-Pierre Gagnon, Sebastian Garcia Marti, Claire Glenton, Charles I Okwundu, Blanca Peñaloza, Fatima Suleman, Andrew D Oxman
BACKGROUND: Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services...
September 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28898688/improving-non-technical-skills-teamwork-in-post-partum-haemorrhage-a-grouped-randomised-trial
#12
Pippa M Letchworth, Shane P Duffy, Dan Phillips
OBJECTIVE: To determine the effect of a decision support technology on teamwork and associated non-technical (NTS) and technical skills when teams manage post-partum haemorrhage (PPH) in the simulated environment. METHODS: Multidisciplinary (MDT) maternity teams were taught how to manage post partum haemorrhage. They were randomised to the intervention: using a decision support mobile digital platform or a control group. Each team managed a post-partum simulation, which was recorded and reviewed by assessors...
August 26, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28895659/implementation-strategies-for-health-systems-in-low-income-countries-an-overview-of-systematic-reviews
#13
REVIEW
Tomas Pantoja, Newton Opiyo, Simon Lewin, Elizabeth Paulsen, Agustín Ciapponi, Charles S Wiysonge, Cristian A Herrera, Gabriel Rada, Blanca Peñaloza, Lilian Dudley, Marie-Pierre Gagnon, Sebastian Garcia Marti, Andrew D Oxman
BACKGROUND: A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness...
September 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28894545/comparing-performances-of-intelligent-classifier-algorithms-for-predicting-type-of-pain-in-patients-with-spinal-cord-injury
#14
Nasrolah Nasr HeidarAbadi, Laleh Hakemi, Pirhossein Kolivand, Reza Safdari, Marjan Ghazi Saeidi
BACKGROUND AND AIM: In this study, performances of classification techniques were compared in order to predict type of pain in patients with spinal cord injury. Pain is one of the main problems in people with spinal cord injury. Identifying the optimal classification technique will help improve decision support systems in clinical settings. METHODS: A descriptive retrospective analysis was performed in 253 patients. We compared performances of "Bayesian Networks", "Decision Tree", neural networks: "Multi-Layer Perceptron" (MLP), and "Support Vector Machines" (SVM)...
July 2017: Electronic Physician
https://www.readbyqxmd.com/read/28894528/notification-of-international-normalized-ratio-test-in-atrial-fibrillation-patients-treated-with-warfarin-via-short-message-service-study-protocol-for-a-randomized-controlled-trial
#15
Reza Sheibani, Mehdi Sheibani, Yamin Hejazi, Saeid Eslami
BACKGROUND: Atrial Fibrillation (AF) is the most common abnormal heart rhythm. AF patients usually use warfarin therapy. Safety and efficacy of warfarin are dependent on maintaining the International Normalized Ratio (INR) within the therapeutic range. OBJECTIVE: We will use a Short Message Service (SMS) to evaluate the effect of a reminder on carrying out the INR laboratory test in a timely manner. METHODS: This study (a Randomized Controlled Trial) will be done in Loghman hospital Tehran, Iran...
July 2017: Electronic Physician
https://www.readbyqxmd.com/read/28890151/when-to-perform-preoperative-bone-scintigraphy-for-kidney-cancer-staging-indications-for-preoperative-bone-scintigraphy
#16
Alessandro Larcher, Fabio Muttin, Nicola Fossati, Paolo Dell'Oglio, Ettore Di Trapani, Armando Stabile, Francesco Ripa, Francesco Trevisani, Cristina Carenzi, Maria Picchio, Alberto Briganti, Andrea Salonia, Alexandre Mottrie, Roberto Bertini, Francesco Montorsi, Umberto Capitanio
OBJECTIVES: To identify an objective and reproducible strategy for preoperative staging bone scintigraphy [BS] in patients diagnosed with renal cell carcinoma [RCC], since in absence of objective criteria, the decision to perform preoperative BS remains a subjective practice. METHODS: 2,008 RCC patients treated with surgery and prospectively included into an institutional database. The study outcome was presence of one or more bone lesions suspicious for metastases at staging BS...
September 7, 2017: Urology
https://www.readbyqxmd.com/read/28888156/exploring-the-oxygen-supply-and-demand-framework-as-a-learning-tool-in-undergraduate-nursing-education
#17
Mary Gillespie, Eileen Shackell
In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education...
September 6, 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/28885561/acute-and-late-toxicities-of-concurrent-chemoradiotherapy-for-locally-advanced-non-small-cell-lung-cancer
#18
REVIEW
Vivek Verma, Charles B 2nd Simone, Maria Werner-Wasik
For patients with unresectable locally-advanced non-small cell lung cancer (LA-NSCLC), concurrent chemoradiotherapy improves overall survival as compared to sequential chemotherapy and radiation therapy, but is associated with higher rates of toxicities. Acute, clinically significant esophagitis or pneumonitis can occur in one in five patients. The risks of esophagitis and pneumonitis can impact the decision to deliver concurrent therapy and limit the total dose of radiation therapy that is delivered. Hematologic toxicities and emesis are common toxicities from systemic therapies for LA-NSCLC and can result in delaying chemotherapy dosing or chemotherapy dose reductions...
September 8, 2017: Cancers
https://www.readbyqxmd.com/read/28884381/development-of-a-computer-aided-differential-diagnosis-system-to-distinguish-between-usual-interstitial-pneumonia-and-non-specific-interstitial-pneumonia-using-texture-and-shape-based-hierarchical-classifiers-on-hrct-images
#19
SangHoon Jun, BeomHee Park, Joon Beom Seo, SangMin Lee, Namkug Kim
A computer-aided differential diagnosis (CADD) system that distinguishes between usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) using high-resolution computed tomography (HRCT) images was developed, and its results compared against the decision of a radiologist. Six local interstitial lung disease patterns in the images were determined, and 900 typical regions of interest were marked by an experienced radiologist. A support vector machine classifier was used to train and label the regions of interest of the lung parenchyma based on the texture and shape characteristics...
September 7, 2017: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/28883746/clinical-impact-of-early-diagnosis-of-autism-on-the-prognosis-and-parent-child-relationships
#20
REVIEW
Jennifer Harrison Elder, Consuelo Maun Kreider, Susan N Brasher, Margaret Ansell
Autism spectrum disorder (ASD) refers to a lifelong condition that usually appears in late infancy or early childhood, and is characterized by social and communication deficits that impede optimal functioning. Despite widespread research and greater public awareness, ASD has an unclear etiology and no known cure, making it difficult to acquire accurate and timely diagnoses. In addition, once an ASD diagnosis is made, parents find it challenging to navigate the healthcare system and determine which interventions are most effective and appropriate for their child...
2017: Psychology Research and Behavior Management
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