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1

Accuracy of a computerized clinical decision-support system for asthma assessment and management  

Microsoft Academic Search

ObjectiveTo evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic.DesignCohort study of all asthma visits to pediatric pulmonology from January to December, 2009.MeasurementsCDSS and physician assessments of asthma severity, control, and treatment step.ResultsBoth the clinician and the computerized CDSS generated assessments of asthma control in 767\\/1032

Laura J Hoeksema; Alia Bazzy-Asaad; Edwin A Lomotan; Diana E Edmonds; Gabriela Ramírez-Garnica; Richard N Shiffman; Leora I Horwitz

2011-01-01

2

Exploiting Decision Theory for Supporting Therapy Selection in Computerized Clinical Guidelines  

Microsoft Academic Search

\\u000a Supporting therapy selection is a fundamental task for a system for the computerized management of clinical guidelines (GL).\\u000a The goal is particularly critical when no alternative is really better than the others, from a strictly clinical viewpoint.\\u000a In these cases, decision theory appears to be a very suitable means to provide advice. In this paper, we describe how algorithms\\u000a for

Stefania Montani; Paolo Terenziani; Alessio Bottrighi

2005-01-01

3

Viewpoint: controversies surrounding use of order sets for clinical decision support in computerized provider order entry.  

PubMed

Order sets provide straightforward clinical decision support within computerized provider order entry systems. They make "the right thing" easier to do because they are much faster than writing single orders; they deliver real-time, evidence-based prompts; they are easy to update; and they support coverage of multiple patient problems through linkages among order sets. This viewpoint paper discusses controversies surrounding use of order sets--advantages and pitfalls, decision-making criteria, and organizational considerations, including suggestions for vendors. Order sets have the potential to improve clinician efficiency, provide real-time guidance, facilitate compliance with Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicare and Medicaid Services performance measure sets, and encourage overall acceptance of computerized provider order entry, but may not do so unless these controversies are addressed. PMID:17068352

Bobb, Anne M; Payne, Thomas H; Gross, Peter A

2007-01-01

4

Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review  

Microsoft Academic Search

BACKGROUND: Computerized clinical decision support systems are information technology-based systems designed to improve clinical decision-making. As with any healthcare intervention with claims to improve process of care or patient outcomes, decision support systems should be rigorously evaluated before widespread dissemination into clinical practice. Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake. The objective

R Brian Haynes; Nancy L Wilczynski

2010-01-01

5

Computerized clinical decision support for prescribing: provision does not guarantee uptake  

PubMed Central

There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990–2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved.

Moxey, Annette; Robertson, Jane; Newby, David; Hains, Isla; Williamson, Margaret; Pearson, Sallie-Anne

2010-01-01

6

Accuracy of a computerized clinical decision-support system for asthma assessment and management  

PubMed Central

Objective To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic. Design Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009. Measurements CDSS and physician assessments of asthma severity, control, and treatment step. Results Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167 (39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all ‘cough’ to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits. Limitations The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations. Conclusions A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients.

Hoeksema, Laura J; Bazzy-Asaad, Alia; Lomotan, Edwin A; Edmonds, Diana E; Ramirez-Garnica, Gabriela; Shiffman, Richard N

2011-01-01

7

Development of a workflow integration survey (WIS) for implementing computerized clinical decision support.  

PubMed

Interventions that focus on improving computerized clinical decision support (CDS) demonstrate that successful workflow integration can increase the adoption and use of CDS. However, metrics for assessing workflow integration in clinical settings are not well established. The goal of this study was to develop and validate a survey to assess the extent to which CDS is integrated into workflow. Qualitative data on CDS design, usability, and integration from four sites was collected by direct observation, interviews, and focus groups. Thematic analysis based on the sociotechnical systems theory revealed consistent themes across sites. Themes related to workflow integration included navigation, functionality, usability, and workload. Based on these themes, a brief 12-item scale to assess workflow integration was developed, refined, and validated with providers in a simulation study. To our knowledge, this is one of the first tools developed to specifically measure workflow integration of CDS. PMID:22195096

Flanagan, Mindy; Arbuckle, Nicole; Saleem, Jason J; Militello, Laura G; Haggstrom, David A; Doebbeling, Bradley N

2011-01-01

8

Development of a Workflow Integration Survey (WIS) for Implementing Computerized Clinical Decision Support  

PubMed Central

Interventions that focus on improving computerized clinical decision support (CDS) demonstrate that successful workflow integration can increase the adoption and use of CDS. However, metrics for assessing workflow integration in clinical settings are not well established. The goal of this study was to develop and validate a survey to assess the extent to which CDS is integrated into workflow. Qualitative data on CDS design, usability, and integration from four sites was collected by direct observation, interviews, and focus groups. Thematic analysis based on the sociotechnical systems theory revealed consistent themes across sites. Themes related to workflow integration included navigation, functionality, usability, and workload. Based on these themes, a brief 12-item scale to assess workflow integration was developed, refined, and validated with providers in a simulation study. To our knowledge, this is one of the first tools developed to specifically measure workflow integration of CDS.

Flanagan, Mindy; Arbuckle, Nicole; Saleem, Jason J.; Militello, Laura G.; Haggstrom, David A.; Doebbeling, Bradley N.

2011-01-01

9

Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial  

Microsoft Academic Search

Objective: Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost- effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization. Design: A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an

JESSINA C. MCGREGOR; ELIZABETH WEEKES; P HARMD; GRAEME N. FORREST; HAROLD C. STANDIFORD; ELI N. PERENCEVICH; JON P. FURUNO; ANTHONY D. HARRIS

2010-01-01

10

Coupling clinical decision support system with computerized prescriber order entry and their dynamic plugging in the medical workflow system  

Microsoft Academic Search

This work deals with coupling Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE) and their dynamic plugging in the medical Workflow Management System (WfMS). First, in this paper we argue some existing CDSS representative of the state of the art in order to emphasize their inability to deal with coupling with CPOE and medical WfMS. The multiagent

Lotfi Bouzguenda; Manel Turki

2012-01-01

11

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study  

PubMed Central

Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

2012-01-01

12

What makes an effective computerized clinical decision support system? A systematic review and logistic regression analysis of randomized controlled trials  

Microsoft Academic Search

Context: Computerized clinical decision support systems (CCDSSs) give practitioners patient-specific care advice and are considered an important increment to electronic clinical documentation and order entry systems. Despite decades of research on CCDSS, results from rigorous clinical evaluations remain mixed and systems vary greatly in design and implementation.\\u000aObjective: To identify factors differentiating CCDSSs that improve the process of care or

Pavel S Roshanov

2011-01-01

13

Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review  

PubMed Central

Background Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes. Results Thirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002). Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33) of CCDSSs improved testing behavior overall, including 83% (5/6) for diagnosis, 63% (5/8) for treatment monitoring, 35% (6/17) for disease monitoring, and 100% (3/3) for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported. Conclusions Some CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such as system design, user interface, local context, implementation strategy, and evaluate impact on user satisfaction and workflow, costs, and unintended consequences.

2011-01-01

14

Computerized clinical decision support for medication prescribing and utilization in pediatrics  

PubMed Central

Background and objective Accurate and informed prescribing is essential to ensure the safe and effective use of medications in pediatric patients. Computerized clinical decision support (CCDS) functionalities have been embedded into computerized physician order entry systems with the aim of ensuring accurate and informed medication prescribing. Owing to a lack of comprehensive analysis of the existing literature, this review was undertaken to analyze the effect of CCDS implementation on medication prescribing and use in pediatrics. Materials and methods A literature search was performed using keywords in PubMed to identify research studies with outcomes related to the implementation of medication-related CCDS functionalities. Results and discussion Various CCDS functionalities have been implemented in pediatric patients leading to different results. Medication dosing calculators have decreased calculation errors. Alert-based CCDS functionalities, such as duplicate therapy and medication allergy checking, may generate excessive alerts. Medication interaction CCDS has been minimally studied in pediatrics. Medication dosing support has decreased adverse drug events, but has also been associated with high override rates. Use of medication order sets have improved guideline adherence. Guideline-based treatment recommendations generated by CCDS functionalities have had variable influence on appropriate medication use, with few studies available demonstrating improved patient outcomes due to CCDS use. Conclusion Although certain medication-related CCDS functionalities have shown benefit in medication prescribing for pediatric patients, others have resulted in high override rates and inconsistent or unknown impact on patient care. Further studies analyzing the effect of individual CCDS functionalities on safe and effective prescribing and medication use are required.

Stultz, Jeremy S

2012-01-01

15

Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review  

PubMed Central

Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.

2011-01-01

16

Research Paper: Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial  

Microsoft Academic Search

ObjectiveMany hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization.DesignA randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the

Jessina C. McGregor; Elizabeth Weekes; Graeme N. Forrest; Harold C. Standiford; Eli N. Perencevich; Jon P. Furuno; Anthony D. Harris

2006-01-01

17

Computerized clinical decision support systems for therapeutic drug monitoring and dosing: A decision-maker-researcher partnership systematic review  

PubMed Central

Background Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs) may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing. Methods We conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14), insulin (6), theophylline/aminophylline (4), aminoglycosides (3), digoxin (2), lidocaine (1), or as part of a multifaceted approach (3). Cluster randomization was rarely used (18%) and CCDSSs were usually stand-alone systems (76%) primarily used by physicians (85%). Overall, 18 of 30 studies (60%) showed an improvement in the process of care and 4 of 19 (21%) an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range. Conclusions CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing benefit in the largest studies. At present, no firm recommendation for specific systems can be given. More potent CCDSSs need to be developed and should be evaluated by independent researchers using cluster randomization and primarily assess patient outcomes related to drug efficacy and safety.

2011-01-01

18

Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review  

Microsoft Academic Search

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs.To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand

Gilad J. Kuperman; Anne M. Bobb; Thomas H. Payne; Anthony J. Avery; Tejal K. Gandhi; Gerard Burns; David C. Classen; David W. Bates

2007-01-01

19

Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes  

PubMed Central

Background Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions Evidence supports the effectiveness of CCDSSs for screening and treatment of dyslipidaemia in primary care with less consistent evidence for CCDSSs used in screening for cancer and mental health-related conditions, vaccinations, and other preventive care. CCDSS effects on patient outcomes, safety, costs of care, and provider satisfaction remain poorly supported.

2011-01-01

20

Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings  

PubMed Central

Background Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources) for the change and strategies to implement and maintain new systems. Methods To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D) in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners) participated across five sites, accruing over 300 outpatient visits on 168 patients. Results Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.

2009-01-01

21

The effectiveness of computerized clinical guidelines in the process of care: a systematic review  

Microsoft Academic Search

BACKGROUND: Clinical practice guidelines have been developed aiming to improve the quality of care. The implementation of the computerized clinical guidelines (CCG) has been supported by the development of computerized clinical decision support systems. This systematic review assesses the impact of CCG on the process of care compared with non-computerized clinical guidelines. METHODS: Specific features of CCG were studied through

Gianfranco Damiani; Luigi Pinnarelli; Simona C Colosimo; Roberta Almiento; Lorella Sicuro; Rocco Galasso; Lorenzo Sommella; Walter Ricciardi

2010-01-01

22

Designing Computerized Decision Support That Works for Clinicians and Families  

PubMed Central

Evidence-based decision-making is central to the practice of pediatrics. Clinical trials and other biomedical research provide a foundation for this process, and practice guidelines, drawing from their results, inform the optimal management of an increasing number of childhood health problems. However, many clinicians fail to adhere to guidelines. Clinical decision support delivered using health information technology, often in the form of electronic health records, provides a tool to deliver evidence-based information to the point of care and has the potential to overcome barriers to evidence-based practice. An increasing literature now informs how these systems should be designed and implemented to most effectively improve outcomes in pediatrics. Through the examples of computerized physician order entry, as well as the impact of alerts at the point of care on immunization rates, the delivery of evidence-based asthma care, and the follow-up of children with attention deficit hyperactivity disorder, the following review addresses strategies for success in using these tools. The following review argues that, as decision support evolves, the clinician should no longer be the sole target of information and alerts. Through the Internet and other technologies, families are increasingly seeking health information and gathering input to guide health decisions. By enlisting clinical decision support systems to deliver evidence-based information to both clinicians and families, help families express their preferences and goals, and connect families to the medical home, clinical decision support may ultimately be most effective in improving outcomes.

Fiks, Alexander G.

2011-01-01

23

Designing computerized decision support that works for clinicians and families.  

PubMed

Evidence-based decision-making is central to the practice of pediatrics. Clinical trials and other biomedical research provide a foundation for this process, and practice guidelines, drawing from their results, inform the optimal management of an increasing number of childhood health problems. However, many clinicians fail to adhere to guidelines. Clinical decision support delivered using health information technology, often in the form of electronic health records, provides a tool to deliver evidence-based information to the point of care and has the potential to overcome barriers to evidence-based practice. An increasing literature now informs how these systems should be designed and implemented to most effectively improve outcomes in pediatrics. Through the examples of computerized physician order entry, as well as the impact of alerts at the point of care on immunization rates, the delivery of evidence-based asthma care, and the follow-up of children with attention deficit hyperactivity disorder, the following review addresses strategies for success in using these tools. The following review argues that, as decision support evolves, the clinician should no longer be the sole target of information and alerts. Through the Internet and other technologies, families are increasingly seeking health information and gathering input to guide health decisions. By enlisting clinical decision support systems to deliver evidence-based information to both clinicians and families, help families express their preferences and goals, and connect families to the medical home, clinical decision support may ultimately be most effective in improving outcomes. PMID:21315295

Fiks, Alexander G

2011-03-01

24

Clinical Applications of Computerized Thermography.  

National Technical Information Service (NTIS)

Computerized or digital, thermography is a rapidly growing diagnostic imaging modality. It has superseded contact thermography and analog imaging thermography which do not allow effective quantization. Medical applications of digital thermography can be c...

M. Anbar

1988-01-01

25

Computerized decision support in adult and pediatric critical care  

PubMed Central

Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.

Williams, Cydni N; Bratton, Susan L; Hirshberg, Eliotte L

2013-01-01

26

On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop  

PubMed Central

Background Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. Methods A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. Results We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. Conclusions We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.

2013-01-01

27

Computerization of clinical laboratory procedure manuals.  

PubMed

Current code requires federally licensed clinical laboratories to have standard operating procedure manuals describing all tests performed. A computerized system for generating, revising, and excerpting manuals, which produces hard copy and microfiche, has been developed and appears to meet the regulatory criteria. The salient aspects of pertinent federal regulations, the features of the computerized system, the format of the manual, the users' experience therewith are described. PMID:707557

Pryor, L R; Rea, S D

1978-09-01

28

Clinical applications of computerized thermography  

NASA Technical Reports Server (NTRS)

Computerized or digital, thermography is a rapidly growing diagnostic imaging modality. It has superseded contact thermography and analog imaging thermography which do not allow effective quantization. Medical applications of digital thermography can be classified in two groups: static and dynamic imaging. They can also be classified into macro thermography (resolution greater than 1 mm) and micro thermography (resolution less than 100 microns). Both modalities allow a thermal resolution of 0.1 C. The diagnostic power of images produced by any of these modalities can be augmented by the use of digital image enhancement and image recognition procedures. Computerized thermography has been applied in neurology, cardiovascular and plastic surgery, rehabilitation and sports medicine, psychiatry, dermatology and ophthalmology. Examples of these applications are shown and their scope and limitations are discussed.

Anbar, Michael

1988-01-01

29

Computerization of the safeguards analysis decision process  

SciTech Connect

Safeguards regulations are evolving to meet new demands for timeliness and sensitivity in detecting the loss or unauthorized use of sensitive nuclear materials. The opportunities to meet new rules, particularly in bulk processing plants, involve developing techniques which use modern, computerized process control and information systems. Using these computerized systems in the safeguards analysis involves all the challenges of the man-machine interface experienced in the typical process control application and adds new dimensions to accuracy requirements, data analysis, and alarm resolution in the regulatory environment. 4 refs., 1 fig.

Ehinger, M.H.

1990-01-01

30

Computerized Patient Scheduling in a Clinic  

PubMed Central

This paper describes a computerized approach to the problem of scheduling patients to treatment centers in a clinic. Patients spend one week at the clinic, the first day of which is spent in medical examination and the determination of treatment requirements. The remaining four days are devoted to treatment. The scheduling problem is centered primarily about the utilization of the 19 treatment centers. Each center has a capacity which may change depending on the status of equipment and personnel. From thirty to forty patients must each receive the required treatment at some of these centers. Therefore, the schedule must assure that all required patient treatment is accomplished while at the same time making the fullest possible use of each treatment center. This computerized patient schedule creates an effective, distributed schedule that is timely, adaptive, and objective. It further provides the clinic director with a flexible planning tool whereby resources and patients can be more effectively used and controlled with a minimum of human effort required.

Rose, Lawrence L.; Gotterer, Malcolm H.

1978-01-01

31

What can natural language processing do for clinical decision support?  

Microsoft Academic Search

Computerized clinical decision support (CDS) aims to aid decision making of health care providers and the public by providing easily accessible health-related information at the point and time it is needed. natural language processing (NLP) is instrumental in using free-text information to drive CDS, representing clinical knowledge and CDS interventions in standardized formats, and leveraging clinical narrative. The early innovative

Dina Demner-fushman; Wendy Webber Chapman; Clement J. Mcdonald

2009-01-01

32

Operationalizing Prostate Cancer Clinical Pathways: An Ontological Model to Computerize, Merge and Execute Institution-Specific Clinical Pathways  

Microsoft Academic Search

The computerization of paper-based Clinical Pathways (CP) can allow them to be operationalized as a decision-support and care planning tool at the point-of-care. We applied a knowledge man- agement approach to computerize the prostate cancer CP for three different locations. We present a new prostate cancer CP ontology that features the novel merging of multiple CP based on the similar-

Samina Raza Abidi; Syed Sibte Raza Abidi; Lorna Butler; Sajjad Hussain

2008-01-01

33

Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.  

PubMed

The specificity of medication-related alerts must be improved to overcome the pernicious effects of alert fatigue. A systematic comparison of new drug orders to historical orders could improve alert specificity and relevance. Using historical order data from a computerized provider order entry system, we alerted physicians to atypical orders during the prescribing of five medications: calcium, clopidogrel, heparin, magnesium, and potassium. The percentage of atypical orders placed for these five medications decreased during the 92 days the alerts were active when compared to the same period in the previous year (from 0.81% to 0.53%; p=0.015). Some atypical orders were appropriate. Fifty of the 68 atypical order alerts were over-ridden (74%). However, the over-ride rate is misleading because 28 of the atypical medication orders (41%) were changed. Atypical order alerts were relatively few, identified problems with frequencies as well as doses, and had a higher specificity than dose check alerts. PMID:24253195

Woods, Allie D; Mulherin, David P; Flynn, Allen J; Stevenson, James G; Zimmerman, Christopher R; Chaffee, Bruce W

2014-05-01

34

Tight glycemic control and computerized decision-support systems: a systematic review  

Microsoft Academic Search

Objective  To identify and summarize characteristics of computerized decision-support systems (CDSS) for tight glycemic control (TGC)\\u000a and to review their effects on the quality of the TGC process in critically ill patients.\\u000a \\u000a \\u000a \\u000a Methods  We searched Medline (1950–2008) and included studies on critically ill adult patients that reported original data from a clinical\\u000a trial or observational study with a main objective of evaluating

Saeid Eslami; Ameen Abu-Hanna; Evert de Jonge; Nicolette F. de Keizer

2009-01-01

35

Evaluating the impact of computerized clinical documentation.  

PubMed

A computerized system for care planning and documentation of patient care was initiated at a western teaching hospital, using the framework of Nursing Interventions Classification and Nursing Outcomes Classification standardized languages. The software integrates care planning and documentation, and includes both order entry as well as a charting application. Prior to initiating the project, a study was conducted to evaluate staff attitude toward computerization, time needed for documentation, and comprehensiveness of charting entries. Data from staff surveys, observations, and chart audits conducted pre- and post-computer project implementation demonstrated that the staff attitudes toward computers were less positive, the time required for charting was unchanged, and there were improvements in how completely the nurses documented charting elements. PMID:15900170

Smith, Kathy; Smith, Vivienne; Krugman, Mary; Oman, Kathleen

2005-01-01

36

Evaluation of a Computerized Contraceptive Decision Aid for Adolescent Patients.  

ERIC Educational Resources Information Center

Discusses a computer-based contraceptive decision aid used with adolescent female family planning clinic patients (N=949). Results show improved short-term knowledge of and confidence in oral contraceptive (OC) efficacy. Higher OC knowledge after one year and fewer pregnancies were seen in one group. Findings suggest the usefulness of informatics…

Chewning, Betty; Mosena, Pat; Wilson, Dale; Erdman, Harold; Potthoff, Sandra; Murphy, Anita; Kuhnen, Kathleen Kennedy

1999-01-01

37

Using Computerized Clinical Nursing Data Bases for Nursing Research.  

ERIC Educational Resources Information Center

Addresses the recognition of differences between clinical and research data in using computerized clinical nursing databases and the issues of privacy and confidentiality for patients whose records are involved. Describes procedures for assessing the quality and usability of these data for nursing research. (SK)

Nail, Lillian M.; Lange, Linda L.

1996-01-01

38

Physicians' Decisions to Override Computerized Drug Alerts in Primary Care  

Microsoft Academic Search

Background: Although computerized physician order entry reduces medication errors among inpatients, little is known about the use of this system in primary care. Methods: We calculated the override rate among 3481 consecutivealertsgeneratedat5adultprimarycareprac- tices that use a common computerized physician order entry system for prescription writing. For detailed re- view, we selected a random sample of 67 alerts in which physicians

Saul N. Weingart; Maria Toth; Daniel Z. Sands; Mark D. Aronson; Roger B. Davis; Russell S. Phillips

2003-01-01

39

Planning and Multiple Criteria Decision Making with NAPSY, a Computerized System for Evaluating Complex Alternatives.  

National Technical Information Service (NTIS)

A survey is presented of the computerized decision making utility analysis system NAPSY. NAPSY is a flexible aid in management problem solving at multiple criteria level when complex alternatives have to be evaluated in regard to a hierarchically structur...

C. Zangemeister

1976-01-01

40

Medication related computerized decision support system (CDSS): make it a clinicians' partner!  

PubMed

Medication related Computerized Decision Support System (CDSS) are known to have a positive impact on Adverse Drug Events (ADE) prevention but they face acceptance problems due to over alerting and usability issues. We present here a Human factors approach to the design of these Clinical Decision Support (CDS) functions and to their integration into different Electronic Health Record (EHR) / Computerized Physicians Order Entry (CPOE) systems, so that the resulting CDSS corresponds to the users needs and fits clinical workflows and cognitive processes. We used ethnographic observations completed with semi-structured interviews to analyse existing work situations and work processes. These were then described in detail using the SHEL (Software, Hardware, Environment & Liveware) formalism, which enables a structured description of the work system and provides an appropriate classification of human errors potentially leading to ADEs. We then propose a Unified Modelling Language (UML) model supporting the characterization by the CDSS of the drug monitoring and clinical context of patients at risk of ADE. This model combines the status of the lab test orders on the one hand with the validity and normality of the lab results on the other hand. This makes the system able to catch the context of the monitoring of the drugs through their corresponding lab tests and lab results (e.g. kalemia for potassium) and also part of the context of the clinical status of the patient (actual lab values, but also diseases and other pathologies that are identified as potential causes of the ADE e.g. renal insufficiency and potassium). We show that making the system able to catch the monitoring and clinical contexts opens interesting opportunities for the design of the CDS information content and display mode. Implementing this model would allow the CDSS to take into account the actions already engaged by the healthcare team and to adapt the information delivered to the monitoring and clinical context, thus making the CDSS a partner to the clinicians, nurses and pharmacists. PMID:21685614

Marcilly, Romaric; Leroy, Nicolas; Luyckx, Michel; Pelayo, Sylvia; Riccioli, Costanza; Beuscart-Zéphir, Marie-Catherine

2011-01-01

41

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.  

PubMed

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes. PMID:22837104

Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

2013-04-01

42

Clinical Archive”: A computerized medical record of patients in apheresis  

Microsoft Academic Search

Today the medical records of sick or injured persons who need apheresis treatment are not always the same in the various Transfusional Centres for lack of dedicated software.The Transfusion Centre of Bari Policlinic has tried to define and create a computerized medical record in order to have a valid tool to better report information both during clinical treatment and after

Emilio Galtieri; Luciano Cazzato; Giovanni Poliseno; Nicola Paglionico; Donato Dimonte

2008-01-01

43

Computerized Aid Improves Safety Decision Process for Survivors of Intimate Partner Violence  

PubMed Central

A computerized safety decision aid was developed and tested with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups (n = 90). The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user. Women reported that the decision aid was useful and provided much-needed privacy for making safety decisions. The majority (69%) reported severe to extreme danger in their relationship as scored by Danger Assessment (DA); only 60% reported having made a safety plan. After using the safety decision aid, the women felt more supported in their decision (p = .012) and had less total decisional conflict (p = .014). The study demonstrated that a computerized safety decision aid improved the safety planning process, as demonstrated by reduced decisional conflict after only one use in a sample of abused women.

Glass, Nancy; Eden, Karen B.; Bloom, Tina; Perrin, Nancy

2011-01-01

44

Computerized aid improves safety decision process for survivors of intimate partner violence.  

PubMed

A computerized safety decision aid was developed and tested with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups (n = 90). The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user. Women reported that the decision aid was useful and provided much-needed privacy for making safety decisions. The majority (69%) reported severe to extreme danger in their relationship as scored by Danger Assessment (DA); only 60% reported having made a safety plan. After using the safety decision aid, the women felt more supported in their decision (p = .012) and had less total decisional conflict (p = .014). The study demonstrated that a computerized safety decision aid improved the safety planning process, as demonstrated by reduced decisional conflict after only one use in a sample of abused women. PMID:20040709

Glass, Nancy; Eden, Karen B; Bloom, Tina; Perrin, Nancy

2010-11-01

45

A Framework for Breast Cancer Prevention Using a Computerized Decision Aid  

Cancer.gov

A Framework for Breast Cancer Prevention Using a Computerized Decision Aid Elissa Ozanne, Ph.D. Kelly Adduci, M.P.H. Caroline Annis, M.S. Laura Esserman, M.D., M.B.A. Abstract Background Current prevention decision making typically uses the Gail,

46

Gender, Feedback, and Decision Making: How Men and Women Differ on the Use of Computerized Feedback?  

Microsoft Academic Search

This study examines the impact of gender on the utilization of computerized feedback. By comparing the decision making process of men and women using a computer-based managerial decision system, the results of this study show that women use the feedback provided by their systems more effectively. This is relevant to HCI's focus on the ways humans interact with information, technologies,

Soussan Djamasbi; Eleanor Loiacono

47

Diabetes Telehealth and Computerized Decision Support Systems: A Sound System with a Human Touch Is Needed  

PubMed Central

Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care.

Holmstrom, Inger

2010-01-01

48

An Event-Driven Approach to Computerizing Clinical Guidelines Using XML  

Microsoft Academic Search

Clinical events form the basis of patient care practice. Their computerization is an important aid to the work of clinicians. Clinical guidelines or protocols direct clinicians and patients on when and how to handle clinical problems. Thus, clinical guidelines are an encapsulation of clinical events. Hence, an event-driven approach to computerizing the management of clinical guidelines is worthy of investigation.

Essam Mansour; Bing Wu; Kudakwashe Dube; Jian Xing Li

2006-01-01

49

Clinical Decision-Support Systems  

Microsoft Academic Search

Clinical decision-support systems (CDSS) apply best-known medical knowledge to patient data for the purpose of generating case-specific decision-support advice. CDSS forms the cornerstone of health informatics research and practice. It is an embedded concept in almost all major clinical information systems and plays an instrumental role in helping health care achieve its ultimate goal: providing high- quality patient care while,

Kai Zheng

50

"Clinical Archive": a computerized medical record of patients in apheresis.  

PubMed

Today the medical records of sick or injured persons who need apheresis treatment are not always the same in the various Transfusional Centres for lack of dedicated software. The Transfusion Centre of Bari Policlinic has tried to define and create a computerized medical record in order to have a valid tool to better report information both during clinical treatment and after for their archives. The software, called "Clinical Archives", can store clinical, therapeutic and administrative data. It has a good user interface, it is easy and intuitive in its various steps and procedures and it can always be expanded thanks to the connection online with other computerized systems (cell separators, laboratory, etc.). The software is entirely home-made and it is our intention to distribute it free to those who wish it for an analysis of its potentials and possible improvements and/or extensions. With this software we have tried to make an important contribution to the technological evolution of our scientific community in the field of Clinical Governance and Outcomes. PMID:18977176

Galtieri, Emilio; Cazzato, Luciano; Poliseno, Giovanni; Paglionico, Nicola; Dimonte, Donato

2008-12-01

51

The Physician Compliance of Red Blood Cell Transfusion by Computerized Transfusion Decision Support System  

Microsoft Academic Search

“When should we trigger a transfusion?” is always a critical question between the patient's benefits and risks in RBC transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting red blood cell (RBC) transfusion were investigated. Totally 20,551 RBC-transfusion episodes between January

Chao-Sung Chang; Yu-Chih Lin; Chiu Chu Lin; Chi-Jung Yeh; Yung-Chao Wu; Yi-Ching Lin

52

Adaptive Decision Aiding in Computer-Assisted Instruction: Adaptive Computerized Training System (ACTS).  

ERIC Educational Resources Information Center

This report describes results of the first year of a three-year program to develop and evaluate a new Adaptive Computerized Training System (ACTS) for electronics maintenance training. (ACTS incorporates an adaptive computer program that learns the student's diagnostic and decision value structure, compares it to that of an expert, and adapts the…

Hopf-Weichel, Rosemarie; And Others

53

Engineering of a Clinical Decision Support Framework for the Point of Care Use  

Microsoft Academic Search

Computerized decision support for use at the point of care has to be comprehensive. It means that clinical information stored in electronic health records needs to be integrated with various forms of clinical knowledge ( elicited from experts, discovered from data or summarized in systematic reviews of clinical trials). In order to provide such comprehensive support we created the MET

Szymon Wilk; Wojtek Michalowski; Dympna O'Sullivan; Ken Farion; Stan Matwin

54

Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit  

Microsoft Academic Search

Objective. To implement and evaluate the effect of a computerized decision support tool on antibiotic use in an intensive care unit (ICU). Design. Prospective before-and-after cohort study. Setting. Twenty-four bed tertiary hospital adult medical\\/surgical ICU. Participants. All consecutive patients from May 2001 to November 2001 (N = 524) and March 2002 to September 2002 (N = 536). Intervention. A real-time

KARIN A. THURSKY; KIRSTY L. BUISING; NARIN BAK; LACHLAN MACGREGOR; C. RAINA MACINTYRE; JEFFREY J. PRESNEILL; JOHN F. CADE; GRAHAM V. BROWN

2006-01-01

55

The effects of system design alternatives on the acquisition of tax knowledge from a computerized tax decision aid  

Microsoft Academic Search

Accounting firms are intensifying their reliance on experiential learning, and experience increasingly involves the use of computerized decision aids [Messier, W. (1995) Research in and development of audit decision aids. In R. H. Ashton & A. H. Ashton, Judgment and decision making in accounting and auditing (pp. 207–230). New York: Cambridge University Press]. Accountants are expected to learn from automated

Jacob M. Rose; Christopher J. Wolfe

2000-01-01

56

Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.  

PubMed Central

200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.

East, T. D.; Heermann, L. K.; Bradshaw, R. L.; Lugo, A.; Sailors, R. M.; Ershler, L.; Wallace, C. J.; Morris, A. H.; McKinley, B.; Marquez, A.; Tonnesen, A.; Parmley, L.; Shoemaker, W.; Meade, P.; Thaut, P.; Hill, T.; Young, M.; Baughman, J.; Olterman, M.; Gooder, V.; Quinn, B.; Summer, W.; Valentine, V.; Carlson, J.; Steinberg, K.

1999-01-01

57

Clinical Decision-Support Systems  

Microsoft Academic Search

\\u000a After reading this chapter, you should know the answers to these questions:\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a What are three requirements for an excellent decision-making system?\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a What are three decision-support roles for computers in clinical medicine?\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a How has the use of computers for clinical decision support evolved since the1960s?\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a What is a knowledge-based system?\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a What influences account for the gradual

Mark A. Musen; Yuval Shahar; Edward H. Shortliffe

58

The medication minefield: using computerized decision support systems to reduce preventable adverse drug events and hospitalizations.  

PubMed

Preventable adverse drug events (ADEs) are a source of avoidable hospitalizations, morbidity and mortality, especially among those older than 65 years. Computerized decision support systems (CDSSs) can identify and address ADEs, but relatively little has been written about the effectiveness of such system in the community setting. This article will review some important studies on the causes of medication-related admissions in the ambulatory setting, where a lack of communication among prescribers creates a virtual minefield of medication risk. Some preliminary data will show how the application of CDSSs can affect the outcomes of care, including a reduction in preventable admissions and readmissions. PMID:24887524

Bernstein, Richard; Kogan, Polina; Collins, Arlen

2014-01-01

59

Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic  

PubMed Central

Background and Objective Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians’ use of computers, patient and clinicians’ attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Methods Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. Findings The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. Implications We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients’ decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings should be incorporated into the design and implementation of a computerized shared decision aid at an inner-city hospital.

Hajizadeh, Negin; Perez Figueroa, Rafael E.; Uhler, Lauren M.; Chiou, Erin; Perchonok, Jennifer E.; Montague, Enid

2014-01-01

60

Features predicting the success of computerized decision support for prescribing: a systematic review of randomized controlled trials  

Microsoft Academic Search

BACKGROUND: Computerized decision support systems (CDSS) are believed to have the potential to improve the quality of health care delivery, although results from high quality studies have been mixed. We conducted a systematic review to evaluate whether certain features of prescribing decision support systems (RxCDSS) predict successful implementation, change in provider behaviour, and change in patient outcomes. METHODS: A literature

Brent Mollon; Jaron JR Chong; Anne M Holbrook; Melani Sung; Lehana Thabane; Gary Foster

2009-01-01

61

Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.  

PubMed

The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches. PMID:20086264

Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

2010-01-01

62

Clinical Decision Support Systems: Perspectives in Dentistry  

Microsoft Academic Search

Clinical decision-support systems (CDSSs) are computer programs that are designed to provide expert support for health professionals making clinical decisions. The goal of these systems is to help health professionals analyze patient data and make decisions regarding diagnosis, prevention, and treatment of health problems. This article discusses the characteristics of such systems, addresses the challenges in developing them, identifies potential

Eneida A. Mendonça

2004-01-01

63

What Decision Analysis Can Offer the Clinical Decision Maker  

Microsoft Academic Search

Cognitive Continuum Theory can be used to explain why the relationship between research and practice is more problematic than is customarily assumed. The various possible sources of evidence for clinical decision making and the alternative approaches to such decision making can be located within the main modes of this continuum, each of which embodies a different balance of intuition and

Jack Dowie

1999-01-01

64

Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey  

PubMed Central

Objective: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. Design and Measurements: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation. Results: Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and “push” vs “pull” factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive. Conclusion: This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems.

Leung, Gabriel M.; Yu, Philip L. H.; Wong, Irene O. L.; Johnston, Janice M.; Tin, Keith Y. K.

2003-01-01

65

Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems  

PubMed Central

Background The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. Methods The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. Results Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. Conclusions These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.

Wright, Adam; Sittig, Dean F.; Ash, Joan S.; Sharma, Sapna; Pang, Justine E.; Middleton, Blackford

2009-01-01

66

Social, organizational, and contextual characteristics of clinical decision support systems for intensive insulin therapy: A literature review and case study  

Microsoft Academic Search

IntroductionEvaluations of computerized clinical decision support systems (CDSS) typically focus on clinical performance changes and do not include social, organizational, and contextual characteristics explaining use and effectiveness. Studies of CDSS for intensive insulin therapy (IIT) are no exception, and the literature lacks an understanding of effective computer-based IIT implementation and operation.

Thomas R. Campion Jr.; Lemuel R. Waitman; Addison K. May; Asli Ozdas; Nancy M. Lorenzi; Cynthia S. Gadd

2010-01-01

67

Differentiation of Calcium Oxalate Monohydrate and Calcium Oxalate Dihydrate Stones Using Quantitative Morphological Information from Micro-Computerized and Clinical Computerized Tomography  

PubMed Central

Purpose We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images. Materials and Methods A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 ?m. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index. Results On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively. Conclusions On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy.

Duan, Xinhui; Qu, Mingliang; Wang, Jia; Trevathan, James; Vrtiska, Terri; Williams, James C.; Krambeck, Amy; Lieske, John; McCollough, Cynthia

2014-01-01

68

Computerized provider order entry in the clinical laboratory  

PubMed Central

Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE) systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption.

Baron, Jason M.; Dighe, Anand S.

2011-01-01

69

Network based clinical decision support system  

Microsoft Academic Search

Developed prototype of network based clinical decision support system consists of database of clinical data and web-based applications for signal and image analysis methods and algorithms. The methods for eye fundus image analysis and ECG P-wave morphology evaluation are the first methods covering two clinical specialties - cardiology and ophthalmology in the system. Network based database and combined analysis of

D. Jegelevicius; A. Krisciukaitis; A. Lukosevicius; V. Marozas; A. Paunksnis; V. Barzdziukas; M. Patasius; D. Buteikiene; A. Vainoras; L. Gargasas

2009-01-01

70

Overview of Clinical Decision Support Systems  

Microsoft Academic Search

Clinical decision support systems (CDSS) are computer systems designed to impact clinician decision making about individual\\u000a patients at the point in time that these decisions are made.With the increased focus on the prevention of medical errors that\\u000a has occurred since the publication of the landmark Institute of Medicine report, To Err Is Human, computer-based physician order entry (CPOE) systems, coupled

Eta S. Berner; Tonya J. La Lande

71

An Introduction to Clinical Decision Support Systems  

Microsoft Academic Search

Library support of clinical decision making ranges from passive (traditional library collections of books and journals) to highly active (professional services, such as clinical medical librarians, LATCH, and informationists). Support of mobile computing resources and subscriptions to point-of-care services, such as UpToDate® and DynaMed®, moves libraries toward interactive resources to aid health care providers in their decisions about specific patient

Mary Moore; Kimberly A. Loper

2011-01-01

72

Assessing cardiovascular drug safety for clinical decision-making.  

PubMed

Optimal therapeutic decision-making requires integration of patient-specific and therapy-specific information at the point of care, particularly when treating patients with complex cardiovascular conditions. The formidable task for the prescriber is to synthesize information about all therapeutic options and match the best treatment with the characteristics of the individual patient. Computerized decision support systems have been developed with the goal of integrating such information and presenting the acceptable therapeutic options on the basis of their effectiveness, often with limited consideration of their safety for a specific patient. Assessing the safety of therapies relative to each patient is difficult, and sometimes impossible, because the evidence required to make such an assessment is either imperfect or does not exist. In addition, many of the alerts sent to prescribers by decision-support systems are not perceived as credible, and 'alert fatigue' causes warnings to be ignored putting patients at risk of harm. The CredibleMeds.org and BrugadaDrugs.org websites are prototypes for evidence-based sources of safety information that rank drugs for their risk of a specific form of drug toxicity-in these cases, drug-induced arrhythmias. Broad incorporation of this type of information in electronic prescribing algorithms and clinical decision support could speed the evolution of safe personalized medicine. PMID:23591268

Woosley, Raymond L; Romero, Klaus

2013-06-01

73

A shotgun wedding: business decision support meets clinical decision support.  

PubMed

By effectively closing the loop between the data, analytics, processes, and methods supporting business and clinical decision making, a healthcare organization closes the loop between its knowledge generation activities and its actions at the bedside: knowledge guiding actions, actions generating knowledge. PMID:12365296

Oliveira, Jason

2002-01-01

74

The physician compliance of red blood cell transfusion by computerized transfusion decision support system.  

PubMed

"When should we trigger a transfusion?" is always a critical question between the patient's benefits and risks in red blood cell (RBC) transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting RBC transfusion were investigated. In total 20,551 RBC-transfusion episodes between January and December 2008 were reviewed. The nearest hemoglobin concentration before transfusion is defined as the transfusion trigger. The physician compliance, the factors associated with the transfusion triggers and posttransfusion hemoglobin increment were investigated. The physician compliance is 83.1%. The transfusion trigger is 8.32 ± 1.84 (mean ± standard deviation) g/dL. The transfusion triggers are statistically significant in terms of both different order sources and disease types (p<0.05).The posttransfusion hemoglobin level increased in two-thirds of the episodes. The percentages of hemoglobin increments after transfusion are dependent on the transfusion triggers. Appropriate transfusion practice may reduce the overuse of blood components and improve transfusion quality. CTDSS should be more powerful to intervene in the appropriateness of transfusion practice. PMID:22632889

Chang, Chao-Sung; Lin, Yu-Chih; Lin, Chiu-Chu; Yeh, Chi-Jung; Wu, Yung-Chao; Lin, Yi-Ching

2012-06-01

75

Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in \\  

Microsoft Academic Search

BACKGROUND: Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational

Madhukar H Trivedi; Ella J Daly; Janet K Kern; Bruce D Grannemann; Prabha Sunderajan; Cynthia A Claassen

2009-01-01

76

Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines  

PubMed Central

Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline.

2010-01-01

77

Structuring clinical practice guidelines in a relational database model for decision support on the Internet.  

PubMed Central

The rapid proliferation of clinical practice guidelines (CPGs) has made computerization increasingly useful to clinicians. Computerization, however, requires transformation of the content and logic of each guideline into a computer-accessible form. In this project, we sought to use a relational database to construct a generalized guideline knowledge base for use with Internet-based decision support applications. We hypothesized that knowledge representation schemes could be developed to capture guideline content and logic within the constraints of a relational database model. In this paper we describe a database schema based on a relational model for computerizing CPGs using a hybrid of structured and procedural knowledge representation schemes. We developed and refined this model in the context of five diverse CPGs and found it accommodated all necessary representational requirements.

Lobach, D. F.; Gadd, C. S.; Hales, J. W.

1997-01-01

78

Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia  

Microsoft Academic Search

Background Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient\\u000a at increased risk of thrombotic events. Objective A clinical decision support system (CDSS) was developed to alert physicians using computerized provider order entry when\\u000a a patient with an active order for heparin experienced platelet count decreases consistent with HIT. Methods Comparisons for timeliness

Jeffrey M. Riggio; Mandelin K. Cooper; Benjamin E. Leiby; Jeanine M. Walenga; Geno J. Merli; Jonathan E. Gottlieb

2009-01-01

79

Knowledge taxonomy for Clinical Practice Guidelines - Implications for Computerization  

Microsoft Academic Search

Much effort has been put into developing clinical practice guidelines (CPG's), but yet the effect of CPG's is limited. A path for better practitioner adherence to CPG's could be to offer IT-based process support, based on CPG's To accomplish this it is necessary to transform existing narrative CPG's into a computer-readable format. Based on an analysis of a corpus of

Karen Marie Lyng

80

Using Computational Intelligence to Develop Intelligent Clinical Decision Support Systems  

Microsoft Academic Search

\\u000a Clinical Decision Support Systems have the potential to optimize medical decisions, improve medical care, and reduce costs.\\u000a An effective strategy to reach these goals is by transforming conventional Clinical Decision Support in Intelligent Clinical\\u000a Decision Support, using knowledge discovery in data and computational intelligence tools. In this paper we used genetic programming\\u000a and decision trees. Adaptive Intelligent Clinical Decision Support

Alexandru G. Floares

2009-01-01

81

Computerized Tomography Scans in Severe Asthma: Utility and Clinical Implications  

PubMed Central

Purpose of Review Asthma is a global burden, affecting 5% of the general adult population, of whom approximately 5-10% suffer from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Increasingly novel techniques in computerised tomography are being used to understand the pathophysiology of severe asthma. The utility and clinical implications of these CT techniques are the focus of this review. Recent Findings Novel qualitative and quantitative CT imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure, and perform functional analysis of regional ventilation. Summary Despite advances in CT imaging techniques, there is an urgent need for both proof-of-concept studies, large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure-function relationship, with the potential to discover novel severe asthma phenotypes, predict mortality, morbidity, and response to existing and novel pharmacological and non-pharmacological therapies.

Walker, Carolina; Gupta, Sumit; Hartley, Ruth; Brightling, Christopher E

2012-01-01

82

Research Paper: Exploring Barriers and Facilitators to the Use of Computerized Clinical Reminders  

Microsoft Academic Search

ObjectiveEvidence-based practices in preventive care and chronic disease management are inconsistently implemented. Computerized clinical reminders (CRs) can improve compliance with these practices in outpatient settings. However, since clinician adherence to CR recommendations is quite variable and declines over time, we conducted observations to determine barriers and facilitators to the effective use of CRs.DesignWe conducted an observational study of nurses and

Jason J. Saleem; Emily S. Patterson; Laura G. Militello; Marta L. Render; Greg Orshansky; Steven M. Asch

2005-01-01

83

Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey  

Microsoft Academic Search

ObjectiveGiven the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation.Design and MeasurementsA representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They

GABRIEL M. LEUNG; PHILIP L. H. YU; IRENE O. L. WONG; JANICE M. JOHNSTON; KEITH Y. K. TIN

2003-01-01

84

User-adapted clinical decision support systems  

Microsoft Academic Search

Clinical Decision Support Systems (CDSSs) have been one of the challenging real-world applications of artifi- cial intelligence techniques for decades. CDSSs built so far mainly deal with explicit medical knowledge, typically encoded into a knowledge base. The ratio- nale is that medical personal knowledge may be updated or time constraints limit physicians' ability to properly manage that knowledge. However, inter-user

Andrea Sboner; Riccardo Bellazzi; Paolo Carli; Mario Cristofolini

85

An intelligent information systems architecture for clinical decision support on the Internet.  

PubMed Central

This paper presents a prototype of an agent-based intelligent information systems architecture that can provide clinical decision support in a distributed, heterogeneous environment such as the Internet. After presenting the architecture, a specific transaction sequence is detailed and implemented to test the architecture. A transaction sequence is a detailed analysis of all actions by all entities to accomplish the system goal. In this case, the goal is to give decision support information access to a provider in the context of a computerized patient record. Based on the results of the prototype implementation, we argue that the system is scaleable and discuss other transactions, standards, and needed development.

Canfield, K.; Ramesh, V.; Quirolgico, S.; Silva, M.

1996-01-01

86

Modelling and Decision Support of Clinical Pathways  

NASA Astrophysics Data System (ADS)

The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems.

Gabriel, Roland; Lux, Thomas

87

Protocol for implementation of family health history collection and decision support into primary care using a computerized family health history system  

PubMed Central

Background The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is using an implementation research (T3 research) framework to develop and integrate a self-administered computerized family history system with built-in decision support into 2 primary care clinics in North Carolina. Methods/Design The family health history system collects a three generation family history on 48 conditions and provides decision support (pedigree and tabular family history, provider recommendation report and patient summary report) for 4 pilot conditions: breast cancer, ovarian cancer, colon cancer, and thrombosis. All adult English-speaking, non-adopted, patients scheduled for well-visits are invited to complete the family health system prior to their appointment. Decision support documents are entered into the medical record and available to provider's prior to the appointment. In order to optimize integration, components were piloted by stakeholders prior to and during implementation. Primary outcomes are change in appropriate testing for hereditary thrombophilia and screening for breast cancer, colon cancer, and ovarian cancer one year after study enrollment. Secondary outcomes include implementation measures related to the benefits and burdens of the family health system and its impact on clinic workflow, patients' risk perception, and intention to change health related behaviors. Outcomes are assessed through chart review, patient surveys at baseline and follow-up, and provider surveys. Clinical validity of the decision support is calculated by comparing its recommendations to those made by a genetic counselor reviewing the same pedigree; and clinical utility is demonstrated through reclassification rates and changes in appropriate screening (the primary outcome). Discussion This study integrates a computerized family health history system within the context of a routine well-visit appointment to overcome many of the existing barriers to collection and use of family history information by primary care providers. Results of the implementation process, its acceptability to patients and providers, modifications necessary to optimize the system, and impact on clinical care can serve to guide future implementation projects for both family history and other tools of personalized medicine, such as health risk assessments.

2011-01-01

88

A discussion of clinical decision support services.  

PubMed

The software known as Clinical Decision Support Services (CDSS) has emerged as a buzzword from the explosion of information systems within health care. CDSS is installed within a practice to provide resources and tools to support the utilization of patient data in the provider decision-making process. Additional applications of CDSS include streamlining administrative duties and assisting in cost control. This paper examines the details of CDSS design and implementation to analyze strengths, weaknesses, and feasibility of CDSS for practices of varying sizes and objectives. PMID:23787710

Booker, Corenthian Corey J; Andrews, Paige N

2013-09-01

89

Impact of Clinical Reminder Redesign on Physicians' Priority Decisions  

PubMed Central

Objective Computerized clinical reminder (CCR) systems can improve preventive service delivery by providing patient-specific reminders at the point of care. However, adherence varies between individual CCRs and is correlated to resolution time amongst other factors. This study aimed to evaluate how a proposed CCR redesign providing information explaining why the CCRs occurred would impact providers’ prioritization of individual CCRs. Design Two CCR designs were prototyped to represent the original and the new design, respectively. The new CCR design incorporated a knowledge-based risk factor repository, a prioritization mechanism, and a role-based filter. Sixteen physicians participated in a controlled experiment to compare the use of the original and the new CCR systems. The subjects individually simulated a scenario-based patient encounter, followed by a semi-structured interview and survey. Measurements We collected and analyzed the order in which the CCRs were prioritized, the perceived usefulness of each design feature, and semi-structured interview data. Results We elicited the prioritization heuristics used by the physicians, and found a CCR system needed to be relevant, easy to resolve, and integrated with workflow. The redesign impacted 80% of physicians and 44% of prioritization decisions. Decisions were no longer correlated to resolution time given the new design. The proposed design features were rated useful or very useful. Conclusion This study demonstrated that the redesign of a CCR system using a knowledge-based risk factor repository, a prioritization mechanism, and a role-based filter can impact clinicians’ decision making. These features are expected to ultimately improve the quality of care and patient safety.

Wu, Sze-jung; Lehto, Mark R.; Yih, Yuehwern; Saleem, Jason J.; Doebbeling, B.N.

2010-01-01

90

Clinical decision support systems and antibiotic use  

Microsoft Academic Search

Aim  To review and appraise randomised controlled trials (RCT) and ‘before and after' studies published on clinical decision support\\u000a systems (CDSS) used to support the use of antibiotics.\\u000a \\u000a \\u000a \\u000a Methods  A literature search was carried out in October 2006 using MEDLINE including Medical Subject Heading (MeSH) terms (1966–2006),\\u000a EMBASE (Excerpta Medica, 1980–2006) and International Pharmaceutical Abstracts (IPA, 1970–2006) using the combinations of\\u000a the

Nada Atef Shebl; Bryony Dean Franklin; Nick Barber

2007-01-01

91

Electronic information and clinical decision support for prescribing: state of play in Australian general practice  

PubMed Central

Background. Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access. Objective. To determine GPs’ access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing. Methods. Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken. Results. Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs. Conclusions. The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain.

Robertson, Jane; Moxey, Annette J; Newby, David A; Gillies, Malcolm B; Williamson, Margaret; Pearson, Sallie-Anne

2011-01-01

92

'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing  

PubMed Central

Objective Computerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care. Materials and methods Quantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices. Results 132 prescriptions were issued in the course of 73 of the consultations, of which 81 (61%) attracted at least one alert. Of the total of 117 alerts, only three resulted in the GP checking, but not altering, the prescription. CDSS provided information and safety alerts at the point of generating a prescription. This was ‘too much, too late’ as the majority of the ‘work’ of prescribing occurred prior to using the computer. By the time an alert appeared, the GP had formulated the problem(s), potentially spent several minutes considering, explaining, negotiating, and reaching agreement with the patient about the proposed treatment, and had possibly given instructions and printed an information leaflet. Discussion CDSS alerts do not coincide with the prescribing workflow throughout the whole GP consultation. Current systems interrupt to correct decisions that have already been taken, rather than assisting formulation of the management plan. Conclusions CDSS are likely to be more acceptable and effective if the prescribing support is provided much earlier in the process of generating a prescription.

Hayward, James; Thomson, Fionagh; Milne, Heather; Buckingham, Susan; Sheikh, Aziz; Fernando, Bernard; Cresswell, Kathrin; Williams, Robin; Pinnock, Hilary

2013-01-01

93

Ontology-based Modeling of Clinical Practice Guidelines: A Clinical Decision Support System for Breast Cancer Follow-up Interventions at Primary Care Settings  

Microsoft Academic Search

Breast cancer follow-up care can be provided by family phy- sicians after specialists complete the primary treatment. Can- cer Care Nova Scotia has developed a breast cancer follow- up Clinical Practice Guideline (CPG) targeting family physi- cians. In this paper we present a project to computerize and deploy the said CPG in a Breast Cancer Follow-up Decision Support System (BCF-DSS)

Samina Raza Abidi; Syed Sibte Raza Abidi; Sajjad Hussain; Mike Shepherd

2007-01-01

94

Computerized systems for high level information processing and decision making in the field of PSA.  

National Technical Information Service (NTIS)

A comprehensive review of Probabilistic Safety Assessment (PSA) related program packages is made. Three fields in methodological succession are covered: plant modeling, data quantification procedures and decision-making support. Packages for fault tree co...

P. Kafka H. Kunitz

1990-01-01

95

[Clinical trial of BOBCAT: 1st report on the reliability and validity of computerized pure-tone audiometry].  

PubMed

Computerized diagnostic audiometry is quickly emerging as a viable productivity tool in the audiology clinic. To date, there has been little reported on its reliability and validity with the hearing-impaired. The 'Battery of Basic Computerized Audiometric Tests' (BOBCAT) is a computer program which puts a wide variety of clinical hearing tests under computer control. The purpose of the present study was to ascertain the reliability and validity of BOBCAT in the measurement of hearing sensitivity. A field study was conducted in a group of 92 workers exposed to noise to measure air- and bone-conduction thresholds. Coefficients of reliability of 0.85 and higher were obtained between air and bone thresholds for both methods of testing; that is, manual and computer-controlled audiometry. The same measurement between manual and computerized air-conduction pure-tone thresholds gave values ranging from 0.93 to 0.98. A principal-components analysis documented content validity of computerized audiometry. These results are interpreted as clear evidence of both reliability and validity of the BOBCAT procedure, with one exception: 6.7% of all observations are showing air-conduction computerized thresholds of -10 dB at one or more frequencies, with no confirmation by manual audiometry. This is attributed to insufficient randomization of intervals between stimuli, a problem which should be taken care of by new versions of the software. PMID:3056359

Picard, M; Ilecki, H J; Baxter, J D

1988-01-01

96

Engineering of a Clinical Decision Support Framework for the Point of Care Use  

PubMed Central

Computerized decision support for use at the point of care has to be comprehensive. It means that clinical information stored in electronic health records needs to be integrated with various forms of clinical knowledge (elicited from experts, discovered from data or summarized in systematic reviews of clinical trials). In order to provide such comprehensive support we created the MET-A3Support framework for constructing clinical applications aimed at various medical conditions. We employed the multiagent system paradigm and the O-MaSE methodology to define an engineering process involving three main activities: requirements engineering, analysis and design. Then we applied the process to build MET-A3Support. The paper describes the engineering process and its results, including models representing selected elements of our framework.

Wilk, Szymon; Michalowski, Wojtek; O'Sullivan, Dympna; Farion, Ken; Matwin, Stan

2008-01-01

97

Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success  

PubMed Central

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Murphy, Elizabeth V.

2014-01-01

98

Ethical implications of standardization of ICU care with computerized protocols.  

PubMed Central

Ethical issues related to the use of computerized protocols to control mechanical ventilation of patients with Acute Respiratory Distress Syndrome (ARDS) are identical to the ethical issues surrounding the use of any therapy or intervention. Four ethical principles must be considered: nonmaleficence, beneficence, autonomy, and distributed justice. The major ethical challenges to computerized protocol use as a specific application of clinical decision support tools are found within the principles of nonmaleficence and of beneficence. The absence of credible outcome data on which ARDS patient survival probabilities with different therapeutic options could be based is a constraint common to most ICU clinical decision making. Clinicians are thus deprived of the knowledge necessary to define benefit and are limited to beneficent intention in clinical decisions. Computerized protocol controlled decision making for the clinical management of mechanical ventilation for ARDS patients is ethically defensible. It is as well supported as most ICU therapy options.

Morris, A. H.; East, T. D.; Wallace, C. J.; Orme, J.; Clemmer, T.; Weaver, L.; Thomas, F.; Dean, N.; Pearl, J.; Rasmusson, B.

1994-01-01

99

The adolescent health review: test of a computerized screening tool in school-based clinics.  

PubMed

This study tested the viability of a stand-alone screening process in school-based health centers, and gauged its acceptance by patients and providers. The study also examined the prevalence of a variety of health risks disclosed in response to a new screening instrument and the relationship between these health risks and the stated purpose for the clinic visit. Seven school-based clinics located in six high schools and one alternative school in an urban school district participated in the study; 692 patients (83% female, 67% minority) completed the Adolescent Health Review (AHR), a multidimensional screening instrument that addressed 14 risk domains. The AHR was computerized for administration, scoring, and report generation. Females reported risk in significantly more domains than males (4.2 vs. 3.2; t = 4.5, p < .0001), including higher risk in family interaction problems, a history of physical or sexual abuse, emotional distress, suicidal behavior, marijuana use, and sexual activity. Significantly more males than females reported violent behavior. Risk rates were high regardless of stated purpose for the clinic visit. According to clinic staff, use of the AHR increased routine screening and the process was well accepted by patients and providers. Providers benefited from the opportunity to discuss risks with patients by using the printed reports to facilitate conversation and develop health care plans. PMID:12621719

Harrison, Patricia A; Beebe, Timothy J; Park, Eunkyung; Rancone, Jeanne

2003-01-01

100

Knowledge engineering for medical decision making: A review of computer-based clinical decision aids  

Microsoft Academic Search

Computer-based models of medical decision making account for a large portion of clinical computing efforts. This article reviews representative examples from each of several major medical computing paradigms. These include 1) clinical algorithms, 2) clinical databanks that include analytic functions, 3) mathematical models of physical processes, 4) pattern recognition, 5) Bayesian statistics, 6) decision analysis, and 7) symbolic reasoning or

EDWARD H. SHORTLIFFE; BRUCE G. BUCHANAN; EDWARD A. FEIGENBAUM

1979-01-01

101

CADMIUM II: acquisition and representation of radiological knowledge for computerized decision support in mammography.  

PubMed Central

CADMIUM II is a system for the interpretation of mammograms. A novel aspect of the system is that it combines symbolic reasoning with image processing, in contrast with most other approaches, which use only image processing and rely on artificial neural networks (ANNs) to classify mammograms. A problem of ANNs is that the advice they give cannot be traced back to communicable diagnostic inferences. Our approach is to provide advice based on explicit knowledge about the diagnostic process. To this end, we have conducted a knowledge elicitation study which looked at the descriptors used by expert radiologists when making diagnostic decisions about mammograms. The analysis of the radiologists' reports yielded a set of salient diagnostic features. These were used to inform the advice provided by the symbolic decision making component of CADMIUM II.

Alberdi, E.; Taylor, P.; Lee, R.; Fox, J.; Sordo, M.; Todd-Pokropek, A.

2000-01-01

102

PRACTICAL ASPECTS OF COMPUTER-BASED CLINICAL DECISION SUPPORT SYSTEMS  

Microsoft Academic Search

The general problem of computer-based clinical decision support systems is considered. A class of rules in medical databases characteristic for therapeutic decisions has been distinguished. The necessity of application of a complete set of data for learning computerised systems of decision support has been pointed out. Rough set approach is applied to the analysis of the problem. An illustrative example

Andrzej OSSOWSKI

2002-01-01

103

A strategy for development of computerized critical care decision support systems  

Microsoft Academic Search

It is not enough to merely manage medical information. It is difficult to justify the cost of hospital information systems\\u000a (HIS) or intensive care unit (ICU) patient data management systems (PDMS) on this basis alone. The real benefit of an integrated\\u000a HIS or PDMS is in decision support. Although there are a variety of HIS and ICU PDMS systems available

Thomas D. East; Alan H. Morris; C. Jane Wallace; Terry P. Clemmer; James F. Orme; Lindell K. Weaver; Susan Henderson; Dean F. Sittig

1991-01-01

104

Reducing Diagnostic Error with Computer-Based Clinical Decision Support  

ERIC Educational Resources Information Center

Information technology approaches to delivering diagnostic clinical decision support (CDS) are the subject of the papers to follow in the proceedings. These will address the history of CDS and present day approaches (Miller), evaluation of diagnostic CDS methods (Friedman), and the role of clinical documentation in supporting diagnostic decision

Greenes, Robert A.

2009-01-01

105

Information architecture of a clinical decision support system  

Microsoft Academic Search

Recent healthcare legislation, the move to electronic health records, and the accelerating pace of medical knowledge discovery combine to create an environment in which clinical decision support systems are a necessary part of most medical processes. Based on a review of current best practices, we present the information architecture of a clinical decision support system comprised of four primary components:

David E. Robbins; Varadraj P. Gurupur; John Tanik

2011-01-01

106

CDSS (Clinical Decision Support System) Architecture in Korea  

Microsoft Academic Search

We present architecture for implementing independent, extensible, and interoperable clinical decision support service in perspective of EHR. In this architecture, components for implementing independent knowledge service and interface mechanism with EHR service or existing hospital information system are identified. In our architecture knowledge engine is critical component for implementing knowledge service. In this paper, we suggested interoperable CDSS(clinical decision support

Jeong Ah Kim; InSook Cho; Yoon Kim

2008-01-01

107

Evaluating informatics applications - clinical decision support systems literature review  

Microsoft Academic Search

This paper reviews clinical decision support systems (CDSS) literature, with a focus on evaluation. The literature indicates a general consensus that clinical decision support systems are thought to have the potential to improve care. Evidence is more equivocal for guidelines and for systems to aid physicians with diagnosis. There also is general consensus that a variety of systems are little

Bonnie Kaplan

2001-01-01

108

Clinical Decision Support System Applied the Analytic Hierarchy Process  

Microsoft Academic Search

\\u000a We describe a clinical decision support system applied the Analytic Hierarchy Process (AHP), with taking planning lifestyle\\u000a modifications for Diabetic patients as an example. From our results, clinical decision support systems applied the AHP can\\u000a promote interactive decision making through finding a point of agreement among (1) physician’s aspect based on experience\\u000a and belief, (2) patient’s aspect based on characteristics,

Machi Suka; Takumi Ichimura; Katsumi Yoshida

2003-01-01

109

Clinical Decision Support Systems in Psychiatry in the Information Age  

Microsoft Academic Search

Objective: Clinical decision support systems (CDSSs) are active knowledge systems that use two or more items of patient data to generate case-specific advice. They were developed to improve health-care quality. There is evidence that they can be a valuable tool in fostering the process of dissemination and uptake of clinical guidelines that, in turn, can improve clinical decision-making and outcomes.

Beth Kotze; Bilyana Brdaroska

2004-01-01

110

Instrumentation considerations of a clinical and a computerized technique for the measurement of foot angles.  

PubMed

Measurement of the foot angles either directly from the patient, from video images, or from radiographs is integral to podiatric clinical practice to confirm diagnoses and to plan, prescribe, and monitor treatment protocols. The reliability, precision, and accuracy involved in any measured value limits the validity and usefulness of the measurement to optimal patient management. Studies are described that ensured the accuracy and validity of the standard clinical tool, the universal goniometer (UG), by applying a calibration protocol. These same calibration angles were then measured by a computer-assisted human movement analysis system, the Ariel Performance Analysis System (APAS). The APAS was found to overestimate consistently the UG angular measures by less than 1 degree and this amount of error was considered clinically irrelevant. The angular results obtained by a clinician and a technician using the APAS on two separate days were tested and were found to be comparable and reliable to within 1 degree, and thus the analysis was deemed to be of excellent reliability and precision. The study found that clinicians could establish the accuracy and validity of their instruments by means of simple calibration, and that computer measures could be repeated on patients by a clinical or a technician. The simple calibration procedure described will assist the clinician to ensure that the measures obtained in the clinical setting have minimal measurement error and that the values can be confidently used to make decisions and draw clinical inferences. PMID:9798173

Stacpoole-Shea, S; Shea, G; Otago, L; Payne, W

1998-01-01

111

A Randomized Trial Using Computerized Decision Support to Improve Treatment of Major Depression in Primary Care  

PubMed Central

OBJECTIVE To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression. DESIGN Randomized controlled trial. SETTING Academically affiliated primary care practice in Pittsburgh, PA. PATIENTS Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria. INTERVENTION PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: “active care” (AC), “passive care” (PC), or “usual care” (UC). MEASUREMENTS AND MAIN RESULTS Patients' 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D ?7). Patients' mean HRS-D score decreased regardless of their PCPs' guideline-exposure condition (20.4 to 14.2 from baseline to 6-month follow-up; P < .001). However, neither continuous (HRS-D ?7: 22% AC, 23% PC, 22% UC; P = .8) nor categorical measures of recovery (P = .2) differed by EMR exposure condition upon follow-up. Care processes for depression were also similar by PCP assignment despite exposure to repeated reminders of the depression diagnosis and treatment advice (e.g., depression mentioned in ?3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P = .09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P = .3). CONCLUSIONS Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.

Rollman, Bruce L; Hanusa, Barbara H; Lowe, Henry J; Gilbert, Trae; Kapoor, Wishwa N; Schulberg, Herbert C

2002-01-01

112

Clinical decision support for imaging in the era of the Patient Protection and Affordable Care Act.  

PubMed

Imaging clinical decision support (CDS) systems provide evidence for or against imaging procedures ordered within a computerized physician order entry system at the time of the image order. Depending on the pertinent clinical history provided by the ordering clinician, CDS systems can optimize imaging by educating providers on appropriate image order entry and by alerting providers to the results of prior, potentially relevant imaging procedures, thereby reducing redundant imaging. The American Recovery and Reinvestment Act (ARRA) has expedited the adoption of computerized physician order entry and CDS systems in health care through the creation of financial incentives and penalties to promote the "meaningful use" of health IT. Meaningful use represents the latest logical next step in a long chain of legislation promoting the areas of appropriate imaging utilization, accurate reporting, and IT. It is uncertain if large-scale implementation of imaging CDS will lead to improved health care quality, as seen in smaller settings, or to improved patient outcomes. However, imaging CDS enables the correlation of existing imaging evidence with outcome measures, including morbidity, mortality, and short-term imaging-relevant management outcomes (eg, biopsy, chemotherapy). The purposes of this article are to review the legislative sequence relevant to imaging CDS and to give guidance to radiology practices focused on quality and financial performance improvement during this time of accelerating regulatory change. PMID:23206649

Zafar, Hanna M; Mills, Angela M; Khorasani, Ramin; Langlotz, Curtis P

2012-12-01

113

Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk  

PubMed Central

OBJECTIVE The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. RESEARCH DESIGN AND METHODS A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD? patients, respectively). RESULTS Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (€1,415, P = NS), resulting in an ICER of €38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of €20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = €14,814) than for CVD? patients (ICER = €121,285). Coronary heart disease costs were reduced (€?587, P < 0.05). CONCLUSIONS DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD.

Cleveringa, Frits G.W.; Welsing, Paco M.J.; van den Donk, Maureen; Gorter, Kees J.; Niessen, Louis W.; Rutten, Guy E.H.M.; Redekop, William K.

2010-01-01

114

Formalizing Clinical Decisions in Individual Treatments: Some First Steps  

Microsoft Academic Search

A fundamental problem in forensic psychology practice is the lack of formal statistical methods to support team decisions about an individual patient's progress during intramural treatment. It is common practice to base decisions about the progress of a treatment on subjective clinical impressions of therapists. In this article, an approach is proposed that can be seen as a contribution to

Marinus Spreen; Marieke E. Timmerman; Paul Ter Horst; Erwin Schuringa

2010-01-01

115

A Clinical Decision Support System For Managing Flexor Tendon Injuries  

Microsoft Academic Search

A Clinical Decision Support System has been developed using the Exsys software for the flexor tendon injuries in Zone II encompassing the continuum from injury to complete rehabilitation of the tendon. The system architecture uses the rules based logic blocks to create a decision support system, which takes the user through series of questions, and based on the answers input,

Prashant Junankar; Dinesh P. Mital; Syed Haque; Shankar Srinivasan

2006-01-01

116

A privacy-preserving framework for distributed clinical decision support  

Microsoft Academic Search

We propose a framework for distributed knowledge-mining that results in a useful clinical decision support tool in the form of a decision tree. This framework facilitates knowledge building using statistics based on patient data from multiple sites that satisfy a certain filtering condition, without the need for actual data to leave the participating sites. Our information retrieval and diagnostics supporting

George Mathew; Zoran Obradovic

2011-01-01

117

An Interoperable Framework for a Clinical Decision Support System  

Microsoft Academic Search

Abstract The healthcare sector is facing a significant challenge: delivering quality clinical care in a costly and intricate environment. There is a general consensus that a solution for many,aspects of this problem,lies in establishing a framework,for effective and efficient clinical decision support. The key to good decision support is offering clinicians just-in-time accessibility to relevant patient specific knowledge. However, at

Iryna Bilykh

118

Evaluation of a Guideline-Based Decision Support System.  

National Technical Information Service (NTIS)

Clinical practice guidelines are underutilized in the clinical setting. Computerized decision support systems may facilitate utilization. The objective of the report is to evaluate the impact a technically optimized, Web-based, interactive guideline prese...

D. F. Lobach

2003-01-01

119

A Framework and Model for Evaluating Clinical Decision Support Architectures  

PubMed Central

In this paper, we develop a four-phase model for evaluating architectures for clinical decision support that focuses on: defining a set of desirable features for a decision support architecture; building a proof-of-concept prototype; demonstrating that the architecture is useful by showing that it can be integrated with existing decision support systems and comparing its coverage to that of other architectures. We apply this framework to several well-known decision support architectures, including Arden Syntax, GLIF, SEBASTIAN and SAGE

Wright, Adam; Sittig, Dean F.

2008-01-01

120

A modular Clinical Decision Support System Clinical prototype extensible into multiple clinical settings  

Microsoft Academic Search

Traditionally, Clinical Decision Support Systems (CDSS) collect patient data from physiological monitors and other sources, providing clinicians with derived instructions and information to aid treatment planning. With advancements in telecommunication networks, CDSS functionality can be extended over distances, and accessed remotely (e.g. by appropriate healthcare providers not available in the patient's immediate surroundings). This paper discusses a modular CDSS that

Fran Wu; Mitch Williams; Peter Kazanzides; Ken Brady; Jim Fackler

2009-01-01

121

Risk assessment and clinical aeromedical decision-making.  

PubMed

This article presents a format of aeromedical decision-making used in neurology cases referred to a U.S. Navy Special Board of Flight Surgeons (SBFS) from 1988 to 1990. The format consists of a series of questions addressing aeromedical concerns, an aeromedical disposition flowchart, and a decision analysis tree. Decision Analysis is a tool used in clinical medicine to assist decision-making under conditions of uncertainty. The Decision Analysis approach may be applied to complex aeromedical disposition questions that face flight surgeons. The concept of risk assessment as it applies to decision-making and aeromedical disposition is discussed. The outcome of 24 neurology cases referred for aeromedical disposition are presented. PMID:8368988

Clark, J B

1993-08-01

122

Grand Challenges in Clinical Decision Support v10  

PubMed Central

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: Improve the human-computer interface; Disseminate best practices in CDS design, development, and implementation; Summarize patient-level information; Prioritize and filter recommendations to the user; Create an architecture for sharing executable CDS modules and services; Combine recommendations for patients with co-morbidities; Prioritize CDS content development and implementation; Create internet-accessible clinical decision support repositories; Use freetext information to drive clinical decision support; Mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare.

Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A.; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

2008-01-01

123

PRO forma: a general technology for clinical decision support systems  

Microsoft Academic Search

The need for flexible and well understood knowledge representations which are capable of capturing clinical guidelines and protocols for decision support systems is widely recognised. The PROforma method for specifying clinical guidelines and protocols comprises a graphical notation for their design, and a formal knowledge representation language to enable them to be executed by a computer to support the management

John Fox; Nicky Johns; Colin Lyons; Ali Rahmanzadeh; Richard Thomson; Peter Wilson

1997-01-01

124

Virtual medical record implementation for enhancing clinical decision support.  

PubMed

Development of clinical decision support systems (CDS) is a process which highly depends on the local databases, this resulting in low interoperability. To increase the interoperability of CDS a standard representation of clinical information is needed. The paper suggests a CDS architecture which integrates several HL7 standards and the new vMR (virtual Medical Record). The clinical information for the CDS systems (the vMR) is represented with Topic Maps technology. Beside the implementation of the vMR, the architecture integrates: a Data Manager, an interface, a decision making system (based on Egadss), a retrieving data module. Conclusions are issued. PMID:22874164

Gomoi, Valentin-Sergiu; Dragu, Daniel; Stoicu-Tivadar, Vasile

2012-01-01

125

Cognitive Elements in Clinical Decision-Making  

ERIC Educational Resources Information Center

Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for…

Dunphy, Bruce C.; Cantwell, Robert; Bourke, Sid; Fleming, Mark; Smith, Bruce; Joseph, K. S.; Dunphy, Stacey L

2010-01-01

126

ISABEL: a novel Internet-delivered clinical decision support system  

Microsoft Academic Search

The development, and the results of clinical evaluation of ISABEL, an Internet- delivered integrated clinical decision-support system developed over the past 3 years, is described. Utilising a novel technique, pattern-recognition software from AutonomyTM is used to search standard medical text. The system consists of an innovative differential diagnosis tool to provide a list of potential diagnoses for a patient's clinical

P Ramnarayan; G Kulkarni; A Tomlinson; J Britto

127

CLINICAL DECISION-SUPPORT SYSTEMS IN RADIATION THERAPY  

Microsoft Academic Search

Computers have been used in radiation therapy since the early 1960s to perform dose calculations. In the last decade, researchers have developed computer-based clinical decision-support systems for assisting in different decision-making tasks in radiation therapy. This paper reviews eleven prototype systems developed for target volume delineation, treatment planning, treatment plan evaluation, and treatment machine diagnosis. The advent of three-dimensional (3D)

NILESH L. JAIN; MICHAEL G. KAHN

1993-01-01

128

Computerized Physician Order Entry  

PubMed Central

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.

Khanna, Raman; Yen, Tony

2014-01-01

129

Medical and nursing clinical decision making: a comparative epistemological analysis.  

PubMed

The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skillful conduct of clinical decision making. PMID:15189556

Rashotte, Judy; Carnevale, F A

2004-07-01

130

Computerized Vocational Information System (CVIS): Evaluation Manual. A Futuristic Concept of Vocational and Educational Decision-Making.  

ERIC Educational Resources Information Center

Designed to assist Computerized Vocational Information System (CVIS) users in evaluating projects in local secondary school sites, the handbook provides users with a variety of variables or viewpoints from which to assess the CVIS system. Four different approaches are presented to CVIS evaluation: the analysis of use patterns; the reaction of…

Harris, JoAnn, Ed.

131

Improving clinical decision support using data mining techniques  

NASA Astrophysics Data System (ADS)

Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

Burn-Thornton, Kath E.; Thorpe, Simon I.

1999-02-01

132

Clinical Decision Making in Renal Pain Management  

PubMed Central

Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., while 100 patients belonged to the placebo group that was given distilled water (aqua redestilata). All patients completed visual analogue pain scale (VAPS) from 0 to 10 prior to and after the treatment. Results: Using EBM parameters Diclofenac Na and Metamizol were shown to be the most efficient in the treatment of renal colic. In these two groups, relative risk (RR) was 21 and 8,5% respectively; Absolute Risk Reduction (ARR) was 74 and 86% respectively, and Number Needed to Treat (NNT) was 1 for both groups, while chi-squared (X2) test has shown that there is no statistically significant difference between these two drugs when it comes to their effect. In the Butylscopolamine group, RR was 81; ARR 18%, while NNT was 5. With respect to side effects, only in his group it was shown that Relative Risk Increase (RRI) was 84, ARI 83%, while Number Needed to Harm (NNH) was 2. Conclusion: The most optimal medication for the treatment of renal colic according to EBM parameters is Diclofenac Na, followed by Metamizol. Butylscopolamine is not recommended for the treatment of renal colic.

Aganovic, Damir; Prcic, Alen; Kulovac, Benjamin; Hadziosmanovic, Osman

2012-01-01

133

The role of emotions in clinical reasoning and decision making.  

PubMed

What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic (hypothetico-deductive thinking) or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention-especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper's main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care. PMID:23975905

Marcum, James A

2013-10-01

134

Interactive financial decision support for clinical research trials.  

PubMed

The purpose of this article is to describe a decision support approach useful for evaluating proposals to conduct clinical research trials. Physicians often do not have the time or background to account for all the expenses of a clinical trial. Their evaluation process may be limited and driven by factors that do not indicate the potential for financial losses that a trial may impose. We analyzed clinical trial budget templates used by hospitals, health science centers, research universities, departments of medicine, and medical schools. We compiled a databank of costs and reviewed recent research trials conducted by the Department of Cardiothoracic Surgery in a major academic health science center. We then developed an interactive spreadsheet-based budgetary decision support approach that accounts for clinical trial income and costs. It can be tailored to provide quick and understandable data entry, accurate cost rates per subject, and clear go/no-go signals for the physician. PMID:21528831

Holler, Benjamin; Forgione, Dana A; Baisden, Clinton E; Abramson, David A; Calhoon, John H

2011-01-01

135

Examining the Relationship between Clinical Decision Support and Performance Measurement  

PubMed Central

In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges.

Haggstrom, David A.; Saleem, Jason J.; Militello, Laura G.; Arbuckle, Nicole; Flanagan, Mindy; Doebbeling, Bradley N.

2009-01-01

136

Using Clinical Decision Support Software in Health Insurance Company  

NASA Astrophysics Data System (ADS)

This paper proposes the idea to use Clinical Decision Support software in Health Insurance Company as a tool to reduce the expenses related to Medication Errors. As a prove that this class of software will help insurance companies reducing the expenses, the research was conducted in eight hospitals in United Arab Emirates to analyze the amount of preventable common Medication Errors in drug prescription.

Konovalov, R.; Kumlander, Deniss

137

A Clinical Decision Support System for Metabolism Synthesis  

Microsoft Academic Search

Improving the quality of healthcare, reducing medical errors, guarantying the safety of patients is the most serious duty of the hospital. In this paper, a practical guideline-based clinical decision support system for metabolism synthesis is proposed. Firstly, the medical logic model was established; secondly, the model was automatically converted to the ruler sets which could be used in computer for

Qunyi Zhou

2009-01-01

138

A computerized system to improve documentation and reporting of pharmacists' clinical interventions, cost savings, and workload activities.  

PubMed

A major factor in delivering patient care is documenting activities by pharmacists. This documentation is not only essential to sustain existing programs but necessary to justify future growth of resources. A computerized documentation system for clinical interventions and workload activities was developed in a 340-bed university teaching hospital. With the expansion of its pharmaceutical care model, the department reworked its distribution process to allocate more pharmacist time for patient care. Manual documentation of these services, however, soon was identified as an obstacle. A software program was developed to alleviate the problems inherent with manual documentation. This "user-friendly" program tracks clinical recommendations and interventions by pharmacists, and calculates cost savings/avoidance. It also facilitates monthly and annual reporting for department managers. PMID:7624270

Zimmerman, C R; Smolarek, R T; Stevenson, J G

1995-01-01

139

The Relationship Between the Clinical Orientation of Substance Abuse Professionals and Their Clinical Decisions  

ERIC Educational Resources Information Center

In this study, the authors examined the relationship between the clinical orientations of substance abuse professionals (SAPs) and their clinical decisions. Cluster analysis grouped a sample of 245 SAPs on two clinical orientations that differed in their relative endorsement of traditional versus contemporary substance abuse counseling processes…

Toriello, Paul J.; Leierer, Stephen J.

2005-01-01

140

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan Report of the Joint Clinical Decision Support Workgroup  

Microsoft Academic Search

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and

JONATHAN M. TEICH; JEROME A. OSHEROFF; ERIC A. PIFER; DEAN F. SITTIG; ROBERT A. JENDERS

2005-01-01

141

An architecture for online comparison and validation of processing methods and computerized guidelines in intensive care units  

Microsoft Academic Search

Clinical decision support systems are a combination of software techniques to help the clinicians in their medical decision making process via functionalities ranging from basic signal analysis to therapeutic planning and computerized guidelines. The algorithms providing all these functionalities must be very carefully validated on real patient data and must be confronted to everyday clinical practice.One of the main problems

L. Allart; Christian Vilhelm; H. Mehdaoui; H. Hubert; B. Sarrazin; D. Zitouni; M. Lemdani; Pierre Ravaux

2009-01-01

142

Temporal pattern mining for multivarite clinical decision support.  

PubMed

Multivariate temporal data are collections of contiguous data values that reflect complex temporal changes over a given duration. Technological advances have resulted in significant amounts of such data in high-throughput disciplines, including EEG and iEEG data for effective and efficient healthcare informatics, and decision support. Most data analytics and data-mining algorithms are effective in capturing global trends, but fail to capture localized behavioral changes in large temporal data sets. We present a two-step algorithmic methodology to uncover temporal patterns and exploiting them for an efficient and accurate decision support system. This methodology aids the discovery of previously unknown, nontrivial, and potentially useful temporal patterns for enhanced patient-specific clinical decision support with high degrees of sensitivity and specificity. Classification results on multivariate time series iEEG data for epileptic seizure detection also demonstrate the efficacy and accuracy of the technique to uncover interesting and effective domain class-specific temporal patterns. PMID:23921002

Saini, Sheetal; Dua, Sumeet

2013-01-01

143

The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital.  

PubMed

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P?

Kazemi, Alireza; Ellenius, Johan; Pourasghar, Faramarz; Tofighi, Shahram; Salehi, Aref; Amanati, Ali; Fors, Uno G H

2011-02-01

144

Clinical Decision Support Alert Appropriateness: A Review and Proposal for Improvement  

PubMed Central

Background Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. Methods We present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable. Results Despite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context. Conclusion The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety.

McCoy, Allison B.; Thomas, Eric J.; Krousel-Wood, Marie; Sittig, Dean F.

2014-01-01

145

Physicians' acceptance of pharmacokinetics-based clinical decision support systems  

Microsoft Academic Search

This paper reports a finding of a field study on the physicians’ acceptance of a pharmacokinetics-based clinical decision support system (CDSS). A research model was used to explain the acceptance of the technology of 140 participated physicians from three hospitals. The results indicated that the research model was acceptable with a reasonable goodness-of-fit. Both performance expectancy and effort expectancy have

I-chiu Chang; Hsin-ginn Hwang; Won-fu Hung; Yi-chang Li

2007-01-01

146

A Comparison of Content-Balancing Procedures for Estimating Multiple Clinical Domains in Computerized Adaptive Testing: Relative Precision, Validity, and Detection of Persons with Misfitting Responses  

ERIC Educational Resources Information Center

This simulation study sought to compare four different computerized adaptive testing (CAT) content-balancing procedures designed for use in a multidimensional assessment with respect to measurement precision, symptom severity classification, validity of clinical diagnostic recommendations, and sensitivity to atypical responding. The four…

Riley, Barth B.; Dennis, Michael L.; Conrad, Kendon J.

2010-01-01

147

Mechanistic biomarkers for clinical decision making in rheumatic diseases  

PubMed Central

The use of biomarkers is becoming increasingly intrinsic to the practice of medicine and holds great promise for transforming the practice of rheumatology. Biomarkers have the potential to aid clinical diagnosis when symptoms are present or to provide a means of detecting early signs of disease when they are not. Some biomarkers can serve as early surrogates of eventual clinical outcomes or guide therapeutic decision making by enabling identification of individuals likely to respond to a specific therapy. Using biomarkers might reduce the costs of drug development by enabling individuals most likely to respond to be enrolled in clinical trials, thereby minimizing the number of participants required. In this Review, we discuss the current use and the potential of biomarkers in rheumatology and in select fields at the forefront of biomarker research. We emphasize the value of different types of biomarkers, addressing the concept of ‘actionable’ biomarkers, which can be used to guide clinical decision making, and ‘mechanistic’ biomarkers, a subtype of actionable biomarker that is embedded in disease pathogenesis and, therefore, represents a superior biomarker. We provide examples of actionable and mechanistic biomarkers currently available, and discuss how development of such biomarkers could revolutionize clinical practice and drug development.

Robinson, William H.; Lindstrom, Tamsin M.; Cheung, Regina K.; Sokolove, Jeremy

2013-01-01

148

Web-based health services and clinical decision support.  

PubMed

The purpose of this study was the development of a Web-based e-health service for comprehensive assistance and clinical decision support. The service structure consists of a Web server, a PHP-based Web interface linked to a clinical SQL database, Java applets for interactive manipulation and visualization of signals and a Matlab server linked with signal and data processing algorithms implemented by Matlab programs. The service ensures diagnostic signal- and image analysis-sbased clinical decision support. By using the discussed methodology, a pilot service for pathology specialists for automatic calculation of the proliferation index has been developed. Physicians use a simple Web interface for uploading the pictures under investigation to the server; subsequently a Java applet interface is used for outlining the region of interest and, after processing on the server, the requested proliferation index value is calculated. There is also an "expert corner", where experts can submit their index estimates and comments on particular images, which is especially important for system developers. These expert evaluations are used for optimization and verification of automatic analysis algorithms. Decision support trials have been conducted for ECG and ophthalmology ultrasonic investigations of intraocular tumor differentiation. Data mining algorithms have been applied and decision support trees constructed. These services are under implementation by a Web-based system too. The study has shown that the Web-based structure ensures more effective, flexible and accessible services compared with standalone programs and is very convenient for biomedical engineers and physicians, especially in the development phase. PMID:15718591

Jegelevicius, Darius; Marozas, Vaidotas; Lukosevicius, Arunas; Patasius, Martynas

2004-01-01

149

Enrollment into a time sensitive clinical study in the critical care setting: results from computerized septic shock sniffer implementation  

PubMed Central

Objective Recruitment of patients into time sensitive clinical trials in intensive care units (ICU) poses a significant challenge. Enrollment is limited by delayed recognition and late notification of research personnel. The objective of the present study was to evaluate the effectiveness of the implementation of electronic screening (septic shock sniffer) regarding enrollment into a time sensitive (24?h after onset) clinical study of echocardiography in severe sepsis and septic shock. Design We developed and tested a near-real time computerized alert system, the septic shock sniffer, based on established severe sepsis/septic shock diagnostic criteria. A sniffer scanned patients' data in the electronic medical records and notified the research coordinator on call through an institutional paging system of potentially eligible patients. Measurement The performance of the septic shock sniffer was assessed. Results The septic shock sniffer performed well with a positive predictive value of 34%. Electronic screening doubled enrollment, with 68 of 4460 ICU admissions enrolled during the 9?months after implementation versus 37 of 4149 ICU admissions before sniffer implementation (p<0.05). Efficiency was limited by study coordinator availability (not available at nights or weekends). Conclusions Automated electronic medical records screening improves the efficiency of enrollment and should be a routine tool for the recruitment of patients into time sensitive clinical trials in the ICU setting.

Pieper, Matthew S; Pulido, Juan; Gajic, Ognjen

2011-01-01

150

Clinical decision support with automated text processing for cervical cancer screening  

PubMed Central

Objective To develop a computerized clinical decision support system (CDSS) for cervical cancer screening that can interpret free-text Papanicolaou (Pap) reports. Materials and Methods The CDSS was constituted by two rulebases: the free-text rulebase for interpreting Pap reports and a guideline rulebase. The free-text rulebase was developed by analyzing a corpus of 49?293 Pap reports. The guideline rulebase was constructed using national cervical cancer screening guidelines. The CDSS accesses the electronic medical record (EMR) system to generate patient-specific recommendations. For evaluation, the screening recommendations made by the CDSS for 74 patients were reviewed by a physician. Results and Discussion Evaluation revealed that the CDSS outputs the optimal screening recommendations for 73 out of 74 test patients and it identified two cases for gynecology referral that were missed by the physician. The CDSS aided the physician to amend recommendations in six cases. The failure case was because human papillomavirus (HPV) testing was sometimes performed separately from the Pap test and these results were reported by a laboratory system that was not queried by the CDSS. Subsequently, the CDSS was upgraded to look up the HPV results missed earlier and it generated the optimal recommendations for all 74 test cases. Limitations Single institution and single expert study. Conclusion An accurate CDSS system could be constructed for cervical cancer screening given the standardized reporting of Pap tests and the availability of explicit guidelines. Overall, the study demonstrates that free text in the EMR can be effectively utilized through natural language processing to develop clinical decision support tools.

MacLaughlin, Kathy L; Henry, Michael R; Greenes, Robert A; Hankey, Ronald A; Liu, Hongfang; Chaudhry, Rajeev

2012-01-01

151

MET3: AN INTEGRATIVE OPEN SOURCE BASED MULTI AGENT CLINICAL DECISION SUPPORT SYSTEM  

Microsoft Academic Search

Clinical decision-making is a multi-stage process that involves a series of tasks requiring different types of clinical knowledge. Decision support can play an important role during the entire process. However, research on clinical decision making and clinical decision support systems has been focused on individual tasks. In this paper we present the design and implementation of MET3 - a multi-agent

JELBER SAYYAD-SHIRABAD; SZYMON WILK; WOJTEK MICHALOWSKI; KEN FARION

152

Clinical Decision Making--A Functional Medicine Perspective  

PubMed Central

As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care.

2012-01-01

153

A Clinical Decision Support System for Breast Cancer Patients  

NASA Astrophysics Data System (ADS)

This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

154

A method for interactive hypothesis testing for clinical decision support systems using Ptolemy II  

Microsoft Academic Search

This paper introduces a method for interactive knowledge testing for a clinical decision support system developed as a part of the Artemis Project. Knowledge within the medical domain is vast and continuously being defined and re-defined. The volume of modern clinical decision support systems that support a flexible and intuitive environment that recognizes this principle is shocking limited. Clinical decision

Rishikesan Kawaleswaran; Mike Eklund

2011-01-01

155

SANDS: A service-oriented architecture for clinical decision support in a National Health Information Network  

Microsoft Academic Search

In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according

Adam Wright; Dean F. Sittig

2008-01-01

156

The addition of decision support into computerized physician order entry reduces red blood cell transfusion resource utilization in the intensive care unit.  

PubMed

Computerized physician order entry (CPOE) has the potential for cost containment in critically ill patients through practice standardization and elimination of unnecessary interventions. Previous study demonstrated the beneficial short-term effect of adding a decision support for red blood cell (RBC) transfusion into the hospital CPOE. We evaluated the effect of such intervention on RBC resource utilization during the two-year study period. From the institutional APACHE III database we identified 2,200 patients with anemia, but no active bleeding on admission: 1,100 during a year before and 1,100 during a year after the intervention. The mean number of RBC transfusions per patient decreased from 1.5 +/- 1.9 units to 1.3 +/- 1.8 units after the intervention (P = 0.045). RBC transfusion cost decreased from $616,442 to $556,226 after the intervention. Hospital length of stay and adjusted hospital mortality did not differ before and after protocol implementation. In conclusion, the implementation of an evidenced-based decision support system through a CPOE can decrease RBC transfusion resource utilization in critically ill patients. PMID:17236185

Fernández Pérez, Evans R; Winters, Jeffrey L; Gajic, Ognjen

2007-07-01

157

Clinical genomics information management software linking cancer genome sequence and clinical decisions.  

PubMed

Using sequencing information to guide clinical decision-making requires coordination of a diverse set of people and activities. In clinical genomics, the process typically includes sample acquisition, template preparation, genome data generation, analysis to identify and confirm variant alleles, interpretation of clinical significance, and reporting to clinicians. We describe a software application developed within a clinical genomics study, to support this entire process. The software application tracks patients, samples, genomic results, decisions and reports across the cohort, monitors progress and sends reminders, and works alongside an electronic data capture system for the trial's clinical and genomic data. It incorporates systems to read, store, analyze and consolidate sequencing results from multiple technologies, and provides a curated knowledge base of tumor mutation frequency (from the COSMIC database) annotated with clinical significance and drug sensitivity to generate reports for clinicians. By supporting the entire process, the application provides deep support for clinical decision making, enabling the generation of relevant guidance in reports for verification by an expert panel prior to forwarding to the treating physician. PMID:23603536

Watt, Stuart; Jiao, Wei; Brown, Andrew M K; Petrocelli, Teresa; Tran, Ben; Zhang, Tong; McPherson, John D; Kamel-Reid, Suzanne; Bedard, Philippe L; Onetto, Nicole; Hudson, Thomas J; Dancey, Janet; Siu, Lillian L; Stein, Lincoln; Ferretti, Vincent

2013-09-01

158

Use of a Computerized Decision Support System for Primary and Secondary Prevention of Work-Related MSD Disability  

Microsoft Academic Search

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs

Sarah K. Womack; Thomas J. Armstrong

2005-01-01

159

CEDRIC: A Computerized Chronic Disease Management System for Urban, Safety Net Clinics  

PubMed Central

To meet the challenge of improving health care quality in urban, medically underserved areas of the US that have a predominance of chronic diseases such as diabetes, we have developed a new information system called CEDRIC for managing chronic diseases. CEDRIC was developed in collaboration with clinicians at an urban safety net clinic, using a community-participatory partnered research approach, with a view to addressing the particular needs of urban clinics with a high physician turnover and large uninsured/underinsured patient population. The pilot implementation focuses on diabetes management. In this paper, we describe the system’s architecture and features.

Ogunyemi, Omolola; Mukherjee, Sukrit; Ani, Chizobam; Hindman, David; George, Sheba; Ilapakurthi, Ramarao; Verma, Mary; Dayrit, Melvin

2011-01-01

160

Clinical decision support systems in myocardial perfusion imaging.  

PubMed

Diagnostic imaging is becoming more complicated, physicians are also required to master an ever-expanding knowledge base and take into account an ever increasing amount of patient-specific clinical information while the time available to master this knowledge base, assemble the relevant clinical data, and apply it to specific tasks is steadily shrinking. Compounding these problems, there is an ever increasing number of aging "Baby Boomers" who are becoming patients coupled with a declining number of cardiac diagnosticians experienced in interpreting these studies. Hence, it is crucial that decision support tools be developed and implemented to assist physicians in interpreting studies at a faster rate and at the highest level of up-to-date expertise. Such tools will minimize subjectivity and intra- and inter-observer variation in image interpretation, help achieve a standardized high level of performance, and reduce healthcare costs. Presently, there are many decision support systems and approaches being developed and implemented to provide greater automation and to further objectify and standardize analysis, display, integration, interpretation, and reporting of myocardial perfusion SPECT and PET studies. This review focuses on these systems and approaches. PMID:24482142

Garcia, Ernest V; Klein, J Larry; Taylor, Andrew T

2014-06-01

161

Using Computerized Clinical Practice Guidelines to Generate Tailored Patient Education Materials  

Microsoft Academic Search

In this paper we present a novel approach to generate tailored patient education materials by using an evidence- based clinical practice guideline to model patients and direct the selection of relevant education content. We converted a Canadian guideline for managing dyslipidemia into the XML-based GEM formalism, and then modified it to support the tailoring of patient education material. We created

Brent Jones; Syed Sibte Raza Abidi; Winston Ying

2005-01-01

162

Free and Open Source Enabling Technologies for Patient-Centric, Guideline-Based Clinical Decision Support: A Survey  

PubMed Central

Summary Objectives: Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. Methods: We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. Results: To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. Conclusions: There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

Leong, T.-Y.; Kaiser, K.; Miksch, S.

2010-01-01

163

Clinical use of BOBCAT: testing reliability and validity of computerized pure-tone audiometry with noise-exposed workers, children and the aged.  

PubMed

An investigation was conducted to determine the feasibility of implementing computerized audiometry in various clinical groups, using the Battery of Basic Computerized Audiometry Tests (BOBCAT). Reliability, validity and speed of execution were assessed as a function of hearing loss in a group of noise-exposed workers. Children and the aged were also included to represent potentially 'more-difficult-to-test' patients due to fluctuating attention, motivation and/or response behavior. Children were aged 7.5-12 years; seniors, 65-80 years. Reliability was assessed by calculating reliability coefficients between air conduction pure-tone thresholds (0.5, 1, 2, 3, 4 and 6 kHz) obtained under two test modalities namely, computerized audiometry and conventional testing performed by a small panel of trained examiners. Both procedures followed ANSI S3.21 1978 standards. Content validity was measured using measures of central tendency and correlations. Coefficients of reliability remained equally high across frequencies regardless of degree of hearing loss and group. As well, group means and correlations between conventional and computerized audiometry indicated that the two methods measured pure-tone hearing sensitivity with the same degree of accuracy; that is, within +/- 0.5 dB. Finally, speed of execution was found to be slower using BOBCAT, in particular with noise-exposed workers. This finding was interpreted as evidence that trained examiners have used shortcuts when they expect consistent and/or unbiased response behavior. PMID:8447762

Picard, M; Ilecki, H J; Baxter, J D

1993-01-01

164

Decision making for cancer clinical trial participation: a systematic review. | accrualnet.cancer.gov  

Cancer.gov

More research on the decision-making process for participation in cancer clinical trials is needed. A better understanding of the decision-making process may help improve patient-provider communication and create interventions to facilitate decision-making, leading to increased clinical trial participation.

165

Biostatistics in clinical decision making for cardiothoracic radiologists.  

PubMed

Cardiothoracic radiologists are intuitively aware of sensitivity and specificity as they pertain to diagnostic tests involving clinical information. However, many cardiothoracic radiologists are unfamiliar with odds ratios, likelihood ratios, predictive values, and receiver operating characteristic (ROC) curves, which provide more information about the performance of a test. Our article will first review the fundamental concepts of sensitivity, specificity, predictive values, and likelihood ratios. The ROC curve methodology will be covered with an emphasis on creating a look-up table, a straightforward table that communicates important information to the clinician to aid in diagnosis. The article reviews sensitivity and specificity, as well as predictive values, logistic regression, and ROC curves, using conceptual principles without unnecessary mathematical rigor. We will apply principles of sensitivity and specificity to continuous measurements by constructing ROC curves in order to tie together key ideas in diagnostic decision making. Three clinical examples are presented to illustrate these fundamental statistical concepts: predictors of pulmonary embolism in children, use of dobutamine-cardiac magnetic resonance imaging to identify impaired ventricular function in patients who have suffered a myocardial infarction, and diagnostic accuracy of 64-multidetector row computed tomography to identify occluded vessels in adult patients with suspected coronary artery disease. In addition, a glossary is provided at the end of the article with key terms important in diagnostic imaging. An understanding of the concepts presented will assist cardiothoracic radiologists in critically discerning the usefulness of diagnostic tests and how these statistics can be applied to make judgments and decisions that are essential to clinical practice. PMID:23358369

Zurakowski, David; Johnson, Victor M; Lee, Edward Y

2013-11-01

166

Computerized tomographic simulation compared with clinical mark-up in palliative radiotherapy: A prospective study  

SciTech Connect

Purpose To evaluate the impact of computed tomographic (CT) planning in comparison to clinical mark-up (CM) for palliative radiation of chest wall metastases. Methods and Materials In patients treated with CM for chest wall bone metastases (without conventional simulation/fluoroscopy), two consecutive planning CT scans were acquired with and without an external marker to delineate the CM treatment field. The two sets of scans were fused for evaluation of clinical tumor volume (CTV) coverage by the CM technique. Under-coverage was defined as the proportion of CTV not covered by the CM 80% isodose. Results Twenty-one treatments (ribs 17, sternum 2, and scapula 2) formed the basis of our study. Due to technical reasons, comparable data between CM and CT plans were available for 19 treatments only. CM resulted in a mean CTV under-coverage of 36%. Eleven sites (58%) had an under-coverage of >20%. Mean volume of normal tissues receiving {>=}80% of the dose was 5.4% in CM and 9.3% in CT plans (p = 0.017). Based on dose-volume histogram comparisons, CT planning resulted in a change of treatment technique from direct apposition to a tangential pair in 7 of 19 cases. Conclusions CT planning demonstrated a 36% under-coverage of CTV with CM of ribs and chest wall metastases.

Haddad, Peiman [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Radiation Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Cheung, Fred [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Pond, Gregory [Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Easton, Debbie [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Cops, Frederick [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Bezjak, Andrea [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); McLean, Michael [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Levin, Wilfred [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Billingsley, Susan [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Williams, Diane [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Wong, Rebecca [Palliative Radiation Oncology Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)]. E-mail: Rebecca.Wong@rmp.uhn.on.ca

2006-07-01

167

[Clinical decision-making support systema in renal failure].  

PubMed

Introduction: Support systems in clinical decision-making use individual characteristicsof the patient to generate recommendations to the clinician.Objective: To assess the impact of a tool for adjusting drug dosing in renal failure asa support system in clinical decision-making regarding the level of acceptance of theinterventions as well as the time invested by the pharmacist.Method: Non-randomized, prospective and hospital interventional study comparingpre- and post-implementation phases of an automated renal function alert system, carriedout at two county hospitals. Forty drugs were monitored before the intervention(2007). The blood work of the patients receiving any of these drugs was reviewed. Incase of impaired renal function, an adjustment recommendation was inserted in themedical prescription. If the physician accepted it, it was rated as success. The averagetime was 1 minute per blood work reviewed and 3 minutes per recommendation. Anautomated adjustment recommendation system according to renal function with alertpop-ups was implemented in 2008 for 100 drugs. Later (2009), the number of interventionsand the success rate for this tool were assessed and compared.Results: Pre-implementation phase. 28,234 electronic medical prescriptions correspondingto a mean number of 205 hospitalized patients/day were validated and 4,035 bloodworks were reviewed. One hundred and twenty-one pharmaceutical interventions(0.43% of the medical prescriptions) were inserted. A success rate of 33.06% of theinterventions was obtained. The time invested by the pharmacist for consulting the bloodworks and making the recommendations was 73.3 hours (67.25 hours correspondingto patients without renal function impairment and in whom no intervention was made).Post-implementation phase. 26,584 electronic medical orders corresponding to 193 hospitalizedpatients/day were validated and 1,737 automated interventions were performed(6.53% of total medical orders), of which 65.69% were accepted (success).Conclusions: The implementation of clinical decision-making support systems allowsextending the number of patients and drugs monitored, optimizing the time investedby the pharmacist. Simultaneous occurrence of an alert during prescription may havecontributed to the greater success rate observed. PMID:24951906

Martínez Bernabé, E; Paluzie-Ávila, G; Terre Ohme, S; Ruiz Poza, D; Parada Aradilla, M A; González Martínez, J; Albertí Valmaña, R; Castellvi Gordo, M

2014-01-01

168

Clinical decision support for perioperative information management systems.  

PubMed

Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, ?-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered. PMID:23690340

Wanderer, Jonathan P; Ehrenfeld, Jesse M

2013-12-01

169

A Four-Phase Model of the Evolution of Clinical Decision Support Architectures  

PubMed Central

Background A large body of evidence over many years suggests that clinical decision support systems can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. However, to this day, clinical decision support systems are not widely used outside of a small number of sites. One reason why decision support systems are not widely used is the relative difficulty of integrating such systems into clinical workflows and computer systems. Purpose To review and synthesize the history of clinical decision support systems, and to propose a model of various architectures for integrating clinical decision support systems with clinical systems. Methods The authors conducted an extensive review of the clinical decision support literature since 1959, sequenced the systems and developed a model. Results The model developed consists of four phases: standalone decision support systems, decision support integrated into clinical systems, standards for sharing clinical decision support content and service models for decision support. These four phases have not heretofore been identified, but they track remarkably well with the chronological history of clinical decision support, and show evolving and increasingly sophisticated attempts to ease integrating decision support systems into clinical workflows and other clinical systems. Conclusions Each of the four evolutionary approaches to decision support architecture has unique advantages and disadvantages. A key lesson was that there were common limitations that almost all the approaches faced, and no single approach has been able to entirely surmount: 1) fixed knowledge representation systems inherently circumscribe the type of knowledge that can be represented in them, 2) there are serious terminological issues, 3) patient data may be spread across several sources with no single source having a complete view of the patient, and 4) major difficulties exist in transferring successful interventions from one site to another.

Wright, Adam; Sittig, Dean F.

2008-01-01

170

Computerized material management, inventory control, and purchase orders in the clinical laboratory.  

PubMed

The management of supplies, purchase orders, and equipment is of critical importance to the operation of the clinical laboratory. The InvMan software program has reduced hands-on time for performing the counting of inventory and the time required to generate purchase orders. These changes save the laboratory about $11,170 per year in personnel costs. While the use of a structured system does impose some constraints on the user, the program has helped the laboratory organize all of its supply, vendor, location, PO, and equipment data. It has allowed the laboratory to respond more rapidly and accurately to inquiries related to inventory. The varied functions of InvMan provide flexibility to the laboratory and permit it to define the inventory as best fits a particular situation. The application is well suited to its target audience. The program has performed well, allowing the laboratory to make significant improvements to its material management system. PMID:10539221

Chapman, J T

1999-06-01

171

Optimizing Perioperative Decision Making: Improved Information for Clinical Workflow Planning  

PubMed Central

Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40–70% of hospital revenues and 30–40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

Doebbeling, Bradley N.; Burton, Matthew M.; Wiebke, Eric A.; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

2012-01-01

172

Implementing an Integrative Multi-agent Clinical Decision Support System with Open Source Software  

Microsoft Academic Search

Clinical decision making is a complex multi-stage process. Decision support can play an important role at each stage of this\\u000a process. At present, the majority of clinical decision support systems have been focused on supporting only certain stages.\\u000a In this paper we present the design and implementation of MET3—a prototype multi-agent system providing an integrative decision\\u000a support that spans over

Jelber Sayyad Shirabad; Szymon Wilk; Wojtek Michalowski; Ken Farion

173

Designing a decision support system for existing clinical organizational structures: considerations from a rheumatology clinic.  

PubMed

The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies. PMID:17068995

Dahlström, Orjan; Thyberg, Ingrid; Hass, Ursula; Skogh, Thomas; Timpka, Toomas

2006-10-01

174

Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax  

PubMed Central

Purpose To identify the value of unilateral pedal lymphangiography (LAG) with non-contrast CT in the location and treatment decision of idiopathic chylothorax after failure of thoracic duct ligation. Materials and Methods Twenty four patients aged 9–84 year old (median 44 yr) who had idiopathic chylothorax were involved, and unilateral pedal LAG with non-contrast CT was performed in every patient. All patients failed to previous right supra-diaphragmatic thoracic duct ligation. Results The amount of iodized oil used was 6–14 ml with no related complications. LAG demonstrated 8 patients with thoracic duct leaks and 10 patients with leaks elsewhere, but no visible chylous leak in 6 patients. Ligation of thoracic duct was performed as the primary treatment in all 8 cases as having thoracic duct leakage and cured 7(87.5%) patients. For 8 patients not having thoracic duct lesion under LAG, the successful rate of thoracic duct ligation was 25% (2 out of 8 patients), which was significantly lower than patients due to thoracic duct lesions (P?=?0.02). Meanwhile, non-operative therapy had significantly higher successful rate (87.5% vs 25%, P?=?0.02). Conclusions Unilateral pedal LAG with non-contrast CT could identify the causes and locate the leaks of idiopathic chylothorax in 75% of patients after failure of thoracic duct ligation. Two thirds of patients were found not to have thoracic duct leakage and would be better managed by non-operative treatment.

2014-01-01

175

A Model Driven Approach to Automate the Implementation of Clinical Guidelines in Decision Support Systems  

Microsoft Academic Search

Clinical guidelines and protocols are used to aid decision making in health care. This paper presents a model- based approach to the development of decision support systems for clinical guidelines. The guidelines are modelled using the UML Statechart language and the final system is automatically generated using an automated model transformation. Our approach is illustrated with a Spanish clinical guideline

Ivan Porres; Eladio Domínguez; Beatriz Pérez; Áurea Rodríguez; María Antonia Zapata

2008-01-01

176

An Integrated Computerized Triage System in the Emergency Department  

PubMed Central

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients.

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

177

On the Clinical Indices of Energy Expenditure in Low-Birth-Weight Infants: A Computerized System for Measuring the Effect of Nursing Care Activities  

PubMed Central

A computerized system measuring the clinical indices of energy expenditure - heart rate, temperature, and activity - was pilot tested on 3 LBW infants over 24 hours. Mean heel temperature was 34.7°C; mean abdominal skin temperature was 35.1°C; mean incubator wall temperature was 29°C; and mean air temperature was 25.5°C. The mean heart rate was 163 beats/min and mean activity level was 8-9 baseline crossings/ min. A correlation of .84 was established between the number of voltage baseline crossings and an established clinical observational tool of motor activity. This is a valid, reliable system.

Roncoli, M.; Brooten, D.; Delivoria-Papadopolous, M.

1985-01-01

178

Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success  

Microsoft Academic Search

Objective To identify features of clinical decision support systems critical for improving clinical practice. Design Systematic review of randomised controlled trials. Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews. Study selection Studies had to evaluate the ability of decision support systems

Kensaku Kawamoto; Caitlin A Houlihan; E Andrew Balas; David F Lobach

2005-01-01

179

Changes in diagnostic decision-making after a computerized decision support consultation based on perceptions of need and helpfulness: a preliminary report.  

PubMed Central

We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or cases as the unit of analysis. It is possible that what may appear to be counter-intuitive, and perhaps irrational, may not necessarily be so. We are currently examining potential explanatory hypotheses in our ongoing current, larger study.

Wolf, F. M.; Friedman, C. P.; Elstein, A. S.; Miller, J. G.; Murphy, G. C.; Heckerling, P.; Fine, P.; Miller, T.; Sisson, J.; Barlas, S.; Capitano, A.; Ng, M.; Franz, T.

1997-01-01

180

Towards Ethical Decision Support and Knowledge Management in Neonatal Intensive Care  

Microsoft Academic Search

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such

L. Yang; M. Frize; R. C. Walker; C. Catley

2004-01-01

181

Attitude of Iranian physicians and nurses toward a clinical decision support system for pulmonary embolism and deep vein thrombosis.  

PubMed

This research project sought to design and implement a computerized clinical decision support system (CDSS) that was able to identify patients who were at risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), as well as produce reminders for prophylactic action for these diseases. The main purpose of the CDSS was to attempt to reduce the morbidity and mortality caused by embolism and thrombosis in patients admitted to hospitals. After implementation of this system in one of the large educational hospitals of Iran, a standard questionnaire was used, and interviews were conducted with physicians and nurses to evaluate the performance of the designed system for reducing the incidence of pulmonary embolism and thrombosis. From physicians and nurses' point of view, a system which assists the medical staff in making better decisions regarding patient care, and also reminds pulmonary embolism and thrombosis preventive procedures with timely warnings, can influence patient care quality improvement and lead to the improved performance of the medical staff in preventing the incidence of pulmonary embolism and thrombosis. PMID:24768080

Agharezaei, Zhila; Bahaadinbeigy, Kambiz; Tofighi, Shahram; Agharezaei, Laleh; Nemati, Ali

2014-07-01

182

Impact of a clinical decision support system on pharmacy clinical interventions, documentation efforts, and costs.  

PubMed

Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. A CDSS is a promising approach to the aggregation and use of patient data to identify patients who would most benefit from interventions by pharmacy clinicians. However, there are limited published reports describing the impact of CDSS on clinical pharmacy measures. In February 2011, Good Shepherd Medical Center, a 425-bed acute care community hospital in East Texas, implemented a CDSS (TheraDoc clinical surveillance system). Prior to CDSS implementation, clinicians struggled with obtaining and documenting the data needed to support clinical initiatives. The value of having both clinical and staff pharmacists utilizing the CDSS has improved communication and knowledge among staff and improved relationships with medical staff, nursing, and case management. The department of pharmacy increased its clinical interventions from an average of 1,986 per month to 4,065 per month; this represents a 105% increase in the number of interventions. The annual estimated cost savings after CDSS implementation is $2,999,508, representing a 96% increase per year and translating into a $1,469,907 annual return on investment. PMID:24421548

Calloway, Stacy; Akilo, Hameed A; Bierman, Kyle

2013-10-01

183

Accuracy and performance evaluation of a clinical decision support system for laboratory result alerts  

Microsoft Academic Search

This study was designed to evaluate the accuracy and performance of a clinical decision support (CDS) architecture consisting of a knowledge engine and data interface adapter (DIA), which were developed as critical components for a clinical decision support system (CDSS). Accuracy and performance are the most essential quality attributes. CDSSs are becoming increasingly important in efforts to increase quality control

InSook Cho; SunTae Kim; JeongAh Kim; Kyu Seob Ha; Yoon Kim

2011-01-01

184

Using a Guideline-Centered Approach for the Design of a Clinical Decision Support System  

Microsoft Academic Search

Knowledge acquisition for the design of clinical decision support systems can be facilitated when clinical practice guidelines serve as a knowledge source. We have applied the Guideline Elements Model (GEM) in the design of a decision support system to promote smoking cessation. Following markup of knowledge components with the GEM Cutter editor, the Extractor stylesheet was used to create a

Richard N. Shiffman; George Michel; Abdelwaheb Essaihi; Theodore W. Marcy

185

Trends and opportunities for integrated real time neonatal clinical decision support  

Microsoft Academic Search

Neonatal Intensive Care Unit maintain and support life during the critical period of premature development. This research presents the challenges, trends and opportunities for integrated real time neonatal clinical decision support. We demonstrated this potential using environment known as Artemis, a clinical decision support system. A review of the current devices in the intensive care unit and neonatal practice shows

Nadja Bressan; Andrew James; Carolyn McGregor

2012-01-01

186

Intelligent Clinical Decision Support Systems based on SNOMED CT  

Microsoft Academic Search

The decision support systems that have been developed to assist physicians in the diagnostic process often are based on static data which may be out of date. We present a comprehensive analysis of artificial intelligent methods which could be applied to documents encoded by SNOMED CT. By mining information directly from SNOMED CT encoded documents, a decision support system could

Ewelina Ciolko; Fletcher Lu; Amardeep Joshi

2010-01-01

187

Implementing clinical practice guidelines while taking account of changing evidence: ATHENA DSS, an easily modifiable decision-support system for managing hypertension in primary care.  

PubMed Central

This paper describes the ATHENA Decision Support System (DSS), which operationalizes guidelines for hypertension using the EON architecture. ATHENA DSS encourages blood pressure control and recommends guideline-concordant choice of drug therapy in relation to comorbid diseases. ATHENA DSS has an easily modifiable knowledge base that specifies eligibility criteria, risk stratification, blood pressure targets, relevant comorbid diseases, guideline-recommended drug classes for patients with comorbid disease, preferred drugs within each drug class, and clinical messages. Because evidence for best management of hypertension evolves continually, ATHENA DSS is designed to allow clinical experts to customize the knowledge base to incorporate new evidence or to reflect local interpretations of guideline ambiguities. Together with its database mediator Athenaeum, ATHENA DSS has physical and logical data independence from the legacy Computerized Patient Record System (CPRS) supplying the patient data, so it can be integrated into a variety of electronic medical record systems.

Goldstein, M. K.; Hoffman, B. B.; Coleman, R. W.; Musen, M. A.; Tu, S. W.; Advani, A.; Shankar, R.; O'Connor, M.

2000-01-01

188

Clinical Decisions and Outcomes in a Navy Psychiatric Service.  

National Technical Information Service (NTIS)

Doctors' decisions, treatment practices, and outcomes were examined for patients admitted to neuropsychiatric services, in the Naval Hospital, Philadelphia, Pa., during a study period in 1967-1968. A known-group design was used to differentiate the strate...

D. Edwards E. K. E. Gunderson D. E. Brown W. R. Taylor

1973-01-01

189

Incorporating Image Processing in a Clinical Decision Support System  

Microsoft Academic Search

A prototype system to assist radiologists in the differential diagnosis of mammographic calcifications is presented. Our approach\\u000a is to incorporate image-processing operators within a knowledge-based decision support system. The work described in this\\u000a paper involves three stages. The first is to identify a set of terms that can represent the knowledge required in an example\\u000a of radiological decision-making. The next

Paul Taylor; Eugenio Alberdi; Richard Lee; John Fox; Margarita Sordo; Andrew Todd-pokropek

2001-01-01

190

EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support  

PubMed Central

Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet.

2013-01-01

191

Computerized antimicrobial decision support: an offline evaluation of a database-driven empiric antimicrobial guidance program in hospitalized patients with a bloodstream infection  

Microsoft Academic Search

Introduction: We developed a computerized antimicrobial guidance program based on the last 5 years of our laboratory culture data augmented by expert infectious disease logic. The program is designed to assist physicians with the targeting of empiric antimicrobials for hospitalized patients by tracking pathogenic bacteria and their evolving antimicrobial resistance profiles. Costs, toxicities, and environmental impact of antimicrobial use also

Charles J. Mullett; John G. Thomas; Connie L. Smith; Arif R. Sarwari; Rashida A. Khakoo

2004-01-01

192

VisualDecisionLinc: a visual analytics approach for comparative effectiveness-based clinical decision support in psychiatry.  

PubMed

Comparative Effectiveness Research (CER) is designed to provide research evidence on the effectiveness and risks of different therapeutic options on the basis of data compiled from subpopulations of patients with similar medical conditions. Electronic Health Record (EHR) system contain large volumes of patient data that could be used for CER, but the data contained in EHR system are typically accessible only in formats that are not conducive to rapid synthesis and interpretation of therapeutic outcomes. In the time-pressured clinical setting, clinicians faced with large amounts of patient data in formats that are not readily interpretable often feel 'information overload'. Decision support tools that enable rapid access at the point of care to aggregate data on the most effective therapeutic outcomes derived from CER would greatly aid the clinical decision-making process and individualize patient care. In this manuscript, we highlight the role that visual analytics can play in CER-based clinical decision support. We developed a 'VisualDecisionLinc' (VDL) tool prototype that uses visual analytics to provide summarized CER-derived data views to facilitate rapid interpretation of large amounts of data. We highlight the flexibility that visual analytics offers to gain an overview of therapeutic options and outcomes and if needed, to instantly customize the evidence to the needs of the patient or clinician. The VDL tool uses visual analytics to help the clinician evaluate and understand the effectiveness and risk of different therapeutic options for different subpopulations of patients. PMID:21963813

Mane, Ketan K; Bizon, Chris; Schmitt, Charles; Owen, Phillips; Burchett, Bruce; Pietrobon, Ricardo; Gersing, Kenneth

2012-02-01

193

The Clinical Intuition Exploration Guide: A Decision-Making Tool for Counselors and Supervisors  

ERIC Educational Resources Information Center

Clinical intuition is a common experience among counselors, yet many do not know what to do with intuition when it occurs. This article reviews the role intuition plays in clinical work and presents the research-based Clinical Intuition Exploration Guide to help counselors navigate the decision-making process. The guide consists of self-reflection…

Jeffrey, Aaron

2012-01-01

194

Partitioning knowledge bases between advanced notification and clinical decision support systems  

Microsoft Academic Search

Clinical decision support system (CDSS) and their logic syntax include the coding of notifications (e.g., Arden Syntax). The following paper will describe the rationale for segregating policies, user preferences and clinical monitoring rules into “advanced notification” and” clinical” components, which together form a novel and complex CDSS. Notification rules and hospital policies are respectively abstracted from care-provider roles and alerting

Yves A. Lussier; Rose Williams; Jianrong Li; Srikant Jalan; Tara Borlawsky; Edie Stern; Inderpal Kohli

2007-01-01

195

KON^3: A Clinical Decision Support System, in Oncology Environment, Based on Knowledge Management  

Microsoft Academic Search

The application of scientific methodology to clinical practice is typically realized through recommendations, policies and protocols represented as Clinical Practice Guidelines (CPG). CPG help the clinician in his choices, improving the patient care process.The representation of Guidelines and their introduction in medical information system can lead to efficient Clinical Decision Support Systems (CDSS), however this poses several interesting challenges as

Michele Ceccarelli; Antonio Donatiello; Dante Vitale

2008-01-01

196

Web-based clinical decision support system for triage of vestibular patients  

Microsoft Academic Search

Objectives: We sought to use a clinical decision support system (CDSS) to save costs and to improve scheduling of vestibular patients in an otolaryngology clinic. Study Design and Setting: We conducted a concurrent review of 50 vestibular patients scheduled in the University of Missouri otolaryngology clinic with or without testing based on the outcome of a CDSS. The CDSS was

William C Kinney

2003-01-01

197

Clinical Verification of A Clinical Decision Support System for Ventilator Weaning  

PubMed Central

Background Weaning is typically regarded as a process of discontinuing mechanical ventilation in the daily practice of an intensive care unit (ICU). Among the ICU patients, 39%-40% need mechanical ventilator for sustaining their lives. The predictive rate of successful weaning achieved only 35-60% for decisions made by physicians. Clinical decision support systems (CDSSs) are promising in enhancing diagnostic performance and improve healthcare quality in clinical setting. To our knowledge, a prospective study has never been conducted to verify the effectiveness of the CDSS in ventilator weaning before. In this study, the CDSS capable of predicting weaning outcome and reducing duration of ventilator support for patients has been verified. Methods A total of 380 patients admitted to the respiratory care center of the hospital were randomly assigned to either control or study group. In the control group, patients were weaned with traditional weaning method, while in the study group, patients were weaned with CDSS monitored by physicians. After excluding the patients who transferred to other hospitals, refused further treatments, or expired the admission period, data of 168 and 144 patients in the study and control groups, respectively, were used for analysis. Results The results show that a sensitivity of 87.7% has been achieved, which is significantly higher (p<0.01) than the weaning determined by physicians (sensitivity: 61.4%). Furthermore, the days using mechanical ventilator for the study group (38.41 ± 3.35) is significantly (p<0.001) shorter than the control group (43.69 ± 14.89), with a decrease of 5.2 days in average, resulting in a saving of healthcare cost of NT$45,000 (US$1,500) per patient in the current Taiwanese National Health Insurance setting. Conclusions The CDSS is demonstrated to be effective in identifying the earliest time of ventilator weaning for patients to resume and sustain spontaneous breathing, thereby avoiding unnecessary prolonged ventilator use and decreasing healthcare cost.

2013-01-01

198

An Examination of Accelerated and Basic Baccalaureate Nursing Students' Perceptions of Clinical Decision Making  

ERIC Educational Resources Information Center

Developing decision-making skills is essential in education in order to be a competent nurse. The purpose of this study was to examine and compare the perceptions of clinical decision-making skills of students enrolled in accelerated and basic baccalaureate nursing programs. A comparative descriptive research design was used for this study.…

Krumwiede, Kelly A.

2010-01-01

199

Clinical Decision Support Systems: a Review of Knowledge Representation and Inference under Uncertainties  

Microsoft Academic Search

This paper provides a literature review in clinical decision support systems (CDSSs) with a focus on the way knowledge bases are constructed, and how inference mechanisms and group decision making methods are used in CDSSs. Particular attention is paid to the uncertainty handling capability of the commonly used knowledge representation and inference schemes. The definition of what constitute good CDSSs

GUILAN KONG; DONG-LING XU; JIAN-BO YANG

2008-01-01

200

Development and exploitation of a clinical decision support system for the management of renal anaemia  

Microsoft Academic Search

The management of renal disease and its comorbidities lends itself to the use of computer- assisted decision support systems (CDSS); however, several issues with regard to computer-based treatment algorithms remain unresolved. This review examines the development and application of a clinical decision support system for the management of renal anaemia. Studies illustrate the dependence of outcome on prespecified haemoglobin (Hb)

Eric J. Will; Donald Richardson; Cae Tolman; Cherry Bartlett

201

Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control.  

ERIC Educational Resources Information Center

Clinical applications of statistical process control (SPC) in human service organizations are considered. SPC is seen as providing a standard set of criteria that serves as a common interface for data-based decision making, which may bring decision making under the control of established contingencies rather than the immediate contingencies of…

Hantula, Donald A.

1995-01-01

202

ISSUES IN ONTOLOGY DESIGN FOR A CLINICAL DECISION SUPPORT SYSTEM  

Microsoft Academic Search

Introduction. Proposes that ontology design and development will be a major area for LIS theory and prac- tice in the future. Summarizes the differences between ontologies and thesauri. Examines issues in the de- sign and development of an ontology for decision support, and proposes some procedures and guidelines. Method. Describes a case study of developing an ontology to represent the

CHRISTOPHER S. G. KHOO; JIN-CHEON NA

2009-01-01

203

Advanced Clinical Decision Support for Transport of the Critically Ill Patient.  

National Technical Information Service (NTIS)

The overarching goal of this application has been to develop and test the efficacy of a comprehensive, interfacility transport system that maximizes clinical decision support (CDS) opportunities available to the transport team. This system will embody bot...

H. R. Flori

2012-01-01

204

A taxonomic description of computer-based clinical decision support systems  

Microsoft Academic Search

ObjectiveComputer-based clinical decision support systems (CDSSs) vary greatly in design and function. Using a taxonomy that we had previously developed, we describe the characteristics of CDSSs reported in the literature.

Amy Berlin; Marco Sorani; Ida Sim

2006-01-01

205

SANDS: A Service-Oriented Architecture for Clinical Decision Support in a National Health Information Network  

PubMed Central

In this paper we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture.

Wright, Adam; Sittig, Dean F.

2008-01-01

206

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study  

PubMed Central

Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.

Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah

2004-01-01

207

The pitfalls of premature closure: clinical decision-making in a case of aortic dissection  

PubMed Central

Premature closure is a type of cognitive error in which the physician fails to consider reasonable alternatives after an initial diagnosis is made. It is a common cause of delayed diagnosis and misdiagnosis borne out of a faulty clinical decision-making process. The authors present a case of aortic dissection in which premature closure was avoided by the aggressive pursuit of the appropriate differential diagnosis, and discuss the importance of disciplined clinical decision-making in the setting of chest pain.

Kumar, Bharat; Kanna, Balavenkatesh; Kumar, Suresh

2011-01-01

208

AMIA Position Paper: Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan: Report of the Joint Clinical Decision Support Workgroup  

Microsoft Academic Search

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and

Jonathan M. Teich; Jerome A. Osheroff; Eric A. Pifer; Dean F. Sittig; Robert A. Jenders

2005-01-01

209

Using Decision Analysis to Modify Clinical Decisions Made by Pharmacists and Students.  

ERIC Educational Resources Information Center

A study investigated whether the decision making of pharmacists and pharmacy students could be modified by providing computer-generated information on probabilities for efficacy and adverse reactions for antihypertensive agents, using case scenarios. Pharmacists were more likely than students to be influenced by probability information.…

Brown, Thomas E. R.; And Others

1995-01-01

210

CPR decision making and older adults: clinical implications.  

PubMed

Originally developed in 1960 as an emergency intervention for individuals who unexpectedly went into cardiac arrest, cardiopulmonary resuscitation (CPR) is now in widespread use. With broader use of CPR over the past several decades, some limitations and unintended consequences of the procedure have been identified. In addition, accumulated data have demonstrated low probabilities of survival and uneven success rates of CPR for certain subgroups. Despite advances in the understanding of CPR outcomes, the general public and many health professionals significantly overestimate the benefits and underestimate any negative consequences. As a result, CPR decision making is often based on incomplete or inaccurate information. This article discusses the "rest of the story" about CPR, namely the existing evidence about CPR survival and potential complications of CPR. The article also highlights how nurses can help promote informed decision making about CPR to older adults and their families. PMID:21117527

Cadogan, Mary P

2010-12-01

211

Development of a Parent-Report Cognitive Function Item Bank Using Item Response Theory and Exploration of its Clinical Utility in Computerized Adaptive Testing  

PubMed Central

Objective?The purpose of this study is to report the reliability, validity, and clinical utility of a parent-report perceived cognitive function (pedsPCF) item bank.?Methods?From the U.S. general population, 1,409 parents of children aged 7–17 years completed 45 pedsPCF items. Their psychometric properties were evaluated using Item Response Theory (IRT) approaches. Receiver operating characteristic (ROC) curves and discriminant function analysis were used to predict clinical problems on child behavior checklist (CBCL) scales. A computerized adaptive testing (CAT) simulation was used to evaluate clinical utility.?Results?The final 43-item pedsPCF item bank demonstrates no item bias, has acceptable IRT parameters, and provides good prediction of related clinical problems. CAT simulation resulted in correlations of 0.98 between CAT and the full-length pedsPCF.?Conclusions?The pedsPCF has sound psychometric properties, U.S. general population norms, and a brief-yet-precise CAT version is available. Future work will evaluate pedsPCF in other clinical populations in which cognitive function is important.

Butt, Zeeshan; Zelko, Frank; Cella, David; Krull, Kevin R.; Kieran, Mark W.; Goldman, Stewart

2011-01-01

212

Ability of pharmacy clinical decision-support software to alert users about clinically important drug-drug interactions  

Microsoft Academic Search

ObjectivePharmacy clinical decision-support (CDS) software that contains drug–drug interaction (DDI) information may augment pharmacists' ability to detect clinically significant interactions. However, studies indicate these systems may miss some important interactions. The purpose of this study was to assess the performance of pharmacy CDS programs to detect clinically important DDIs.DesignResearchers made on-site visits to 64 participating Arizona pharmacies between December 2008

Kim R. Saverno; Lisa E. Hines; Terri L. Warholak; Amy J. Grizzle; Lauren Babits; Courtney Clark; Ann M. Taylor; Daniel C. Malone

2011-01-01

213

An Ontology-based Framework for Authoring and Executing Clinical Practice Guidelines for Clinical Decision Support Systems  

Microsoft Academic Search

Clinical Practice Guidelines (CPG) are used by healthcare practitioners to standardise clinical practice and to provide evidence-based healthcare. However, due to the paper-based nature of CPG they are under-utilised at the point-of-care. In this paper we present our CPG-based Clinical Decision Support System (CDSS) development framework - CPG-EX. This offers the functionality to (i) model a CPG in a computer-interpretable

Sajjad Hussain; Syed Abidi

2008-01-01

214

By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions  

Microsoft Academic Search

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.Setting: University medical center.Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern

William Wong; Arnold R. Eiser; Robert G. Mrtek; Paul S. Heckerling

2004-01-01

215

Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support  

Microsoft Academic Search

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant

Casey Lynnette Overby; Peter Tarczy-Hornoch; James I Hoath; Ira J Kalet; David L Veenstra

2010-01-01

216

Development of a Scalable Pharmacogenomic Clinical Decision Support Service  

PubMed Central

Advances in sequencing technology are making genomic data more accessible within the healthcare environment. Published pharmacogenetic guidelines attempt to provide a clinical context for specific genomic variants; however, the actual implementation to convert genomic data into a clinical report integrated within an electronic medical record system is a major challenge for any hospital. We created a two-part solution that integrates with the medical record system and converts genetic variant results into an interpreted clinical report based on published guidelines. We successfully developed a scalable infrastructure to support TPMT genetic testing and are currently testing approximately two individuals per week in our production version. We plan to release an online variant to clinical interpretation reporting system in order to facilitate translation of pharmacogenetic information into clinical practice.

Fusaro, Vincent A.; Brownstein, Catherine; Wolf, Wendy; Clinton, Catherine; Savage, Sarah; Mandl, Kenneth D.; Margulies, David; Manzi, Shannon

2013-01-01

217

Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.  

PubMed

"The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83 % (513/618) of patients that provided feedback, 97 % felt PHP was easy to use and 98 % easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ?0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records. PMID:24101435

Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin; O'Leary, James; Vasquez, Lisa; Copeland, Sara; Galvin, Shelley L; DeGroat, Nicole; Pardanani, Setul; Gregory Feero, W; Adams, Claire; Jones, Renee; Scott, Joan

2014-07-01

218

Using the Clinical Document Architecture as Open Data Exchange Format for Interfacing EMRs with Clinical Decision Support Systems  

Microsoft Academic Search

Clinical decision support systems (CDSS) can significantly increase the quality of care while decreasing cost and effort. They are difficult to develop and most existing systems are proprietary, tightly integrated with specific electronic medical record (EMR) systems, and expensive to own. EGADSS is an open-source CDSS that has been developed as a standalone, standards-based, re-usable component to make decision-support available

Iryna Bilykh; Jens H. Jahnke; Glen Mccallum; Morgan Price

2006-01-01

219

Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study.  

PubMed

There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths. PMID:23932101

Thomson, Oliver P; Petty, Nicola J; Moore, Ann P

2014-02-01

220

Suggested criteria for successful deployment of a Clinical Decision Support System (CDSS)  

Microsoft Academic Search

Three criteria are suggested to help design a Clinical Decision Support System (CDSS) that would have a better chance of being successfully deployed in a clinical environment. These criteria have been successfully applied to a CDSS designed to estimate outcomes for neonatal intensive care unit (NICU) patients. The CDSS was deployed in a pilot study at the Children's Hospital of

Monique Frize; S. Weyand; E. Bariciak

2010-01-01

221

A Soft Systems Methodology Model for Clinical Decision Support Systems (SSMM-CDSS)  

Microsoft Academic Search

A systematic approach for the development of clinical decision support systems is essential for an effective design and implementation of medical information system. This research paper proposes the use of Soft Systems Methodology (SSM) as a tool for analysing clinical support system of medical information system using various models. From the SSM model so developed, a quantitative survey is designed

Grace Saulan Loo; Philip C. H. Lee

2001-01-01

222

Incorporating usability design factors into development of clinical decision support systems  

Microsoft Academic Search

Usability is an important component of software engineering. Medical computer systems that take usability into consideration allow users to improve clinical productivity effectively and efficiently, while promoting positive feelings of satisfaction. Clinical decision support systems (CDSS) share similar usability issues as other applications, and raise unique user concerns. In this paper, we propose the CDSS usability framework as a solution

Lan Yang; Monique Frize

2003-01-01

223

Clinical Decision Support Systems: Basic Principles and Applications in Diagnosis and Therapy  

Microsoft Academic Search

This chapter introduces the basic principles of clinical decision support (CDS) systems. CDS systems aim to codify and strategically manage biomedical knowledge to handle challenges in clinical practice using mathematical modelling tools, medical data processing techniques and Artificial Intelligence (AI) methods. CDS systems cover a wide range of applications, from diagnosis support to modelling the possibility of occurrence of various

Chapter XIV

224

Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models  

ERIC Educational Resources Information Center

In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

2006-01-01

225

Does Reflux Monitoring With Multichannel Intraluminal Impedance Change Clinical Decision Making?  

PubMed Central

Objectives Multichannel intraluminal impedance with pH (pH-MII) has become the criterion standard test for the evaluation of gastroesophageal reflux disease, but it is not clear whether the results of this test change clinical decision making. The goal of the present study was to determine the differences in clinical decision making by attending physicians based on the pH probe results versus MII results. Methods We conducted a prospective study in which physicians were initially given pH probe results and asked how they would change the patient’s clinical management based on these results. Physicians were then given the MII results and asked how their management would change. Physicians then were asked whether they believed MII affected their clinical decision making overall. Results pH probe results changed clinical management 40% of the time and MII results changed clinical management an additional 22% of the time. Clinical decision making was not influenced by the performance of pH-MII on or off acid suppression. The escalation of acid suppression therapy was the main management change that occurred based on the pH-MII results. Conclusions The addition of MII to the standard pH probe resulted in a change in management in approximately 25% of the patients, suggesting that there may be a role for pH-MII in clinical practice.

Rosen, Rachel; Hart, Kristen; Nurko, Samuel

2012-01-01

226

Guest Expert: Barbara Biedzycki: Decision-making regarding clinical trial participation | accrualnet.cancer.gov  

Cancer.gov

Welcome to our first 'Guest Blogger' of 2011, Dr. Barbara Biedzycki. Barbara is a Clinical Research Associate at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore. She recently completed her doctoral program and much of her research has been on decision-making regarding clinical trial participation.

227

"Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa  

PubMed Central

Background Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”. Results The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration http://www.clinicaltrials.gov/NCT01409824.

2013-01-01

228

Dental patient preferences and choice in clinical decision-making.  

PubMed

In economics, the concept of utility refers to the strength of customer preference. In health care assessment, the visual analogue scale (VAS), the standard gamble, and the time trade-off are used to measure health state utilities. These utility measurements play a key role in promoting shared decision-making in dental care. Individual preference, however, is complex and dynamic. The purpose of this study was to investigate the relationship between patient preference and educational intervention in the field of dental health. The data were collected by distributing questionnaires to employees of two companies in Japan. Participants were aged 18-65 years and consisted of 111 males and 93 females (204 in total). One company (Group A) had a dental program of annual check-ups and health education in the workplace, while the other company (Group B) had no such program. Statistical analyses were performed with the t-test and Chi-square test. The questionnaire items were designed to determine: (1) oral health-related quality of life, (2) dental health state utilities (using VAS), and (3) time trade-off for regular dental check-ups. The percentage of respondents in both groups who were satisfied with chewing function, appearance of teeth, and social function ranged from 23.1 to 42.4%. There were no significant differences between groups A and B in the VAS of decayed, filled, and missing teeth. The VAS of gum bleeding was 42.8 in Group A and 51.3 in Group B (p<0.05). The percentage of persons having a regular dental check-up every three months was 34.1 and 31.3% in Groups A and B respectively. These results suggest that low preference results from lack of opportunity or utilization of dental care in the worksite. Ascertaining the factors involved in patient preference may have significant potential benefits in shared decision-making. PMID:22790334

Fukai, Kakuhiro; Yoshino, Koichi; Ohyama, Atsushi; Takaesu, Yoshinori

2012-01-01

229

A Three-Question Framework to Facilitate Clinical Decision Making  

ERIC Educational Resources Information Center

Context: Highly developed critical thinking and the ability to discriminate among many possible therapeutic interventions is a core behavior for the practicing athletic trainer. However, while athletic training students receive a great deal of clinically applicable information, many are not explicitly trained in efficient methods for channeling…

Sibold, Jeremy

2012-01-01

230

Detecting fast, online reasoning processes in clinical decision making.  

PubMed

In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed. PMID:24274045

Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

2014-06-01

231

Incorporating clinical guidelines through clinician decision-making  

Microsoft Academic Search

BACKGROUND: It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that

Paul R Falzer; Brent A Moore; D Melissa Garman

2008-01-01

232

Seeking evidence to support usability principles for medication-related clinical decision support (CDS) functions.  

PubMed

There is a need for evidence-based usability principles to support the design of usable medication-related computerized CDS functions and systems. Such evidence requires establishing scientific relationships between usability principles, their violation in terms of usability flaws, issuing usage problems and their consequences or outcomes in the clinical work and patient care. This kind of evidence is not currently directly available in scientific evaluation studies of medication CDS functions. A possible proxy to seek evidence is systematic review of existing scientific evaluation reports. We rely on a four-stage framework describing the chain of consequences and inferences linking usability principles to clinical outcomes to design the systematic review methodology and interpretation principles. This paper describes the four-stage framework and the resulting consequences for the systematic review design. PMID:23920590

Marcilly, Romaric; Beuscart-Zéphir, Marie-Catherine; Ammenwerth, Elske; Pelayo, Sylvia

2013-01-01

233

Social, Organizational, and Contextual Characteristics of Clinical Decision Support Systems for Intensive Insulin Therapy: A Literature Review and Case Study  

PubMed Central

Introduction: Evaluations of computerized clinical decision support systems (CDSS) typically focus on clinical performance changes and do not include social, organizational, and contextual characteristics explaining use and effectiveness. Studies of CDSS for intensive insulin therapy (IIT) are no exception, and the literature lacks an understanding of effective computer-based IIT implementation and operation. Results: This paper presents (1) a literature review of computer-based IIT evaluations through the lens of institutional theory, a discipline from sociology and organization studies, to demonstrate the inconsistent reporting of workflow and care process execution and (2) a single-site case study to illustrate how computer-based IIT requires substantial organizational change and creates additional complexity with unintended consequences including error. Discussion: Computer-based IIT requires organizational commitment and attention to site-specific technology, workflow, and care processes to achieve intensive insulin therapy goals. The complex interaction between clinicians, blood glucose testing devices, and CDSS may contribute to workflow inefficiency and error. Evaluations rarely focus on the perspective of nurses, the primary users of computer-based IIT whose knowledge can potentially lead to process and care improvements. Conclusion: This paper addresses a gap in the literature concerning the social, organizational, and contextual characteristics of CDSS in general and for intensive insulin therapy specifically. Additionally, this paper identifies areas for future research to define optimal computer-based IIT process execution: the frequency and effect of manual data entry error of blood glucose values, the frequency and effect of nurse overrides of CDSS insulin dosing recommendations, and comprehensive ethnographic study of CDSS for IIT.

Campion, Thomas R.; Waitman, Lemuel R.; May, Addison K.; Ozdas, Asli; Lorenzi, Nancy M.; Gadd, Cynthia S.

2009-01-01

234

Improving pain & symptom management for advanced cancer patients with a clinical decision support system.  

PubMed

In palliative medicine, healthcare providers aim to provide end-of-life cancer patients with a plan of care to minimize pain and manage symptoms, while providing psychosocial and educational support to patients and their families. Unfortunately, it has been reported that patients often experience unnecessary suffering due to ineffective symptom management as they near end-of-life. Recent advances in health informatics have motivated healthcare institutions to take advantage of clinical decision support systems that assist healthcare providers with evidence-based decision making for pain and symptom management. In this paper, we present a unique clinical decision support system that incorporates case-based reasoning and evidence-based standards of care. It is anticipated that this user-friendly, web-based CBR system will improve decision making for pain and symptom management for end-of-life cancer patients. PMID:18487726

Elvidge, Krista

2008-01-01

235

Framework for securing personal health data in clinical decision support systems.  

PubMed

If appropriate security mechanisms aren't in place, individuals and groups can get unauthorized access to personal health data residing in clinical decision support systems (CDSS). These concerns are well founded; there has been a dramatic increase in reports of security incidents. The paper provides a framework for securing personal health data in CDSS. The framework breaks down CDSS into data gathering, data management and data delivery functions. It then provides the vulnerabilities that can occur in clinical decision support activities and the measures that need to be taken to protect the data. The framework is applied to protect the confidentiality, integrity and availability of personal health data in a decision support system. Using the framework, project managers and architects can assess the potential risk of unauthorized data access in their decision support system. Moreover they can design systems and procedures to effectively secure personal health data. PMID:17583166

Sandell, Protik

2007-01-01

236

A structural design of clinical decision support system for chronic diseases risk management  

Microsoft Academic Search

In clinical decision making, the event of primary interest is recurrent, so that for a given unit the event could be observed\\u000a more than once during the study. In general, the successive times between failures of human physiological systems are not\\u000a necessarily identically distributed. However, if any critical deterioration is detected, then the decision of when to take\\u000a thei ntervention,

Chi-Chang Chang; Chuen-Sheng Cheng

2007-01-01

237

Clinical Decision Support Systems for the Practice of Evidence-based Medicine  

Microsoft Academic Search

BackgroundThe use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality.ObjectiveTo describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for

Ida Sim; Paul Gorman; Robert A Greenes; R Brian Haynes; Bonnie Kaplan; Harold Lehmann; Paul C Tang

2001-01-01

238

Implementing an integrative multi-agent clinical decision support system with open source software.  

PubMed

Clinical decision making is a complex multi-stage process. Decision support can play an important role at each stage of this process. At present, the majority of clinical decision support systems have been focused on supporting only certain stages. In this paper we present the design and implementation of MET3-a prototype multi-agent system providing an integrative decision support that spans over the entire decision making process. The system helps physicians with data collection, diagnosis formulation, treatment planning and finding supporting evidence. MET3 integrates with external hospital information systems via HL7 messages and runs on various computing platforms available at the point of care (e.g., tablet computers, mobile phones). Building MET3 required sophisticated and reliable software technologies. In the past decade the open source software movement has produced mature, stable, industrial strength software systems with a large user base. Therefore, one of the decisions that should be considered before developing or acquiring a decision support system is whether or not one could use open source technologies instead of proprietary ones. We believe MET3 shows that the answer to this question is positive. PMID:20703742

Sayyad Shirabad, Jelber; Wilk, Szymon; Michalowski, Wojtek; Farion, Ken

2012-02-01

239

Using online exercises and patient simulation to improve students' clinical decision-making.  

PubMed

Faced with increasingly complex clinical situations, nurses must respond with accurate clinical judgment. But del Bueno (2005) reports that only 35 percent of new graduate nurses exhibit entry-level expectations of the necessary critical-thinking skills. Croskerry (2003) argues that clinicians' education should be directed at developing cognitive strategies that reduce errors in clinical decision-making. A challenge for nurse educators is finding activities to help students analyze their thinking as they address clinical problems. The author describes an assignment, given to third-year baccalaureate students, that used both online learning and high-fidelity patient simulation. Through discussions with instructors and peers, as well as personal reflection, students gained insight into both their sound and faulty critical thinking and clinical decisions. PMID:21280447

Guhde, Jacqueline

2010-01-01

240

Pharmacogenomics, ancestry and clinical decision making for global populations.  

PubMed

Pharmacogenomically relevant markers of drug response and adverse drug reactions are known to vary in frequency across populations. We examined minor allele frequencies (MAFs), genetic diversity (FST) and population structure of 1156 genetic variants (including 42 clinically actionable variants) in 212 genes involved in drug absorption, distribution, metabolism and excretion (ADME) in 19 populations (n=1478). There was wide population differentiation in these ADME variants, reflected in the range of mean MAF (?MAF) and FST. The largest mean ?MAF was observed in African ancestry populations (0.10) and the smallest mean ?MAF in East Asian ancestry populations (0.04). MAFs ranged widely, for example, from 0.93 for single-nucleotide polymorphism (SNP) rs9923231, which influences warfarin dosing to 0.01 for SNP rs3918290 associated with capecitabine metabolism. ADME genetic variants show marked variation between and within continental groupings of populations. Enlarging the scope of pharmacogenomics research to include multiple global populations can improve the evidence base for clinical translation to benefit all peoples. PMID:23835662

Ramos, E; Doumatey, A; Elkahloun, A G; Shriner, D; Huang, H; Chen, G; Zhou, J; McLeod, H; Adeyemo, A; Rotimi, C N

2014-06-01

241

Social and clinical predictors of prostate cancer treatment decisions among men in South Carolina  

PubMed Central

Objective To assess social and clinical influences of prostate cancer treatment decisions among white and black men in the Midlands of South Carolina. Methods We linked data collected on treatment decision making in men diagnosed with prostate cancer from 1996 through 2002 with clinical and sociodemographic factors collected routinely by the South Carolina Central Cancer Registry (SCCCR). Unconditional logistic regression was used to assess social and clinical influences on treatment decision. Results A total of 435 men were evaluated. Men of both races who chose surgery (versus radiation) were more likely to be influenced by their physician and by family/ friends. Black men who chose surgery also were ~5 times more likely to make independent decisions (i.e., rather than be influenced by their doctor). White men who chose surgery were twice as likely to be influenced by the desire for cure and less likely to consider the side effects of impotence (odds ratio (OR) = 0.40; 95% confidence interval (CI): 0.18, 0.88) and incontinence (OR = 0.27; 95% CI: 0.12, 0.63); by contrast, there was a suggestion of an opposite effect in black men, whose decision regarding surgery tended to be more strongly influenced by these side effects. Conclusion Results suggest that both clinical and social predictors play an important role for men in choosing a prostate cancer treatment, but these influences may differ by race.

Wagner, Sara E.; Drake, Bettina F.; Elder, Keith; Hebert, James R.

2012-01-01

242

Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.  

PubMed Central

A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.

Bell, M J; Ternberg, J L; Feigin, R D; Keating, J P; Marshall, R; Barton, L; Brotherton, T

1978-01-01

243

Hodgkin lymphoma patients in first remission: routine positron emission tomography/computerized tomography imaging is not superior to clinical follow-up for patients with no residual mass.  

PubMed

There is no consensus regarding optimal follow-up mode for Hodgkin lymphoma (HL) patients that achieve complete remission following chemotherapy or combined chemo- and radiation therapy. Several studies demonstrated high sensitivity of positron emission tomography/computerized tomography (PET/CT) in detecting disease progression; however, these techniques are currently not recommended for routine follow-up. This retrospective study conducted in two Israeli (N = 291) and one New Zealand academic centres (N = 77), compared a group of HL patients, followed-up with routine imaging every 6 months during the first 2 years after achieving remission, once in the third year, with additional dedicated studies performed due to symptoms or physical findings (Group I) to a group of patients without residual masses who underwent clinically-based surveillance with dedicated imaging upon relapse suspicion (Group II). Five-year overall survival (OS) was 94% and median time to relapse was 8·6 months for both modes. Relapse rates in Groups I and II were 13% and 9%, respectively. During the first 3 years of follow-up, 47·5 and 4·7 studies were performed per detected relapse in Groups I and II, respectively. The current study demonstrated no benefit in either progression-free survival (PFS) or OS in HL patients followed by routine imaging versus clinical follow-up. The cost was 10 times higher for routine imaging. PMID:24313286

Dann, Eldad J; Berkahn, Leanne; Mashiach, Tatiana; Frumer, Michael; Agur, Ariel; McDiarmid, Bridgett; Bar-Shalom, Rachel; Paltiel, Ora; Goldschmidt, Neta

2014-03-01

244

A Trial of Automated Safety Alerts for Inpatient Digoxin Use with Computerized Physician Order Entry  

Microsoft Academic Search

ObjectiveAutomated clinical decision support (CDS) has shown promise in improving safe medication use. The authors performed a trial of CDS, given both during computerized physician order entry (CPOE) and in response to new laboratory results, comparing the time courses of clinician behaviors related to digoxin use before and after implementation of the alerts.DesignAlerts were implemented to notify of the potential

William L Galanter; Audrius Polikaitis; Robert J DiDomenico

2004-01-01

245

Use of a clinical decision support system to increase osteoporosis screening  

PubMed Central

Background In 2002, the US Preventive Services Task Force recommended routine osteoporosis screening for women aged 65 years or older. However, studies have indicated that osteoporosis remains underdiagnosed, and various methods such as the use of health information technology have been tried to increase screening rates. We investigated whether we could boost the low rates of bone mineral density testing with implementation of a point-of-care clinical decision support system in our primary care practice. Methods We retrospectively reviewed the medical records of female patients eligible for osteoporosis screening who had no prior bone mineral density test who were seen at our primary care practice sites in 2007 or 2008 (before and after implementation of a point-of-care clinical decision support system). Results Overall, screening rates were 80.1% in 2007 and 84.1% in 2008 (P < 0.001). Of patients who did not have osteoporosis screening before the visit, 5.87% completed the screening after the visit in 2007, compared with 9.79% in 2008 (when the clinical support system was implemented), a 66.7% improvement (P = 0.025). Conclusion Clinical decision support for primary care doctors significantly improved osteoporosis screening rates among eligible women. Carefully designed clinical decision support systems can optimize care delivery, ensuring that important preventive services such as osteoporosis screening for patients at risk for fracture are performed while unnecessary testing is avoided.

DeJesus, Ramona S; Angstman, Kurt B; Kesman, Rebecca; Stroebel, Robert J; Bernard, Matthew E; Scheitel, Sidna M; Hunt, Vicki L; Rahman, Ahmed S; Chaudhry, Rajeev

2012-01-01

246

Computerized information-gathering in specialist rheumatology clinics: an initial evaluation of an electronic version of the Short Form 36  

Microsoft Academic Search

Objectives. Longitudinal outcome data are important for research and are becoming part of routine clinical practice. We assessed an initial version of an electronic Short Form 36 (SF-36), a well-established health assessment questionnaire, in comparison with standard paper forms, in two specialist rheumatology clinics. Methods. Out-patients (20 with systemic lupus erythematosus and 31 with vasculitis) were randomly selected to complete

A. S. Wilson; G. D. Kitas; D. M. Carruthers; C. Reay; J. Skan; S. Harris; G. J. Treharne; S. P. Young; P. A. Bacon

2002-01-01

247

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes  

Microsoft Academic Search

Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing\\u000a on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome\\u000a assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of\\u000a the current study is to investigate the radiographic, functional and clinical

Heiko Koller; Frank Acosta; Rosemarie Forstner; Juliane Zenner; Herbert Resch; Mark Tauber; Stefan Lederer; Alexander Auffarth; Wolfgang Hitzl

2009-01-01

248

Constructing a clinical decision-making framework for image-guided radiotherapy using a Bayesian Network  

NASA Astrophysics Data System (ADS)

A decision-making framework for image-guided radiotherapy (IGRT) is being developed using a Bayesian Network (BN) to graphically describe, and probabilistically quantify, the many interacting factors that are involved in this complex clinical process. Outputs of the BN will provide decision-support for radiation therapists to assist them to make correct inferences relating to the likelihood of treatment delivery accuracy for a given image-guided set-up correction. The framework is being developed as a dynamic object-oriented BN, allowing for complex modelling with specific subregions, as well as representation of the sequential decision-making and belief updating associated with IGRT. A prototype graphic structure for the BN was developed by analysing IGRT practices at a local radiotherapy department and incorporating results obtained from a literature review. Clinical stakeholders reviewed the BN to validate its structure. The BN consists of a sub-network for evaluating the accuracy of IGRT practices and technology. The directed acyclic graph (DAG) contains nodes and directional arcs representing the causal relationship between the many interacting factors such as tumour site and its associated critical organs, technology and technique, and inter-user variability. The BN was extended to support on-line and off-line decision-making with respect to treatment plan compliance. Following conceptualisation of the framework, the BN will be quantified. It is anticipated that the finalised decision-making framework will provide a foundation to develop better decision-support strategies and automated correction algorithms for IGRT.

Hargrave, C.; Moores, M.; Deegan, T.; Gibbs, A.; Poulsen, M.; Harden, F.; Mengersen, K.

2014-03-01

249

Science and intuition: do both have a place in clinical decision making?  

PubMed

Intuition is widely used in clinical decision making yet its use is underestimated compared to scientific decision-making methods. Information processing is used within scientific decision making and is methodical and analytical, whereas intuition relies more on a practitioner's perception. Intuition is an unconscious process and may be referred to as a 'sixth sense', 'hunch' or 'gut feeling'. It is not underpinned by valid and reliable measures. Expert health professionals use a rapid, automatic process to recognise familiar problems instantly. Intuition could therefore involve pattern recognition, where experts draw on experiences, so could be perceived as a cognitive skill rather than a perception or knowing without knowing how. The NHS places great importance on evidence-based practice but intuition is seemingly becoming an acceptable way of thinking and knowing in clinical decision making. Recognising nursing as an art allows intuition to be used and the environment or situation to be interpreted to help inform decision making. Intuition can be used in conjunction with evidence-based practice and to achieve good outcomes and deserves to be acknowledged within clinical practice. PMID:23448983

Pearson, Helen

250

Building a normative decision support system for clinical and operational risk management in hemodialysis.  

PubMed

This paper describes the design and implementation of a decision support system for risk management in hemodialysis (HD) departments. The proposed system exploits a domain ontology to formalize the problem as a Bayesian network. It also relies on a software tool, able to automatically collect HD data, to learn the network conditional probabilities. By merging prior knowledge and the available data, the system allows to estimate risk profiles both for patients and HD departments. The risk management process is completed by an influence diagram that enables scenario analysis to choose the optimal decisions that mitigate a patient's risk. The methods and design of the decision support tool are described in detail, and the derived decision model is presented. Examples and case studies are also shown. The tool is one of the few examples of normative system explicitly conceived to manage operational and clinical risks in health care environments. PMID:18779083

Cornalba, Chiara; Bellazzi, Roberto G; Bellazzi, Riccardo

2008-09-01

251

Mobile clinical decision support systems and applications: a literature and commercial review.  

PubMed

The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Ninety-two relevant papers and 192 commercial apps were found. Forty-four papers were focused only on mobile clinical decision support systems. One hundred seventy-one apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users. PMID:24399281

Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Sainz-de-Abajo, Beatriz; Robles, Montserrat; García-Gómez, Juan Miguel

2014-01-01

252

Implementing a Clinical Decision Support System for Glucose Control for the Intensive Cardiac Care  

Microsoft Academic Search

Adherence to guidelines and protocols in clinical practice can be difficult to achieve. We describe the implementation of\\u000a a Clinical Decision Support System (CDSS) for glucose control on the Intensive Cardiac Care Unit (ICCU) of the Erasmus MC.\\u000a An existing paper protocol for glucose control was used for the CDSS rule set. In the first phase we implemented a proof

Rogier Barendse; Jonathan Lipton; Maarten Van Ettinger; Stefan Nelwan; Niek Van Der Putten

2009-01-01

253

Usability evaluation of a clinical decision support tool for osteoporosis disease management  

Microsoft Academic Search

BACKGROUND: Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at

Monika Kastner; Danielle Lottridge; Christine Marquez; David Newton; Sharon E Straus

2010-01-01

254

How School Social Workers Use Consultation to Aid Clinical Decision Making  

ERIC Educational Resources Information Center

This qualitative study of school social workers who practice with youths identified as seriously emotionally disturbed offers guidelines for the use of information gleaned through consultation in clinical decision making. School social workers engage in regular consultation with professionals in the school setting, the community, the family, and…

Mann, Kimberly A.

2008-01-01

255

The Value of Intelligent Multimedia Simulation for Teaching Clinical Decision-Making Skills.  

ERIC Educational Resources Information Center

Examines advantages and disadvantages of multimedia simulation in nursing education. Provides an example of a modular design with an integrated intelligent agent and knowledge base for teaching clinical decision making. Concludes that this approach overcomes some of the problems of intelligent tutoring systems. Contains 40 references. (SK)

Garrett, Bernard M.; Callear, David

2001-01-01

256

A modular framework for clinical decision support systems: medical device plug-and-play is critical  

Microsoft Academic Search

This paper describes the design and initial implementation of a modular framework for Clinical Decision Support Systems and highlights the need for medical device plug-and-play standards. The software handles the tasks of data acquisition and validation, visualization, and treatment management in order to enable the development of protocol guideline modules as \\

M. Williams; F. Wu; P. Kazanzides; K. Brady; J. Fackler

2009-01-01

257

Involving users in the design and usability evaluation of a clinical decision support system  

Microsoft Academic Search

Aim: To design and evaluate a clinical decision support system (CDSS) to support cardiovascular risk prevention in type 2 diabetes. Methods: A preliminary requirements specification and three prototype CDSS interface designs were developed. Seven patients and seven clinicians conducted ‘usability tests’ on five different task scenarios with the CDSS prototypes to test its effectiveness, efficiency and ‘user-friendliness’. Structured, qualitative questions

Carmen Carroll; Phil Marsden; Pat Soden; Emma Naylor; John P. New; Tim Dornan

2002-01-01

258

Interoperability and Integration Considerations for a Process-Oriented Clinical Decision Support System  

Microsoft Academic Search

Electronic medical record systems (EMRs) can be made more attractive to the clinicians if Clinical Decision Support Systems (CDSS) are integrated with them. However, CDSS have to be developed with integration in mind, such that they may be integrated not just with the local EMR but EMRs developed by others as well. Web Services Technology ameliorates the challenge of integration

H. Shah; G. Krishnan; P. Williams; A. Vogler; R. D. Allard; P. M. Nadkarni

2011-01-01

259

Ability of online drug databases to assist in clinical decision-making with infectious disease therapies  

Microsoft Academic Search

BACKGROUND: Infectious disease (ID) is a dynamic field with new guidelines being adopted at a rapid rate. Clinical decision support tools (CDSTs) have proven beneficial in selecting treatment options to improve outcomes. However, there is a dearth of information on the abilities of CDSTs, such as drug information databases. This study evaluated online drug information databases when answering infectious disease-specific

Hyla H Polen; Antonia Zapantis; Kevin A Clauson; Jennifer Jebrock; Mark Paris

2008-01-01

260

Clinical psychophysics: Applications of ratio scaling and signal detection methods to research on pain, fear, drugs, and medical decision making  

Microsoft Academic Search

Recent developments in psychophysics termed statistical decision theory (or signal detection theory; SDT) and magnitude estimation (ME) are being applied to an increasing variety of previously recalcitrant problems in clinical psychology and medical decision making. The SDT method separates human decision making into a discrimination accuracy measure and a criterion or bias measure. This characteristic is helpful in analyzing confusing

John M. Grossberg; Bridget F. Grant

1978-01-01

261

Use of Computer-based Records, Completeness of Documentation, and Appropriateness of Documented Clinical Decisions  

PubMed Central

Objective: To investigate whether using a computer-based patient record (CPR) affects the completeness of documentation and appropriateness of documented clinical decisions. Design: A blinded expert panel of four experienced internists evaluated 50 progress notes of patients who had chronic diseases and whose physicians used either a CPR or a traditional paper record. Measurements: Completeness of problem and medication lists in progress notes, allergies noted in the entire record, consideration of relevant patient factors in the progress note's diagnostic and treatment plans, and appropriateness of documented clinical decisions. Results: The expert reviewers rated the problem lists and medication lists in the CPR progress notes as more complete (1.79/2.00 vs. 0.93/2.00, P < 0.001, and 1.75/2.00 vs. 0.91/2.00, P < 0.001, respectively) than those in the paper record. The allergy lists in both records were similar. Providers using a CPR documented consideration of more relevant patient factors when making their decisions (1.53/2.00 vs. 1.07/2.00, P < 0.001), and documented more appropriate clinical decisions (3.63/5.00 vs. 2.50/5.00, P < 0.001), compared with providers who used traditional paper records. Conclusions: Physicians in our study who used a CPR produced more complete documentation and documented more appropriate clinical decisions, as judged by an expert review panel. Because the physicians who used the CPR in our study volunteered to do so, further study is warranted to test whether the same conclusions would apply to all CPR users and whether the improvement in documentation leads to better clinical outcomes.

Tang, Paul C.; LaRosa, Michael P.; Gorden, Susan M.

1999-01-01

262

Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury: a randomized, controlled trial.  

PubMed

OBJECTIVES: Clinical decision support (CDS), such as computerized alerts, improves prescribing in the setting of acute kidney injury (AKI), but considerable opportunity remains to improve patient safety. The authors sought to determine whether pharmacy surveillance of AKI patients could detect and prevent medication errors that are not corrected by automated interventions. METHODS: The authors conducted a randomized clinical trial among 396 patients admitted to an academic, tertiary care hospital between June 1, 2010 and August 31, 2010 with an acute 0.5 mg/dl change in serum creatinine over 48 hours and a nephrotoxic or renally cleared medication order. Patients randomly assigned to the intervention group received surveillance from a clinical pharmacist using a web-based surveillance tool to monitor drug prescribing and kidney function trends. CDS alerting and standard pharmacy services were active in both study arms. Outcome measures included blinded adjudication of potential adverse drug events (pADEs), adverse drug events (ADEs) and time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications. RESULTS: Potential ADEs or ADEs occurred for 104 (8.0%) of control and 99 (7.1%) of intervention patient-medication pairs (p=0.4). Additionally, the time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications did not differ between control and intervention patients (33.4 hrs vs. 30.3 hrs, p=0.3). CONCLUSIONS: Pharmacy surveillance had no incremental benefit over previously implemented CDS alerts. PMID:22719796

McCoy, Allison B; Cox, Zachary L; Neal, Erin B; Waitman, Lemuel R; Peterson, Neeraja B; Bhave, Gautam; Siew, Edward D; Danciu, Ioana; Lewis, Julia B; Peterson, Josh F

2012-01-01

263

Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.  

PubMed

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making. PMID:12890455

Cook, S A; Rosser, R; Meah, S; James, M I; Salmon, P

2003-07-01

264

Clinical decision support must be useful, functional is not enough: a qualitative study of computer-based clinical decision support in primary care  

PubMed Central

Background Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the use of computer-based clinical decision support (eCDS) in primary care and how different professional groups experience it. Our aim was to describe specific reasons for using or not using eCDS among primary care professionals. Methods The setting was a Finnish primary health care organization with 48 professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics. Results The content of the guidance is a significant feature of the primary care professional’s intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder the use. Conclusions Primary care professionals have to perceive eCDS guidance useful for their work before they use it.

2012-01-01

265

Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions  

Microsoft Academic Search

BACKGROUND: Shared decision-making is advocated because of its potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. However, current evidence suggests that shared decision-making has not yet been widely adopted by health professionals. Therefore, a systematic review was performed on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by

Karine Gravel; Ian D Graham

2006-01-01

266

Comparing and using assessments of the value of information to clinical decision-making.  

PubMed

This paper discusses the Value project, which assessed the value to clinical decision-making of information supplied by National Health Service (NHS) library and information services. The project not only showed how health libraries in the United Kingdom help clinicians in decision-making but also provided quality assurance guidelines for these libraries to help make their information services more effective. The paper reviews methods and results used in previous studies of the value of health libraries, noting that methodological differences appear to affect the results. The paper also discusses aspects of user involvement, categories of clinical decision-making, the value of information to present and future clinical decisions, and the combination of quantitative and qualitative assessments of value, as applied to the Value project and the studies reviewed. The Value project also demonstrated that the value placed on information depends in part on the career stage of the physician. The paper outlines the structure of the quality assurance tool kit, which is based on the findings and methods used in the Value project. PMID:8913550

Urquhart, C J; Hepworth, J B

1996-10-01

267

Comparing and using assessments of the value of information to clinical decision-making.  

PubMed Central

This paper discusses the Value project, which assessed the value to clinical decision-making of information supplied by National Health Service (NHS) library and information services. The project not only showed how health libraries in the United Kingdom help clinicians in decision-making but also provided quality assurance guidelines for these libraries to help make their information services more effective. The paper reviews methods and results used in previous studies of the value of health libraries, noting that methodological differences appear to affect the results. The paper also discusses aspects of user involvement, categories of clinical decision-making, the value of information to present and future clinical decisions, and the combination of quantitative and qualitative assessments of value, as applied to the Value project and the studies reviewed. The Value project also demonstrated that the value placed on information depends in part on the career stage of the physician. The paper outlines the structure of the quality assurance tool kit, which is based on the findings and methods used in the Value project.

Urquhart, C J; Hepworth, J B

1996-01-01

268

Audit of Health Data Captured Routinely in Primary Healthcare for the Clinical Decision Support System PREDICT (PREDICT CVD4)  

Microsoft Academic Search

Computerised clinical decision support systems require health data to be captured in an explicit, structured way. However, traditional patient medical records contain data that is recorded in multiple ways using coding systems, free text, medical jargon and idiosyncratic abbreviations. To be meaningful, data transferred either automatically or manually from medical records to a clinical decision support program must accurately reflect

Tania Riddell; Tim Kenealy; Sue Wells; Rod Jackson; Joanna Broad

269

Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support  

PubMed Central

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3) evaluating the ability of an electronic medical record/electronic health record (EMR/EHR) to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age <18 THEN patient is a child), sufficient clinical data exists in University of Washington’s EMR systems to support 50% of PGx knowledge contained in drug labels that could be expressed as rules.

2010-01-01

270

Tactical Decision Making and Decision Support Systems.  

ERIC Educational Resources Information Center

The use of computerized decision support systems in higher education for making tactical institutional decisions is reviewed, with attention to the kind of administrative problems that lie somewhere between programmed to nonprogrammed decisions and require a combination of computer support and administrative judgment. (MSE)

Harmon, Joel I.

1986-01-01

271

Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting 1 1 Vital Images Inc. has supported research at UCLA (to D. S. K. L., J. A. B., and E. G. M.). Monex provided support (to M. M.). GE Medical Systems provided software license and research support (to C. D. J., J. A. B., and A. H. D.). Voxar, Inc. produces products that compete with products listed in this paper (to M. A. B.). The study design was approved by the National Cancer Institute Cancer Therapy Evaluation Program. Computerized tomographic colonography examinations for American College of Radiology Imaging Network Protocol A6656 were submitted by E. G. McFarland, Mallinckrodt Institute of Radiology, St. Louis, Missouri; M. Zalis, Massachusetts General Hospital, Boston, Massachusetts; C. D. Johnson, Mayo Clinic, Rochester, Minnesota; M. Macari, New York University, New York, New York; D. Lu, University of California, Los Angeles, California; A. H. Dachman, University of Chicago, C  

Microsoft Academic Search

Background & Aims: No multicenter study has been reported evaluating the performance and interobserver variability of computerized tomographic colonography. The aim of this study was to assess the accuracy of computerized tomographic colonography for detecting clinically important colorectal neoplasia (polyps ?10 mm in diameter) in a multi-institutional study. Methods: A retrospective study was developed from 341 patients who had computerized

C. Daniel Johnson; Alicia Y. Toledano; Benjamin A. Herman; Abraham H. Dachman; Elizabeth G. Mcfarland; Matthew A. Barish; James A. Brink; Randy D. Ernst; Joel G. Fletcher; Robert A. Halvorsen; Amy K. Hara; Kenneth D. Hopper; Robert E. Koehler; David S. K. Lu; Michael Macari; Robert L. Maccarty; Frank H. Miller; Martina Morrin; Erik K. Paulson; Judy Yee; Michael Zalis

2003-01-01

272

Nursing Research Using Computerized Data Bases  

PubMed Central

Because of the implementation of large computerized information systems, the analyses of patient care data important to clinical nursing research is possible. Simultaneously, the heralding of computer technology in clinical practice areas has necessitated new research ideas to be pursued. This paper will describe a taxonomy of research data available on hospital information systems that may be used for clinical nursing research.

McCormick, Kathleen A.

1981-01-01

273

The future in clinical genetics: affective forecasting biases in patient and clinician decision making.  

PubMed

When clinicians facilitate and patients make decisions about predictive genetic testing, they often base their choices on the predicted emotional consequences of positive and negative test results. Research from psychology and decision making suggests that such predictions may often be biased. Work on affective forecasting-predicting one's future emotional states-shows that people tend to overestimate the impact of (especially negative) emotional events on their well-being; a phenomenon termed the impact bias. In this article, we review the causes and consequences of the impact bias in medical decision making, with a focus on applying such findings to predictive testing in clinical genetics. We also recommend strategies for reducing the impact bias and consider the ethical and practical implications of doing so. PMID:23952534

Peters, S A; Laham, S M; Pachter, N; Winship, I M

2014-04-01

274

Lung Cancer Assistant: a hybrid clinical decision support application for lung cancer care.  

PubMed

Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290

Sesen, M Berkan; Peake, Michael D; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael

2014-09-01

275

Diagnostic testing and treatment under ambiguity: Using decision analysis to inform clinical practice  

PubMed Central

Partial knowledge of patient health status and treatment response is a pervasive concern in medical decision making. Clinical practice guidelines (CPGs) make recommendations intended to optimize patient care, but optimization typically is infeasible with partial knowledge. Decision analysis shows that a clinician’s objective, knowledge, and decision criterion should jointly determine the care he prescribes. To demonstrate, this paper studies a common scenario regarding diagnostic testing and treatment. A patient presents to a clinician, who obtains initial evidence on health status. The clinician can prescribe a treatment immediately or he can order a test yielding further evidence that may be useful in predicting treatment response. In the latter case, he prescribes a treatment after observation of the test result. I analyze this scenario in three steps. The first poses a welfare function and characterizes optimal care. The second describes partial knowledge of response to testing and treatment that might realistically be available. The third considers decision criteria. I conclude with reconsideration of clinical practice guidelines.

Manski, Charles F.

2013-01-01

276

A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.  

PubMed

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight. PMID:22195151

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

277

A Legal Framework to Enable Sharing of Clinical Decision Support Knowledge and Services across Institutional Boundaries  

PubMed Central

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale – across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A.; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

278

Workflow-based Data Reconciliation for Clinical Decision Support: Case of Colorectal Cancer Screening and Surveillance  

PubMed Central

A major barrier for computer-based clinical decision support (CDS), is the difficulty in obtaining the patient information required for decision making. The information gap is often due to deficiencies in the clinical documentation. One approach to address this gap is to gather and reconcile data from related documents or data sources. In this paper we consider the case of a CDS system for colorectal cancer screening and surveillance. We describe the use of workflow analysis to design data reconciliation processes. Further, we perform a quantitative analysis of the impact of these processes on system performance using a dataset of 106 patients. Results show that data reconciliation considerably improves the performance of the system. Our study demonstrates that, workflow-based data reconciliation can play a vital role in designing new-generation CDS systems that are based on complex guideline models and use natural language processing (NLP) to obtain patient data.

Wagholikar, Kavishwar; Sohn, Sunghwan; Wu, Stephen; Kaggal, Vinod; Buehler, Sheila; Greenes, Robert A.; Wu, Tsung-Teh; Larson, David; Liu, Hongfang; Chaudhry, Rajeev; Boardman, Lisa

279

Distributing knowledge maintenance for clinical decision-support systems: the "knowledge library" model.  

PubMed Central

The maintenance of knowledge-rich clinical decision-support systems is challenging, in particular in the complex setting of a large academic medical center. Distributing the maintenance tasks to the source of expertise can address scalability, accuracy and currency issues. It also helps to foster a more global sense of ownership among the system users. The knowledge maintenance model must provide processes and tools to deal with a wide range of stakeholders (resident and attending physicians, consulting specialists, other care providers, case managers, ancillary departments), with knowledge embedded in legacy departmental systems, and with the continuous evolution of the content and form of the knowledge base. We describe and illustrate the "knowledge library" model in use at Vanderbilt University Medical Center for the distributed maintenance of the integrated knowledge base that drives the WizOrder clinical decision-support, physician order entry, and notes capture system.

Geissbuhler, A.; Miller, R. A.

1999-01-01

280

Conflicts of interest in research: is clinical decision-making compromised? An opinion paper.  

PubMed

Lack of transparency in funded research can compromise clinical decision-making in an evidence-based practice. Transparency can be defined as full disclosure of all financial assistance and support to authors and investigators. There is a perception that ethical principles are eroding and that research data can be biased due to conflicts of interest. These research outcomes biased or not, are used for clinical decision-making in the evidence-based practice. One suggested solution to this common ethical dilemma is to continue the dialogue on transparency in research and to create oversight bodies which include representatives from business and industry, private practice, academia, and research. There is increasing evidence of the need for more ethics education at all levels. PMID:20945733

Adibi, Shawn; Abidi, Shawn; Bebermeyer, Richard D

2010-08-01

281

Combining decision support methodologies to diagnose pneumonia.  

PubMed Central

OBJECTIVE: To evaluate the performance of a computerized decision support system that combines two different decision support methodologies (a Bayesian network and a natural language understanding system) for the diagnosis of patients with pneumonia. DESIGN: Evaluation study using data from a prospective, clinical study. PATIENTS: All patients 18 years and older who presented to the emergency department of a tertiary care setting and whose chest x-ray report was available during the encounter. METHODS: The computerized decision support system calculated a probability of pneumonia using information provided by the two systems. Outcome measures were the area under the receiver operating characteristic curve, sensitivity, specificity, predictive values, likelihood ratios, and test effectiveness. RESULTS: During the 3-month study period there were 742 patients (45 with pneumonia). The area under the receiver operating characteristic curve was 0.881 (95% CI: 0.822, 0.925) for the Bayesian network alone and 0.916 (95% CI: 0.869, 0.949) for the Bayesian network combined with the natural language understanding system (p=0.01). CONCLUSION: Combining decision support methodologies that process information stored in different data formats can increase the performance of a computerized decision support system.

Aronsky, D.; Fiszman, M.; Chapman, W. W.; Haug, P. J.

2001-01-01

282

Computerized analysis of voluntary eye movements. A clinical method for evaluation of smooth pursuit and saccades in oto-neurological diagnosis.  

PubMed

To permit rapid and exact quantification of the oculomotor function in clinical practice, a computerized program has been designed for the recording and analysis of pursuit eye movements and voluntary saccades. In a pursuit sequence the subject tracks a moving target, projected onto a screen at a constant speed of 20 degrees/sec over a horizontal visual angle of 60 degrees. The pursuit sequence is followed by a refixation saccade when the subject rapidly shifts his gaze back to the starting point of the target. A complete test procedure consists of ten consecutive pursuit sequences and refixation saccades in each direction. The EOG signal is fed to a PDP11/23 computer for storage and analysis. The pursuit eye movements are quantified and arranged in five velocity intervals: less than 8, 8-16, 16-24, 24-32 and greater than 32 degrees/sec. The relative distribution of the velocity content is calculated for these intervals and presented in histogram form. Saccades superimposing on the smooth pursuit are identified and grouped according to amplitude and direction. The refixation saccades are quantified as mean peak velocities and also the highest and lowest velocities of the refixation saccades are determined. In a material of 70 healthy subjects, normative data and limits for pathological function were established. In the smooth pursuit, 69% of the velocity values were located within the 16-24 degrees/sec interval. Pathological limits were set for each velocity interval and impaired pursuit tracking ability was considered to be present when those limits were reached in at least three of the five intervals. Normal mean peak eye velocity of the refixation saccade was found to be 460 degrees/sec with a range of 354-575 degrees/sec. Application of the test procedure and method of analysis is described in two patients with impairment of the oculomotor function due to a disturbance in the cerebellar brain stem area. PMID:6524345

Bergenius, J

1984-01-01

283

What do I do now?: clinical decision making by new graduates.  

PubMed

Newly graduated nurses (NGNs) are thrust into roles that some purport they are inadequately prepared to handle. This study investigated the experience of NGNs as they made clinical judgments in the critical care setting. Three themes emerged: developing confidence in practice, seeking assistance, and decision making. Nursing professional development educators can use the results to coordinate an education plan that extends beyond formal orientation and provides support for NGNs throughout the first year of practice. PMID:23877286

Wiles, Lynn L; Simko, Lynn C; Schoessler, Mary

2013-01-01

284

Extracting Qualitative Knowledge from Medical Guidelines for Clinical Decision-Support Systems  

Microsoft Academic Search

\\u000a Medical guidelines provide knowledge about processes that is not directly suitable for building clinical decision-support\\u000a systems. We discuss a two-step approach where knowledge from a guideline on COPD is translated into temporal logic, and augmented\\u000a with physiological background knowledge. This allows capturing the dynamics of the processes using qualitative knowledge,\\u000a while maintaining the temporal nature of the processes. As a

Maarten van der Heijden; Peter J. F. Lucas

2009-01-01

285

Evaluation of Case Based Reasoning for Clinical Decision Support Systems applied to Acute Meningitis Diagnose  

Microsoft Academic Search

\\u000a This work presents a research about the applicability of Case Based Reasoning to Clinical Decision Support Systems (CDSS),\\u000a particularly applied to the diagnosis of the disease known as Acute Bacterial Meningitis.\\u000a \\u000a \\u000a In the last few years, the amount of information available to the medical doctor, who usually finds himself in the situation\\u000a of making a diagnosis of one or more

Cecilia Maurente; Ernesto Ocampo Edye; Silvia Herrera Delgado; Daniel Rodriguez-García

2008-01-01

286

Gastric Polyps: A Review of Clinical, Endoscopic, and Histopathologic Features and Management Decisions  

PubMed Central

The increasing use of endoscopy has led to more discernable abnormalities in the stomach, including polyps. Gastric polyps encompass a spectrum of pathologic conditions that can vary in histology, neoplastic potential, and management. Despite their high prevalence, there is a paucity of literature to support management and treatment decisions for endoscopists. The goal of this review is to summarize clinical, endoscopic, and histopathologic features of various polyps, review syndromes associated with such polyps, and provide management recommendations.

Islam, Rafiul Sameer; Patel, Neal C.; Lam-Himlin, Dora

2013-01-01

287

Increasing profitability through computerization.  

PubMed

The author explores the pragmatic or financial justification for computerizing a dental practice and discusses a computerized approach to precollection and collection for the dental office. The article also deals with the use of computerized correspondence to augment the recall policy of the office and to help generate new patient referrals and discusses the pros and cons of utilizing a dental computer service bureau in implementing these policies. PMID:3422197

Sokol, D J

1988-01-01

288

A programmable rules engine to provide clinical decision support using HTML forms.  

PubMed

The authors have developed a simple method for specifying rules to be applied to information on HTML forms. This approach allows clinical experts, who lack the programming expertise needed to write CGI scripts, to construct and maintain domain-specific knowledge and ordering capabilities within WizOrder, the order-entry and decision support system used at Vanderbilt Hospital. The clinical knowledge base maintainers use HTML editors to create forms and spreadsheet programs for rule entry. A test environment has been developed which uses Netscape to display forms; the production environment displays forms using an embedded browser. PMID:10566470

Heusinkveld, J; Geissbuhler, A; Sheshelidze, D; Miller, R

1999-01-01

289

Towards collaborative chronic care using a clinical guideline-based decision support system.  

PubMed

Few clinical guideline-based decision support systems (DSS) have been successfully applied in chronic disease management. This paper investigates how clinical guideline-based DSS can help to put innovative chronic care models into practice and improve the quality of chronic care. A prototype of a guideline-based collaborative chronic care system called GC3 was developed based on a framework integrating guidelines into care workflow where a business process engine and a GELLO-based decision engine are integrated together to execute guidelines. We deployed the system in one of the largest hospitals in China and its affiliated community centers in order to manage type 2 diabetic patients. Pilot use of GC3 demonstrates its benefits to regional chronic care including evidence-based decision support, shared care content, improved clinician adherence to guidelines and enhanced patient self-management. This study verifies the feasibility and effectiveness in implementing collaborative chronic care across health providers using clinical guideline-based DSS. PMID:22874239

Liu, Haifeng; Mei, Jing; Xie, Guotong

2012-01-01

290

The EndoPredict Gene-Expression Assay in Clinical Practice - Performance and Impact on Clinical Decisions  

PubMed Central

The validated EndoPredict assay is a novel tool to predict the risk of metastases of patients with estrogen receptor positive, HER2 negative breast cancer treated with endocrine therapy alone. It has been designed to integrate genomic and clinical information and includes clinico-pathological factors such as tumor size and nodal status. The test is feasible in a decentral setting in molecular pathology laboratories. In this project, we investigated the performance of this test in clinical practice, and performed a retrospective evaluation of its impact on treatment decisions in breast cancer. During one year, EndoPredict assays from 167 patients could be successfully performed. For retrospective evaluation of treatment decisions, a questionnaire was sent to the clinical partner. Regarding the molecular EP class, samples from 56 patients (33.5%) had a low-risk, whereas 111 patients (66.5%) showed a high-risk gene profile. After integration of the clinicopathological factors the combined clinical and molecular score (EPclin) resulted in a low-risk group of 77 patients (46.4%), while 89 (53.6%) had a high risk EPclin score. The EPclin-based estimated median 10-year-risk for metastases with endocrine therapy alone was 11% for the whole cohort. The median handling time averaged three days (range: 0 to 11 days), 59.3% of the tests could be performed in three or less than three days. Comparison of pre- and post-test therapy decisions showed a change of therapy in 37.7% of patients. 16 patients (12.3%) had a change to an additional chemotherapy while 25.4% of patients (n?=?33) changed to an endocrine therapy alone. In 73 patients (56.2%) no change of therapy resulted. In 6.1% of patients (n?=?8), the patients did not agree to the recommendation of the tumor board. Our results show that the EndoPredict assay could be routinely performed in decentral molecular pathology laboratories and the results markedly change treatment decisions.

Muller, Berit Maria; Keil, Elke; Lehmann, Annika; Winzer, Klaus-Jurgen; Richter-Ehrenstein, Christiane; Prinzler, Judith; Bangemann, Nikola; Reles, Angela; Stadie, Sylvia; Schoenegg, Winfried; Eucker, Jan; Schmidt, Marcus; Lippek, Frank; Johrens, Korinna; Pahl, Stefan; Sinn, Bruno Valentin; Budczies, Jan; Dietel, Manfred; Denkert, Carsten

2013-01-01

291

Physician's expectations regarding prescribing clinical decision support systems in a Belgian hospital.  

PubMed

Objectives: Developing and implementing clinical decision support systems (CDSSs) is time-consuming and costly. Therefore, prioritization of the most relevant systems is warranted. The physician's perceived usefulness has been identified as a decisive reason for using CDSSs. The objective of this study was to investigate the physician's perceived usefulness of different types of CDSSs and to identify the user needs and expectations regarding future CDSSs. Methods: Cross-sectional single-centre survey among physicians with a clinical assignment in a university hospital. Physicians were questioned about their current experiences with drug prescribing and the perceived usefulness and desired features of future CDSSs. Results: One hundred and sixty-four physicians completed the survey (52·6%). The majority acknowledged that it is very difficult to take all relevant information into account when prescribing drugs. Drug-drug interaction checking, drug-allergy checking, and dosing guidance were considered as most useful. Automated clinical guidelines and adverse drug event monitoring were considered as least useful. The user-friendliness of the systems, clinical relevance of the alerts, and prevention of alert fatigue were perceived as important aspects for a successful implementation. Conclusions: From the physicians' perspective drug-drug interaction checking, drug-allergy checking, and dosing guidance should receive the highest priority for development and implementation. Because the perceived usefulness has been identified as a decisive reason for using CDSSs, it seems feasible to take into account this prioritization when developing and implementing CDSSs. In order to overcome the physicians' perceived disadvantages, attention should go to the development of user-friendly systems that deliver clinical relevant alerts. PMID:24820921

Cornu, P; Steurbaut, S; Beukeleer, M De; Putman, K; Velde, R van de; Dupont, A G

2014-06-01

292

Exploring Decision-Making of HIV-Infected Hispanics and African Americans Participating in Clinical Trials  

PubMed Central

Underrepresentation of HIV-infected Hispanics and African Americans in clinical trials seriously limits our understanding of the benefits and risks of treatment in these populations. This qualitative study examined factors that racial/ethnic minority patients consider when making decisions regarding research participation. Thirty-five HIV-infected Hispanic and African American patients enrolled in clinical research protocols at the National Institutes of Health were recruited to participate in focus groups and in-depth interviews. The sample of mostly men (n = 22), had a mean age of 45, nearly equal representation of race/ethnicity, and diagnosed 2 to 22 years ago. Baseline questionnaires included demographics and measures of social support and acculturation. Interviewers had similar racial/ethnic, cultural, and linguistic backgrounds as the participants. Four major themes around participants’ decisions to enroll in clinical trials emerged: Enhancers, Barriers, Beliefs, and Psychosocial Context. Results may help researchers develop strategies to facilitate inclusion of HIV-infected Hispanics and African Americans into clinical trials.

Rivera-Goba, Migdalia V.; Dominguez, Dinora C.; Stoll, Pamela; Grady, Christine; Ramos, Catalina; Mican, JoAnn M.

2011-01-01

293

Clinical reasoning and population health: decision making for an emerging paradigm of health care.  

PubMed

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community. PMID:18569855

Edwards, Ian; Richardson, Barbara

2008-01-01

294

The negotiation of death: clinical decision making at the end of life.  

PubMed

The ability of medical science to prolong biological life through the use of technology raises the question of how far physicians should go in treating the terminally ill patient. In clinical decision making involving the dying patient, physicians, patients and families bring various perceptions and interpretations to the situation. These different realities must be negotiated in order to define the meaning of the situation and the meaning of various medical technologies. The patient's demise becomes a negotiated death, a bargaining over how far medical technology should go in prolonging life or in prolonging death. A case study of the process of ethical decision making in the foregoing of life-supporting therapy in an intensive care setting is presented and analyzed. The decision making process in this case follows a 'cascade' pattern rather than a controlled, reflective model. While ethicists view the withholding and withdrawing of life-supporting treatment as morally equivalent, physicians tend to make a distinction based on the perceived locus of moral responsibility for the patient's death. In the author's interpretation the moral responsibility for the patient's death by withdrawing treatment is shared with family members, while the moral responsibility for the patient's death by withholding treatment is displaced to the patient. The author suggests that an illusion of choice in medical decision making, as offered by the physician, begins a negotiation of meanings that allows a sharing of moral responsibility for medical failure and its eventual acceptance by patient, family and physician alike. PMID:1519077

Slomka, J

1992-08-01

295

Computerization in the OR.  

PubMed

This article highlights the process of establishing a computerized scheduling and materials management system in a surgical department. The following facets of the computerization process are discussed: options staff members should consider when choosing a computer system, the importance of scheduling and inventory control, cost savings, how computer systems work when using electronic data interchange and bar coding, and case studies. PMID:9513701

Bird, L J

1997-08-01

296

A UMLS-based knowledge acquisition tool for rule-based clinical decision support system development.  

PubMed

Decision support systems in the medical field have to be easily modified by medical experts themselves. The authors have designed a knowledge acquisition tool to facilitate the creation and maintenance of a knowledge base by the domain expert and its sharing and reuse by other institutions. The Unified Medical Language System (UMLS) contains the domain entities and constitutes the relations repository from which the expert builds, through a specific browser, the explicit domain ontology. The expert is then guided in creating the knowledge base according to the pre-established domain ontology and condition-action rule templates that are well adapted to several clinical decision-making processes. Corresponding medical logic modules are eventually generated. The application of this knowledge acquisition tool to the construction of a decision support system in blood transfusion demonstrates the value of such a pragmatic methodology for the design of rule-based clinical systems that rely on the highly progressive knowledge embedded in hospital information systems. PMID:11418542

Achour, S L; Dojat, M; Rieux, C; Bierling, P; Lepage, E

2001-01-01

297

A decision support system for breast cancer treatment based on data mining technologies and clinical practice guidelines  

Microsoft Academic Search

Evidence based medicine is the clinical practice that uses medical data and proof in order to make efficient decisions in the field of the medical domain. Information technology services play a crucial role in exploiting the huge size of medical data involved. Furthermore health care society nowadays utilizes clinical guidelines as a new assistant in their efforts to improve clinical

M. T. Skevofilakas; K. S. Nikita; P. H. Templaleksis; K. N. Birbas; I. G. Kaklamanos; G. N. Bonatsos

2005-01-01

298

Applying a belief rule-base inference methodology to a guideline-based clinical decision support system  

Microsoft Academic Search

A critical issue in the clinical decision support system (CDSS) research area is how to represent and reason with both uncertain medical domain knowledge and clinical symptoms to arrive at accurate conclusions. Although a number of methods and tools have been developed in the past two decades for modelling clinical guidelines, few of those modelling methods have capabilities of handling

Guilan Kong; Dong-Ling Xu; Xinbao Liu; Jian-Bo Yang

2009-01-01

299

Opportunities and challenges in creating an international centralised knowledge base for clinical decision support systems in ePrescribing  

Microsoft Academic Search

Prescribing errors cause substantial potentially avoidable patient harm. There is increasing evidence that the implementation of clinical decision support systems to support prescribing may reduce the risk of such errors. Efforts have thus far concentrated on the implementation of these systems within local health communities. However, considerable potential benefit exists in sharing the content of these prescribing decision support systems

Kathrin M Cresswell; David W Bates; Shobha Phansalkar; Aziz Sheikh

2011-01-01

300

Constructing Clinical Decision Support Systems for Adverse Drug Event Prevention: A Knowledge-based Approach.  

PubMed

A knowledge-based approach is proposed that is employed for the construction of a framework suitable for the management and effective use of knowledge on Adverse Drug Event (ADE) prevention. The framework has as its core part a Knowledge Base (KB) comprised of rule-based knowledge sources, that is accompanied by the necessary inference and query mechanisms to provide healthcare professionals and patients with decision support services in clinical practice, in terms of alerts and recommendations on preventable ADEs. The relevant Knowledge Based System (KBS) is developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication). In the current paper, we present the foundations of the framework, its knowledge model and KB structure, as well as recent progress as regards the population of the KB, the implementation of the KBS, and results on the KBS verification in decision support operation. PMID:21347009

Koutkias, Vassilis; Kilintzis, Vassilis; Stalidis, George; Lazou, Katerina; Collyda, Chrysa; Chazard, Emmanuel; McNair, Peter; Beuscart, Regis; Maglaveras, Nicos

2010-01-01

301

Perforated mucinous cystadenoma of the vermiform appendix: an overview in reasoning clinical decisions.  

PubMed

Recent advances in the management of appendiceal mucinous neoplasms (AMN) such as peritonectomy combined with hyperthermic intraperitoneal chemotherapy have introduced new standards of care. However, many dilemmas are encountered in decision making as in the following patient. A 74-year-old woman was admitted with an appendiceal cystadenoma found in a preadmission CT scan. However, the tumour was not documented by the in hospital investigation due to its perforation and its reduction in size. Consequently, a series of management dilemmas were encountered that were solved by cautious evaluation of the pre and peroperative findings. She was submitted to a right hemicolectomy. A spontaneous perforation was suspected, but the accurate diagnosis was documented postoperatively by histopathology. This paradigm motivated this review which concluded that reasoning clinical decisions in the light of recent advances and appropriate care based on the disease-stage are essential for an optimal outcome in the management of AMN. PMID:22689271

Papadopoulos, Iordanis N; Christodoulou, Spyridon; Kokoropoulos, Panayiotis; Konstantudakis, George; Economopoulos, Nikolaos; Leontara, Vassilia

2011-01-01

302

Patient electronic health data-driven approach to clinical decision support.  

PubMed

This article presents a novel visual analytics (VA)-based clinical decision support (CDS) tool prototype that was designed as a collaborative work between Renaissance Computing Institute and Duke University. Using Major Depressive Disorder data from MindLinc electronic health record system at Duke, the CDS tool shows an approach to leverage data from comparative population (patients with similar medical profile) to enhance a clinicians' decision making process at the point of care. The initial work is being extended in collaboration with the University of North Carolina CTSA to address the key challenges of CDS, as well as to show the use of VA to derive insight from large volumes of Electronic Health Record patient data. PMID:22029811

Mane, Ketan K; Bizon, Chris; Owen, Phillips; Gersing, Ken; Mostafa, Javed; Schmitt, Charles

2011-10-01

303

Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial.  

PubMed

Background:Decision aids may improve informed consent in clinical trial recruitment, but have not been evaluated in this context. This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial.Methods:The IBIS-II trial investigated breast cancer prevention with anastrazole in two cohorts: women with increased risk (Prevention), and women treated for ductal carcinoma in situ (DCIS). Australia, New Zealand and United Kingdom participants were randomised to receive a DA (DA group) or standard trial consent materials (control group). Questionnaires were completed after deciding about participation in IBIS-II (post decision) and 3 months later (follow-up).Results:Data from 112 Prevention and 34 DCIS participants were analysed post decision (73 DA; 73 control); 95 Prevention and 24 DCIS participants were analysed at follow-up (58 DA; 61 control). There was no effect on the primary outcome of decisional conflict. The DCIS-DA group had higher knowledge post decision, and the Prevention-DA group had lower decisional regret at follow-up.Conclusions:This was the first study to evaluate a DA in the clinical trial setting. The results suggest DAs can potentially increase knowledge and reduce decisional regret about clinical trial participation. PMID:24892447

Juraskova, I; Butow, P; Bonner, C; Bell, M L; Smith, A B; Seccombe, M; Boyle, F; Reaby, L; Cuzick, J; Forbes, J F

2014-07-01

304

Impact of cardiovascular magnetic resonance on management and clinical decision-making in heart failure patients  

PubMed Central

Background Cardiovascular magnetic resonance (CMR) can provide important diagnostic and prognostic information in patients with heart failure. However, in the current health care environment, use of a new imaging modality like CMR requires evidence for direct additive impact on clinical management. We sought to evaluate the impact of CMR on clinical management and diagnosis in patients with heart failure. Methods We prospectively studied 150 consecutive patients with heart failure and an ejection fraction ?50% referred for CMR. Definitions for “significant clinical impact” of CMR were pre-defined and collected directly from medical records and/or from patients. Categories of significant clinical impact included: new diagnosis, medication change, hospital admission/discharge, as well as performance or avoidance of invasive procedures (angiography, revascularization, device therapy or biopsy). Results Overall, CMR had a significant clinical impact in 65% of patients. This included an entirely new diagnosis in 30% of cases and a change in management in 52%. CMR results directly led to angiography in 9% and to the performance of percutaneous coronary intervention in 7%. In a multivariable model that included clinical and imaging parameters, presence of late gadolinium enhancement (LGE) was the only independent predictor of “significant clinical impact” (OR 6.72, 95% CI 2.56-17.60, p=0.0001). Conclusions CMR made a significant additive clinical impact on management, decision-making and diagnosis in 65% of heart failure patients. This additive impact was seen despite universal use of prior echocardiography in this patient group. The presence of LGE was the best independent predictor of significant clinical impact following CMR.

2013-01-01

305

Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review  

Microsoft Academic Search

BACKGROUND: The measurement of processes and outcomes that reflect the complexity of the decision-making process within specific clinical encounters is an important area of research to pursue. A systematic review was conducted to identify instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. METHODS: For every year available up until April 2007, PubMed, PsycINFO,

David Moher; Glyn Elwyn; Annie LeBlanc; Karine Gravel

2007-01-01

306

A study of diverse clinical decision support rule authoring environments and requirements for integration  

PubMed Central

Background Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules. Methods The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools. Results While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users. Conclusions A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting.

2012-01-01

307

Translating shared decision-making into health care clinical practices: Proof of concepts  

PubMed Central

Background There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol. Discussion This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.

Legare, France; Elwyn, Glyn; Fishbein, Martin; Fremont, Pierre; Frosch, Dominick; Gagnon, Marie-Pierre; Kenny, David A; Labrecque, Michel; Stacey, Dawn; St-Jacques, Sylvie; van der Weijden, Trudy

2008-01-01

308

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties  

PubMed Central

Background The U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis. Design We developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as “CDS opportunities,” might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists’ clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics.

2012-01-01

309

SFINX—a drug-drug interaction database designed for clinical decision support systems  

Microsoft Academic Search

Objective  The aim was to develop a drug-drug interaction database (SFINX) to be integrated into decision support systems or to be used\\u000a in website solutions for clinical evaluation of interactions.\\u000a \\u000a \\u000a \\u000a Methods  Key elements such as substance properties and names, drug formulations, text structures and references were defined before\\u000a development of the database. Standard operating procedures for literature searches, text writing rules and

Ylva Böttiger; Kari Laine; Marine L. Andersson; Tuomas Korhonen; Björn Molin; Marie-Louise Ovesjö; Tuire Tirkkonen; Anders Rane; Lars L. Gustafsson; Birgit Eiermann

2009-01-01

310

Integrating complex business processes for knowledge-driven clinical decision support systems.  

PubMed

This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS. PMID:23366138

Kamaleswaran, Rishikesan; McGregor, Carolyn

2012-01-01

311

Using a clinical decision support system to determine the quality of antimicrobial dosing in intensive care patients with renal insufficiency  

Microsoft Academic Search

BackgroundThe benefits on clinical practice of a clinical decision support system (CDSS) are predominantly determined by the quality of the clinical rules used in this system. Therefore, it is essential to investigate the performance and potential benefits on quality of care of these rules.MethodsA clinical rule assisting physicians in selecting the appropriate dosage according to renal function of frequently prescribed

P J Helmons; Rene J Grouls; A N Roos; AJGH Bindels; SJW Wessels-Basten; E W Ackerman; E H Korsten

2010-01-01

312

A Study on User Satisfaction regarding the Clinical Decision Support System (CDSS) for Medication  

PubMed Central

Objectives Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety. Methods The study was based on survey data from 218 users (103 doctors, 103 nurses, and 15 pharmacists) at a university hospital that uses the CDSS. In order to identify the factors influencing user satisfaction with the CDSS, a multiple linear regression was performed. In order to compare the satisfaction level among the professional groups, an analysis of variance (ANOVA) was performed. Results The reliability of information, decision supporting capability, and departmental support were significant factors in influencing user satisfaction. In addition, nurses were the most satisfied group, followed by pharmacists and doctors according to the ANOVA. Areas for further improvement in enhancing drug safety were real time information searching and decision supporting capabilities to prevent adverse drug events (ADE) in a timely manner. Conclusions We found that the CDSS users were generally satisfied with the system and that it complements the nationwide drug utilization review (DUR) system in reducing ADE. Further CDSS evaluation in other hospitals is needed to improve user satisfaction and drug safety.

Kim, Junghee; Kim, Sukil; Ho, Seung Hee; Kim, Hyong Hoi; Park, Chun Bok

2012-01-01

313

Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology.  

PubMed

A substantial reduction in hospitalization rates has been associated with the implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement intervention using the accompanying paper-based clinical practice tools (INTERACT II). There is significant potential to further increase the impact of INTERACT by integrating INTERACT II tools into nursing home (NH) health information technology (HIT) via standalone or integrated clinical decision support (CDS) systems. This article highlights the process of translating INTERACT II tools from paper to NH HIT. The authors believe that widespread dissemination and integration of INTERACT II CDS tools into various NH HIT products could lead to sustainable improvement in resident and clinician process and outcome measures, including enhanced interclinician communication and a reduction in potentially avoidable hospitalizations. PMID:22267955

Handler, Steven M; Sharkey, Siobhan S; Hudak, Sandra; Ouslander, Joseph G

2011-01-01

314

Providing pharmacogenomics clinical decision support using whole genome sequencing data as input.  

PubMed

Pharmacogenomics(PGx) is believed to be the driver for adopting pre-emptive clinical genetic testing. We investigated two potential resources for enabling automated pharmacogenomic decision support. First, we analyzed pharmacogenomics dosing guidelines (PDGs) and how they might be executed to provide alerts for clinicians ordering drugs. Second, we use whole genome sequencing (WGS) data instead of genotyping arrays to obtain patients' genetic profiles. In a pilot study, we attempted to generate clinical recommendations (based on PDGs) for 69 patients whose genomes were obtained from a public data set provided by Compete Genomics. We report on the generated recommendations and the additional variations detected by WGS that are not well addressed by existing guidelines. PMID:24303303

Huser, Vojtech; Cimino, James J

2013-01-01

315

Clinical presentations of critical cardiac defects in the newborn: Decision making and initial management  

PubMed Central

The risk of mortality and morbidity of patients with congenital heart defects (CHDs) is highest during neonatal period and increases when diagnosis and proper management are delayed. Neonates with critical CHDs may present with severe cyanosis, respiratory distress, shock, or collapse, all of which are also frequent clinical presentations of various respiratory problems or sepsis in the newborn. Early diagnosis and stabilization and timely referral to a tertiary cardiac center are crucial to improve the outcomes in neonates with CHDs. In this review, the clinical presentation of critical and potentially life-threatening CHDs is discussed along with brief case reviews to help understand the hemodynamics of these defects and ensure proper decision-making in critically ill patients.

2010-01-01

316

Providing Pharmacogenomics Clinical Decision Support Using Whole Genome Sequencing Data As Input  

PubMed Central

Pharmacogenomics(PGx) is believed to be the driver for adopting pre-emptive clinical genetic testing. We investigated two potential resources for enabling automated pharmacogenomic decision support. First, we analyzed pharmacogenomics dosing guidelines (PDGs) and how they might be executed to provide alerts for clinicians ordering drugs. Second, we use whole genome sequencing (WGS) data instead of genotyping arrays to obtain patients’ genetic profiles. In a pilot study, we attempted to generate clinical recommendations (based on PDGs) for 69 patients whose genomes were obtained from a public data set provided by Compete Genomics. We report on the generated recommendations and the additional variations detected by WGS that are not well addressed by existing guidelines.

Huser, Vojtech; Cimino, James J.

2013-01-01

317

Clinical decision support systems: a discussion of quality, safety and legal liability issues.  

PubMed Central

Developers of Clinical Decision Support Systems (CDSSs) have to date been more concerned with the efficacy of systems (e.g. measurable improvements in clinical outcomes) than with safety (e.g. potential for harmful side-effects). In future CDSS developers will be required (by the courts etc.) to acknowledge a "duty of care" covering all aspects of design, development and deployment. Experience in the transport, power and other safety-critical industries has led to a range of quality and safety assurance methods whose adoption may be needed before CDSSs can safely become an integral part of routine patient care, and before the trust of healthcare professionals, patients and other stakeholders can be gained. No single method will be sufficient for safe development and deployment; a range of techniques will be needed and used selectively. This paper is a contribution to discussion of quality, safety and legal liability issues in the medical informatics community.

Fox, John; Thomson, Richard

2002-01-01

318

Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support  

PubMed Central

Background Clinical decision support systems can prevent knowledge-based prescription errors and improve patient outcomes. The clinical effectiveness of these systems, however, is substantially limited by poor user acceptance of presented warnings. To enhance alert acceptance it may be useful to quantify the impact of potential modulators of acceptance. Methods We built a logistic regression model to predict alert acceptance of drug–drug interaction (DDI) alerts in three different settings. Ten variables from the clinical and human factors literature were evaluated as potential modulators of provider alert acceptance. ORs were calculated for the impact of knowledge quality, alert display, textual information, prioritization, setting, patient age, dose-dependent toxicity, alert frequency, alert level, and required acknowledgment on acceptance of the DDI alert. Results 50?788 DDI alerts were analyzed. Providers accepted only 1.4% of non-interruptive alerts. For interruptive alerts, user acceptance positively correlated with frequency of the alert (OR 1.30, 95% CI 1.23 to 1.38), quality of display (4.75, 3.87 to 5.84), and alert level (1.74, 1.63 to 1.86). Alert acceptance was higher in inpatients (2.63, 2.32 to 2.97) and for drugs with dose-dependent toxicity (1.13, 1.07 to 1.21). The textual information influenced the mode of reaction and providers were more likely to modify the prescription if the message contained detailed advice on how to manage the DDI. Conclusion We evaluated potential modulators of alert acceptance by assessing content and human factors issues, and quantified the impact of a number of specific factors which influence alert acceptance. This information may help improve clinical decision support systems design.

Seidling, Hanna M; Phansalkar, Shobha; Seger, Diane L; Paterno, Marilyn D; Shaykevich, Shimon; Haefeli, Walter E

2011-01-01

319

Using statistical process control to make data-based clinical decisions.  

PubMed Central

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

Pfadt, A; Wheeler, D J

1995-01-01

320

Decision support systems for clinical radiological practice -- towards the next generation  

PubMed Central

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully.

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-01-01

321

A commentary on PSA velocity and doubling time for clinical decisions in prostate cancer.  

PubMed

Although the value of prostate-specific antigen (PSA) velocity or doubling time has never been seriously questioned for aiding the clinical management of recurrent or advanced cancer, there has historically been considerable uncertainty about PSA kinetics for decisions about biopsy and initial treatment. Recent studies, including analyses of cohorts from all the major randomized trials of localized prostate cancer, have failed to find any evidence that PSA velocity and application of PSA cutpoints are of benefit in this setting. Given current data on PSA velocity and doubling time, we propose the following "take home" messages for the practicing urologist: (1) High PSA velocity is not an indication for biopsy; (2) for men with a low total PSA but a high PSA velocity, consideration should be given to having PSA taken at a shorter interval; (3) men with an indication for biopsy should be biopsied irrespective of PSA velocity; (4) changes in PSA after negative biopsy findings do not determine the need for repeat biopsy; (5) monitoring PSA over time can aid judgment in decisions about biopsy, as informed by the clinical context; (6) PSA velocity is uninformative of risk at diagnosis; (7) high PSA velocity is not an indication for treatment in men on active surveillance; (8) PSA velocity at the time of recurrence should be entered into prediction models (or "nomograms") to aid patient counseling; (9) PSA changes after treatment for advanced disease can help indicate therapeutic response. PMID:24581521

Vickers, Andrew J; Thompson, Ian M; Klein, Eric; Carroll, Peter R; Scardino, Peter T

2014-03-01

322

Decision support systems for clinical radiological practice -- towards the next generation.  

PubMed

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully. PMID:20965900

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-11-01

323

The Life Cycle of Clinical Decision Support (CDS): CDS Theory and Practice from Request to Maintenance  

PubMed Central

The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient safety with delivery of timely and appropriate recommendations that are both patient-specific and more often than not appropriately actionable. However, the users of CDS, providers, are frequently bombarded with inappropriate and inapplicable CDS that is frequently neither informational, integrated into the workflow, patient-specific, and may present out of date and irrelevant recommendations. The life cycle of Clinical Decision Support begins with a request for CDS, continues with design and implementation, and concludes with ongoing knowledge maintenance. This State of the Practice will look at how using the best science and latest knowledge regarding CDS can create request and maintenance processes that work in the real world. Dr. David Bates will present the best science and knowledge behind CDS that works. Dr.’s Joseph Kannry and Thomas Yackel will present case studies of CDS requests and design processes that use this science to generate useful, useable, and timely patient-specific recommendations. Dr. Tonya Hongsermeier will present best practices in knowledge maintenance. Finally, Dr. Michael Krall will present a case study of knowledge maintenance from Kaiser Permanente that results in appropriate and up-to-date CDS.

Kannry, Joseph; Bates, David; Hongsermeier, Tonya; Krall, Michael; Yackel, Thomas

2012-01-01

324

Methods for monitoring and prognosis of clinical status of patients in acute phase of myocardial infarction for computer network based clinical decision support system  

Microsoft Academic Search

The methods for evaluation of crucial factors describing status of cardiologic patients in intensive care units based on advanced signal processing methods were incorporated into prototype network based clinical decision support system. The methods realize: (a) evaluation of heart rate variability in aim to predict clinical outcome; (b) evaluation of central hemodynamics in non-invasive way by means of chest impedance

Algimantas Krisciukaitis; Renata Simoliunien?; Andrius Macas; Giedre Baksyte; Viktoras Saferis; Remigijus Zaliunas

2011-01-01

325

Clinical decision support for genetically guided personalized medicine: a systematic review  

PubMed Central

Objective To review the literature on clinical decision support (CDS) for genetically guided personalized medicine (GPM). Materials and Methods MEDLINE and Embase were searched from 1990 to 2011. The manuscripts included were summarized, and notable themes and trends were identified. Results Following a screening of 3416 articles, 38 primary research articles were identified. Focal areas of research included family history-driven CDS, cancer management, and pharmacogenomics. Nine randomized controlled trials of CDS interventions for GPM were identified, seven of which reported positive results. The majority of manuscripts were published on or after 2007, with increased recent focus on genotype-driven CDS and the integration of CDS within primary clinical information systems. Discussion Substantial research has been conducted to date on the use of CDS to enable GPM. In a previous analysis of CDS intervention trials, the automatic provision of CDS as a part of routine clinical workflow had been identified as being critical for CDS effectiveness. There was some indication that CDS for GPM could potentially be effective without the CDS being provided automatically, but we did not find conclusive evidence to support this hypothesis. Conclusion To maximize the clinical benefits arising from ongoing discoveries in genetics and genomics, additional research and development is recommended for identifying how best to leverage CDS to bridge the gap between the promise and realization of GPM.

Welch, Brandon M

2013-01-01

326

Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns  

PubMed Central

Background The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored. Objective To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills. Methods Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators. Results A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills. Conclusions Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective.

Miloslavsky, Eli M.; Hayden, Emily M.; Currier, Paul F.; Mathai, Susan K.; Contreras-Valdes, Fernando; Gordon, James A.

2012-01-01

327

Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours  

PubMed Central

Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

2011-01-01

328

A Clinical Decision Support System with an Integrated EMR for Diagnosis of Peripheral Neuropathy.  

PubMed

The prevalence of peripheral neuropathy in general population is ever increasing. The diagnosis and classification of peripheral neuropathies is often difficult as it involves careful clinical and electro-diagnostic examination by an expert neurologist. In developing countries a large percentage of the disease remains undiagnosed due to lack of adequate number of experts. In this study a novel clinical decision support system has been developed using a fuzzy expert system. The study was done to provide a solution to the demand of systems that can improve health care by accurate diagnosis in limited time, in the absence of specialists. It employs a graphical user interface and a fuzzy logic controller with rule viewer for identification of the type of peripheral neuropathy. An integrated medical records database is also developed for the storage and retrieval of the data. The system consists of 24 input fields, which includes the clinical values of the diagnostic test and the clinical symptoms. The output field is the disease diagnosis, whether it is Motor (Demyelinating/Axonopathy) neuropathy, sensory (Demyelinating/Axonopathy) neuropathy, mixed type or a normal case. The results obtained were compared with the expert's opinion and the system showed 93.27 % accuracy. The study aims at showing that Fuzzy Expert Systems may prove useful in providing diagnostic and predictive medical opinions. It enables the clinicians to arrive at a better diagnosis as it keeps the expert knowledge in an intelligent system to be used efficiently and effectively. PMID:24692180

Kunhimangalam, Reeda; Ovallath, Sujith; Joseph, Paul K

2014-04-01

329

The evaluation of a rectal cancer decision aid and the factors influencing its implementation in clinical practice  

PubMed Central

Background Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice. Methods First, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient’s preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics. Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables associated with the intention to use the decision aid. Discussion This study will evaluate the impact of the rectal cancer decision aid on patients and help with planning strategies to overcome barriers and facilitate implementation of the decision aid in routine clinical practice. To our knowledge this is the first study designed to evaluate a decision aid in the field of colorectal surgery.

2014-01-01

330

Using State Administrative and Pharmacy Data Bases to Develop a Clinical Decision Support Tool for Schizophrenia Guidelines  

Microsoft Academic Search

Administrative and pharmacy data bases represent a largely untapped resource for clinical decision support and quality improvement. In this study, we examined the feasibility of using New York State Office of Mental Health (NYSOMH) data bases to develop an automated clinical report to support implementation of schizophrenia guidelines. First we reviewed the structure of existing data bases for capacity and

Molly Finnerty; Richard Altmansberger; James Bopp; Sharon Carpinello; John P. Docherty; William Fisher; Peter Jensen; Parukutty Krishnan; Michael Mittleman; Mark Olfson; Joel Tricarico; Tom White; Chip Felton

2002-01-01

331

Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007)  

Microsoft Academic Search

BACKGROUND: Computerised clinical decision support systems (CDSSs) are used widely to improve quality of care and patient outcomes. This systematic review evaluated the impact of CDSSs in targeting specific aspects of prescribing, namely initiating, monitoring and stopping therapy. We also examined the influence of clinical setting (institutional vs ambulatory care), system- or user-initiation of CDSS, multi-faceted vs stand alone CDSS

Sallie-Anne Pearson; Annette Moxey; Jane Robertson; Isla Hains; Margaret Williamson; James Reeve; David Newby

2009-01-01

332

The NIAID Division of AIDS enterprise information system: integrated decision support for global clinical research programs.  

PubMed

The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs. PMID:21816958

Kagan, Jonathan M; Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

2011-12-01

333

A patient-driven adaptive prediction technique to improve personalized risk estimation for clinical decision support  

PubMed Central

Objective Competing tools are available online to assess the risk of developing certain conditions of interest, such as cardiovascular disease. While predictive models have been developed and validated on data from cohort studies, little attention has been paid to ensure the reliability of such predictions for individuals, which is critical for care decisions. The goal was to develop a patient-driven adaptive prediction technique to improve personalized risk estimation for clinical decision support. Material and methods A data-driven approach was proposed that utilizes individualized confidence intervals (CIs) to select the most ‘appropriate’ model from a pool of candidates to assess the individual patient's clinical condition. The method does not require access to the training dataset. This approach was compared with other strategies: the BEST model (the ideal model, which can only be achieved by access to data or knowledge of which population is most similar to the individual), CROSS model, and RANDOM model selection. Results When evaluated on clinical datasets, the approach significantly outperformed the CROSS model selection strategy in terms of discrimination (p<1e–14) and calibration (p<0.006). The method outperformed the RANDOM model selection strategy in terms of discrimination (p<1e–12), but the improvement did not achieve significance for calibration (p=0.1375). Limitations The CI may not always offer enough information to rank the reliability of predictions, and this evaluation was done using aggregation. If a particular individual is very different from those represented in a training set of existing models, the CI may be somewhat misleading. Conclusion This approach has the potential to offer more reliable predictions than those offered by other heuristics for disease risk estimation of individual patients.

Boxwala, Aziz A; El-Kareh, Robert; Kim, Jihoon; Ohno-Machado, Lucila

2012-01-01

334

Effectiveness of a novel and scalable clinical decision support intervention to improve venous thromboembolism prophylaxis: a quasi-experimental study  

PubMed Central

Background Venous thromboembolism (VTE) causes morbidity and mortality in hospitalized patients, and regulators and payors are encouraging the use of systems to prevent them. Here, we examine the effect of a computerized clinical decision support (CDS) intervention implemented across a multi-hospital academic health system on VTE prophylaxis and events. Methods The study included 223,062 inpatients admitted between April 2007 and May 2010, and used administrative and clinical data. The intervention was integrated into a commercial electronic health record (EHR) in an admission orderset used for all admissions. Three time periods were examined: baseline (period 1), and the time after implementation of the first CDS intervention (period 2) and a second iteration (period 3). Providers were prompted to accept or decline prophylaxis based on patient risk. Time series analyses examined the impact of the intervention on VTE prophylaxis during time periods two and three compared to baseline, and a simple pre-post design examined impact on VTE events and bleeds secondary to anticoagulation. VTE prophylaxis and events were also examined in a prespecified surgical subset of our population meeting the public reporting criteria defined by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI). Results Unadjusted analyses suggested that “recommended”, “any”, and “pharmacologic” prophylaxis increased from baseline to the last study period (27.1% to 51.9%, 56.7% to 78.1%, and 42.0% to 54.4% respectively; p?

2012-01-01

335

Performance of a Computerized Protocol for Trauma Shock Resuscitation  

Microsoft Academic Search

Background  A computerized protocol was developed and used to standardize bedside clinician decision making for resuscitation of shock\\u000a due to severe trauma during the first day in the intensive care unit (ICU) at a metropolitan Level I trauma center. We report\\u000a overall performance of a computerized protocol for resuscitation of shock due to severe trauma, incorporating two options\\u000a for resuscitation monitoring

Joseph F. SucherFrederick; Frederick A. Moore; R. Matthew Sailors; Ernest A. Gonzalez; Bruce A. McKinley

2010-01-01

336

Computerized Interpretation of Dynamic Breast MRI.  

National Technical Information Service (NTIS)

One of the most important obstacles of clinical application of breast MRI is the lack of standardization in terms of interpretation guidelines. The purpose of the proposed research is to develop computerized methods to take full advantage of the wealth in...

W. Chen M. L. Giger

2005-01-01

337

Computerized Grading of Anatomy Laboratory Practical Examinations  

ERIC Educational Resources Information Center

At the Medical College of Wisconsin, a procedure was developed to allow computerized grading and grade reporting of laboratory practical examinations in the Clinical Human Anatomy course. At the start of the course, first year medical students were given four Lists of Structures. On these lists, numbered items were arranged alphabetically; the…

Krippendorf, Beth B.; Bolender, David L.; Kolesari, Gary L.

2008-01-01

338

Computerized Interpretation of Dynamic Breast MRI.  

National Technical Information Service (NTIS)

One of the most important obstacles of clinical application of breast MRI is the lack of standardization in terms of interpretation guidelines. The purpose of the proposed research is to develop computerized methods to take full advantage of the wealth in...

W. Chen

2004-01-01

339

Clinical decision support systems for brain tumor characterization using advanced magnetic resonance imaging techniques  

PubMed Central

In recent years, advanced magnetic resonance imaging (MRI) techniques, such as magnetic resonance spectroscopy, diffusion weighted imaging, diffusion tensor imaging and perfusion weighted imaging have been used in order to resolve demanding diagnostic problems such as brain tumor characterization and grading, as these techniques offer a more detailed and non-invasive evaluation of the area under study. In the last decade a great effort has been made to import and utilize intelligent systems in the so-called clinical decision support systems (CDSS) for automatic processing, classification, evaluation and representation of MRI data in order for advanced MRI techniques to become a part of the clinical routine, since the amount of data from the aforementioned techniques has gradually increased. Hence, the purpose of the current review article is two-fold. The first is to review and evaluate the progress that has been made towards the utilization of CDSS based on data from advanced MRI techniques. The second is to analyze and propose the future work that has to be done, based on the existing problems and challenges, especially taking into account the new imaging techniques and parameters that can be introduced into intelligent systems to significantly improve their diagnostic specificity and clinical application.

Tsolaki, Evangelia; Kousi, Evanthia; Svolos, Patricia; Kapsalaki, Efthychia; Theodorou, Kyriaki; Kappas, Constastine; Tsougos, Ioannis

2014-01-01

340

Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer  

PubMed Central

Background: Current management of breast cancer (BC) relies on risk stratification based on well-defined clinicopathologic factors. Global gene expression profiling studies have demonstrated that BC comprises distinct molecular classes with clinical relevance. In this study, we hypothesised that molecular features of BC are a key driver of tumour behaviour and when coupled with a novel and bespoke application of established clinicopathologic prognostic variables can predict both clinical outcome and relevant therapeutic options more accurately than existing methods. Methods: In the current study, a comprehensive panel of biomarkers with relevance to BC was applied to a large and well-characterised series of BC, using immunohistochemistry and different multivariate clustering techniques, to identify the key molecular classes. Subsequently, each class was further stratified using a set of well-defined prognostic clinicopathologic variables. These variables were combined in formulae to prognostically stratify different molecular classes, collectively known as the Nottingham Prognostic Index Plus (NPI+). The NPI+ was then used to predict outcome in the different molecular classes. Results: Seven core molecular classes were identified using a selective panel of 10 biomarkers. Incorporation of clinicopathologic variables in a second-stage analysis resulted in identification of distinct prognostic groups within each molecular class (NPI+). Outcome analysis showed that using the bespoke NPI formulae for each biological BC class provides improved patient outcome stratification superior to the traditional NPI. Conclusion: This study provides proof-of-principle evidence for the use of NPI+ in supporting improved individualised clinical decision making.

Rakha, E A; Soria, D; Green, A R; Lemetre, C; Powe, D G; Nolan, C C; Garibaldi, J M; Ball, G; Ellis, I O

2014-01-01

341

The Arden Syntax standard for clinical decision support: experiences and directions.  

PubMed

Arden Syntax is a widely recognized standard for representing clinical and scientific knowledge in an executable format. It has a history that reaches back until 1989 and is currently maintained by the Health Level 7 (HL7) organization. We created a production-ready development environment, compiler, rule engine and application server for Arden Syntax. Over the course of several years, we have applied this Arden - Syntax - based CDS system in a wide variety of clinical problem domains, such as hepatitis serology interpretation, monitoring of nosocomial infections or the prediction of metastatic events in melanoma patients. We found the Arden Syntax standard to be very suitable for the practical implementation of CDS systems. Among the advantages of Arden Syntax are its status as an actively developed HL7 standard, the readability of the syntax, and various syntactic features such as flexible list handling. A major challenge we encountered was the technical integration of our CDS systems in existing, heterogeneous health information systems. To address this issue, we are currently working on incorporating the HL7 standard GELLO, which provides a standardized interface and query language for accessing data in health information systems. We hope that these planned extensions of the Arden Syntax might eventually help in realizing the vision of a global, interoperable and shared library of clinical decision support knowledge. PMID:22342733

Samwald, Matthias; Fehre, Karsten; de Bruin, Jeroen; Adlassnig, Klaus-Peter

2012-08-01

342

Successful Outcomes of a Clinical Decision Support System in an HIV Practice: A Randomized Controlled Trial  

PubMed Central

Background Data to support improved patient outcomes from clinical decision support systems (CDSS) are lacking in HIV care. Objective To conduct a randomized controlled trial testing the efficacy of a CDSS to improve HIV outcomes in an outpatient clinic. Design We conducted a randomized controlled trial where half of each provider’s patients were randomized to interactive or static computer alerts (ClinicalTrials.gov #NCT00678600). Setting The study was conducted at the Massachusetts General Hospital HIV Clinic. Subjects Participants were HIV providers and their HIV-infected patients. Intervention Computer alerts were generated for virologic failure (HIV RNA >400 c/mL after HIV RNA ?400 c/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory tests. Providers received interactive computer alerts, facilitating appointment rescheduling and repeat laboratory testing, for half of their patients and static alerts for the other half. Measurements The primary endpoint was change in CD4 count. Other endpoints included time-to-clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity. Results Thirty-three HIV providers followed 1,011 HIV-infected patients. For the intervention arm, the mean CD4 count increase was greater (5.3 versus 3.2 cells/mm3/month; difference = 2.0 cells/mm3/month 95% CI [0.1, 4.0], p=0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 versus 30.1 events per 100 patient-years, p=0.022). Median time-to-next scheduled appointment was shorter in the intervention arm after a suboptimal follow-up alert (1.71 versus 3.48 months; p<0.001) and after a toxicity alert (2.79 versus >6 months for control); p=0.072). Ninety-six percent of providers supported adopting the CDSS as part of standard care. Limitations This was a one-year informatics study conducted at a single hospital sub-specialty clinic. Conclusion A CDSS using interactive provider alerts improved CD4 counts and clinic follow-up for HIV-infected patients. Wider implementation of such systems can provide important clinical benefits.

Robbins, Gregory K.; Lester, William; Johnson, Kristin L.; Chang, Yuchiao; Estey, Gregory; Surrao, Dominic; Zachary, Kimon; Lammert, Sara M.; Chueh, Henry; Meigs, James B.; Freedberg, Kenneth A.

2013-01-01

343

Using brain-based cognitive measures to support clinical decisions in ADHD.  

PubMed

Measures of cognition support diagnostic and treatment decisions in attention deficit hyperactivity disorder. We used an integrative neuroscience framework to assess cognition and associated brain-function correlates in large attention deficit hyperactivity disorder and healthy groups. Matched groups of 175 attention deficit hyperactivity disorder children/adolescents and 175 healthy control subjects were assessed clinically, with the touch screen-based cognitive assessment battery "IntegNeuro" (Brain Resource Ltd., Sydney, Australia) and the "LabNeuro" (Brain Resource Ltd., Sydney, Australia) platform for psychophysiologic recordings of brain function and body arousal. IntegNeuro continuous performance task measures of sustained attention classified 68% of attention deficit hyperactivity disorder patients with 76% specificity, consistent with previous reports. Our additional cognitive measures of impulsivity, intrusive errors, inhibition, and response variability improved sensitivity to 88%, and specificity to 91%. Positive predictive power was 96%, and negative predictive power, 88%. These metrics were stable across attention deficit hyperactivity disorder subtypes and age. Consistent with their brain-based validity, cognitive measures were correlated with corresponding brain-function and body-arousal measures. We propose a combination of candidate cognitive "markers" that define a signature for attention deficit hyperactivity disorder: "sustained attention," "impulsivity," "inhibition," "intrusions," and "response variability." These markers offer a frame of reference to support diagnostic and treatment decisions, and an objective benchmark for monitoring outcomes of interventions. PMID:20117748

Williams, Leanne M; Hermens, Daniel F; Thein, Thida; Clark, C Richard; Cooper, Nicholas J; Clarke, Simon D; Lamb, Chris; Gordon, Evian; Kohn, Michael R

2010-02-01

344

Pulmonary embolism in a stroke patient after systemic thrombolysis: clinical decisions and literature review.  

PubMed

Pulmonary embolism can be a catastrophic event that can result in early death or serious hemodynamic dysfunction. The dehydration, immobility, and infections occurring in acute stroke patients puts these patients at risk of developing deep vein thrombosis and pulmonary embolism. Recombinant tissue-type plasminogen activator (rt-PA) is the established therapy for acute ischemic stroke, and its prompt administration results in a better outcome in stroke patients. We describe a 73-year-old man who arrived at the emergency room within 2 hours of acute onset of left hemiparesis who was treated with rt-PA and suffered a pulmonary embolism 3 days after acute stroke therapy. rt-PA is also a current therapy for pulmonary embolism, but an ischemic stroke in the previous 3 months is an absolute contraindication to thrombolysis because of the high risk of intracranial hemorrhage. We discuss clinical and therapeutic decisions and review the current literature. PMID:23849749

Pilato, Fabio; Calandrelli, Rosalinda; Profice, Paolo; Della Marca, Giacomo; Broccolini, Aldobrando; Bello, Giuseppe; Bocci, Maria Grazia; Distefano, Marisa; Colosimo, Cesare; Rossini, Paolo Maria

2013-11-01

345

The value of intelligent multimedia simulation for teaching clinical decision-making skills.  

PubMed

This paper examines the value of using intelligent multimedia simulation for the teaching of nursing clinical decision-making skills. The possibilities of multimedia-based educational resources are examined and the rapid growth and questionable effectiveness of current multimedia computer-based learning applications for nursing students are discussed. The advantages and disadvantages of this technology and the problems developing intelligent agent-based systems are examined. A case study is presented which uses a modular design with an integrated intelligent agent and knowledge base. It is argued that by using this type of approach, the real value of intelligent CBL to provide individual formative advice to students in a simulated experience can be realized. PMID:11403585

Garrett, B M; Callear, D

2001-07-01

346

Impact of an EMR-based Clinical Decision Support Tool for Dysphagia Screening on Care Quality  

PubMed Central

Background Dysphagia screening (DS) prior to oral intake in acute stroke patients is a hospital level performance measure. Herein, we report outcomes of an initiative to improve compliance to this quality measure. Methods Design was a pre vs. post-intervention comparison study. Intervention was an Electronic Medical Record (EMR) based Clinical Decision Support system (CDS) embedded within stroke admission orders. The CDS was designed to facilitate DS in stroke patients. Primary outcome was compliance to a process measure in ischemic stroke patients: performance of a swallow screen prior to oral intake. Results DS measure compliance increased from 36% to 74% (p=0.001). Chart audits found screened patients were more likely to have CDS-embedded admission orders initiated or stroke unit admission. Conclusion The EMR offers a ready platform for CDS implementation. DS is a difficult performance measure to improve. The described CDS has the potential for improving performance on this challenging care quality measure.

Lakshminarayan, Kamakshi; Rostambeigi, Nassir; Fuller, Candace C; Peacock, James M; Tsai, Albert W

2012-01-01

347

An extended SQL for temporal data management in clinical decision-support systems.  

PubMed Central

We are developing a database implementation to support temporal data management for the T-HELPER physician workstation, an advice system for protocol-based care of patients who have HIV disease. To understand the requirements for the temporal database, we have analyzed the types of temporal predicates found in clinical-trial protocols. We extend the standard relational data model in three ways to support these querying requirements. First, we incorporate timestamps into the two-dimensional relational table to store the temporal dimension of both instant- and interval-based data. Second, we develop a set of operations on timepoints and intervals to manipulate timestamped data. Third, we modify the relational query language SQL so that its underlying algebra supports the specified operations on timestamps in relational tables. We show that our temporal extension to SQL meets the temporal data-management needs of protocol-directed decision support.

Das, A. K.; Tu, S. W.; Purcell, G. P.; Musen, M. A.

1992-01-01

348

Mechanical versus clinical data combination in selection and admissions decisions: a meta-analysis.  

PubMed

In employee selection and academic admission decisions, holistic (clinical) data combination methods continue to be relied upon and preferred by practitioners in our field. This meta-analysis examined and compared the relative predictive power of mechanical methods versus holistic methods in predicting multiple work (advancement, supervisory ratings of performance, and training performance) and academic (grade point average) criteria. There was consistent and substantial loss of validity when data were combined holistically-even by experts who are knowledgeable about the jobs and organizations in question-across multiple criteria in work and academic settings. In predicting job performance, the difference between the validity of mechanical and holistic data combination methods translated into an improvement in prediction of more than 50%. Implications for evidence-based practice are discussed. PMID:24041118

Kuncel, Nathan R; Klieger, David M; Connelly, Brian S; Ones, Deniz S

2013-11-01

349

Exploring use of images in clinical articles for decision support in evidence-based medicine  

NASA Astrophysics Data System (ADS)

Essential information is often conveyed pictorially (images, illustrations, graphs, charts, etc.) in biomedical publications. A clinician's decision to access the full text when searching for evidence in support of clinical decision is frequently based solely on a short bibliographic reference. We seek to automatically augment these references with images from the article that may assist in finding evidence. In a previous study, the feasibility of automatically classifying images by usefulness (utility) in finding evidence was explored using supervised machine learning and achieved 84.3% accuracy using image captions for modality and 76.6% accuracy combining captions and image data for utility on 743 images from articles over 2 years from a clinical journal. Our results indicated that automatic augmentation of bibliographic references with relevant images was feasible. Other research in this area has determined improved user experience by showing images in addition to the short bibliographic reference. Multi-panel images used in our study had to be manually pre-processed for image analysis, however. Additionally, all image-text on figures was ignored. In this article, we report on developed methods for automatic multi-panel image segmentation using not only image features, but also clues from text analysis applied to figure captions. In initial experiments on 516 figure images we obtained 95.54% accuracy in correctly identifying and segmenting the sub-images. The errors were flagged as disagreements with automatic parsing of figure caption text allowing for supervised segmentation. For localizing text and symbols, on a randomly selected test set of 100 single panel images our methods reported, on the average, precision and recall of 78.42% and 89.38%, respectively, with an accuracy of 72.02%.

Antani, Sameer; Demner-Fushman, Dina; Li, Jiang; Srinivasan, Balaji V.; Thoma, George R.

2008-01-01

350

A randomized controlled trial of screening for maternal depression with a clinical decision support system  

PubMed Central

Objective To determine if automated screening and just in time delivery of testing and referral materials at the point of care promotes universal screening referral rates for maternal depression. Methods The Child Health Improvement through Computer Automation (CHICA) system is a decision support and electronic medical record system used in our pediatric clinics. All families of patients up to 15?months of age seen between October 2007 and July 2009 were randomized to one of three groups: (1) screening questions printed on prescreener forms (PSF) completed by mothers in the waiting room with physician alerts for positive screens, (2) everything in (1) plus ‘just in time’ (JIT) printed materials to aid physicians, and (3) a control group where physicians were simply reminded to screen on printed physician worksheets. Results The main outcome of interest was whether physicians suspected a diagnosis of maternal depression and referred a mother for assistance. This occurred significantly more often in both the PSF (2.4%) and JIT groups (2.4%) than in the control group (1.2%) (OR 2.06, 95% CI 1.08 to 3.93). Compared to the control group, more mothers were noted to have depressed mood in the PSF (OR 7.93, 95% CI 4.51 to 13.96) and JIT groups (OR 8.10, 95% CI 4.61 to 14.25). Similarly, compared to the control group, more mothers had signs of anhedonia in the PSF (OR 12.58, 95% CI 5.03 to 31.46) and JIT groups (OR 13.03, 95% CI 5.21 to 32.54). Conclusions Clinical decision support systems like CHICA can improve the screening of maternal depression.

Biondich, Paul; Anand, Vibha; Dugan, Tamara M; Downs, Stephen M

2013-01-01

351

Clinical decision making in the treatment of complex PTSD and substance misuse.  

PubMed

Treating clients with complex posttraumatic stress disorder (PTSD) who also misuse substances presents a number of clinical challenges. The nature of complex PTSD is that we are faced with the far-reaching consequences of early and prolonged trauma on clients' lives, typically interfering with a host of emotional, relational, and functional capacities. Often substance misuse has become an offshoot of this experience, initially an "adaptive" response to unbearable circumstances, but over time exacerbating client dysfunction, at times leading to revictimization, and frequently culminating in a substance use disorder. Many clinicians feel overwhelmed in the face of this myriad of problems. This article provides an overview of some of the clinical choice points facing clinicians in this work: Where do we start? How do we proceed? What do we treat first? How do we handle a dysregulated client? The article attempts to provide some guidance about how to approach these multifaceted decisions, with an emphasis on attending to comorbidity, to assist clinicians in providing symptom-focused treatment for this complex population. PMID:23533007

Litt, Lisa

2013-05-01

352

Evaluating acceptance and user experience of a guideline-based clinical decision support system execution platform.  

PubMed

This study aims to determine what the initial disposition of physicians towards the use of Clinical Decision Support Systems (CDSS) based on Computerised Clinical Guidelines and Protocols (CCGP) is; and whether their prolonged utilisation has a positive effect on their intention to adopt them in the future. For a period of 3 months, 8 volunteer paediatricians monitored each up to 10 asthmatic patients using two CCGPs deployed in the-GuidesMed CDSS. A Technology Acceptance Model (TAM) questionnaire was supplied to them before and after using the system. Results from both questionnaires are analysed searching for significant improvements in opinion between them. An additional survey was performed to analyse the usability of the system. It was found that initial disposition of physicians towards e-GuidesMed is good. Improvement between the pre and post iterations of the TAM questionnaire has been found to be statistically significant. Nonetheless, slightly lower values in the Compatibility and Habit variables show that participants perceive possible difficulties to integrate e-GuidesMed into their daily routine. The variable Facilitators shows the highest correlation with the Intention to Use. Usability of the system has also been rated very high and, in this regard, no fundamental flaw has been detected. Initial views towards e-GuidesMed are positive, and become reinforced after continued utilisation of the system. In order to achieve an effective implementation, it becomes essential to facilitate conditions to integrate the system into the physician's daily routine. PMID:23377779

Buenestado, David; Elorz, Javier; Pérez-Yarza, Eduardo G; Iruetaguena, Ander; Segundo, Unai; Barrena, Raúl; Pikatza, Juan M

2013-04-01

353

Integrating pharmacogenetic information and clinical decision support into the electronic health record.  

PubMed

Pharmacogenetics (PG) examines gene variations for drug disposition, response, or toxicity. At the National Institutes of Health Clinical Center (NIH CC), a multidepartment Pharmacogenetics Testing Implementation Committee (PGTIC) was established to develop clinical decision support (CDS) algorithms for abacavir, carbamazepine, and allopurinol, medications for which human leukocyte antigen (HLA) variants predict severe hypersensitivity reactions. Providing PG CDS in the electronic health record (EHR) during order entry could prevent adverse drug events. Medical Logic Module (MLM) programming was used to implement PG CDS in our EHR. The MLM checks to see if an HLA sequence-based gene test is ordered. A message regarding test status (result present, absent, pending, or test not ordered) is displayed on the order form, and the MLM determines if the prescriber can place the order, place it but require an over-ride reason, or be blocked from placing the order. Since implementation, more than 725 medication orders have been placed for over 230 patients by 154 different prescribers for the three drugs included in our PG program. Prescribers commonly used an over-ride reason when placing the order mainly because patients had been receiving the drug without reaction before implementation of the CDS program. Successful incorporation of PG CDS into the NIH CC EHR required a coordinated, interdisciplinary effort to ensure smooth activation and a positive effect on patient care. Prescribers have adapted to using the CDS and have ordered PG testing as a direct result of the implementation. PMID:24302286

Goldspiel, Barry R; Flegel, Willy A; DiPatrizio, Gary; Sissung, Tristan; Adams, Sharon D; Penzak, Scott R; Biesecker, Leslie G; Fleisher, Thomas A; Patel, Jharana J; Herion, David; Figg, William D; Lertora, Juan J L; McKeeby, Jon W

2014-01-01

354

Could 13C MRI assist clinical decision-making for patients with heart disease?  

PubMed

Even at this early stage of development, it is clear that the imaging of hyperpolarized (13)C-enriched molecules and their metabolic products offers a new approach to the study of the physiology and disease of the heart. The technology is practical in humans and, for this reason, we consider whether a role in clinical decision-making should motivate further development. The range of interventions available to treat coronary and valvular heart disease is already extensive, and new options are imminent. Yet the appropriate management of patients with left ventricular dysfunction can be challenging because the mechanism of reduced function may be unclear and the ability of the ventricle to respond to therapy may be difficult to predict. Pyruvate is a promising early target for development as a diagnostic agent because it lies at a critical branch point in cardiac biochemistry. The rate of metabolism of hyperpolarized pyruvate to CO(2) relative to lactate may prove to be a useful indicator of preserved mitochondrial function, and therefore provide a specific signal of viable myocardium. Other species including physiological substrates and nonphysiological molecules may provide additional information. Once suitable technology becomes available, it is likely that clinical research will progress quickly. The ability to monitor directly specific metabolic pathways may lead to an improvement in the selection of patients who will benefit from interventions, pharmacologic or otherwise. PMID:21608058

Malloy, Craig R; Merritt, Matthew E; Sherry, A Dean

2011-10-01

355

The Practice of Clinical Decision Support: Applying Standards and Technology to Deliver Knowledge-Driven Interventions  

PubMed Central

Clinical decision support (CDS) delivered in the context of electronic health record systems is receiving increasing attention as a way to help improve clinical practice and health behaviors. Nevertheless, multiple technologies exist to implement and maintain CDS, and there is little consensus on their use. The use of health information technology (HIT) standards for encoding data, representing knowledge and delivering knowledge-based interventions can help facilitate implementation of CDS. However, many standards from numerous standards development organizations (SDOs) exist that are variously incorporated into vendor software, and consensus on the use of these standards is lacking. Accordingly, the purpose of the presentation is twofold. First, the presenters, who are co-chairs of the Health Level Seven CDS Work Group, will survey the state of the art and science regarding HIT standards that are applicable to CDS. In this analysis of the standards landscape, the presenters will emphasize those standards concerning knowledge representation and delivery as well as convey the latest developments regarding these standards and related efforts to develop new standards. Second, the presenters will show how this work has been translated into software tools and actual implementations that are used to deliver knowledge interventions and to provide CDS.

Jenders, Robert A.; Del Fiol, Guilherme; Kawamoto, Kensaku

2012-01-01

356

Could 13C MRI Assist Clinical Decision-Making for Patients with Heart Disease?  

PubMed Central

Even at this early stage of development, it is clear that imaging hyperpolarized 13C-enriched molecules and their metabolic products offers a new approach to studying physiology and disease in the heart. The technology will be practical in humans and for this reason we consider whether a role in clinical decision-making should motivate further development. The range of interventions available to treat coronary and valvular heart disease is already extensive, and new options are imminent. Yet the proper management of patients with left ventricular dysfunction can be challenging because the mechanism of reduced function may be unclear and the ability of the ventricle to respond to therapy may be difficult to predict. Pyruvate is a promising early target for development as a diagnostic agent to because it lies at a critical branch point in cardiac biochemistry. The relative rate of metabolism of hyperpolarized pyruvate to CO2 compared to lactate may prove to be a useful indicator of preserved mitochondrial function and therefore provide a specific signal of viable myocardium. Other molecules including physiological substrates as well as nonphysiological molecules provide additional information. Once suitable technology becomes available it is likely that clinical research will progress quickly. The ability to directly monitor specific metabolic pathways may improve our ability to select patients who will benefit from interventions, pharmacologic or otherwise.

Malloy, Craig R.; Merritt, Matthew E.; Sherry, A. Dean

2011-01-01

357

Development of a real-time clinical decision support system upon the web mvc-based architecture for prostate cancer treatment  

Microsoft Academic Search

Background  A real-time clinical decision support system (RTCDSS) with interactive diagrams enables clinicians to instantly and efficiently\\u000a track patients' clinical records (PCRs) and improve their quality of clinical care. We propose a RTCDSS to process online\\u000a clinical informatics from multiple databases for clinical decision making in the treatment of prostate cancer based on Web\\u000a Model-View-Controller (MVC) architecture, by which the system

Hsueh-Chun Lin; Hsi-Chin Wu; Chih-Hung Chang; Tsai-Chung Li; Wen-Miin Liang; Jong-Yi Wang Wang

2011-01-01

358

Cost Effectiveness of an Electronic Medical Record Based Clinical Decision Support System  

PubMed Central

Objective Medical groups have invested billions of dollars in Electronic Medical Records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The UKPDS Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (.26%, p=.014) relative to patients in the control arm. Intervention costs were $120 (SE=45) per patient in the first year and $76 (SE=45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE=.01) and increased lifetime costs by $112 (SE=660), resulting in an incremental cost effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system.

O'Connor, Patrick J.; Sperl-Hillen, JoAnn M.; Rush, William A.; Johnson, Paul E.; Amundson, Gerald H.; Asche, Stephen E.; Ekstrom, Heidi L.

2012-01-01

359

Participants' Reactions to Computerized Testing.  

ERIC Educational Resources Information Center

This study investigated participants' reactions to computerized testing and assessed the practicability of this testing method in the classroom. A sample of 315 secondary-level students took a computerized and a printed version of a standardized aptitude test battery and a survey assessing their reactions to the computerized testing. Overall…

Moe, Kim C.; Johnson, Marilyn F.

360

A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making.  

PubMed

Abstract Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n?=?6), good (n?=?20), fair (n?=?0) or weak (n?=?3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p?

Stacey, Dawn; Brière, Nathalie; Robitaille, Hubert; Fraser, Kimberly; Desroches, Sophie; Légaré, France

2014-09-01

361

Computerizing on a Shoestring.  

ERIC Educational Resources Information Center

Focuses on the computerization of the Gibault High School Library in Waterloo, Illinois, discussing the development of microcomputer programs to expand services in the area of library skills instruction and search strategy methods. Hardware, software, finances, personnel, and planning considerations are noted. (EJS)

Boehmer, M. Clare

1982-01-01

362

Computerized Fleet Maintenance.  

ERIC Educational Resources Information Center

The computerization of school bus maintenance records by the Niskayuna (New York) Central School District enabled the district's transportation department to engage in management practices resulting in significant savings. The district obtains computer analyses of the work performed on all vehicles, including time spent, parts, labor, costs,…

Cataldo, John J.

363

Accounting computerized teaching research  

Microsoft Academic Search

With the rapid development of computer technology and the widespread use of computers, human society has entered a computer and network based, new information times. In particular, after China Joins the World Trade Organization (WTO), the world economics' integration is further accelerated, computerized accounting has played an important role in various enterprises. Selecting compound talents who not only understands accounting

Mao Jiuzhi; Zhao Rui; Zhou Xiaona

2010-01-01

364

Computerizing the Library.  

ERIC Educational Resources Information Center

Discusses the development of a computerized high school library which uses CD-ROM optical storage systems. Describes hardware and software, setting up the system, preparing the online catalog, teaching information retrieval skills, and project evaluation. Notes prices of CD-ROM disks and equipment purchased. 4 references. (SV)

Chan, Jeanie; Whelan, Errol

1988-01-01

365

Enhancing decision making about participation in cancer clinical trials: development of a question prompt list. | accrualnet.cancer.gov  

Cancer.gov

This paper examines the usefulness of question prompt lists (QPLs) in aiding doctor-patient communication during discussions of clinical trials. The QPL presents patients with a menu of potential issues to discuss with a physician. Focus groups were conducted to assess the perceived utility of QPLs with trial-experienced and trial-naïve patients. All patients viewed the QPL as a valuable tool to support their decision-making regarding clinical trials.

366

Assessment of Competence in Clinical Reasoning and Decision-Making under Uncertainty: The Script Concordance Test Method  

ERIC Educational Resources Information Center

Real-life, complex problems often require that decisions are made despite limited information or insufficient time to explore all relevant aspects. Incorporating authentic uncertainties into an assessment, however, poses problems in establishing results and analysing their methodological qualities. This study aims at developing a test on clinical

Ramaekers, Stephan; Kremer, Wim; Pilot, Albert; van Beukelen, Peter; van Keulen, Hanno

2010-01-01

367

Amatoxin poisoning treatment decision-making: Pharmaco-therapeutic clinical strategy assessment using multidimensional multivariate statistic analysis  

Microsoft Academic Search

Ninety percent of fatal higher fungus poisoning is due to amatoxin-containing mushroom species. In addition to absence of antidote, no chemotherapeutic consensus was reported. The aim of the present study is to perform a retrospective multidimensional multivariate statistic analysis of 2110 amatoxin poisoning clinical cases, in order to optimize therapeutic decision-making. Our results allowed to classify drugs as a function

Patrick Poucheret; Françoise Fons; Jean Christophe Doré; Didier Michelot; Sylvie Rapior

2010-01-01

368

Decision-Making in Patients with Gallstones: Development of a Clinical Algorithm Using the Instrument of a Consensus Development Conference  

Microsoft Academic Search

Since decision-making in patients with gallstone disease is a very common medical problem, a carefully planned consensus development conference was held to develop a clinical algorithm using an electronically transmitted group response of the panel and the general audience. Only symptomatic patients are candidates for treatment. Minimal diagnostic requirements are ultrasound, determination of leukocytes, alkaline phosphatase and bilirubin in the

F. Holzinger; H. G. Beger; W. Lorenz; H. Bockhorn; C. Ohmann; M. W. Büchler

1995-01-01

369

Architectural and data model of clinical decision support system for managing asthma in school-aged children  

Microsoft Academic Search

This paper presents the architecture and data model of a Clinical Decision Support System for managing asthma in school-aged children. The system is based on modular framework, including modules that cover the patient in home, school and healthcare environment to ensure continuous monitoring and control of the patient's medical conditions. The system has capabilities to learn from the patient's individual

Liljana Aleksovska-Stojkovska; Suzana Loskovska

2011-01-01

370

Performance of a clinical decision support system and of clinical pharmacists in preventing drug-drug interactions on a geriatric ward.  

PubMed

Background Drug-drug interactions (DDIs) can lead to adverse drug events and compromise patient safety. Two common approaches to reduce these interactions in hospital practice are the use of clinical decision support systems and interventions by clinical pharmacists. Objective To compare the performance of both approaches with the main objective of learning from one approach to improve the other. Setting Acute geriatric ward in a university hospital. Methods Prospective single-centre, cohort study of patients admitted to the geriatric ward. An independent pharmacist compared the clinical decision support alerts with the DDIs identified by clinical pharmacists and evaluated their interventions. Contextual factors used by the clinical pharmacists for evaluation of the clinical relevance were analysed. Adverse drug events related to DDIs were investigated and the causality was evaluated by a clinical pharmacologist based on validated criteria. Main outcome measure Number of alerts, interventions and the acceptance rates. Results Fifty patients followed by the clinical pharmacists, were included. The clinical pharmacists identified 240 DDIs (median of 3.5 per patient) and advised a therapy change for 16 of which 13 (81.2 %) were accepted and three (18.8 %) were not. The decision support system generated only six alerts of which none were accepted by the physicians. Thirty-seven adverse drug events were identified for 29 patients that could be related to 55 DDIs. For two interactions the causality was evaluated as certain, for 31 as likely, for ten as possible and for 12 as unlikely. Mainly intermediate level interactions were related to adverse drug events. Contextual factors taken into account by the clinical pharmacists for evaluation of the interactions were blood pressure, international normalised ratio, heart rate, potassium level and glycemia. Additionally, the clinical pharmacists looked at individual administration intervals and drug sequence to determine the clinical relevance of the interactions. Conclusion Clinical pharmacists performed better than the decision support system mainly because the system screened only for high level DDIs and because of the low specificity of the alerts. This specificity can be increased by including contextual factors into the logic and by defining appropriate screening intervals that take into account the sequence in which the drugs are given. PMID:24566821

Cornu, Pieter; Steurbaut, Stephane; Soštari?, Sabina; Mrhar, Aleš; Dupont, Alain G

2014-06-01

371

Electronic Health Record Clinical Decision Support Systems and National Ambulatory Care Quality  

PubMed Central

Context Electronic health records (EHRs) are increasingly used by U.S. outpatient physicians. EHRs could improve clinical care via clinical decision support (CDS), electronic guideline-based reminders and alerts. Objective Using nationally representative data, we assessed the relationship of EHR and CDS use to ambulatory care quality, hypothesizing that higher quality of care would be associated with EHRs and CDS. Design Retrospective, cross-sectional analysis of physician survey data on patient visits. Setting Ambulatory care physician practices in non-federal offices and hospitals. Participants National estimates were based on 190,314 patient visits from the 2005–07 National Ambulatory Medical Care Survey and 2005–06 National Hospital Ambulatory Medical Care Survey. Main Outcome Measures We used a previously developed set of 20 visit-based quality indicators to assess the provision of guideline recommended care with a focus on appropriate pharmacotherapy and preventive counseling. Results EHRs were connected with 28% of an estimated 1.0 billion annual U.S. patient visits. CDS was present in 57% of the visits where an EHR was used (16% of all visits). Use of EHR and CDS varied with provider and patient characteristics, including significantly increased use in the West and in multi-physician settings compared with solo practices. For 19 of 20 quality indicators, visits associated with EHRs had similar quality compared with visits conducted without EHR. Higher quality was noted only for diet counseling in high risk adults (p=0.002). Among the EHR visits, 19 of the 20 quality indicators showed no significant difference in quality between visits with and without CDS. CDS was associated with significantly better performance for only one indicator, lack of routine ECG ordering in low risk patients (p=0.001). Conclusions Our finding of no consistent association between EHR and CDS use and better quality raises concern about the ability of EHR, in isolation, to fundamentally alter outpatient care quality.

Romano, Max J.; Stafford, Randall S.

2014-01-01

372

Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study  

PubMed Central

Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior. Methods Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval. Discussion The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings. It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.

Desroches, Sophie; Gagnon, Marie-Pierre; Tapp, Sylvie; Legare, France

2008-01-01

373

Recommendations for a Clinical Decision Support for the Management of Individuals with Chronic Kidney Disease  

PubMed Central

Background and objectives: Care for advanced CKD patients is suboptimal. CKD practice guidelines aim to close gaps in care, but making providers aware of guidelines is an ineffective implementation strategy. The Institute of Medicine has endorsed the use of clinical decision support (CDS) for implementing guidelines. The authors’ objective was to identify the requirements of an optimal CDS system for CKD management. Design, setting, participants, and measurements: The aims of this study expanded on those of previous work that used the facilitated process improvement (FPI) methodology. In FPI, an expert workgroup develops a set of quality improvement tools that can subsequently be utilized by practicing physicians. The authors conducted a discussion with a group of multidisciplinary experts to identify requirements for an optimal CDS system. Results: The panel considered the process of patient identification and management, associated barriers, and elements by which CDS could address these barriers. The panel also discussed specific knowledge needs in the context of a typical scenario in which CDS would be used. Finally, the group developed a set of core requirements that will likely facilitate the implementation of a CDS system aimed at improving the management of any chronic medical condition. Conclusions: Considering the growing burden of CKD and the potential healthcare and resource impact of guideline implementation through CDS, the relevance of this systematic process, consistent with Institute of Medicine recommendations, cannot be understated. The requirements described in this report could serve as a basis for the design of a CKD-specific CDS.

Patwardhan, Meenal B.; Kawamoto, Kensaku; Lobach, David; Patel, Uptal D.; Matchar, David B.

2009-01-01

374

Evolution of a knowledge base for a clinical decision support system encoded in the Arden Syntax.  

PubMed Central

Clinical decision support systems (CDSS) are being used increasingly in medical practice. Thus, long-term maintenance of the knowledge bases (KB) of such systems becomes important. To quantify changes that occur as a KB evolves, we studied the KB at the Columbia-Presbyterian Medical Center. This KB has a total of 229 Medical Logic Modules (MLMs) encoded in the Arden Syntax. Eliminating those never used in practice, we retrospectively analyzed 156 MLMs developed over 78 months. We noted 2020 distinct versions of these MLMs that included 5528 changed statements over time. These changes occurred primarily in the logic slot (38.7% of all changes), the action slot (17.8%), in queries (15.0%) and in the data slot exclusive of queries (12.4%). We conclude that long-term maintenance of a KB for a CDSS requires significant changes over time. We discuss the implications of these results for the design of KB editors for the Arden Syntax.

Jenders, R. A.; Huang, H.; Hripcsak, G.; Clayton, P. D.

1998-01-01

375

Survey of critical thinking and clinical decision making in nursing student of Kerman University  

PubMed Central

Context: The ability to think critically is an essential element in nursing education and more specifically in nurses’ clinical decision making (CDM). Aims: Critical thinking (CT) and CDM ability as well as their relationship were examined among nursing students of Kerman University. Settings and Design: Study was designed in four towns: Kerman, Bam, Jiroft, and Zarand, settled in Kerman province. Materials and Methods: This research was a cross-sectional descriptive correlation study. 300 nursing students with different level of education were asked to fill two questionnaires including: (1) California Critical Thinking Skills Test (CCTST) and (2) Lauri and Salantera (2002) CDM instrument. Statistical Analysis Used: Data were analyzed with SPSS12 and descriptive and inferential statistics. Results: Nursing students yielded a low score (mean = 5/40 from 20) of CT and a mild score (mean = 12.8 from 20) of CDM. We found positively correlation between male and CT and CDM score with mean score of the nursing student. Also CDM score in male was more than female but not significant, and Jirofts CDM nursing student was significantly better than other city. Conclusions: Although students that answers evaluation question in CCTST better can gave better CDM score but there isn’t relationship between CT and CDM of nursing student. The finding showed that mean score of nursing student CT was low. Reason can be either due to the defects of nursing education program, teaching, and learning strategies.

Noohi, Esmat; Karimi-Noghondar, Maryam; Haghdoost, Aliakbar

2012-01-01

376

Dose coefficients and derived guidance and clinical decision levels for contaminated wounds  

SciTech Connect

The NCRP Wound Model describing the retention of selected radionuclides at the site of a contaminated wound and their uptake into the transfer compartment has been combined with the ICRP element-specific systemic models for those radionuclides to derive dose coefficients for intakes via contaminated wounds. Those coefficients have been used to generate derived guidance levels (i.e., the activity in a wound that would result in an effective dose of 20 or 50 mSv, or in some cases, a committed organ equivalent dose of 500 mSv), and clinical decision levels (i.e., activity levels that would indicate the need for consideration of medical intervention to remove activity from the wound site or administration of decorporation therapy or both), typically set at 5 times the derived guidance levels. Data are provided for the radionuclides commonly encountered at nuclear power plants and nuclear weapons, fuel fabrication or recycling, waste disposal, medical and research facilities. These include: {sup 60}Co, {sup 90}Sr, {sup 99m}Tc, {sup 131}I, {sup 137}Cs, {sup 192}Ir, {sup 210}Po, {sup 226,228}Ra, {sup 228,232}Th, {sup 235,238}U, {sup 237}Np, {sup 238,239}Pu, {sup 241}Am, {sup 242,244}Cm, and {sup 252}Cf.

Bertelli, Luiz [Los Alamos National Laboratory; Toohey, Richard E [ORISE/ORAU; Sugarman, Steven A [ORISE/ORAU; Christensen, Doran R [ORISE/ORAU

2009-01-01

377

Design, Implementation, Use, and Preliminary Evaluation of SEBASTIAN, a Standards-Based Web Service for Clinical Decision Support  

PubMed Central

Despite their demonstrated ability to improve care quality, clinical decision support systems are not widely used. In part, this limited use is due to the difficulty of sharing medical knowledge in a machine-executable format. To address this problem, we developed a decision support Web service known as SEBASTIAN. In SEBASTIAN, individual knowledge modules define the data requirements for assessing a patient, the conclusions that can be drawn using that data, and instructions on how to generate those conclusions. Using standards-based XML messages transmitted over HTTP, client decision support applications provide patient data to SEBASTIAN and receive patient-specific assessments and recommendations. SEBASTIAN has been used to implement four distinct decision support systems; an architectural overview is provided for one of these systems. Preliminary assessments indicate that SEBASTIAN fulfills all original design objectives, including the re-use of executable medical knowledge across diverse applications and care settings, the straightforward authoring of knowledge modules, and use of the framework to implement decision support applications with significant clinical utility.

Kawamoto, Kensaku; Lobach, David F.

2005-01-01

378

Current Status and Future Prospects for Electronic Point-of-Care Clinical Decision Support in Diabetes Care  

PubMed Central

Early efforts to use point-of-care clinical decision support (CDS) were limited to the use of prompts and reminders, which improved test ordering but not intermediate outcomes of care such as glucose, blood pressure, or lipid levels. More sophisticated diabetes CDS tools are now available that use electronic medical record data to provide patient-specific advice on medication use based on previous treatment, distance from goal, and other clinical data. These tools have shown modest but significant improvement in glucose and blood pressure control. Promising next-generation developments will include prioritizing clinical actions that have maximum benefit to a given patient at the point of care and developing effective methods to communicate CDS information to patients to better incorporate patient preferences in care decisions.

O'Connor, Patrick J.; Desai, Jay; Butler, John; Kharbanda, Elyse; Sperl-Hillen, JoAnn M.

2013-01-01

379

Fertility Intent and Contraceptive Decision-making among HIV Positive and Negative Antenatal Clinic Attendees in Durban, South Africa  

PubMed Central

We explored contraceptive decision-making among South African antenatal clinic attendees, fertility intent post-HIV diagnosis, and women’s experiences at government health facilities. Data are from in-depth interviews with HIV negative and HIV positive women. We interviewed women in Zulu; interviews were recorded, transcribed and translated. We conducted qualitative analyses of interviews. Women were the dominant decision-makers about contraceptive use, whether they involved their partners or not. A majority of women obtained a contraceptive method at a government facility; however, several women were unable to attain sterilizations. Women were presented with limited contraceptive options and were not always able to access services.

Marlow, Heather M.; Maman, Suzanne; Groves, Allison K.; Moodley, Daya

2014-01-01

380

Computerized Psychiatric Diagnostic Interview  

PubMed Central

A computerized psychiatric diagnostic interview was developed and administered to 121 adult acute psychiatric inpatients. Data on the 100 completers was evaluated for sensitivity and specificity of the computer diagnostic evaluation relative to the hospital discharge diagnosis and revealed sensitivity greater than 70% for major depression, alcohol/substance abuse, adjustment disorder, bipolar/mania, dependent personaltiy disorder, and histrionic personality disorder. Specificity was greater than 70% for schizophrania, alcohol/substance abuse, and borderline personality disorder. Meen interview time was 51 minutes. Eighty-two percent of patients evaluated the computerized interview as interesting and 78% rated it as thorough. The mouse input, large screen letters, and user-friendliness of the Macintosh computer make this ideal for patient-computer interaction.

Zetin, Mark; Warren, Stacey; Lanssens, Ed; Tominaga, Doris

1987-01-01

381

Computerizing Audit Studies  

PubMed Central

This paper briefly discusses the history, benefits, and shortcomings of traditional audit field experiments to study market discrimination. Specifically it identifies template bias and experimenter bias as major concerns in the traditional audit method, and demonstrates through an empirical example that computerization of a resume or correspondence audit can efficiently increase sample size and greatly mitigate these concerns. Finally, it presents a useful meta-tool that future researchers can use to create their own resume audits.

Lahey, Joanna N.; Beasley, Ryan A.

2014-01-01

382

Computerized tomography calibrator  

NASA Technical Reports Server (NTRS)

A set of interchangeable pieces comprising a computerized tomography calibrator, and a method of use thereof, permits focusing of a computerized tomographic (CT) system. The interchangeable pieces include a plurality of nestable, generally planar mother rings, adapted for the receipt of planar inserts of predetermined sizes, and of predetermined material densities. The inserts further define openings therein for receipt of plural sub-inserts. All pieces are of known sizes and densities, permitting the assembling of different configurations of materials of known sizes and combinations of densities, for calibration (i.e., focusing) of a computerized tomographic system through variation of operating variables thereof. Rather than serving as a phanton, which is intended to be representative of a particular workpiece to be tested, the set of interchangeable pieces permits simple and easy standardized calibration of a CT system. The calibrator and its related method of use further includes use of air or of particular fluids for filling various openings, as part of a selected configuration of the set of pieces.

Engel, Herbert P. (Inventor)

1991-01-01

383

Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation.  

PubMed

Clinical decision support systems--interactive computer systems that help doctors make clinical choices--can reduce errors in drug prescribing by offering real-time alerts about possible adverse reactions. But physicians and other users often suffer "alert fatigue" caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems' effectiveness. Designers and vendors sharply limit the ability to modify alert systems because they fear being exposed to liability if they permit removal of a warning that could have prevented a harmful prescribing error. Our analysis of product liability principles and existing research into the use of clinical decision support systems, however, finds that more finely tailored or parsimonious warnings could ease alert fatigue without imparting a high risk of litigation for vendors, purchasers, and users. Even so, to limit liability in this area, we recommend stronger government regulation of clinical decision support systems and development of international practice guidelines highlighting the most important warnings. PMID:22147858

Kesselheim, Aaron S; Cresswell, Kathrin; Phansalkar, Shobha; Bates, David W; Sheikh, Aziz

2011-12-01

384

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons  

PubMed Central

Objectives To assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain. Design and setting Nationwide survey among spine surgeons in the Netherlands. Participants Surgeon members of the Dutch Spine Society were questioned on their surgical treatment strategy for chronic low back pain. Primary and secondary outcome measures The surgeons' opinion on the use of prognostic patient factors and predictive tests for patient selection were addressed on Likert scales, and the degree of uniformity was assessed. In addition, the influence of surgeon-specific factors, such as clinical experience and training, on decision making was determined. Results The comments from 62 surgeons (70% response rate) were analysed. Forty-four surgeons (71%) had extensive clinical experience. There was a statistically significant lack of uniformity of opinion in seven of the 11 items on prognostic factors and eight of the 11 items on predictive tests, respectively. Imaging was valued much higher than predictive tests, psychological screening or patient preferences (all p<0.01). Apart from the use of discography and long multisegment fusions, differences in training or clinical experience did not appear to be of significant influence on treatment strategy. Conclusions The present survey showed a lack of consensus among spine surgeons on the appreciation and use of predictive tests. Prognostic patient factors were not consistently incorporated in their treatment strategy either. Clinical decision making for spinal fusion to treat chronic low back pain does not have a uniform evidence base in practice. Future research should focus on identifying subgroups of patients for whom spinal fusion is an effective treatment, as only a reliable prediction of surgical outcome, combined with the implementation of individual patient factors, may enable the instalment of consensus guidelines for surgical decision making in patients with chronic low back pain.

de Bie, Rob; Oner, Cumhur; Castelein, Rene; de Kleuver, Marinus

2011-01-01

385

Why do clinicians not refer patients to online decision support tools? Interviews with front line clinics in the NHS  

PubMed Central

Objective To assess whether clinical teams would direct patients to use web-based patient decision support interventions (DESIs) and whether patients would use them. Design Retrospective semistructured interviews and web server log analysis. Participants and settings 57 NHS professionals (nurses, doctors and others) in orthopaedic, antenatal, breast, urology clinics and in primary care practices across 22 NHS sites given access to DESIs hosted on the NHS Direct website. Results Fewer than expected patients were directed to use the web tools. The most significant obstacles to referral to the tools were the attitudes of clinicians and clinical teams. Technical problems contributed to the problems but the low uptake was mainly explained by clinicians’ limited understanding of how patient DESIs could be helpful in clinical pathways, their perception that ‘shared decision-making’ was already commonplace and that, in their view, some patients are resistant to being involved in treatment decisions. External factors, such as efficiency targets and ‘best practice’ recommendations were also cited being significant barriers. Clinicians did not feel the need to refer patients to use decision support tools, web-based or not, and, as a result, felt no requirement to change existing practice routines. Uptake is highest when clinicians set expectations that these tools are integral to practice and embed their use into clinical pathways. Conclusions Existing evidence of patient benefit and the free availability of patient DESIs via the web are not sufficient drivers to achieve routine use. Health professionals were not motivated to refer patients to these interventions. Clinicians will not use these interventions simply because they are made available, despite good evidence of benefit to patients. These attitudes are deep seated and will not be modified by solely developing web-based interventions: a broader strategy will be required to embed DESIs into routine practice.

Elwyn, Glyn; Rix, Andrew; Holt, Tom; Jones, Deborah

2012-01-01

386

The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making  

PubMed Central

Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient’s life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed.

2014-01-01

387

The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making.  

PubMed

Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient's life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed. PMID:24618004

Welie, Jos Vm; Ten Have, Henk Amj

2014-01-01

388

Usability evaluation of a clinical decision support tool for osteoporosis disease management  

PubMed Central

Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs. Methods We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses. Results In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout. Conclusions Findings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.

2010-01-01

389

Clinical evaluation of a high-resolution new peripheral quantitative computerized tomography (pQCT) scanner for the bone densitometry at the lower limbs.  

PubMed

Precision, long-term stability, linearity and accuracy of the x-ray peripheral quantitative computerized tomographic (pQCT) bone scanner XCT 3000 (Norland-Stratec Medical Sys.) were evaluated using the European Forearm Phantom (EFP). In vivo measurements were assessed using a standardized procedure at the distal femur and the distal tibia. In the patient-scan mode, the spatial resolution of the system was 1.04 +/- 0.05 lp/mm as measured at the 10% level of the modulation transfer function (MTF). The contrast-detail diagram (CDD) yielded a minimal difference in attenuation coefficient (AC) of 0.07 cm(-1) at an object size of 0.5 mm. The effective dose for humans was calculated to be less than 1.5 microSv per scan. Short-term precision in vivo was expressed as root mean square standard deviation of paired measurements of 20 healthy volunteers (RMSSD = 0.5%). At the distal femur total volumetric density (ToD) and total cross-sectional area (ToA) were found to be less sensitive to positioning errors than at the distal tibia. Structural parameters like the polar cross-sectional moment of inertia (CSMIp) or the polar cross-sectional moment of resistance (CSMRp) showed a good short-term precision at the distal femur (RMSSD = 1.2 and 1.4%). The relation between the two skeletal sites with respect to CSMIp or CSMRp showed a high coefficient of determination (r2 = 0.77 and 0.74). PMID:9725604

Braun, M J; Meta, M D; Schneider, P; Reiners, C

1998-08-01

390

Item Selection Criteria with Practical Constraints for Computerized Classification Testing  

ERIC Educational Resources Information Center

This study compares four item selection criteria for a two-category computerized classification testing: (1) Fisher information (FI), (2) Kullback-Leibler information (KLI), (3) weighted log-odds ratio (WLOR), and (4) mutual information (MI), with respect to the efficiency and accuracy of classification decision using the sequential probability…

Lin, Chuan-Ju

2011-01-01

391

Supporting patient care and medical research at a heart failure outpatient clinic using a medical workstation with a computerized patient record  

Microsoft Academic Search

Heart failure is a complex clinical syndrome and a major cause of disability and death. Reliable criteria for the diagnosis and the classification of the seventy of heart failure are important for treatment and prognosis. At the outpatient clinic of the Thoraxcentre, a group of 250 patients with heart failure are being studied to evaluate determinants of diagnosis and classification

J. A. M. Wijbenga; A. M. van Ginneken; H. Stam; R. Cornet; J. W. Deckers

1995-01-01

392

[Computerization in a community health service provider].  

PubMed

As the second largest health service provider organization in Israel, we have been progressively computerized. The process was begun in 1988, focusing on improving administrative and financial processes. Today there is a single centralized database for 6,000 users. The system monitors member eligibility, accounting procedures and clinical processes, including diagnoses, laboratory tests, imaging procedures and drug-prescribing. The potential of the computer for physician support is now being realized through integration of clinical guidelines and reminder systems into the computerized clinical record. In addition, the centralized database is used for quality improvement, facilitating cost-effective drug-prescribing and efficient use of technology. The establishment of a computerized working environment for 2,000 physicians and 4,000 other healthcare workers serving 1.3 million patients is a unique model for the development of community health services. Data regarding demographics, disease patterns, drug-prescribing, use of new technology and costs are now readily available to all, from senior management to the individual physician in independent practice. The computer revolution has also presented a new set of problems such patient-record confidentiality and the effect of the computer on the physician-patient encounter. PMID:12415968

Porter, B

1999-10-01

393

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain  

Microsoft Academic Search

BACKGROUND: Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. METHODS: Here we describe the process and outcomes of a project to operationalize the

Jodie A Trafton; Susana B Martins; Martha C Michel; Dan Wang; Samson W Tu; David J Clark; Jan Elliott; Brigit Vucic; Steve Balt; Michael E Clark; Charles D Sintek; Jack Rosenberg; Denise Daniels; Mary K Goldstein

2010-01-01

394

Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine.  

PubMed

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians' decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view. PMID:24602600

Gómez-Huelgas, R; Pérez-Jiménez, F; Serrano-Ríos, M; González-Santos, P; Román, P; Camafort, M; Conthe, P; García-Alegría, J; Guijarro, R; López-Miranda, J; Tirado-Miranda, R; Valdivielso, P

2014-05-01

395

"Many miles to go ...": a systematic review of the implementation of patient decision support interventions into routine clinical practice  

PubMed Central

Background Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. Methods An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. Results After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. Conclusions It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘referral model’ consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the ‘barriers’ and ‘facilitators’ approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.

2013-01-01

396

Clinical decision making in a high-risk primary care environment: a qualitative study in the UK  

PubMed Central

Objective Examine clinical reasoning and decision making in an out of hours (OOH) primary care setting to gain insights into how general practitioners (GPs) make clinical decisions and manage risk in this environment. Design Semi-structured interviews using open-ended questions. Setting A 2-month qualitative interview study conducted in Oxfordshire, UK. Participants 21 GPs working in OOH primary care. Results The most powerful themes to emerge related to dealing with urgent potentially high-risk cases, keeping patients safe and responding to their needs, while trying to keep patients out of hospital and the concept of ‘fire fighting’. There were a number of well-defined characteristics that GPs reported making presentations easy or difficult to deal with. Severely ill patients were straightforward, while the older people, with complex multisystem diseases, were often difficult. GPs stopped collecting clinical information and came to clinical decisions when high-risk disease and severe illness requiring hospital attention has been excluded; they had responded directly to the patient's needs and there was a reliable safety net in place. Learning points that GPs identified as important for trainees in the OOH setting included the importance of developing rapport in spite of time pressures, learning to deal with uncertainty and learning about common presentations with a focus on critical cues to exclude severe illness. Conclusions The findings support suggestions that improvements in primary care OOH could be achieved by including automated and regular timely feedback system for GPs and individual peer and expert clinician support for GPs with regular meetings to discuss recent cases. In addition, trainee support and mentoring to focus on clinical skills, knowledge and risk management issues specific to OOH is currently required. Investigating the stopping rules used for diagnostic closure may provide new insights into the root causes of clinical error in such a high-risk setting.

Heneghan, Carl; Thompson, Matthew; Balla, Margaret

2012-01-01

397

Clinical decision support systems to prevent and treat pressure ulcers and under-nutrition in nursing homes.  

PubMed

Clinical decision support systems (CDSSs) are believed to have the potential to improve care and change the behavior of health personnel. The project has focused on developing a CDSS to support prevention of pressure ulcer and undernutrition that is completely integrated in the electronic health record in nursing homes. Nursing staff have been involved in all phases in the development of the CDSS, which at present is ready to be implemented and systematically evaluated. PMID:19593030

Fossum, Mariann; Terjesen, Solbjørg; Odegaard, Marit; Sneltvedt, Unni; Andreassen, Lene; Ehnfors, Margareta; Ehrenberg, Anna

2009-01-01

398

Decision-making process in patients before entering phase III cancer clinical trials: a pilot study. | accrualnet.cancer.gov  

Cancer.gov

The findings of this pilot study with 14 cancer patients showed that patients, after receiving information from the medical oncologist, oncology nurse, or both, decided about participation in a clinical trial instantaneously. However, the information provided by the referring specialist may have been inadequate in the majority of cases. The emotional turmoil experienced after a cancer diagnosis may have contributed to the instantaneous decision making observed. Gathering further information and searching for alternatives should be encouraged.

399

Understanding patient decisions about clinical trials and the associated communication process: a preliminary report. | accrualnet.cancer.gov  

Cancer.gov

This article presents a conceptual model of factors affecting patient decisions about participating in clinical trials and describes videotaping methods for observing interactions between patients, physicians, and family members. Preliminary findings suggest that awareness of the camera during videotaped conversations does not significantly alter the behavior of participants. Further study of this model and methodology may produce results that can be incorporated into provider training.

400

AptaCDSS-E: A classifier ensemble-based clinical decision support system for cardiovascular disease level prediction  

Microsoft Academic Search

Conventional clinical decision support systems are generally based on a single classifier or a simple combination of these models, showing moderate performance. In this paper, we propose a classifier ensemble-based method for supporting the diagnosis of cardiovas- cular disease (CVD) based on aptamer chips. This AptaCDSS-E system overcomes conventional performance limitations by utilizing ensembles of different classifiers. Recent surveys show

Jae-hong Eom; Sung-chun Kim; Byoung-tak Zhang

2008-01-01

401

Satisfaction with the decision to participate in cancer clinical trials is high, but understanding is a problem  

Microsoft Academic Search

Background  Partially presented in poster format at the 40th and 41st Annual Meetings of the American Society of Clinical Oncology, held\\u000a in 2004 in New Orleans, Louisiana and in 2005 in Orlando, Florida.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose  We aimed to: (a) assess patient knowledge about cancer clinical trials (CCT) and satisfaction with their decision to participate,\\u000a (b) determine whether satisfaction correlates with objective understanding, or

M. Jefford; L. Mileshkin; J. Matthews; H. Raunow; C. O’Kane; T. Cavicchiolo; H. Brasier; M. Anderson; J. Reynolds

2011-01-01

402

The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills.  

PubMed

In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Québec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7865034

Page, G; Bordage, G

1995-02-01

403

Effects of a Pharmacist-to-Dose Computerized Request on Promptness of Antimicrobial Therapy  

PubMed Central

Objectives To examine the effects of computerized requests for pharmacist-to-dose (PTD), an advanced clinical decision support tool for dosing guidance, on antimicrobial therapy with vancomycin and aminoglycosides, describe PTD request utilization, and identify factors that may prolong this process. Design A retrospective review was conducted of patients hospitalized from Jan 2004 to Jun 2006 with suspected pneumonia who received vancomycin, tobramycin, or gentamicin via PTD (study) or routine provider order entry (control). Measurements The primary endpoint was time to pharmacist completion of PTD request. Secondary data points included medication turn-around times for first doses of vancomycin or aminoglycosides and for first doses of any antibiotic, dose adjustment for renal dysfunction, medication errors, and time of order entry. Multivariate analysis was conducted to identify predictors of total time to pharmacist verification and time to administration of first doses of vancomycin or aminoglycosides. Results Median time for pharmacist completion of PTD requests was 29 minutes. Delays were noted in the study group (n = 49) by comparison with the control group (n = 48) for median time to first dose of vancomycin or aminoglycoside (185 vs. 138 min, p = 0.45) and for any antibiotic (134 vs. 118 min, p = 0.42), respectively. Fewer medication errors were reported in the study group (5 vs. 18 errors, p = 0.002). In a multivariate model, PTD was not significantly predictive of time to pharmacy verification or medication turn-around time. Conclusions Pharmacists completed pharmacist-to-dose consultations for dosing guidance of vancomycin and aminoglycosides within a median of 30 minutes. Implementation of a computerized request for clinical pharmacists to provide medication-related clinical decision support increased medication turn-around time of vancomycin and aminoglycosides and reduced medication errors. Consultation of clinical pharmacists by computerized request for initial antibiotic dosing of medications with narrow therapeutic windows is an option for medication-related clinical decision support but providers should be aware that consultation may delay medication turn-around time.

Vincent, William R.; Martin, Craig A.; Winstead, P. Shane; Smith, Kelly M.; Gatz, Jennifer; Lewis, Daniel A.

2009-01-01

404

The use of personal digital assistants in clinical decision making by health care professionals: a systematic review.  

PubMed

Ownership of personal digital assistants (PDAs) and smartphones by health professionals is increasingly common. Providing the best available evidence at the point of care is important for time-poor clinical staff and may lead to benefits in the processes and outcomes of clinical care. This review was performed to investigate the usefulness of PDAs in the clinical setting. MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched from 2000 to March 2010. Randomised controlled trials that evaluated the effects on the processes or outcomes of clinical care of using PDAs compared with not using a PDA were included. Two reviewers independently reviewed citations and abstracts, assessed full text articles and abstracted data from the studies. Seven trials met the review inclusion criteria, of which only three were of satisfactory quality. Studies investigated the use of PDAs either in recording patient information or in decision support for diagnoses or treatment. An increase in data collection quality was reported, and the appropriateness of diagnosis and treatment decisions was improved. PDAs appear to have potential in improving some processes and outcomes of clinical care, but the evidence is limited and reliable conclusions on whether they help, in what circumstances and how they should be used are not possible. Further research is required to assess their value and ensure full benefits from their widespread use, but the pace of technological development creates problems for the timely evaluation of these devices and their applications. PMID:23486823

Divall, Pip; Camosso-Stefinovic, Janette; Baker, Richard

2013-03-01

405

Study protocol: a dissemination trial of computerized psychological treatment for depression and alcohol/other drug use comorbidity in an Australian clinical service  

PubMed Central

Background The rise of the internet and related technologies has significant implications for the treatment of complex health problems, including the combination of depression and alcohol/other drug (AOD) misuse. To date, no research exists to test the real world uptake of internet and computer-delivered treatment programs in clinical practice. This study is important, as it is the first to examine the adoption of the SHADE treatment program, a DVD-based psychological treatment for depression and AOD use comorbidity, by clinicians working in a publicly-funded AOD clinical service. The study protocol that follows describes the methodology of this dissemination trial. Methods/design 19 clinicians within an AOD service on the Central Coast of New South Wales, Australia, will be recruited to the trial. Consenting clinicians will participate in a baseline focus group discussion designed to explore their experiences and perceived barriers to adopting innovation in their clinical practice. Computer comfort and openness to innovation will also be assessed. Throughout the trial, current, new and wait-list clients will be referred to the research program via the clinical service, which will involve clients completing a baseline and 15-week follow-up clinical assessment with independent research assistants, comprising a range of mental health and AOD measures. Clinicians will also complete session checklists following each clinical session with a client, outlining the extent to which the SHADE computer program was used. Therapeutic alliance will be measured at intake and discharge from both the clinician and client perspectives. Discussion This study will provide comprehensive data on the factors associated with the adoption of an innovative, computer-delivered evidence-based treatment program, SHADE, by clinicians working in an AOD service. The results will contribute to the development of a model of dissemination of SHADE, which could be applied to a range of technological innovations. Clinical trials registry Australian Clinical Trial Registration Number: ACTRN12611000382976.

2012-01-01

406

Computerized procedures system  

DOEpatents

An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

Lipner, Melvin H. (Monroeville, PA); Mundy, Roger A. (North Huntingdon, PA); Franusich, Michael D. (Upper St. Clair, PA)

2010-10-12

407

Clinical alerts that cried wolf. As clinical alerts pose physician workflow problems, healthcare IT leaders look for answers.  

PubMed

Across the U.S., as healthcare providers implement computerized physician order entry (CPOE) systems, they find themselves dealing with the growing issue of clinical alert fatigue. With patient care alerts proliferating within clinical decision support (CDS) systems, physicians have often come to ignore all alerts. Healthcare IT leaders are working to resolve this important issue to everyone's benefit, increasingly implementing systems that put out only effective alerts or apply asynchronous alerting strategies. PMID:22574398

Perna, Gabriel

2012-04-01

408

Exceptions Handling within GLARE Clinical Guideline Framework  

PubMed Central

Computerized clinical guidelines (CIGs) are widely adopted in order to assist practitioner and patient decision making. However, a main problem in their adoption is the fact that, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exception is necessary, but most current software systems coping with CIGs do not support it. In this paper, we describe how the GLARE system has been extended to deal with exceptions in CIGs.

Leonardi, Giorgio; Bottrighi, Alessio; Galliani, Gabriele; Terenziani, Paolo; Messina, Antonio; Corte, Francesco Della

2012-01-01

409

Toward The 'Tipping Point': Decision Aids And Informed Patient Choice Access to high-quality patient decision aids is accelerating, but not at the point of clinical care  

Microsoft Academic Search

Preference-sensitive treatment decisions involve making value trade-offs be- tween benefits and harms that should depend on informed patient choice. There is strong evidence that patient decision aids not only improve decision quality but also prevent the overuse of options that informed patients do not value. This paper discusses progress in implementing decision aids and the policy prospects for reaching a

Annette M. O'Connor; John E. Wennberg; France Legare; Hilary A. Llewellyn-Thomas; Benjamin W. Moulton; Karen R. Sepucha; Andrea G. Sodano; Jaime S. King

410

Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System  

PubMed Central

Background Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations. Objective Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS. Methods Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform. We then designed visual and workflow representations of the product to perform the operations. The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device. Results A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool. Conclusions The evaluation has shown that our design was functional and met the requirements demanded by the nurses’ tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction.

Yuan, Michael Juntao; Finley, George Mike; Mills, Christy; Johnson, Ron Kim

2013-01-01

411

A national clinical decision support infrastructure to enable the widespread and consistent practice of genomic and personalized medicine  

PubMed Central

Background In recent years, the completion of the Human Genome Project and other rapid advances in genomics have led to increasing anticipation of an era of genomic and personalized medicine, in which an individual's health is optimized through the use of all available patient data, including data on the individual's genome and its downstream products. Genomic and personalized medicine could transform healthcare systems and catalyze significant reductions in morbidity, mortality, and overall healthcare costs. Discussion Critical to the achievement of more efficient and effective healthcare enabled by genomics is the establishment of a robust, nationwide clinical decision support infrastructure that assists clinicians in their use of genomic assays to guide disease prevention, diagnosis, and therapy. Requisite components of this infrastructure include the standardized representation of genomic and non-genomic patient data across health information systems; centrally managed repositories of computer-processable medical knowledge; and standardized approaches for applying these knowledge resources against patient data to generate and deliver patient-specific care recommendations. Here, we provide recommendations for establishing a national decision support infrastructure for genomic and personalized medicine that fulfills these needs, leverages existing resources, and is aligned with the Roadmap for National Action on Clinical Decision Support commissioned by the U.S. Office of the National Coordinator for Health Information Technology. Critical to the establishment of this infrastructure will be strong leadership and substantial funding from the federal government. Summary A national clinical decision support infrastructure will be required for reaping the full benefits of genomic and personalized medicine. Essential components of this infrastructure include standards for data representation; centrally managed knowledge repositories; and standardized approaches for leveraging these knowledge repositories to generate patient-specific care recommendations at the point of care.

2009-01-01

412

Types of Unintended Consequences Related to Computerized Provider Order Entry  

PubMed Central

Objective To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. Design An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. Methods Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences. Results Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences. Conclusion Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.

Campbell, Emily M.; Sittig, Dean F.; Ash, Joan S.; Guappone, Kenneth P.; Dykstra, Richard H.

2006-01-01

413

Should You Computerize Your Office?  

PubMed Central

The author reviews his experience of computerizing a medical office with five family physicians in private practice in rural western Quebec. The benefits and problems are presented. It is argued that it is unrealistic to try to be precise in predicting the consequences of computerization.

Hogg, William E.

1989-01-01

414

The social dimensions of computerization  

Microsoft Academic Search

While industrialized countries have been rapidly computerizing, the ultimate forms of computerization and their social consequences are still somewhat open-ended. The general directions of equipment developments have been relatively clear - toward computer-based systems which run on faster, smaller, and cheaper hardware; toward equipment architectures which distribute computing (and work); and software which is generally more flexible and more likely

Rob Kling

1986-01-01