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https://www.readbyqxmd.com/read/29036778/electronic-clinical-decision-support-tool-for-the-evaluation-of-cardiovascular-risk-in-general-practice-a-pilot-study
#1
Jason Chiang, John Furler, Douglas Boyle, Malcolm Clark, Jo-Anne Manski-Nankervis
BACKGROUND: Cardiovascular disease (CVD) is a major cause of death in Australia. Electronic medical record (EMR)-based clinical decision support (CDS) tools have the potential to support absolute CVD risk (ACVDR) evaluation and management. The objective of this study was to test the acceptability and feasibility of the Treat to Target CVD (T3CVD), an EMR-based CDS tool, for the evaluation of ACVDR in general practice. METHODS: Five general practitioners (GPs) piloted the T3CVD tool in their clinic...
October 2017: Australian Family Physician
https://www.readbyqxmd.com/read/29036503/implementing-electronic-health-records-ehrs-health-care-provider-perceptions-before-and-after-transition-from-a-local-basic-ehr-to-a-commercial-comprehensive-ehr
#2
Marie Krousel-Wood, Allison B McCoy, Chad Ahia, Elizabeth W Holt, Donnalee N Trapani, Qingyang Luo, Eboni G Price-Haywood, Eric J Thomas, Dean F Sittig, Richard V Milani
Objective: We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Methods: Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6-12 months (short term) and 12-24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models...
September 23, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29036464/the-mimic-code-repository-enabling-reproducibility-in-critical-care-research
#3
Alistair E W Johnson, David J Stone, Leo A Celi, Tom J Pollard
Objective: Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset. Materials and Methods: Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies...
September 27, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29036011/evaluating-the-impact-of-prescription-fill-rates-on-risk-stratification-model-performance
#4
Hsien-Yen Chang, Thomas M Richards, Kenneth M Shermock, Stacy Elder Dalpoas, Hong J Kan, G Caleb Alexander, Jonathan P Weiner, Hadi Kharrazi
BACKGROUND: Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates-extracted by comparing electronic health record prescriptions and pharmacy claims fills-represent a novel measure of medication adherence and may improve the performance of risk adjustment models. OBJECTIVE: We evaluated the impact of prescription fill rates on claims-based risk adjustment models in predicting both concurrent and prospective costs and utilization...
October 13, 2017: Medical Care
https://www.readbyqxmd.com/read/29035903/the-future-of-obstetrics-and-gynecology-macra-electronic-health-records-and-more
#5
Deborah A Wing
There is immense change affecting obstetrical and gynecologic medical practice at this moment in time-involving reimbursement with the shift from volume-based to value-based care, increasing regulation, and workforce sustainability. Aspects to be reviewed in this chapter include reimbursements and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), electronic medical records, physician satisfaction surveys, maintenance of certification, and physician burnout.
October 13, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29035894/prevalence-of-potentially-distracting-noncare-activities-and-their-effects-on-vigilance-workload-and-nonroutine-events-during-anesthesia-care
#6
Jason M Slagle, Eric S Porterfield, Amanda N Lorinc, David Afshartous, Matthew S Shotwell, Matthew B Weinger
BACKGROUND: When workload is low, anesthesia providers may perform non-patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events. METHODS: In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis...
October 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29035756/lymph-node-wire-localization-post-chemotherapy-towards-improving-the-false-negative-sentinel-lymph-node-biopsy-rate-in-breast-cancer-patients
#7
Brittany Z Dashevsky, Ashley Altman, Hiroyuki Abe, Nora Jaskowiak, Jean Bao, David V Schacht, Deepa Sheth, Kirti Kulkarni
PURPOSE: To evaluate whether the disease status of the pre-neoadjuvant chemotherapy (NAC) core biopsied lymph node (preNACBxLN) in patients with node positive breast cancer corresponds to nodal status of all surgically retrieved lymph nodes (LNs) post-NAC and whether wire localization of this LN is feasible. MATERIALS AND METHODS: HIPPA compliant IRB approved retrospective study including breast cancer patients (a.) with preNACBxLN confirmed metastases, (b.) who received NAC, and (c...
October 7, 2017: Clinical Imaging
https://www.readbyqxmd.com/read/29035732/development-and-validation-of-an-automated-delirium-risk-assessment-system-auto-delras-implemented-in-the-electronic-health-record-system
#8
Kyoung-Ja Moon, Yinji Jin, Taixian Jin, Sun-Mi Lee
BACKGROUND: A key component of the delirium management is prevention and early detection. OBJECTIVE: To develop an automated delirium risk assessment system (Auto-DelRAS) that automatically alerts health care providers of an intensive care unit (ICU) patient's delirium risk based only on data collected in an electronic health record (EHR) system, and to evaluate the clinical validity of this system. DESIGN: Cohort and system development designs were used...
September 23, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/29035705/linking-patients-with-buprenorphine-treatment-in-primary-care-predictors-of-engagement
#9
Claire B Simon, Judith I Tsui, Joseph O Merrill, Addy Adwell, Elsa Tamru, Jared W Klein
BACKGROUND: Office-based buprenorphine treatment promises to expand effective treatment for opioid use disorder. Unfortunately, patients may be lost during engagement, before induction with medication. Few data are available regarding rates and predictors of successfully reaching induction. METHODS: The sample included 100 consecutive patients seeking treatment in 2016 at an office-based buprenorphine treatment program in an urban, academic primary care clinic. Patients completed phone intake, nurse visit and physician visit prior to induction...
October 10, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29035225/a-review-of-automated-methods-for-detection-of-myocardial-ischemia-and-infarction-using-electrocardiogram-and-electronic-health-record
#10
Sardar Ansari, Negar Farzaneh, Marlena Duda, Kelsey Horan, Hedvig B Andersson
There is a growing body of research focusing on automatic detection of ischemia and myocardial infarction (MI) using computer algorithms. In clinical settings, ischemia and MI are diagnosed using ECG recordings as well as medical context including patient symptoms, medical history and risk factors, information that is often stored in the electronic health records. The ECG signal is inspected to identify changes in the morphology such as ST-segment deviation and T wave changes. Some of the proposed methods compute similar features automatically while others use non-conventional features such as wavelet coefficients...
October 16, 2017: IEEE Reviews in Biomedical Engineering
https://www.readbyqxmd.com/read/29035181/minimizing-medical-radiation-exposure-by-incorporating-a-new-radiation-vital-sign-into-the-electronic-medical-record-quality-of-care-and-patient-safety
#11
Jonathan Lukoff, Jaime Olmos
There is a clearly perceived and imminent need to decrease unnecessary and detrimental exposure to medical ionizing radiation. We propose a new radiation "vital sign" that incorporates cumulative radiation exposure to create a risk score on the basis of an individualized assessment of potential harm from additional exposure to medical radiation. We propose to then tie the risk score to real-time, evidence-based, clinical decision support for procedures that use ionizing radiation. Additionally, we offer recommendations that minimize unnecessary or low-yield uses...
2017: Permanente Journal
https://www.readbyqxmd.com/read/29035176/comparing-hospital-processes-and-outcomes-in-california-medicare-beneficiaries-simulation-prompts-reconsideration
#12
Gabriel J Escobar, Jennifer M Baker, Benjamin J Turk, David Draper, Vincent Liu, Patricia Kipnis
INTRODUCTION: This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit...
2017: Permanente Journal
https://www.readbyqxmd.com/read/29034985/burden-of-atrial-fibrillation-in-m%C3%A4-ori-and-pacific-people-in-new-zealand-a-cohort-study
#13
Yulong Gu, Robert N Doughty, Ben Freedman, John Kennelly, Jim Warren, Matire Harwood, Richard Hulme, Chris Paltridge, Ruth Teh, Anna Rolleston, Natalie Walker
AIMS: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared to non-Māori/non-Pacific people. This study describes a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. METHODS: Electronic medical records for adults (≥20 years, n=135,840, including 19,918 Māori and 43,634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information...
October 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29034813/a-review-of-medical-terminology-standards-and-structured-reporting
#14
Abdullah Awaysheh, Jeffrey Wilcke, François Elvinger, Loren Rees, Weiguo Fan, Kurt Zimmerman
Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies...
October 1, 2017: Journal of Veterinary Diagnostic Investigation
https://www.readbyqxmd.com/read/29034725/polypharmacy-and-risk-of-falls-and-fractures-for-patients-with-hiv-infection-and-substance-dependence
#15
Theresa W Kim, Alexander Y Walley, Alicia S Ventura, Gregory J Patts, Timothy C Heeren, Gabriel B Lerner, Nicholas Mauricio, Richard Saitz
Although people with HIV infection (PLWH) are at higher risk of polypharmacy and substance use, there is limited knowledge about potential harms associated with polypharmacy such as falls and fractures in this population. The study objective was to determine whether polypharmacy, as measured by the number and type of medication, is associated with falls and fractures among PLWH and DSM-IV substance dependence in the past year or ever injection drug use (IDU). We identified the number of medications by electronic medical record review in the following categories: (i) systemically active, (ii) non-antiretroviral (non-ARV), (iii) sedating, (iv) non-sedating as well as any opioid medication and any non-opioid sedating medication...
October 16, 2017: AIDS Care
https://www.readbyqxmd.com/read/29034685/improving-performance-on-preventive-health-quality-measures-using-clinical-decision-support-to-capture-care-done-elsewhere-and-patient-exceptions
#16
Michael E Bowen, Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D Persell, Ethan A Halm
Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < ...
October 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29033350/phenotypical-characterization-of-human-rhinovirus-infections-in-severely-premature-children
#17
Geovanny F Perez, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E Rodriguez-Martinez, Dinesh Pillai, Gustavo Nino
BACKGROUND: Human Rhinovirus (HRV) has been identified as the most common cause of acute respiratory infections and hospitalizations in premature children. It is unclear if premature children are more susceptible to HRV due to their decreased pulmonary reserve or because they have enhanced lower airway reactivity to HRV. METHODS: We conducted a retrospective analysis of the clinical respiratory presentation of all PCR-confirmed HRV infections in full-term and premature children aged ≤3 years in our institution...
September 27, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/29033050/temporal-trends-in-the-incidence-prevalence-and-survival-of-patients-with-atrial-fibrillation-from-2004-to-2016
#18
Brent A Williams, Ashley M Honushefsky, Peter B Berger
A growing epidemic of atrial fibrillation (AF) has been predicted, although no data on the AF burden has been reported for the United States since 2010. The objectives of this study were to (1) describe trends in AF incidence, prevalence, and postdiagnosis survival from 2004 to 2016 within a large health-care system and (2) extrapolate observed prevalence rates to the entire US population to estimate the national AF burden. This retrospective cohort study incorporates the patients and electronic medical record of the Geisinger Health System, an integrated health-care delivery system serving central and northeast Pennsylvania...
August 30, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29032707/safety-of-psychiatric-inpatients-at-the-veterans-health-administration
#19
Steven C Marcus, Richard C Hermann, Martin R Frankel, Sara W Cullen
OBJECTIVE: Although reducing adverse events and medical errors has become a central focus of the U.S. health care system over the past two decades both within and outside the Veterans Health Administration (VHA) hospital systems, patients treated in psychiatric units of acute care general hospitals have been excluded from major research in this field. METHODS: The study included a random sample of 40 psychiatric units from medical centers in the national VHA system...
October 16, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29031478/patterns-of-facial-trauma-before-and-after-legalization-of-marijuana-in-denver-colorado-a-joint-study-between-two-denver-hospitals
#20
Mofiyinfolu Sokoya, Justin Eagles, Tyler Okland, Dylan Coughlin, Hannah Dauber, Christopher Greenlee, Andrew A Winkler
INTRODUCTION: The effect of marijuana on human health has been studied extensively. Marijuana intoxication has been shown to affect performance, attention span, and reaction time. The public health relationship between trauma and cannabis use has also been studied, with mixed conclusions. In this report, the effect of marijuana legalization on many aspects of facial trauma at two hospitals in Denver, Colorado is examined. METHODS: A retrospective review of the electronic medical records was undertaken...
October 7, 2017: American Journal of Emergency Medicine
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