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1

Developing and implementing computerized protocols for standardization of clinical decisions.  

PubMed

Humans have only a limited ability to incorporate information in decision making. In certain situations, the mismatch between this limitation and the availability of extensive information contributes to the varying performance and high error rate of clinical decision makers. Variation in clinical practice is due in part to clinicians' poor compliance with guidelines and recommended therapies. The use of decision-support tools is a response to both the information revolution and poor compliance. Computerized protocols used to deliver decision support can be configured to contain much more detail than textual guidelines or paper-based flow diagrams. Such protocols can generate patient-specific instructions for therapy that can be carried out with little interclinician variability; however, clinicians must be willing to modify personal styles of clinical management. Protocols need not be perfect. Several defensible and reasonable approaches are available for clinical problems. However, one of these reasonable approaches must be chosen and incorporated into the protocol to promote consistent clinical decisions. This reasoning is the basis of an explicit method of decision support that allows the rigorous evaluation of interventions, including use of the protocols themselves. Computerized protocols for mechanical ventilation and management of intravenous fluid and hemodynamic factors in patients with the acute respiratory distress syndrome provide case studies for this discussion. PMID:10691588

Morris, A H

2000-03-01

2

Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists  

PubMed Central

Purpose To investigate use of a new guideline-based, computerized clinical decision support (CCDS) system for asthma in a pediatric pulmonology clinic of a large academic medical center. Methods We conducted a qualitative evaluation including review of electronic data, direct observation, and interviews with all nine pediatric pulmonologists in the clinic. Outcome measures included patterns of computer use in relation to patient care, and themes surrounding the relationship between asthma care and computer use. Results The pediatric pulmonologists entered enough data to trigger the decision support system in 397/445 (89.2%) of all asthma visits from January 2009 to May 2009. However, interviews and direct observations revealed use of the decision support system was limited to documentation activities after clinic sessions ended. Reasons for delayed use reflected barriers common to general medical care and barriers specific to subspecialty care. Subspecialist-specific barriers included the perceived high complexity of patients, the impact of subject matter expertise on the types of decision support needed, and unique workflow concerns such as the need to create letters to referring physicians. Conclusions Pediatric pulmonologists demonstrated low use of a computerized decision support system for asthma care because of a combination of general and subspecialist-specific factors. Subspecialist-specific factors should not be underestimated when designing guideline-based, computerized decision support systems for the subspecialty setting.

Lomotan, Edwin A.; Hoeksema, Laura J.; Edmonds, Diana E.; Ramirez-Garnica, Gabriela; Shiffman, Richard N.; Horwitz, Leora I.

2012-01-01

3

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.  

PubMed

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses' clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review. PMID:23958964

Lee, Seonah

2013-10-01

4

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

5

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

6

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

7

Computerized clinical decision support during medication ordering for long-term care residents with renal insufficiency.  

PubMed

OBJECTIVE To determine whether a computerized clinical decision support system providing patient-specific recommendations in real-time improves the quality of prescribing for long-term care residents with renal insufficiency. DESIGN Randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units. Measurement The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: (1) recommended medication doses; (2) recommended administration frequencies; (3) recommendations to avoid the drug; (4) warnings of missing information. RESULTS The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1,000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 1.1) for the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often in the intervention units-relative risk 1.2 (1.0, 1.4). CONCLUSIONS Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions. Trial Registration: http://clinicaltrials.gov Identifier: NCT00599209. PMID:19390107

Field, Terry S; Rochon, Paula; Lee, Monica; Gavendo, Linda; Baril, Joann L; Gurwitz, Jerry H

2009-04-23

8

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

9

Feasibility of a computerized clinical decision support system for treating tobacco use in dental clinics.  

PubMed

This study tested the feasibility of using information technology to improve dentists' adherence to the Treating Tobacco Use and Dependence Clinical Practice Guidelines by offering a web-based computer-mediated clinical decision support system (CDSS) for tobacco use treatment in dental clinics. The authors developed a CDSS tool, deployed the software in one of New York University College of Dentistry's general practice clinics, interviewed associate student dentists, and reviewed a random selection of patients' charts to determine if, after implementation, there were changes in tobacco use screening and referral to treatment. Students reported that the CDSS was easy to use, increased their efficiency, and provided better quality of evidence than was available prior to the intervention. Chart reviews demonstrated that, after CDSS implementation, patients in the target clinic were significantly more likely to be screened for tobacco use (<0.001), and tobacco-using patients were more likely to be advised (<0.001), referred to the state's Quit Line (<0.001), and prescribed nicotine replacement therapy (0.035). This study concludes that it is feasible to implement a CDSS for tobacco use treatment in dental clinics. The CDSS is a promising method for improving adherence to tobacco use treatment guidelines and warrants further study. PMID:23576591

Montini, Theresa; Schenkel, Andrew B; Shelley, Donna R

2013-04-01

10

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review  

PubMed Central

Background Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit. Methods We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management 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 Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements. Conclusions CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

2011-01-01

11

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

12

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

GILAD J. KUPERMAN; ANNE BOBB; T HOMAS H. PAYNE; ANTHONY J. AVERY; TEJAL K. GANDHI; GERARD BURNS; DAVID C. CLASSEN; DAVID W. BATES

2007-01-01

13

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

14

A Pragmatic Approach to Implementing Best Practices for Clinical Decision Support Systems in Computerized Provider Order Entry Systems  

PubMed Central

Incorporation of clinical decision support (CDS) capabilities is required to realize the greatest benefits from computerized provider order entry (CPOE) systems. Discussions at a conference on CDS in CPOE held in San Francisco, California, June 21–22, 2005 produced several papers in this issue of JAMIA. The first paper reviews CDS for electronic prescribing within CPOE systems; 1 the second describes current controversies regarding creation, maintenance, and uses of CPOE order sets for CDS; 2 and the third presents issues related to certification as a potential means of validating CPOE systems for widespread use. 3 This manuscript summarizes all of the discussions at the meeting and provides a pragmatically oriented view of how to implement CPOE with CDS.

Gross, Peter A.; Bates, David W.

2007-01-01

15

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

PubMed Central

Background Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care. Methods We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with 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 Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants. Conclusion The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

2011-01-01

16

Computerized decision support system for kidney paired donation program  

Microsoft Academic Search

In order to assist physicians and other health professionals for health care improvement, clinical decision support systems, through interactive computerized software, become very popular in clinical practice. The crisis associated with kidney organ shortage has triggered an innovative strategy, termed as Kidney Paired Donation (KPD) program, to address a rapidly expanding demand for donor kidneys. KPD program involves how to

Yanhua Chen; Peter X.-K. Song

2011-01-01

17

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

18

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

19

Automatic information extraction for computerized clinical guideline.  

PubMed

Clinical Guidelines (CG) are recommendations on the appropriate treatment and care of people with specific diseases and conditions. CG should be used by both physicians and patients to make the informed decision. However, the CGs are not well used due to their complexity and because they are frequently updated. The computerized CGs are proposed to make use of the computer to do the decision making. However, it needs a lot of human effort to transform the narrative CG into computerized CG. In this paper, we proposed a method to use the NLP techniques to extract the fine-grained information from the text based CG automatically. Such information could be easily converted to the computer interpretable models. PMID:23920797

Zhu, Huijia; Ni, Yuan; Cai, Peng; Cao, Feng

2013-01-01

20

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

21

Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study.  

PubMed

In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering. PMID:22101906

Subramanian, Sujha; Hoover, Sonja; Wagner, Joann L; Donovan, Jennifer L; Kanaan, Abir O; Rochon, Paula A; Gurwitz, Jerry H; Field, Terry S

2011-11-18

22

Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study  

PubMed Central

In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30?days of use for a chronic drug and 10?days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180?days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.

Subramanian, Sujha; Hoover, Sonja; Wagner, Joann L; Donovan, Jennifer L; Kanaan, Abir O; Rochon, Paula A; Gurwitz, Jerry H

2011-01-01

23

Computerized decision support system for kidney paired donation program.  

PubMed

In order to assist physicians and other health professionals for health care improvement, clinical decision support systems, through interactive computerized software, become very popular in clinical practice. The crisis associated with kidney organ shortage has triggered an innovative strategy, termed as Kidney Paired Donation (KPD) program, to address a rapidly expanding demand for donor kidneys. KPD program involves how to making optimal decision for allowing patients with incompatible living donors to receive compatible organs by best matching donors. Although some computerized optimization tools are being used in the current KPD program, there still lacks a general decision support system which enables us to evaluate and compare different kidney allocation strategies and effects of policy. In this paper, we discuss a general computer-based KPD decision model that appropriately reflects the real world clinical application. Also, the whole decision process is to be visualized by our Graphical User Interface (GUI) software, which offers a user friendly platform not only to provide a convenient interface for clinicians but also to assess different kidney exchange strategies of clinical importance. PMID:22255013

Chen, Yanhua; Song, Peter X-K

2011-01-01

24

Use of computerized decision support systems to improve antibiotic prescribing  

Microsoft Academic Search

This decade will see the emergence of the electronic medical record, electronic prescribing and computerized decision support in the hospital setting. Current opinion from key infectious diseases bodies supports the use of computerized decision support systems as potentially useful tools in antibiotic stewardship programs. However, although antibiotic decision support systems appear beneficial for improving the quality of prescribing and reducing

Karin Thursky

2006-01-01

25

Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department  

PubMed Central

Purpose: To determine the effect of evidence-based clinical decision support (CDS) on the use and yield of computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE) in the emergency department (ED). Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant study, which was performed between October 1, 2003, and September 30, 2009, at a 793-bed quaternary care institution with 60?000 annual ED visits. Use (number of examinations per 1000 ED visits) and yield (percentage of examinations positive for acute PE) of CT pulmonary angiography were compared before and after CDS implementation in August 2007. The authors included all adult patients presenting to the ED and developed and validated a natural language processing tool to identify acute PE diagnoses. Linear trend analysis was used to assess for variation in CT pulmonary angiography use. Logistic regression was used to determine variation in yield after controlling for patient demographic and clinical characteristics. Results: Of 338?230 patients presenting to the ED, 6838 (2.0%) underwent CT pulmonary angiography. Quarterly CT pulmonary angiography use increased 82.1% before CDS implementation, from 14.5 to 26.4 examinations per 1000 patients (P < .0001) between October 10, 2003, and July 31, 2007. After CDS implementation, quarterly use decreased 20.1%, from 26.4 to 21.1 examinations per 1000 patients between August 1, 2007, and September 30, 2009 (P = .0379). Overall, 686 (10.0%) of the CT pulmonary angiographic examinations performed during the 6-year period were positive for PE; subsequent to CDS implementation, yield by quarter increased 69.0%, from 5.8% to 9.8% (P = .0323). Conclusion: Implementation of evidence-based CDS in the ED was associated with a significant decrease in use, and increase in yield, of CT pulmonary angiography for the evaluation of acute PE. © RSNA, 2011

Ip, Ivan K.; Prevedello, Luciano M.; Sodickson, Aaron D.; Farkas, Cameron; Zane, Richard D.; Hanson, Richard; Goldhaber, Samuel Z.; Gill, Ritu R.; Khorasani, Ramin

2012-01-01

26

Associations between the concurrent use of clinical decision support and computerized provider order entry and the rates of appropriate prescribing at discharge  

PubMed Central

Introduction Electronic health record systems used in conjunction with clinical decision support (CDS) or computerized provider order entry (CPOE) have shown potential in improving quality of care, yet less is known about the effects of combination use of CDS and CPOE on prescribing rates at discharge. Objectives This study investigates the effectiveness of combination use of CDS and CPOE on appropriate drug prescribing rates at discharge for AMI or HF patients. Methods Combination use of CDS and CPOE is defined as hospitals self-reporting full implementation across all hospital units of CDS reminders, CDS guidelines, and CPOE. Appropriate prescribing rates of aspirin, ACEI/ARBs, or beta blockers are defined using quality measures from Hospital Compare. Multivariate linear regressions are used to test for differences in mean appropriate prescribing rates between hospitals reporting combination use of CDS and CPOE, compared to those reporting the singular use of one or the other, or the absence of both. Covariates include hospital size, region, and ownership status. Results Approximately 10% of the sample reported full implementation of both CDS and CPOE, while 7% and 17% reported full use of only CPOE or only CDS, respectively. Hospitals reporting full use of CDS only reported between 0.2% (95% CI 0.04 – 1.0) and 1.6% (95% CI 0.6 – 2.6) higher appropriate prescribing rates compared to hospitals reporting use of neither system. Rates of prescribing by hospitals reporting full use of both CPOE and CDS did not significantly differ from the control group. Conclusions Although associations found between full implementation of CDS and appropriate prescribing rates suggest that clinical decision tools are sufficient compared to basic EHR systems in improving prescribing at discharge, the modest differences raise doubt about the clinical relevance of the findings. Future studies need to continue investigating the causal nature and clinical relevance of these associations.

Patterson, M.E.; Marken, P.A.; Simon, S.D.; Hackman, J.L.; Schaefer, R.S.

2012-01-01

27

Computerized clinical documentation system in the pediatric intensive care unit  

Microsoft Academic Search

BACKGROUND: To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and\\/or 5) improved shift to shift nursing continuity. METHODS: Before and after implementation of CDS, a time study involving nursing care, medication delivery, and

James A Menke; Cynthia W Broner; Deborah Y Campbell; Michelle Y McKissick; Joy A Edwards-Beckett

2001-01-01

28

Cassel Psych Center Computerized Biofeedback Clinic.  

ERIC Educational Resources Information Center

|Describes Cassel Psych Center, a computerized biofeedback clinic, where the "well" patient is a major concern, and where biofeedback instruments are used with computers to form a Computerized-Biofeedback Clinical Support System. The Center's activities are designed to parallel the services of the pathologist in a medical setting. (PAS)|

Cassel, Russell N.

1982-01-01

29

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

30

Costs Associated with Developing and Implementing a Computerized Clinical Decision Support System for Medication Dosing for Patients with Renal Insufficiency in the Long-term Care Setting  

PubMed Central

A team of physicians, pharmacists, and informatics professionals developed a CDSS added to a commercial electronic medical record system to provide prescribers with patient-specific maximum dosing recommendations based on renal function. We tracked the time spent by team members and used US national averages of relevant hourly wages to estimate costs. The team required 924.5 hours and $48,668.57 in estimated costs to develop 94 alerts for 62 drugs. The most time intensive phase of the project was preparing the contents of the CDSS (482.25 hours, $27,455.61). Physicians were the team members with the highest time commitment (414.25 hours, $25,902.04). Estimates under alternative scenarios found lower total cost estimates with the existence of a valid renal dosing database ($34,200.71) or an existing decision support add-on for renal dosing ($23,694.51). Development of a CDSS for a commercial computerized prescriber order entry system requires extensive commitment of personnel, particularly among clinical staff.

Field, Terry S.; Rochon, Paula; Lee, Monica; Gavendo, Linda; Subramanian, Sujha; Hoover, Sonia; Baril, Joann; Gurwitz, Jerry

2008-01-01

31

Effectiveness of a real-time clinical decision support system for computerized physician order entry of plasma orders.  

PubMed

BACKGROUND: We investigated the effect of implementing adaptive plasma ordering criteria in the computerized physician order entry (CPOE) system, with alerts that were automatically generated if the recipient's antecedent international normalized ratio (INR) did not meet the institutional criteria. STUDY DESIGN AND METHODS: In a regional health care system consisting of 11 hospitals using a common CPOE, data on the number of plasma orders and alerts that were generated were collected over a 4-month period before prescribers were required to select an indication for plasma. When adaptive ordering was implemented prescribers had to choose from prepopulated indications for plasma: INR of 1.6 or greater with bleeding, INR of 1.6 or greater before an invasive procedure, therapeutic exchange, massive transfusion, and other. Regardless of the antecedent INR the alert did not trigger if massive transfusion or plasmapheresis was selected. Information on prescribers and recipients was collected during this 5-month period. RESULTS: In the 4-month period before the adaptive alerts were implemented, 42.9% of the plasma orders generated an alert; in the 5-month period thereafter the alert rate was significantly lower at 27.9% (p?

Yazer, Mark H; Triulzi, Darrell J; Reddy, Vivek; Waters, Jonathan H

2013-04-30

32

Cost effective computerized decision support: tracking caregiver acceptance at the point of care.  

PubMed Central

We implemented a computerized decision support tool to standardize the administration of supplemental oxygen (O2) therapy in the acute care (non-ICU) hospital setting. Caregiver acceptance of the computerizeds oxygen therapy protocol (COTP) instructions was measured to determine the clinical performance of the computerized decision support tool. 49.6% of instructions generated were followed by the clinical caregiver, and 16.8% of instructions generated were explicitly acknowledged by the user through the COTP computer interface. Despite this low caregiver response rate, significant favorable changes in the administration of oxygen were observed. This paper is focused on the issues of general importance the caregiver response rate raises for the implementation and clinical use of computerized decision support tools, including: (1) limitations of the user interface and (2) inherent difficulty in changing long-standing practice patterns.

Wallace, C. J.; Metcalf, S.; Zhang, X.; Kinder, A. T.; Greenway, L.; Morris, A. H.

1995-01-01

33

Combined single photon emission computerized tomography and conventional computerized tomography: Clinical value for the shoulder surgeons?  

PubMed Central

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as new diagnostic radiologic modality, and discuss its limitations. SPECT/CT may facilitate the establishment of diagnosis, process of decision making, and further treatment for complex shoulder pathologies. Some of these advantages were highlighted in cases that are frequently seen in most shoulder clinics.

Hirschmann, Michael T.; Schmid, Rahel; Dhawan, Ranju; Skarvan, Jiri; Rasch, Helmut; Friederich, Niklaus F.; Emery, Roger

2011-01-01

34

Computerized clinical database development in oncology.  

PubMed

In the era of evidence based medicine documentation of clinical data is extremely important. The field of Health informatics is a discipline at the intersection of information science, computer science and health science. Current health informatics field is mainly catering to the general needs of hospital setups. Development of disease / organ/ specialty based computerized clinical data base is still in its infancy and there is a need for clinicians to actively involve in this field to generate authentic and analyzable clinical data. In this article we present our experience of computerized oncology clinical data base development. PMID:21811362

Deo, Svs

2011-01-01

35

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

36

Clinical Decisions  

PubMed Central

This interactive feature addresses the diagnosis or management of a clinical case. A case vignette is followed by specific clinical options, neither of which can be considered either correct or incorrect. In short essays, experts in the field then argue for each of the options. Readers can participate in forming community opinion by choosing one of the options and, if they like, providing their reasons.

2013-01-01

37

Integrating Clinical Decision Support Into Workflow. Final Report.  

National Technical Information Service (NTIS)

Computerized clinical decision support (CDS), as an integral part of an electronic health record (EHR), can improve clinician decisionmaking, support evidence-based practice, and ultimately improve quality of care. Integration of CDS into clinical workflo...

B. N. Doebbeling D. Haggstrom J. Saleem

2011-01-01

38

A Computerized Decision Support System for Depression in Primary Care  

PubMed Central

Objective: In 2004, results from The Texas Medication Algorithm Project (TMAP) showed better clinical outcomes for patients whose physicians adhered to a paper-and-pencil algorithm compared to patients who received standard clinical treatment for major depressive disorder (MDD). However, implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate. A computerized decision support system (CDSS) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm. Method: This was a 2-group, parallel design, clinical trial (one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006. Fifty-five patients with MDD (DSM-IV criteria) with no significant difference in disease characteristics were enrolled, 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care. The study's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care. Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale (HDRS17) evaluated by an independent rater. Results: Patients treated by physicians employing CDSS had significantly greater symptom reduction, based on the HDRS17, than patients treated with usual care (P < .001). Conclusions: The CDSS algorithm, utilizing measurement-based care, was superior to usual care for patients with MDD in primary care settings. Larger randomized controlled trials are needed to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT00551083

Kurian, Benji T.; Trivedi, Madhukar H.; Grannemann, Bruce D.; Claassen, Cynthia A.; Daly, Ella J.; Sunderajan, Prabha

2009-01-01

39

Computerized decision support systems: improving patient safety in nephrology.  

PubMed

Incorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed. PMID:21502973

Chang, Jamison; Ronco, Claudio; Rosner, Mitchell H

2011-04-19

40

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

41

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

42

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

43

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

2012-07-27

44

Computerized Ultrasound Risk Evaluation (CURE): First Clinical Results  

NASA Astrophysics Data System (ADS)

The Karmanos Cancer Institute has developed an ultrasound (US) tomography system, known as Computerized Ultrasound Risk Evaluation (CURE), for detecting and evaluating breast cancer, with the eventual goal of providing improved differentiation of benign masses from cancer. We report on our first clinical findings with CURE.

Duric, N.; Littrup, P.; Rama, O.; Holsapple, E.

45

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

46

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

2009-12-29

47

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

ERIC Educational Resources Information Center

|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.…

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

2010-01-01

48

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,

49

How clinical decisions are made  

PubMed Central

There is much variation in the implementation of the best available evidence into clinical practice. These gaps between evidence and practice are often a result of multiple individual decisions. When making a decision, there is so much potentially relevant information available, it is impossible to know or process it all (so called ‘bounded rationality’). Usually, a limited amount of information is selected to reach a sufficiently satisfactory decision, a process known as satisficing. There are two key processes used in decision making: System 1 and System 2. System 1 involves fast, intuitive decisions; System 2 is a deliberate analytical approach, used to locate information which is not instantly recalled. Human beings unconsciously use System 1 processing whenever possible because it is quicker and requires less effort than System 2. In clinical practice, gaps between evidence and practice can occur when a clinician develops a pattern of knowledge, which is then relied on for decisions using System 1 processing, without the activation of a System 2 check against the best available evidence from high quality research. The processing of information and decision making may be influenced by a number of cognitive biases, of which the decision maker may be unaware. Interventions to encourage appropriate use of System 1 and System 2 processing have been shown to improve clinical decision making. Increased understanding of decision making processes and common sources of error should help clinical decision makers to minimize avoidable mistakes and increase the proportion of decisions that are better.

Bate, Louise; Hutchinson, Andrew; Underhill, Jonathan; Maskrey, Neal

2012-01-01

50

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

51

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

52

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

53

Development and Impact of a Computerized Pediatric Antiinfective Decision Support Program  

Microsoft Academic Search

ABSTRACT. Objective. Computerized medical deci- sion support tools have been shown to improve the qual- ity of care and have been cited by the Institute of Med- icine as one method to reduce pharmaceutical errors. We evaluated the impact of an antiinfective decision support tool in a pediatric intensive care unit (PICU). Methods. We enhanced an existing adult antiinfec- tive

Charles J. Mullett; R. Scott Evans; John C. Christenson; J. Michael Dean

54

Research Paper: Clinical Decision Support Capabilities of Commercially-available Clinical Information Systems  

Microsoft Academic Search

BackgroundThe 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.PurposeThe 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.MethodsThe authors

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

2009-01-01

55

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

56

Clinical Judgment and Decision Making  

Microsoft Academic Search

? Abstract When clinical psychologists make judgments, are they likely to be cor- rect or incorrect? The following topics are reviewed: (a) methodological,advances,in evaluating the validity of descriptions of personality and psychopathology, (b) recent findings on the cognitive processes of clinicians, and (c) the validity of judgments and utility of decisions made,by mental,health professionals. Results from research on clinical judgment,and

Howard N. Garb

2005-01-01

57

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

58

What can Natural Language Processing do for Clinical Decision Support?  

PubMed Central

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 NLP research of clinical narrative was followed by a period of stable research conducted at the major clinical centers and a shift of mainstream interest to biomedical NLP. This review primarily focuses on the recently renewed interest in development of fundamental NLP methods and advances in the NLP systems for CDS. The current solutions to challenges posed by distinct sublanguages, intended user groups, and support goals are discussed.

Demner-Fushman, Dina; Chapman, Wendy W.; McDonald, Clement J.

2009-01-01

59

Computerized methods for the clinical interpretation of myocardial scintigrams  

SciTech Connect

Computer processing of medical images is mainly used in order to improve the image quality or to derive some quantitative data from the study. Clinical interpretation of the pictures is usually based on criteria which depend on the experience of the observer, who decides to establish a relationship between the results of the study and the clinical situation of the patient. Computerized classification techniques may overcome the operator variability and optimize the criteria which affect pictures to normal or various pathological classes. In order to test the ability of factorial discriminant analysis to interpret thallium-201 myocardial scintigrams, 207 studies (at rest = 95, after stress + redistribution = 50, after dipyridamole + redistribution = 62) performed in patients undergoing coronary angiography have been first evaluated using various criteria of increasing severity, according to a regional tracer uptake model with 10 territories. The receiver operating characteristics (ROC) curves demonstrated, that sensitivity and specificity varied in opposite directions, a high sensitivity (89% to 100%) being only achieved when accepting a lack of specificity (33% to 57%). Discriminant analysis, on the contrary, provided for each type of scintigraphic protocol a single optimal combination of sensitivity (74% to 87%) and specificity (92% to 100%).

Itti, R.; Benjelloun, L.; Benjelloun, H.; Rosenberg, S.; Laudet, M.

1985-05-01

60

Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong  

Microsoft Academic Search

Summary Background and objectives: We evaluated factors associated with physi- cians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valua- tion to quantify physicians' perceived benefits from computerization in a hypothet- ical ambulatory, solo clinic. Methods: We surveyed 949 representative physicians in Hong Kong by

Gabriel M. Leung; Raymond Y. T. Yeung; Timothy Y. Y. Lai; Janice M. Johnston; Keith Y. K. Tin; Irene O. L. Wong; Pauline P. S. Woo; Lai Ming Ho

2004-01-01

61

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

62

Computerized decision support for concurrent utilization review using the HELP system.  

PubMed Central

OBJECTIVE: Development and evaluation of computerized concurrent utilization review (UR) support taking advantage of a clinically rich computerized patient database. DESIGN: The Automated Support System for Utilization Review (ASSURE) applies the Appropriateness Evaluation Protocol (AEP) Day of Care criteria to computerized patient data in the HELP hospital information system. This paper reports the development, verification, and validation of ASSURE. MEASUREMENTS: Implementation correctness was verified by measuring agreement with a nurse reviewer, using separate sample sets for all 20 criteria for a total of 560 current inpatients. Usefulness in detecting inappropriate days of care was validated by two nurse reviewers who were crossed with manual and computer-assisted review methods in a blocked design for 168 current inpatients. Agreement with reviewers, sensitivity, specificity, positive predictive value, and negative predictive value were measured. RESULTS: Agreement was very good for satisfaction of criteria, and good for appropriateness of day of care. A patient day identified by ASSURE as potentially inappropriate would be twice as likely to be judged inappropriate by a reviewer as a randomly selected patient day. Review of the 10% of patient days identified as potentially inappropriate by ASSURE would identify approximately 21% of the inappropriate days of care. CONCLUSION: ASSURE is a clinically useful tool for screening adult acute care patients for inappropriate days of care, and promises to make a major contribution to reducing health care costs. The prognosis for successful routine clinical use is good.

Nelson, B D; Gardner, R M; Hedrick, G; Gould, P

1994-01-01

63

Computerized dental injection fear treatment: a randomized clinical trial.  

PubMed

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists' lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection. PMID:23690352

Heaton, L J; Leroux, B G; Ruff, P A; Coldwell, S E

2013-05-20

64

Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation  

PubMed Central

Background Based on barriers to the use of computerized clinical decision support (CDS) learned in an earlier field study, we prototyped design enhancements to the Veterans Health Administration's (VHA's) colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder. Methods In a controlled simulation experiment, 12 primary care providers (PCPs) used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison. Quantitative measurements were based on a usability survey, workload assessment instrument, and workflow integration survey. We also collected qualitative data on both designs. Results Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted aspects of usability and workflow integration but not workload. The qualitative analysis revealed broad support across participants for the design enhancements with specific suggestions for improving the reminder further. Conclusions This study demonstrates the value of a human-computer interaction evaluation in informing the redesign of information tools to foster uptake, integration into workflow, and use in clinical practice.

2011-01-01

65

Application of Computerized Polysomnographic Systems in Psychophysiology and Clinical Studies  

Microsoft Academic Search

The development of sleep medication, computer technologies, and microelectronics in the past decade brought about the creation of a new class of instruments for the diagnostics of sleep disorders, i.e., computerized polysomnographic systems. The application of the IBM PC PENTIUM using the MS Windows system for software development and standard hardware and software allows a user to economically supplement the

V. B. Dorokhov

2002-01-01

66

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

67

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

68

Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts.  

PubMed

Background Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective study. Objective To determine which DRPs can be identified by a clinical pharmacist in a setting with routine use of CPOE/CDSS. Setting Two surgical and two neurological wards in St. Elisabeth hospital, a 600-bed teaching hospital in the Netherlands. Methods In this observational prospective follow-up study a clinical pharmacist reviewed the pharmacotherapy of patients admitted to surgical and neurological wards to identify DRPs (i.e. medication errors and adverse drug events) and discussed the relevance of identified problems and interventions to resolve these with the responsible physician. Acceptance of the proposed interventions and the presence of alerts in CPOE/CDSS were assessed. Primary outcome was the proportion of DRPs identified by the clinical pharmacist that also triggered a CPOE/CDSS alert. Differences between the DRPs that generated an alert and those that did not were expressed as relative risks or analyzed with Chi square statistics or Mann-Whitney U tests. Main outcome measure The proportion of drug-related problems identified by the clinical pharmacist that also generated an alert in the CPOE/CDSS. Results During 1206 medication reviews, 442 potential DRPs were identified; 286 (65 %) DRPs were considered relevant and 247 (56 %) of the proposed interventions were accepted. A CPOE/CDSS alert was generated for 35 (8 %) of the DRPs the clinical pharmacist identified. The only difference between problems that triggered an alert and those that did not was the class of the DRP (indication 23 vs. 36 %, effectiveness 23 vs. 13 %, safety 23 vs. 10 % and pharmaceutical care issues 31 vs. 42 %, p = 0.02). CPOE/CDSS triggered 623 additional alerts that were handled during routine pharmacy service. Conclusions As most DRPs identified by a clinical pharmacist were not detected in daily clinical practice by CPOE/CDSS, a clinical pharmacist contributes to reducing DRPs. The sensitivity of CPOE/CDSS to detect certain classes of problems should be optimized. PMID:23715760

Zaal, Rianne J; Jansen, Mark M P M; Duisenberg-van Essenberg, Marjolijn; Tijssen, Cees C; Roukema, Jan A; van den Bemt, Patricia M L A

2013-05-29

69

Clinical decision support systems: potential with pitfalls.  

PubMed

Clinical Decision Support Systems (CDSS), an important part of clinical practice, are comprised of a: knowledge base; program for integrating patient-specific information with the knowledge-base; and, user-interface to allow clinicians to interact with the system and get the right information needed to make the right decision for the right patient at the right time. We review the common approaches to CDSS, their strengths and weaknesses and how they are evaluated and developed for clinical use. PMID:22441903

Eberhardt, John; Bilchik, Anton; Stojadinovic, Alexander

2012-04-01

70

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

71

Grand challenges in clinical decision support  

Microsoft Academic Search

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and main- taining 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,

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

2008-01-01

72

Classifying clinical decision making: a unifying approach.  

PubMed

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism. PMID:11095239

Buckingham, C D; Adams, A

2000-10-01

73

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

74

Clinical and Management Requirements for Computerized Mental Health Information Systems  

PubMed Central

Information requirements of mental health providers are sufficiently different from those of other health care managers to warrant a different approach to the development of management information systems (MIS). Advances in computer technology and increased demands for fiscal accountability have led to developing integrated mental health information systems (MHIS) that support clinical and management requirements. In a study made to define a set of generic information requirements of mental health providers that can be supported by an MHIS, it was found that basic data needs can be defined and classified in functional terms: clinical, management, and consultation/education requirements. A basic set of data to support these needs was defined: demographic, financial, clinical, programmatic, and service delivery data.

Levinton, Paula H.; Dunning, Tessa F.E.

1980-01-01

75

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

76

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

77

DEVELOPMENT AND PILOT TESTING OF A COMPUTERIZED ATLAS OF PERIPHERAL BLOOD SMEARS AS A JOB AID FOR PRACTICING CLINICAL LABORATORY SCIENTISTS  

Microsoft Academic Search

ABSTRACT DEVELOPMENT AND PILOT TESTING OF A COMPUTERIZED ATLAS OF PERIPHERAL BLOOD SMEARS AS A JOB AID FOR PRACTICING CLINICAL LABORATORY SCIENTISTS By Michelle L. Montgomery The purpose of this project was to design and create a computerized atlas of peripheral blood smears which could be used as a job aid for practicing clinical laboratory scientists (CLS). Current computerized,hematology,atlases are

Michelle L. Montgomery

2003-01-01

78

Helping novice nurses make effective clinical decisions: the situated clinical decision-making framework.  

PubMed

The nature of novice nurses' clinical decision-making has been well documented as linear, based on limited knowledge and experience in the profession, and frequently focused on single tasks or problems. Theorists suggest that, with sufficient experience in the clinical setting, novice nurses will move from reliance on abstract principles to the application of concrete experience and to view a clinical situation within its context and as a whole. In the current health care environment, novice nurses frequently work with few clinical supports and mentors while facing complex patient situations that demand skilled decision-making. The Situated Clinical Decision-Making Framework is presented for use by educators and novice nurses to support development of clinical decision-making. It provides novice nurses with a tool that a) assists them in making decisions; b) can be used to guide retrospective reflection on decision-making processes and outcomes; c) socializes them to an understanding of the nature of decision-making in nursing; and d) fosters the development of their knowledge, skill, and confidence as nurses. This article provides an overview of the framework, including its theoretical foundations and a schematic representation of its components. A case exemplar illustrates one application of the framework in assisting novice nurses in developing their decision-making skills. Future directions regarding the use and study of this framework in nursing education are considered. PMID:19606659

Gillespie, Mary; Peterson, Barbara L

79

Probability, clinical decision making and hypothesis testing  

PubMed Central

Few clinicians grasp the true concept of probability expressed in the ‘P value.’ For most, a statistically significant P value is the end of the search for truth. In fact, the opposite is the case. The present paper attempts to put the P value in proper perspective by explaining different types of probabilities, their role in clinical decision making, medical research and hypothesis testing.

Banerjee, A.; Jadhav, S. L.; Bhawalkar, J. S.

2009-01-01

80

A multi-criteria decision model for the selection of a computerized manufacturing control system  

Microsoft Academic Search

The purpose of this paper is to describe and demonstrate a quantitative procedure for evaluating alternative computerized manufacturing control software packages that are being considered for possible purchase. The procedure considers both quantitative factors (i.e. costs) and qualitative factors (i.e. vendor reputation) that should be considered in the evaluation process. The various evaluation factors and criteria are identified and a

PARVIZ GHANDFOROUSH; PHILIP Y. HUANG; BERNARD W. TAYLOR III

1985-01-01

81

Computerized intrapartum electronic fetal monitoring: Analysis of the decision to deliver for fetal distress  

Microsoft Academic Search

We applied computerized methods to assess the Electronic Fetal Monitoring (EFM) in labor. We analyzed retrospectively the last hour of EFM for 1,370 babies, delivered by emergency Cesarean sections before the onset of pushing (data collected at the John Radcliffe Hospital, Oxford, UK). There were two cohorts according to the reason for intervention: (a) fetal distress, n1 = 524 and

Antoniya Georgieva; Stephen J Payne; Mary Moulden; Christopher W G Redman

2011-01-01

82

A computerized decision support system to predict the variations in the cerebral blood flow of mechanically ventilated infants.  

PubMed

A computerized decision support system is described to predict the changes in the cerebral blood flow (CBF) of mechanically ventilated infants in response to different ventilatory settings. A CBF controller was developed and combined with a mathematical model of the infant's respiratory system to simulate the effects of ventilatory settings on the infant's CBF. The performance of the system was examined under various ventilatory treatments and the results were compared with available experimental data. The comparisons showed good agreement between the simulation results and experimental data for preterm infants. These included the results obtained under conditions of hypoventilation, hyperventilation, hypoxia, and hyperoxia. The presented decision support system has the potential to be used as an aide to the intensivist in choosing appropriate ventilation treatments for infants to prevent the untoward consequences of hazardous changes in CBF in mechanically ventilated infants such as hypoxic-ischemic brain injuries. PMID:24034731

Tehrani, Fleur T

2013-07-03

83

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

84

Computerized Navigation for Length and Rotation Control in Femoral Fractures: a preliminary clinical study.  

PubMed

OBJECTIVE:: Operative treatment of femoral fractures yields a predictably high union rate, but residual malrotation and leg length discrepancy remains a clinically significant problem. The aim of this study was to determine the safety and efficacy of using computerized navigation in controlling length and rotation in femoral fracture surgery. DESIGN:: prospective consecutive case series of 16 skeletally mature patients with femoral fractures undergoing surgical fixation; 14 were fixed with intramedullary nails and 2 with plates.Setting: an Academic Level I trauma center INTERVENTION:: Computerized navigation was used to determine length and rotation of the operated extremity as compared with the intact healthy contralateral side. MAIN OUTCOME MEASUREMENT:: All patients underwent post-operative CT scanogram for determining length and rotation. RESULTS:: All fractures healed. Mean rotational difference between the treated and non-treated side was 3.45o (range 0 - 7.7o). Mean length differences between the two extremities as calculated by the CT scan was 5.83 mm (range 0-13 mm). Additional operative time required for computerized navigation was measured in two of the cases and totaled ? 30-35 minutes/ case. CONCLUSIONS:: Computerized navigation was accurate and precise at restoring femoral length and rotation during femoral fracture fixation when the intact contralateral femur was used for reference. Further, larger scale randomized studies are required. Additionally, improvements aimed at decreasing operative time and improving user interface of these systems are recommended. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:23695376

Weil, Yoram A; Greenberg, Alexander; Khoury, Amal; Mosheiff, Rami; Liebergall, Meir

2013-05-20

85

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

86

Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: initial clinical trials  

SciTech Connect

Eleven patients with suspected adult respiratory distress syndrome (ARDS) and five control patients were studied using a computerized gamma imaging and analysis technique and 99mTc-labeled human serum albumin. The heart and right lung were imaged, lung:heart ratio was plotted vs. time, and a linear regression was fitted to the data points displayed. The slope of this fit was termed the ''slope index.'' An index value of 2 standard deviations greater than the control mean was considered positive. Radiographs from the six positive studies revealed typical diffuse air-space disease. Radiographs from two of the five negative studies demonstrated air-space consolidation. Both of these patients had elevated pulmonary capillary wedge pressure, cardiomegaly, and clinical course consistent with cardiogenic pulmonary edema. These preliminary data demonstrated a good correlation between positive slope index and clinical ARDS.

Tatum, J.L.; Burke, T.S.; Sugerman, H.J.; Strash, A.M.; Hirsch, J.I.; Fratkin, M.J.

1982-04-01

87

Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: initial clinical trials  

SciTech Connect

Eleven patients with suspected adult respiratory distress syndrome (ARDS) and five control patients were studied using a computerized gamma imaging and analysis technique and /sup 99m/Tc-labeled human serum albumin. The heart and right lung were imaged, lung:heart ratio was plotted vs. time, and a linear regression was fitted to the data points displayed. The slope of this fit was termed the ''slope index.'' An index value of 2 standard deviations greater than the control mean was considered positive. Radiographs from the six positive studies revealed typical diffuse air-space disease. Radiographs from two of the five negative studies demonstrated air-space consolidation. Both of these patients had elevated pulmonary capillary wedge pressure, cardiomegaly, and clinical course consistent with cardiogenic pulmonary edema. These preliminary data demonstrated a good correlation between positive slope index and clinical ARDS.

Tatum, J.L.; Burke, T.S.; Sugerman, H.T.; Strash, A.M.; Hirsch, J.I.; Fratkin, M.J.

1982-04-01

88

Considerations for a successful clinical decision support system.  

PubMed

Clinical decision support systems have the potential to improve patient care in a multitude of ways. Clinical decision support systems can aid in the reduction of medical errors and reduction in adverse drug events, ensure comprehensive treatment of patient illnesses and conditions, encourage the adherence to guidelines, shorten patient length of stay, and decrease expenses over time. A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. In this article, the advantages, potential drawbacks, and clinical decision support system adoption barriers are discussed, followed by an in-depth review of the characteristics that make a clinical decision support system successful. The legal and ethical issues that come with the implementation of a clinical decision support system within an organization and the future expectations of clinical decision support system are reviewed. PMID:23774450

Castillo, Ranielle S; Kelemen, Arpad

2013-07-01

89

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

PubMed Central

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 search of Medline, EMBASE, CINAHL and INSPEC databases (earliest entry to June 2008) was conducted to identify randomized controlled trials involving RxCDSS. Each citation was independently assessed by two reviewers for outcomes and 28 predefined system features. Statistical analysis of associations between system features and success of outcomes was planned. Results Of 4534 citations returned by the search, 41 met the inclusion criteria. Of these, 37 reported successful system implementations, 25 reported success at changing health care provider behaviour, and 5 noted improvements in patient outcomes. A mean of 17 features per study were mentioned. The statistical analysis could not be completed due primarily to the small number of studies and lack of diversity of outcomes. Descriptive analysis did not confirm any feature to be more prevalent in successful trials relative to unsuccessful ones for implementation, provider behaviour or patient outcomes. Conclusion While RxCDSSs have the potential to change health care provider behaviour, very few high quality studies show improvement in patient outcomes. Furthermore, the features of the RxCDSS associated with success (or failure) are poorly described, thus making it difficult for system design and implementation to improve.

2009-01-01

90

[Computerized acquisition and elaboration of clinical data in Rheumatology during ten years: state of art and prospectives  

PubMed

The well known complexity to collect the clinical data of patients and in particular in the area of rheumatology push us to develop a computerized clinical chart in order to facilitate the classification, evaluation and monitoring of these patients. The proposed computerized clinical chart is easy to use but at the same time is a very potent tool that allow the clinicians to organize the classic rheumatological pathologies as well as the more complexes or even rare. The proposed clinical chart is based on a relational database (FileMaker Pro 5.0v1) available for both the actual operative systems implemented on personal computers (Windows and Macintosh); this allow the full compatibility among the two systems, the possibility of exchanging data without any loss of information. The computerized clinical chart is structured on modules for specific pathologies and for homogeneous groups of illnesses. Basically the modules are defined correlated files of data for a specific pathology but that can be used also as a common pool for different pathologies. Our experience, based on ten years of use, indicates in the computerized rheumatological clinical chart an indispensable tool for rheumatologists with a real friendly use. PMID:12163887

Troise Rioda, W.; Nervetti, A.

2001-01-01

91

Computerized diagnostic decision support system for the classification of preinvasive cervical squamous lesions  

Microsoft Academic Search

Previous studies have revealed considerable interobserver and intraobserver variation in the histological classification of preinvasive cervical squamous lesions. The aim of the present study was to develop a decision support system (DSS) for the histological interpretation of these lesions. Knowledge and uncertainty were represented in the form of a Bayesian belief network that permitted the storage of diagnostic knowledge and,

G. J. Price; W. G. Mccluggage; M. L. Morrison; G. Mcclean; L. Venkatraman; J. Diamond; H. Bharucha; R. Montironi; P. H. Bartels; D. Thompson; P. W. Hamilton

2003-01-01

92

A Computerized Bedside Clinical Information System for an Intensive Care Unit Teaching Service  

PubMed Central

The CLINICAL REFERENCE LIBRARY, a subsystem of the Hewlett Packard 5600A Patient Data Management System, contains 20 information modules. Topics range from airway management and nutritional support to aspiration pneumonia and septic shock. The user is able to flip rapidly back and forth through any module or from one module to another, much as one would flip through a book. Using a classical non-randomized, pre-test-post-test, control-experimental research paradigm, medical students and residents exposed to the system “acquired” more knowledge than their counterparts who used conventional teaching methods (p<0.05). Medical students and nurses accessed the system for continuing medical education whereas residents used the system for problem-solving. Nurses had strong negative views about the use and feasibility of computerized patient data management.

Burridge, Philip W.; Skakun, Ernest N.

1983-01-01

93

Computerized Neuropsychological Assessment Devices: Joint Position Paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology  

Microsoft Academic Search

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development

Russell M. Bauer; Grant L. Iverson; Alison N. Cernich; Laurence M. Binder; Ronald M. Ruff; Richard I. Naugle

2012-01-01

94

Bisphosphonate-related osteonecrosis of the jaw: clinical correlations with computerized tomography presentation.  

PubMed

The aim of this study was to correlate clinical and computerized tomography (CT) features of bisphosphonate-related osteonecrosis of the jaws (BRONJ). All ONJ patients for whom there was complete CT scan imaging were eligible. Selected clinical parameters retrieved from their medical records were analyzed for correlation with CT parameters. The clinical presentation of BRONJ was supported by findings in CT imaging in 78.3%. The lesion's size on CT correlated with the presence of purulent secretion (p = 0.03). When sequestrum was present, the median lesion's size on CT was relatively big (28 mm, range 21-43 mm). The mandibular canal cortex was never breached. CT has reasonable detection competence for diagnosing BRONJ. Purulent secretion indicates the likelihood that a more extensive involvement will be displayed on CT. A large lesion on CT should raise the index of suspicion for sequestrum. The CT appearance of a continuous cortex of the mandibular canal may serve as a differential parameter between BRONJ and metastasis to the jaw. PMID:19603201

Elad, Sharon; Gomori, Moshe J; Ben-Ami, Noa; Friedlander-Barenboim, Silvina; Regev, Eran; Lazarovici, Towy S; Yarom, Noam

2009-07-15

95

Computerized Monitoring and Management of Nontidal Wetlands.  

National Technical Information Service (NTIS)

The decision to develop a computerized system is based on several considerations demanding a computerized approach; principally the expectation that increasing amounts of diverse data will need to be incorporated into management decision and the necessity...

K. P. Lade

1988-01-01

96

The Effect of Computerized Physician Order Entry and Decision Support System on Medication Errors in the Neonatal Ward: Experiences from an Iranian Teaching Hospital  

Microsoft Academic Search

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three\\u000a 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.\\u000a Before intervention (Period 1), error rate was 53%, which did not significantly change

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

2011-01-01

97

An integrative model of clinical-ethical decision making  

Microsoft Academic Search

The purpose of this paper is to propose a model of clinical-ethical decision making which will assist the health care professional to arrive at an ethically defensible judgment. The model highlights the integration between ethics and decision making, whereby ethics as a systematic analytic tool bring to bear the positive aspects of the decision making process. The model is composed

Rivka Grundstein-Amado

1991-01-01

98

Programmable Calculators and Minicomputers in Agriculture. A Symposium Exploring Computerized Decision-Making Aids and Their Extension to the Farm Level. Proceedings of a Symposium, Hot Springs, Arkansas, February 6-7, 1980.  

National Technical Information Service (NTIS)

Ten papers presented at a symposium discuss the array of computerized decision-making aids currently available to farmers and ways to speed up the rate of adoption of computers by agriculturalists. Topics presented include the development of software for ...

E. Bentley

1980-01-01

99

Decision-theoretic refinement planning: a new method for clinical decision analysis.  

PubMed Central

Clinical decision analysis seeks to identify the optimal management strategy by modelling the uncertainty and risks entailed in the diagnosis, natural history, and treatment of a particular problem or disorder. Decision trees are the most frequently used model in clinical decision analysis, but can be tedious to construct, cumbersome to use, and computationally prohibitive, especially with large, complex decision problems. We present a new method for clinical decision analysis that combines the techniques of decision theory and artificial intelligence. Our model uses a modular representation of knowledge that simplifies model building and enables more fully automated decision making. Moreover, the model exploits problem structures to yield better computational efficiency. As an example we apply our techniques to the problem of management of acute deep venous thrombosis.

Doan, A.; Haddawy, P.; Kahn, C. E.

1995-01-01

100

Are all pulmonary embolism clinical decision rules equal?  

PubMed

Clinical questionAre four common clinical decision rules, in combination with normal D-dimer results, comparable in their ability to clinically exclude the diagnosis of pulmonary embolism?Article chosenDouma RA, Mos ICM, Erkens PMG, et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med 2011;154:709-18.ObjectiveTo directly compare the performance of four different clinical decision rules, the Wells rule, revised Geneva score, simplified Wells rule, and simplified revised Geneva score, in combination with D-dimer results, to exclude pulmonary embolism. PMID:23972135

Fok, Patrick T; Primavesi, Robert

2013-09-01

101

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain  

PubMed Central

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 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.

2010-01-01

102

SOC: A Distributed Decision Support Architecture for Clinical Diagnosis  

Microsoft Academic Search

In this paper we introduce SOC (Sistema de Orientación Clínica, Clinic Orientation System), a novel distributed decision support system for clinical diagnosis. The decision support systems are based on pattern recognition engines which solve different and specific classification problems. SOC is based on a distributed architecture with three specialized nodes: 1) Information System where the remote data is stored, 2)

Javier Vicente; Juan Miguel García-gómez; César Vidal; Luis Martí-bonmatí; Aurora Del Arco; Montserrat Robles

2004-01-01

103

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

104

Four Factors of Clinical Decision Making: A Teaching Model.  

ERIC Educational Resources Information Center

Four factors of clinical decision making identified by medical students include quality of care, cost, ethics, and legal concerns. This paper argues that physicians have two responsibilities in the clinical decision-making model: to be the primary advocate for quality health care and to ensure balance among the four factors, working in partnership…

Leist, James C.; Konen, Joseph C.

1996-01-01

105

Clinical decision support tools: analysis of online drug information databases  

Microsoft Academic Search

BACKGROUND: Online drug information databases are used to assist in enhancing clinical decision support. However, the choice of which online database to consult, purchase or subscribe to is likely made based on subjective elements such as history of use, familiarity, or availability during professional training. The purpose of this study was to evaluate clinical decision support tools for drug information

Kevin A Clauson; Wallace A Marsh; Hyla H Polen; Matthew J Seamon; Blanca I Ortiz

2007-01-01

106

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

107

Application of Information Technology: A Trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry  

Microsoft Academic Search

BackgroundAutomated clinical decision support has shown promise in reducing medication errors; however, clinicians often do not comply with alerts. Because renal insufficiency is a common source of medication errors, the authors studied a trial of alerts designed to reduce inpatient administration of medications contraindicated due to renal insufficiency.MethodsA minimum safe creatinine clearance was established for each inpatient formulary medication. Alerts

William L. Galanter; Robert J. Didomenico; Audrius Polikaitis

2005-01-01

108

Application of computerized exercise ECG digitization. Interpretation in large clinical trials.  

PubMed

The authors report on a semiautomated program that incorporates both visual identification of fiducial points and digital determination of the ST-segment at 60 ms and 80 ms from the J point, ST slope, changes in R wave, and baseline drift. The off-line program can enhance the accuracy of detecting electrocardiographic (ECG) changes, as well as reproducibility of the exercise and postexercise ECG, as a marker of myocardial ischemia. The analysis program is written in Microsoft QuickBASIC 2.0 for an IBM personal computer interfaced to a Summagraphics mm1201 microgrid II digitizer. The program consists of the following components: (1) alphanumeric data entry, (2) ECG wave form digitization, (2) calculation of test results, (4) physician overread, and (5) editor function for remeasurements. This computerized exercise ECG digitization-interpretation program is accurate and reproducible for the quantitative assessment of ST changes and requires minimal time allotment for physician overread. The program is suitable for analysis and interpretation of large volumes of exercise tests in multicenter clinical trials and is currently utilized in the TIMI II, TIMI III, and BARI studies sponsored by the National Institutes of Health. PMID:1522395

Caralis, D G; Shaw, L; Bilgere, B; Younis, L; Stocke, K; Wiens, R D; Chaitman, B R

1992-04-01

109

Decision making by baccalaureate nursing students in the clinical setting.  

PubMed

Many researchers who have explored nurse decision making have concluded that decision making is a learned skill that must be taught by nurse educators. Yet little research has been conducted to explore nursing students' decision making. If nurse educators are to teach this skill, it is necessary to have a better understanding of the kinds of decisions students are making in the clinical setting and the factors that influence this process. Once we have a greater knowledge in this area, curricular materials can be developed to ensure this skill is taught throughout an undergraduate education, resulting in graduates who possess strong, independent, and interdependent decision making skills. This article will describe one component (the kinds of decisions) of a larger qualitative case study that explored the kinds of decisions and the factors that influenced nursing students' decision making throughout a baccalaureate degree program. PMID:18751648

Baxter, Pamela E; Boblin, Sheryl

2008-08-01

110

Personalizing Drug Selection Using Advanced Clinical Decision Support  

PubMed Central

This article describes the process of developing an advanced pharmacogenetics clinical decision support at one of the United States’ leading pediatric academic medical centers. This system, called CHRISTINE, combines clinical and genetic data to identify the optimal drug therapy when treating patients with epilepsy or Attention Deficit Hyperactivity Disorder. In the discussion a description of clinical decision support systems is provided, along with an overview of neurocognitive computing and how it is applied in this setting.

Pestian, John; Spencer, Malik; Matykiewicz, Pawel; Zhang, Kejian; Vinks, Alexander A.; Glauser, Tracy

2009-01-01

111

A framework and model for evaluating clinical decision support architectures  

Microsoft Academic Search

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.

Adam Wright; Dean F. Sittig

2008-01-01

112

Reduction in Clinical Variance Using Targeted Design Changes in Computerized Provider Order Entry (CPOE) Order Sets  

PubMed Central

Objectives Unwarranted variance in healthcare has been associated with prolonged length of stay, diminished health and increased cost. Practice variance in the management of asthma can be significant and few investigators have evaluated strategies to reduce this variance. We hypothesized that selective redesign of order sets using different ways to frame the order and physician decision-making in a computerized provider order entry system could increase adherence to evidence-based care and reduce population-specific variance. Patients and Methods The study focused on the use of an evidence-based asthma exacerbation order set in the electronic health record (EHR) before and after order set redesign. In the Baseline period, the EHR was queried for frequency of use of an asthma exacerbation order set and its individual orders. Important individual orders with suboptimal use were targeted for redesign. Data from a Post-Intervention period were then analyzed. Results In the Baseline period there were 245 patient visits in which the acute asthma exacerbation order set was selected. The utilization frequency of most orders in the order set during this period exceeded 90%. Three care items were targeted for intervention due to suboptimal utilization: admission weight, activity center use and peak flow measurements. In the Post-Intervention period there were 213 patient visits. Order set redesign using different default order content resulted in significant improvement in the utilization of orders for all 3 items: admission weight (79.2% to 94.8% utilization, p<0.001), activity center (84.1% to 95.3% utilization, p<0.001) and peak flow (18.8% to 55.9% utilization, p<0.001). Utilization of peak flow orders for children ?8 years of age increased from 42.7% to 94.1% (p<0.001). Conclusions Details of order set design greatly influence clinician prescribing behavior. Queries of the EHR reveal variance associated with ordering frequencies. Targeting and changing order set design elements in a CPOE system results in improved selection of evidence-based care.

Jacobs, B. R.; Hart, K. W.; Rucker, D. W.

2012-01-01

113

Computerized Neuropsychological Assessment Devices: Joint Position Paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology†  

PubMed Central

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability, and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.

Bauer, Russell M.; Iverson, Grant L.; Cernich, Alison N.; Binder, Laurence M.; Ruff, Ronald M.; Naugle, Richard I.

2012-01-01

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

Computerized assessment of breast lesion malignancy using DCE-MRI: robustness study on two independent clinical datasets from two manufacturers  

PubMed Central

Rationale and Objectives To conduct a pre-clinical evaluation of the robustness of our computerized system for breast lesion characterization on two breast magnetic resonance imaging (MRI) databases that were acquired using scanners from two different manufacturers. Materials and Methods Two clinical breast MRI databases were acquired from a Siemens scanner and a GE scanner, which shared similar imaging protocols and retrospectively collected under an IRB-approved protocol. In our computerized analysis system, once a breast lesion is identified by the radiologist, the computer performs automatic lesion segmentation and feature extraction, and outputs an estimated probability of malignancy. We used a Bayesian neural network with automatic relevance determination for joint feature selection and classification. To evaluate the robustness of our classification system, we first used Database 1 for feature selection and classifier training, and Database 2 to test the trained classifier. Then, we exchanged the two datasets and repeated the process. Area under the ROC curve (AUC) was used as a performance figure of merit in the task of distinguishing between malignant and benign lesions. Results We obtained an AUC of 0.85 (approximate 95% confidence interval (CI): [0.79, 0.91]) for (a) feature selection and classifier training using Database 1 and testing on Database 2; and an AUC of 0.90 (approximate 95% CI: [0.84, 0.96]) for (b) feature selection and classifier training using Database2 and testing on Database1. We failed to observe statistical significance for the difference AUC of 0.05 between the two database-conditions (P=0.24; 95% confidence interval [? 0.03, 0.1]). Conclusion These results demonstrate the robustness of our computerized classification system in the task of distinguishing between malignant and benign breast lesions on DCE-MRI images from two manufacturers. Our study showed the feasibility of developing a computerized classification system that is robust across different scanners.

Chen, Weijie; Giger, Maryellen L.; Newstead, Gillian M.; Bick, Ulrich; Jansen, Sanaz A.; Li, Hui; Lan, Li

2010-01-01

116

Programmable Calculators and Minicomputers in Agriculture. A Symposium Exploring Computerized Decision-Making Aids and Their Extension to the Farm Level. Proceedings of a Symposium (Hot Springs, Arkansas, February 6-7, 1980)  

ERIC Educational Resources Information Center

|Ten papers presented at a symposium discuss the array of computerized decision-making aids currently available to farmers and ways to speed up the rate of adoption of computers by agriculturalists. Topics presented include the development of software for agricultural decision-making; the role of programmable calculators and minicomputers in…

Bentley, Ernest, Ed.

117

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

118

A framework and model for evaluating clinical decision support architectures.  

PubMed

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. PMID:18462999

Wright, Adam; Sittig, Dean F

2008-03-25

119

DecisionNET: database/network support for clinical decision analysts.  

PubMed

DecisionNET is a proposed remote database/wide-area computer network that should cultivate quantitative approaches to medicine by providing rapid access to medical facts, literature citations, decision models, and commentary of specific use to those involved with quantitative clinical decision making. Increasing accessibility to data and providing a forum for exchange of ideas should prove to be a significant asset to clinicians, either as modelers or as clients. Further work will address specific database implementation, development of a query engine, and coordination of the communications infrastructure. DecisionNET provides a unique model for the growth and maintenance of other medical knowledge bases. PMID:1309081

Cohen, B J; Goldberg, H S; Pauker, S G

1992-12-17

120

Clinical validation of a new algorithm for computerized dosing of vitamin K antagonist therapy: a retrospective simulation study.  

PubMed

The number of patients on oral anticoagulant therapy has increased in recent years, and this trend is expected to continue. The increased workload for physicians has led to the development of computerized systems to make organizational workflow more efficient. These programs may include algorithms to propose a weekly dosage and timing for the following visit. Before introducing a new algorithm in clinical practice, its safety and efficacy must be validated. We undertook a retrospective simulation study to test a new algorithm for the TAOnet system. The main outcome was the percentage of concordant and discordant proposals between manual- and algorithm-based prescriptions. Pairs of computerized and physician prescriptions were assessed. They were categorized as 0.1-5, 5.1-10 and >10% if the dose was different, and assigned as "algorithm better" or "manual better" dependent upon the subsequent international normalized ratio value. In 61.0% of cases, the manual and computerized weekly dosage assignments were identical; in 15.3% of cases, the difference was between 0.1 and 5%; in 14.7 of cases, it was between 5.1 and 10%; and in 9.0% of cases, it was >10%. The algorithm did better in 43.9% of discordant pairs, generally due to less frequent under-dosing. In conclusion, the new algorithm proved to consistently overlap with the manual method. The algorithm is useful but must be tested in a multi-center, prospective, interventional study. PMID:21468696

Basileo, Michela; Micheluzzi, Carlo; Minozzi, Marina; Lazzaroni, Luigi; Iorio, Alfonso

2011-04-06

121

Clinical similarities: an innovative approach for supporting medical decisions.  

PubMed

Taking decisions in the medical domain is a very complex task. The context is strongly affected by uncertainty and the possible undesired side effects of the treatments have to be carefully considered. Currently, these decisions are based on the physician's own experience and the evidences of the published literature, according, when available, with the philosophy of Evidence Based Medicine. The main issues of this approach are that the own experience can be different, and the results in the literature are sometimes contrasting. For helping physicians while taking medical decisions, we are proposing an innovative approach based on the idea of the clinical similarity. Given a set of clinical variables, the proposed approach selects patients that are similar, presenting to the physician the respective decisions taken and the corresponding clinical effects. PMID:23920888

Vallati, M; Gatta, R; De Bari, B; Magrini, S M

2013-01-01

122

Health technology assessment review: Computerized glucose regulation in the intensive care unit - how to create artificial control  

Microsoft Academic Search

ABSTRACT: Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many ICUs have implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (Cuss) use more complex logic to

Miriam Hoekstra; Mathijs Vogelzang; Evgeny Verbitskiy; Maarten W. N. Nijsten

2009-01-01

123

Clinical decision making of nurses regarding elder abuse.  

PubMed

A descriptive correlational design was used to examine the clinical decision making of nurses regarding elder abuse. The relationship of the nurses' applied knowledge of elder abuse, years of experience as a Registered Nurse (RN), clinical level of practice status, the use of intuition, and clinical decision outcomes for patients in cases of suspected elder abuse were examined. The convenience sample of 84 RNs consisted of 68 females and 16 males. Results indicated an overall model of two predictors that significantly predicted outcomes. The t-test revealed no difference between RNs who received elder abuse education and those who did not. PMID:23473297

Meeks-Sjostrom, Diana J

2013-01-01

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

Clinical Decision Making of Nurses Working in Hospital Settings  

PubMed Central

This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.

Bj?rk, Ida Torunn; Hamilton, Glenys A.

2011-01-01

127

The Use of a Computerized Method of Bone Age Assessment in Clinical Practice  

Microsoft Academic Search

We assessed the reliability and repeatability of a new computerized bone age system, both versions 3.4 and 3.5 (licensed by Discerning System Inc. and Ares Service SA, Serono), able to automatically assess bone age on a left hand and wrist radiograph. This computer system is based upon Tanner and White-house’s method (TW2), but there are important differences. Our sample included

Assunta Albanese; Christine Hall; Richard Stanhope

1995-01-01

128

Impact of Computerized Physician Order Entry on Clinical Practice in a Newborn Intensive Care Unit  

Microsoft Academic Search

OBJECTIVE: To study the impact of computerized physician order entry (CPOE) on selected neonatal intensive care unit (NICU) practices.DESIGN: Retrospective review.SETTING: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002.STUDY POPULATION: Data from 111 very-low-birth-weight (VLBW) infants born consecutively within 6 months before and 100 VLBW

Leandro Cordero; Lynn Kuehn; Rajee R Kumar; Hagop S Mekhjian

2004-01-01

129

Building a Case-Based Reasoner for Clinical Decision Support  

Microsoft Academic Search

\\u000a Orion Systems International Limited has recognised the need in the healthcare industry for an application to provide robust\\u000a clinical decision support. One possible approach is to develop a case-based reasoner to support decisions made in the disease\\u000a management process. We have undertaken a project to investigate the validity of using case-based reasoning for this task,\\u000a specifically focusing on the management

Anna Wills; Ian Watson

2004-01-01

130

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

131

Clinical decision support complements evidence-based decision making in dental practice.  

PubMed

Dental professionals as well as consumers of dental health care are driving the demand for access to reliable information so they can make more informed decisions. Clinical decision support (CDS) includes a variety of printed and electronic tools, systems, products, and services that make knowledge and information available to the user. CDS is the main way people will be able to access important facts, ideas, concepts, and the latest thinking about personal and population-based health subjects. CDS has its greatest potential at the point of care where it can facilitate good-quality evidence-based decision-making. PMID:17403500

Newman, Michael G

2007-03-01

132

Evaluating the decision accuracy and speed of clinical data visualizations.  

PubMed

Clinicians face an increasing volume of biomedical data. Assessing the efficacy of systems that enable accurate and timely clinical decision making merits corresponding attention. This paper discusses the multiple-reader multiple-case (MRMC) experimental design and linear mixed models as means of assessing and comparing decision accuracy and latency (time) for decision tasks in which clinician readers must interpret visual displays of data. These tools can assess and compare decision accuracy and latency (time). These experimental and statistical techniques, used extensively in radiology imaging studies, offer a number of practical and analytic advantages over more traditional quantitative methods such as percent-correct measurements and ANOVAs, and are recommended for their statistical efficiency and generalizability. An example analysis using readily available, free, and commercial statistical software is provided as an appendix. While these techniques are not appropriate for all evaluation questions, they can provide a valuable addition to the evaluative toolkit of medical informatics research. PMID:20190060

Pieczkiewicz, David S; Finkelstein, Stanley M

133

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

134

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

135

Examining the relationship between clinical decision support and performance measurement.  

PubMed

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. PMID:20351854

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

2009-11-14

136

Integrating Evidence into Clinical Information Systems for Nursing Decision Support  

PubMed Central

Purpose To illustrate approaches for providing decision support for evidence-based nursing practice through integration of evidence into clinical information systems (CISs) with examples from our experience at Columbia University Medical Center. Organizing Construct Examples are organized according to three types of decision support functions: information management, focusing attention, and patient-specific consultation. Methods Three decision support tools that are integrated into three types of CISs are discussed: 1) infobuttons that provide context-specific access to digital sources of evidence; 2) automated Fall-Injury Risk Assessment; and 3) personal digital assistant-based screening reminders, screening assessments, and tailored documentation templates for the identification and management of obesity, depression, and tobacco cessation. The informatics infrastructure for implementing these decision support tools is described from the perspective of components identified in the published literature. Conclusions Efforts to facilitate application of evidence into nursing practice are unlikely to be successful unless the approaches used are integrated into the clinical workflow. Our approaches use a variety of informatics methods to integrate evidence into CISs as a mechanism for providing decision support for evidence-based practice in a manner consistent with nursing workflow.

Bakken, Suzanne; Currie, Leanne M.; Lee, Nam-Ju; Roberts, W. Dan; Collins, Sarah A.; Cimino, James J.

2008-01-01

137

Incorporating clinical guidelines through clinician decision-making  

PubMed Central

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 their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions. Methods The proposed investigation has two specific aims to identify the processes that affect decisions about incorporating clinical guidelines, and then to develop ad test a strategy that promotes the utilization of evidence-based practices. This paper focuses on the first aim. It presents the rationale, introduces the clinical paradigm of treatment-resistant schizophrenia, and discusses an exemplar of clinician non-conformance to a clinical guideline. A modification of the original study is proposed that targets psychiatric trainees and draws on a cognitively rich theory of decision-making to formulate hypotheses about how the guideline is incorporated into treatment decisions. Twenty volunteer subjects recruited from an accredited psychiatry training program will respond to sixty-four vignettes that represent a fully crossed 2 × 2 × 2 × 4 within-subjects design. The variables consist of criteria contained in the clinical guideline and other relevant factors. Subjects will also respond to a subset of eight vignettes that assesses their overall impression of the guideline. Generalization estimating equation models will be used to test the study's principal hypothesis and perform secondary analyses. Implications The original design of phase two of the proposed investigation will be changed in recognition of newly published literature on the relative effectiveness of treatments for schizophrenia. It is suggested that this literature supports the notion that guidelines serve a valuable function as decision tools, and substantiates the importance of decision-making as the means by which general principles are incorporated into clinical practice.

Falzer, Paul R; Moore, Brent A; Garman, D Melissa

2008-01-01

138

Use of Clinical Decision Support to Improve the Quality of Care Provided to Older Hospitalized Patients  

PubMed Central

Background Frail older inpatients are at risk of unintended adverse events while in hospital, particularly falls, functional decline, delirium and incontinence. Objective The aim of this pragmatic trial was to pilot and evaluate a multi-component knowledge translation intervention that incorporated a nurse-initiated computerized clinical decision support tool to reduce harms in the care of older medical inpatients. Methods A stepped wedge trial design was conducted on six medical units at two hospitals in Calgary, Alberta, Canada. The primary quantitative outcome was the rate of order set use. Secondary outcomes included the number of falls, the average number of days in hospital, and the total number of consults ordered for each of orthopedics, geriatrics, psychiatry and physiotherapy. Qualitative analysis included interviews with nurses to explore barriers and facilitators around the implementation of the electronic decision support tool. Results The estimated mean rate of order set use over a 2 week period was 3.1 (95% CI 1.9–5.3) sets higher after the intervention than before. The estimated odds of a fall happening on a unit over a 2-week period was 9.3 (p = 0.065) times higher before than after the intervention. There was no significant effect of the intervention on length of hospital stay (p = 0.67) or consults to related clinical services (all p <0.2). Interviews with front-line nurses and nurse managers/educators revealed that the order set is not being regularly ordered because its content is perceived as part of good nursing care and due to the high workload on these busy medical units. Conclusions Although not statistically significant, a reduction in the number of falls as a result of the intervention was noted. Frontline users’ engagement is crucial for the successful implementation of any decision support tool. New strategies of implementation will be evaluated before broad dissemination of this knowledge translation intervention.

Groshaus, H.; Boscan, A.; Khandwala, F.; Holroyd-Leduc, J.

2012-01-01

139

Neonatal Informatics: Computerized Physician Order Entry.  

PubMed

Computerized physician order entry (CPOE) is the feature of electronic medical record (EMR) implementation that arguably offers the greatest quality and patient safety benefits. The gains are potentially greater for critically ill neonates, but the effect of CPOE on quality and safety is dependent upon local implementation decisions. OBJECTIVES: After completing this article, readers should be able to: Define the basic aspects of CPOE and clinical decision support (CDS) systems.Describe the potential benefits of implementing CPOE associated with CDS in a neonatal intensive care unit (NICU). PMID:21804768

Palma, Jonathan P; Sharek, Paul J; Classen, David C; Longhurst, Christopher A

2011-01-01

140

Computerized network organization design for clinical patient data management of a cardiology department  

Microsoft Academic Search

In the system described 13 PCs are located in the Echo Lab., Cath Lab., Pacemaker Clinic, Electrophysiology, Out-patient Clinic and Clinical Ward. Original Clipper-compiled software has been developed. The clinical summary database is shared on-line through the network, including demographic data, diagnostic coding, summary of relevant clinical and diagnostic reports, access indices to complete records (paper, videotapes, cinefilm, etc.). Each

E. Cervesato; G. L. Nicolosi; D. Zanuttini

1990-01-01

141

Examinations with Computerized Cranial Axial Tomography Carried out on Patients with Epileptic Seizures, Taking into Consideration the EEG and the Clinical Picture.  

National Technical Information Service (NTIS)

204 patients suffering from epileptic seizures were examined with the help of computerized cranial X-ray tomography; the results were compared with anamnestic, clinical, and EEC-findings. In good agreement with results published in literature, in 54% of t...

R. Geiser

1982-01-01

142

Patients' Perceptions of Sharing in Decisions: A Systematic Review of Interventions to Enhance Shared Decision Making in Routine Clinical Practice  

Microsoft Academic Search

Background: Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. Objective: This systematic review evaluates the effectiveness of interventions to improve health professionals' adoption of shared decision

Stphane Turcotte; Dawn Stacey; Stphane Ratt; Jennifer Kryworuchko; Ian D. Graham

2012-01-01

143

Understanding Why Clinicians Answer or Ignore Clinical Decision Support Prompts  

PubMed Central

Introduction The identification of key factors influencing responses to prompts and reminders within a computer decision support system (CDSS) has not been widely studied. The aim of this study was to evaluate why clinicians routinely answer certain prompts while others are ignored. Methods We utilized data collected from a CDSS developed by our research group – the Child Health Improvement through Computer Automation (CHICA) system. The main outcome of interest was whether a clinician responded to a prompt. Results This study found that, as expected, some clinics and physicians were more likely to address prompts than others. However, we also found clinicians are more likely to address prompts for younger patients and when the prompts address more serious issues. The most striking finding was that the position of a prompt was a significant predictor of the likelihood of the prompt being addressed, even after controlling for other factors. Prompts at the top of the page were significantly more likely to be answered than the ones on the bottom. Conclusions This study detailed a number of factors that are associated with physicians following clinical decision support prompts. This information could be instrumental in designing better interventions and more successful clinical decision support systems in the future.

Carroll, A.E.; Anand, V.; Downs, S.M.

2012-01-01

144

Knowledge-analytics synergy in Clinical Decision Support.  

PubMed

Clinical Decision Support (CDS) systems hold tremendous potential for improving patient care. Most existing systems are knowledge-based tools that rely on relatively simple rules. More recent approaches rely on analytics techniques to automatically mine EHR data to reveal meaningful insights. Here, we propose the Knowledge-Analytics Synergy paradigm for CDS, in which we synergistically combine existing relevant knowledge with analytics applied to EHR data. We propose a framework for implementing such a paradigm and demonstrate its principles over real-world clinical and genomic data of hypertensive patients. PMID:22874282

Slonim, Noam; Carmeli, Boaz; Goldsteen, Abigail; Keller, Oliver; Kent, Carmel; Rinott, Ruty

2012-01-01

145

Computerization of the Decision-Making Framework: Surface Runoff Toxicity Bioassay Test Results (LAT-R Program).  

National Technical Information Service (NTIS)

The Decision-Making Framework (DMF) for the management of dredged material has been developed and used at numerous Corps projects (Lee and others 1991). Among the many components of the DMF is surface runoff water quality, which is one of the pathways inv...

1997-01-01

146

Utilizing Computerized Entertainment Education in the Development of Decision Aids for Lower Literate and Naïve Computer Users  

Microsoft Academic Search

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment

Maria L. Jibaja-Weiss; Robert J. Volk

2007-01-01

147

Computerized radiographic mass detection--part II: Decision support by featured database visualization and modular neural networks.  

PubMed

Based on the enhanced segmentation of suspicious mass areas, further development of computer-assisted mass detection may be decomposed into three distinctive machine learning tasks: 1) construction of the featured knowledge database; 2) mapping of the classified and/or unclassified data points in the database; and 3) development of an intelligent user interface. A decision support system may then be constructed as a complementary machine observer that should enhance the radiologists performance in mass detection. We adopt a mathematical feature extraction procedure to construct the featured knowledge database from all the suspicious mass sites localized by the enhanced segmentation. The optimal mapping of the data points is then obtained by learning the generalized normal mixtures and decision boundaries, where a is developed to carry out both soft and hard clustering. A visual explanation of the decision making is further invented as a decision support, based on an interactive visualization hierarchy through the probabilistic principal component projections of the knowledge database and the localized optimal displays of the retrieved raw data. A prototype system is developed and pilot tested to demonstrate the applicability of this framework to mammographic mass detection. PMID:11370897

Li, H; Wang, Y; Liu, K J; Lo, S C; Freedman, M T

2001-04-01

148

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

149

Clinical and diagnostic assessment for therapeutic decisions in prostate cancer.  

PubMed

Due to the heterogeneity of prostate cancer (PCa) outcomes, there is a need for individualized treatment plans based on clinical and cancer characteristics. Recent advances in sophisticated imaging modalities have improved the ability to stratify patients according to their risk of PCa diagnosis and progression. This, in turn, has positively influenced the clinical decision making process. However, there is also an overuse of diagnostic imaging in the evaluation of PCa patients. Baseline diagnostic and re-staging evaluations need to be indeed personalized, in order to maximize the results and reduce unnecessary, lengthy and costly procedures. The aim of this review was to critically evaluate current international guidelines in order to identify clinical and diagnostic markers that might help clinicians in the selection of the most appropriate imaging approach. For this aim, different imaging modalities were analyzed in patients with newly diagnosed PCa, focusing on local, nodal and distant staging. Every step of staging was taken into consideration based on patient individualized risk, as defined by routinely available clinical variables. Second, different imaging techniques were also reviewed in the context of relapse after primary treatment, highlighting their utility and impact in the clinical decision making process. This review focuses mainly on conventional established imaging techniques, with an eye also to novel approaches that still need to be validated on large patient series. PMID:23013662

Passoni, N M; Di Trapani, E; Suardi, N; Gallina, A; Abdollah, F; Bianchi, M; Picchio, M; Giovacchini, G; Messa, C; Rigatti, P; Montorsi, F; Briganti, A

2012-08-01

150

Viewpoint Paper: Evaluation and Certification of Computerized Provider Order Entry Systems  

Microsoft Academic Search

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of

David C. Classen; Anthony J. Avery; David W. Bates

2007-01-01

151

Enablers, Barriers, and the Influence of Organizational Environmental Factors on Computerized Clinical Documentation Training Developed and Delivered by Nursing Informaticists  

ERIC Educational Resources Information Center

|Within the past decade, the introduction of computerized medical records into the business and practice of health care has created a need for effective training. The implementation of computerized medical records into a health care organization has been often associated with increased costs and decreased productivity. Although existing human…

Kulhanek, Brenda J.

2010-01-01

152

Counseling about medication-induced birth defects with clinical decision support in primary care.  

PubMed

Abstract Background: We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior. Methods: Between October 2008 and April 2010, all women aged 18-50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5-30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse. Results: Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26-3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling. Conclusions: Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception. PMID:23930947

Schwarz, Eleanor Bimla; Parisi, Sara M; Handler, Steven M; Koren, Gideon; Shevchik, Grant; Fischer, Gary S

2013-08-09

153

An evaluation by teachers of a decision aid for viewing bitewing radiographs  

Microsoft Academic Search

Objectives: To evaluate a new decision aid to improve restorative treatment decision making for proximal caries from bitewing radiographs. Methods: Dental teachers involved in patient treatment and clinical caries diagnosis (n = 31) viewed a computerized decision aid. Whilst using the aid, measures of the teachers' diagnostic and treatment accuracy, and also their decision-making knowledge and values were recorded. After

P. A. Mileman; Hout van den W. B

2008-01-01

154

Using a mock trial to make a difficult clinical decision.  

PubMed

Many clinical decisions have to be taken with inadequate scientific information. Reaching a consensus among experts has been tried as one response to this problem. Another, described here, is to use legal process to dissect a difficult question. In this case a mock trial--using barristers, expert witnesses, and a jury--was conducted on whether bone marrow transplantation should be offered to all children with symptomatic sickle cell disease. Transplantation seems to offer about a 90% cure rate for a condition that may kill 15% of children before they reach 20. But transplantation carries a 10% risk of death or severe disability, and doctors cannot predict which children will suffer severely from their sickle cell disease and which will suffer little or nothing. The jury eventually reached a majority decision that transplantation should not be offered now to all symptomatic children. PMID:1477577

Smith, R

1992-11-21

155

Designing a Decision Support System for Existing Clinical Organizational Structures: Considerations From a Rheumatology Clinic  

Microsoft Academic Search

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

Örjan Dahlström; Ingrid Thyberg; Ursula Hass; Thomas Skogh; Toomas Timpka

2006-01-01

156

The Feasibility of Computerized Patient Self-assessment at Mental Health Clinics  

Microsoft Academic Search

Objectives  Improving the quality of care for severe mental illness (SMI) has been difficult because patients’ clinical information is\\u000a not readily available. Audio computer-assisted self-interviewing (ACASI) supports data collection by asking patients waiting\\u000a for appointments clinical questions visually and aurally. It has improved outcomes for many disorders. While reliable and\\u000a accurate for SMI in research settings, this study assesses questions about

Matthew Chinman; Joseph Hassell; Jennifer Magnabosco; Nancy Nowlin-Finch; Susan Marusak; Alexander S. Young

2007-01-01

157

Modeling decision support rule interactions in a clinical setting.  

PubMed

Traditionally, rule interactions are handled at implementation time through rule task properties that control the order in which rules are executed. By doing so, knowledge about the behavior and interactions of decision rules is not captured at modeling time. We argue that this is important knowledge that should be integrated in the modeling phase. In this project, we build upon current work on a conceptual schema to represent clinical knowledge for decision support in the form of if then rules. This schema currently captures provenance of the clinical content, context where such content is actionable (i.e. constraints) and the logic of the rule itself. For this project, we borrowed concepts from both the Semantic Web (i.e., Ontologies) and Complex Adaptive Systems (CAS), to explore a conceptual approach for modeling rule interactions in an enterprise-wide clinical setting. We expect that a more comprehensive modeling will facilitate knowledge authoring, editing and update; foster consistency in rules implementation and maintenance; and develop authoritative knowledge repositories to promote quality, safety and efficacy of healthcare. PMID:23920690

Sordo, Margarita; Rocha, Beatriz H; Morales, Alfredo A; Maviglia, Saverio M; Oglio, Elisa Dell'; Fairbanks, Amanda; Aroy, Teal; Dubois, David; Bouyer-Ferullo, Sharon; Rocha, Roberto A

2013-01-01

158

Evaluation of the Quality of Information Retrieval of Clinical Findings from a Computerized Patient Database Using a Semantic Terminological Model  

PubMed Central

Objectives: To measure the strength of agreement between the concepts and records retrieved from a computerized patient database, in response to physician-derived questions, using a semantic terminological model for clinical findings with those concepts and records excerpted clinically by manual identification. The performance of the semantic terminological model is also compared with the more established retrieval methods of free-text search, ICD-10, and hierarchic retrieval. Design: A clinical database (Diabeta) of 106,000 patient problem record entries containing 2,625 unique concepts in an clinical academic department was used to compare semantic, free-text, ICD-10, and hierarchic data retrieval against a gold standard in response to a battery of 47 clinical questions. Measurements: The performance of concept and record retrieval expressed as mean detection rate, positive predictive value, Yates corrected and Mantel-Haenszel chi-squared values, and Cohen kappa value, with significance estimated using the Mann-Whitney test. Results: The semantic terminological model used to retrieve clinically useful concepts from a patient database performed well and better than other methods, with a mean detection rate of 0.86, a positive predictive value of 0.96, a Yates corrected chi-squared value of 1,537, a Mantel-Haenszel chi-squared value of 19,302, and a Cohen kappa of 0.88. Results for record retrieval were even better, with a mean record detection rate of 0.94, a positive predictive value of 0.99, a Yates corrected chi-squared value of 94,774, a Mantel-Haenszel chi-squared value of 1,550,356, and a Cohen kappa value of 0.94. The mean detection rate, Yates corrected chi-squared value, and Cohen kappa value for semantic retrieval were significantly better than for the other methods. Conclusion: The use of a semantic terminological model in this test scenario provides an effective framework for representing clinical finding concepts and their relationships. Although currently incomplete, the model supports improved information retrieval from a patient database in response to clinically relevant questions, when compared with alternative methods of analysis.

Brown, Philip J. B.; Sonksen, Peter

2000-01-01

159

Information systems that support effective clinical decision making.  

PubMed

This article is the second in a series of four on the role of information and its management across health and social care. It describes the role of data in delivering nursing care and the importance of structured nursing content in electronic records to support modern services. The article gives examples of information systems that enable nurses to access data for clinical decision making, looks at the knowledge needs of future service users, and reflects on the support and training nurses need to operate in integrated health and care services. PMID:23189531

Levy, Sharon; Heyes, Barbara

2012-11-01

160

Current status of mechanical ventilation decision support systems: a review  

Microsoft Academic Search

Objectives of computerized decision support systems for mechanical ventilation are discussed. Questions considered are: Why\\u000a is computerized decision support for mechanical ventilation important? What parameter(s) should be optimized? What are the\\u000a differences between a single attribute and a multiattribute value function used for optimization? How is it possible to achieve\\u000a optimization in clinical practice with existing ventilators? How does one

Robert Rudowski; Thomas D. East; Reed M. Gardner

1996-01-01

161

Adolescent depression: an update and guide to clinical decision making.  

PubMed

Depression in adolescence and adulthood is common, afflicting up to 20 percent of these populations. It represents a significant public health concern and is associated with considerable suffering and functional impairment. Adolescent-onset depression tends to be a particularly malignant and recalcitrant condition, increasing the likelihood of recurrence and chronicity in adulthood. Clinical presentations for various medical and psychiatric conditions, as well as reactions to psychosocial stressors, can mimic or confound the picture of depression in adolescents. Therefore, careful assessment and differential diagnosis is essential. Effective treatments, both pharmacological and psychosocial in nature, exist, and so early detection and intervention is paramount. This article presents an overview of optimal prevention, assessment, and clinical decision-making strategies for managing depression in adolescents. PMID:19855857

Cook, Mary N; Peterson, John; Sheldon, Christopher

2009-09-01

162

The Impact of Computerized Provider Order Entry Systems on Inpatient Clinical Workflow: A Literature Review  

PubMed Central

Previous studies have shown the importance of workflow issues in the implementation of CPOE systems and patient safety practices. To understand the impact of CPOE on clinical workflow, we developed a conceptual framework and conducted a literature search for CPOE evaluations between 1990 and June 2007. Fifty-one publications were identified that disclosed mixed effects of CPOE systems. Among the frequently reported workflow advantages were the legible orders, remote accessibility of the systems, and the shorter order turnaround times. Among the frequently reported disadvantages were the time-consuming and problematic user-system interactions, and the enforcement of a predefined relationship between clinical tasks and between providers. Regarding the diversity of findings in the literature, we conclude that more multi-method research is needed to explore CPOE's multidimensional and collective impact on especially collaborative workflow.

Niazkhani, Zahra; Pirnejad, Habibollah; Berg, Marc; Aarts, Jos

2009-01-01

163

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

164

Computerized Drug Information Services  

ERIC Educational Resources Information Center

To compare computerized services in chemistry, pharmacology, toxicology, and clinical medicine of pharmaceutical interest, equivalent profiles were run on magnetic tape files of CA-Condensates," CBAC," Excerpta Medica," MEDLARS" and Ringdoc." The results are tabulated for overlap of services, relative speed of citing references, and unique…

And Others; Smith, Daniel R.

1972-01-01

165

Computerized Drug Information Services  

ERIC Educational Resources Information Center

|To compare computerized services in chemistry, pharmacology, toxicology, and clinical medicine of pharmaceutical interest, equivalent profiles were run on magnetic tape files of CA-Condensates," CBAC," Excerpta Medica," MEDLARS" and Ringdoc." The results are tabulated for overlap of services, relative speed of citing references, and unique…

And Others; Smith, Daniel R.

1972-01-01

166

Mass spectrometric measurement of end-tidal xenon concentration for clinical stable xenon/computerized tomography cerebral blood flow studies.  

PubMed

We have demonstrated the feasibility of using a compact dedicated mass spectrometer to monitor end-tidal xenon concentration in human subjects during stable xenon computerized tomography measurements of regional cerebral blood flow. End-tidal carbon dioxide concentration is monitored simultaneously and noninvasively without degrading the dynamic response to xenon. For clinical regional cerebral blood flow studies we employed a Nuclide 3-60-G Sectorr mass spectrometer with a 3 in radius, 60 degrees magnetic sector and a variable (0-5000 V) ion accelerating potential. The required high vacuum (10(-7) Torr) was achieved and maintained by means of a turbomolecular pump. A needlemetering valve was incorporated into an anesthesia mask connector, and exhaled gases were transported to the mass spectrometer via a 6 ft length of Teflon tubing (1/16 in i.d.). Molecular flow conditions between the sample and analysis chambers were provided by use of a gold foil leak (0.0005 in. hole). At an inlet pressure of 400 m Torr (achieved by means of the needle valve), the inlet system was characterized by a gas transport lag-time of 1.3 s and a rise-time constant of 85 ms. Xenon (doubly charged ion: m/z 68) and carbon dioxide (doubly charged ion: m/z 22) were monitored alternately at 75 ms intervals. Our experience with mass spectrometry has demonstrated the feasibility of using a compact dedicated instrument for accurately and non-invasively monitoring end-tidal xenon concentration in a clinical setting. PMID:6809066

Dhawan, V; Goldiner, P; Ray, C; Conti, J; Rottenberg, D A

1982-06-01

167

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

168

Computerized physician order entry in critical care.  

PubMed

Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent in the first place by prevention of medication errors and adverse drug events. On the contrary, if CPOE configuration is not done carefully, adverse drug events can be facilitated. Therefore, and for reasons of end-user acceptance, implementation is challenging. CPOE has the potential for significant economic saving. However, the initial implementation cost is high. PMID:19449614

Colpaert, Kirsten; Decruyenaere, Johan

2009-03-01

169

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

170

Mental workload as a key factor in clinical decision making.  

PubMed

The decision making process is central to the practice of a clinician and has traditionally been described in terms of the hypothetico-deductive model. More recently, models adapted from cognitive psychology, such as the dual process and script theories have proved useful in explaining patterns of practice not consistent with purely cognitive based practice. The purpose of this paper is to introduce the concept of mental workload as a key determinant of the type of cognitive processing used by clinicians. Published research appears to be consistent with 'schemata' based cognition as the principle mode of working for those engaged in complex tasks under time pressure. Although conscious processing of factual data is also used, it may be the primary mode of cognition only in situations where time pressure is not a factor. Further research on the decision making process should be based on outcomes which are not dependant on conscious recall of past actions or events and include a measure of mental workload. This further appears to support the concept of the patient, within the clinical environment, as the most effective learning resource. PMID:22411354

Byrne, Aidan

2012-03-13

171

SANDS: An Architecture for Clinical Decision Support in a National Health Information Network  

PubMed Central

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Wright, Adam; Sittig, Dean F.

2007-01-01

172

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

173

A rule-based clinical decision model to support interpretation of multiple data in health examinations.  

PubMed

Health examinations can obtain relatively complete health information and thus are important for the personal and public health management. For clinicians, one of the most important works in the health examinations is to interpret the health examination results. Continuously interpreting numerous health examination results of healthcare receivers is tedious and error-prone. This paper proposes a clinical decision support system to assist solving above problems. In order to customize the clinical decision support system intuitively and flexibly, this paper also proposes the rule syntax to implement computer-interpretable logic for health examinations. It is our purpose in this paper to describe the methodology of the proposed clinical decision support system. The evaluation was performed by the implementation and execution of decision rules on health examination results and a survey on clinical decision support system users. It reveals the efficiency and user satisfaction of proposed clinical decision support system. Positive impact of clinical data interpretation is also noted. PMID:20703517

Kuo, Kuan-Liang; Fuh, Chiou-Shann

2009-12-15

174

Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup.  

PubMed

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 knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

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

2005-03-31

175

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice  

PubMed Central

Summary This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Hajjaj, FM; Salek, MS; Basra, MKA; Finlay, AY

2010-01-01

176

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

177

Creating and sharing clinical decision support content with Web 2.0: Issues and examples  

Microsoft Academic Search

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts

Adam Wright; David W. Bates; Blackford Middleton; Tonya Hongsermeier; Vipul Kashyap; Sean M. Thomas; Dean F. Sittig

2009-01-01

178

Real-Time Pharmacy Surveillance and Clinical Decision Support to Reduce Adverse Drug Events in Acute Kidney Injury  

PubMed Central

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. 30.3hrs, p=0.3). Conclusions Pharmacy surveillance had no incremental benefit over previously implemented CDS alerts

McCoy, A.B.; Cox, Z.L.; Neal, E.B.; Waitman, L.R.; Peterson, N.B.; Bhave, G.; Siew, E.D.; Danciu, I.; Lewis, J.B.; Peterson, J.F.

2012-01-01

179

Case studies using graphically enhanced computer software to improve technology assessments and enhance clinical decisions  

Microsoft Academic Search

This paper describes how clinical engineers and healthcare CIOs, CTOs, and IT\\/IS specialists can use the Analytic Hierarchy Process (AHP) to improve the quality of diverse and important decisions that hospitals face today. AHP is a versatile and proven decision support tool that allows the user to design a hierarchical structure for decision-making and weighs the trade-offs between decision criteria

Elliot B. Sloane; Matthew Liberatore; Robert Nydick

2003-01-01

180

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

Microsoft Academic Search

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

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

2003-01-01

181

The TRIACS analytical workflows platform for distributed clinical decision support  

Microsoft Academic Search

In this paper we discuss a flexible distributed workflow-based approach that enables researchers to study biomedical data for creating decision support pipelines. Specifically we describe the TRIACS platform, which has first been applied to supporting evidence-based decisions for optimum diabetic retinopathy screening intervals In the prioritization mechanism, pseudonymised case data is stratified for screening need by computation of outcome risk

Adina Riposan; Ian J. Taylor; Omer F. Rana; David R. Owens; Edward C. Conley

2009-01-01

182

System-Agnostic Clinical Decision Support Services: Benefits and Challenges for Scalable Decision Support  

PubMed Central

System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating the widespread implementation of CDS systems, little has been described regarding the benefits and challenges of their use. In this manuscript, the authors address this need by describing potential benefits and challenges of using a system-agnostic CDS service. This analysis is based on the authors’ formal assessments of, and practical experiences with, various approaches to developing, implementing, and maintaining CDS capabilities. In particular, the analysis draws on the authors’ experience developing and leveraging a system-agnostic CDS Web service known as SEBASTIAN. A primary potential benefit of using a system-agnostic CDS service is the relative ease and flexibility with which the service can be leveraged to implement CDS capabilities across applications and care settings. Other important potential benefits include facilitation of centralized knowledge management and knowledge sharing; the potential to support multiple underlying knowledge representations and knowledge resources through a common service interface; improved simplicity and componentization; easier testing and validation; and the enabling of distributed CDS system development. Conversely, important potential challenges include the increased effort required to develop knowledge resources capable of being used in many contexts and the critical need to standardize the service interface. Despite these challenges, our experiences to date indicate that the benefits of using a system-agnostic CDS service generally outweigh the challenges of using this approach to implementing and maintaining CDS systems.

Kawamoto, Kensaku; Del Fiol, Guilherme; Orton, Charles; Lobach, David F

2010-01-01

183

Representation of Clinical Practice Guidelines in Conventional and Augmented Decision Tables  

PubMed Central

Abstract Objective: To develop a knowledge representation model for clinical practice guidelines that is linguistically adequate, comprehensible, reusable, and maintainable. Design: Decision tables provide the basic framework for the proposed knowledge representation model. Guideline logic is represented as rules in conventional decision tables. These tables are augmented by layers where collateral information is recorded in slots beneath the logic. Results: Decision tables organize rules into cohesive rule sets wherein complex logic is clarified. Decision table rule sets may be verified to assure completeness and consistency. Optimization and display of rule sets as sequential decision trees may enhance the comprehensibility of the logic. The modularity of the rule formats may facilitate maintenance. The augmentation layers provide links to descriptive language, information sources, decision variable characteristics, costs and expected values of policies, and evidence sources and quality. Conclusion: Augmented decision tables can serve as a unifying knowledge representation for developers and implementers of clinical practice guidelines.

Shiffman, Richard N.

1997-01-01

184

The cognitive processes underpinning clinical decision in triage assessment: A theoretical conundrum?  

PubMed

High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. PMID:23685041

Noon, Amy J

2013-05-16

185

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

186

Computerized analysis of mammographic parenchymal patterns on a large clinical dataset of full-field digital mammograms: robustness study with two high-risk datasets.  

PubMed

The purpose of this study was to demonstrate the robustness of our prior computerized texture analysis method for breast cancer risk assessment, which was developed initially on a limited dataset of screen-film mammograms. This current study investigated the robustness by (1) evaluating on a large clinical dataset, (2) using full-field digital mammograms (FFDM) as opposed to screen-film mammography, and (3) incorporating analyses over two types of high-risk patient sets, as well as patients at low risk for breast cancer. The evaluation included the analyses on the parenchymal patterns of women at high risk of developing of breast cancer, including both BRCA1/2 gene mutation carriers and unilateral cancer patients, and of women at low risk of developing breast cancer. A total of 456 cases, including 53 women with BRCA1/2 gene mutations, 75 women with unilateral cancer, and 328 low-risk women, were retrospectively collected under an institutional review board approved protocol. Regions-of-interest (ROIs), were manually selected from the central breast region immediately behind the nipple. These ROIs were subsequently used in computerized feature extraction to characterize the mammographic parenchymal patterns in the images. Receiver operating characteristic analysis was used to assess the performance of the computerized texture features in the task of distinguishing between high-risk and low-risk subjects. In a round robin evaluation on the FFDM dataset with Bayesian artificial neural network analysis, AUC values of 0.82 (95% confidence interval [0.75, 0.88]) and 0.73 (95% confidence interval [0.67, 0.78]) were obtained between BRCA1/2 gene mutation carriers and low-risk women, and between unilateral cancer and low-risk women, respectively. These results from computerized texture analysis on digital mammograms demonstrated that high-risk and low-risk women have different mammographic parenchymal patterns. On this large clinical dataset, we validated our methods for quantitative analyses of mammographic patterns on FFDM, statistically demonstrating again that women at high risk tend to have dense breasts with coarse and low-contrast texture patterns. PMID:22246204

Li, Hui; Giger, Maryellen L; Lan, Li; Bancroft Brown, Jeremy; MacMahon, Aoife; Mussman, Mary; Olopade, Olufunmilayo I; Sennett, Charlene

2012-10-01

187

A computational model of approximate Bayesian inference for associating clinical algorithms with decision analyses.  

PubMed Central

The lack of rationale or explanation is a major deficiency of clinical algorithms. To address this issue, the authors present a computational model for associating decision analyses with clinical algorithms. Automata theory is used to model categorical reasoning with approximate Bayesian inference based on probability intervals. This approximation reduces the number of computations to linear-order instead of the exponential-order combinations of clinical findings in exact Bayes. The linkage of decision analyses and clinical algorithms by means of this model exploits a new concept of "regular" clinical algorithms and their equivalency in theory and provides valuable perspectives in practice for developers of clinical algorithms.

Kamae, I. R.; Greenes, R. A.

1991-01-01

188

Implementation of workflow engine technology to deliver basic clinical decision support functionality  

PubMed Central

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

2011-01-01

189

The Effect of Computerized Physician Order Entry on Medication Prescription Errors and Clinical Outcome in Pediatric and Intensive Care: A Systematic Review  

Microsoft Academic Search

CONTEXT.Pediatric and intensive care patients are particularly at risk for medication errors. Computerized physician order entry systems could be effective in reducing medication errors and improving outcome. Effectiveness of computerized physician order entry systems has been shown in adult medical care. However, in critically ill patients and\\/or children, medication prescribing is a more complex process, and usefulness of computerized physician

Floor van Rosse; Barbara Maat; Carin M. A. Rademaker; Adrianus J. van Vught; Antoine C. G. Egberts; Casper W. Bollen

2009-01-01

190

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

2011-09-20

191

Intelligent clinical decision support systems based on SNOMED CT.  

PubMed

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 contain timely updated diagnostic information, which is of significant value in fast changing situations such as minimally understood emerging diseases and epidemics. Through a high level comparison of many AI methods it is found that a TAN-Bayesian method could be the most suitable to apply to SNOMED CT data. PMID:21095839

Ciolko, Ewelina; Lu, Fletcher; Joshi, Amardeep

2010-01-01

192

Representation of Clinical Practice Guidelines in Conventional and Augmented Decision Tables  

Microsoft Academic Search

ObjectiveTo develop a knowledge representation model for clinical practice guidelines that is linguistically adequate, comprehensible, reusable, and maintainable.DesignDecision tables provide the basic framework for the proposed knowledge representation model. Guideline logic is represented as rules in conventional decision tables. These tables are augmented by layers where collateral information is recorded in slots beneath the logic.ResultsDecision tables organize rules into cohesive

RICHARD N. SHIFFMAN

1997-01-01

193

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

194

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

195

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…

Jeffrey, Aaron

2012-01-01

196

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

197

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

198

Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making  

Microsoft Academic Search

Nederhand MJ, IJzerman MJ, Hermens HJ, Turk DC, Zilvold G. Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making. Arch Phys Med Rehabil 2004;85:496–501.

Marc J. Nederhand; Maarten J. IJzerman; Hermie J. Hermens; Dennis C. Turk; Gerrit Zilvold

2004-01-01

199

P-CAPE: a high-level tool for entering and processing clinical practice guidelines. Partners Computerized Algorithm and Editor.  

PubMed

The Partners Computerized Algorithm Processor and Editor (P-CAPE) is a high-level tool intended to remove the programming bottleneck for implementing practice guidelines in our computer-based record system, and to integrate guideline-based advice into the clinician's workflow. P-CAPE has three major components: 1) An Editor that allows an analyst to enter the parameters of a guideline in the form of an algorithm; 2) A Navigator that processes the steps of the guideline and logs all transactions in a patient-specific file; and 3) A clinician Notifier that sends messages to a patient's covering clinician, seeking data or presenting recommendations and order sets that can be processed by the system. P-CAPE's guideline object model was adapted from the InterMed Collaboratory GuideLine Interface Format (GLIF). PMID:9929265

Zielstorff, R D; Teich, J M; Paterno, M D; Segal, M; Kuperman, G J; Hiltz, F L; Fox, R L

1998-01-01

200

Student nurses' perceptions of clinical decision-making in the final year of adult nursing studies  

Microsoft Academic Search

This paper focuses upon an exploration of undergraduate students' perceptions of clinical decision-making skills in their final year of a baccalaureate adult nursing programme. A phenomenological study was carried out, with a sample of 21 students undertaking their nursing management module. They produced a consensus concept mapping of clinical decision-making and completed self-assessment questionnaires exploring their personal confidence and understanding

B. Garrett

2005-01-01

201

A clinical decision support system prototype for cardiovascular intensive care  

Microsoft Academic Search

This paper describes the development and validation of a decision-support system prototype that can help manage hypovolemic\\u000a hypotension in the Cardiovascular Intensive Care Unit (CVICU). The prototype uses physiologic pattern-matching, therapeutic\\u000a protocols, computational drug-dosage response modeling and expert reasoning heuristics in its selection of intervention strategies\\u000a and choices. As part of model testing, the prototype simulated real-time operation by processing

Francis Lau

1994-01-01

202

[An expert system of aiding decision making in breast pathology connected to a clinical data base].  

PubMed

The René Huguenin Cancer Center holds a medical file for each patient which is intended to store and process medical data. Since 1970, we introduced computerization: a development plan was elaborated and simultaneously a statistical software (Clotilde--GSI/CFRO) was selected. Thus, we now have access to a large database, structured according to medical rationale, and utilizable with methods of artificial intelligence towards three objectives: improved data acquisition, decision making and exploitation. The first application was to breast pathology, which represents one of the Center's primary activities. The structure of the data concerning patients is by all criteria part of the medical knowledge. This information needs to be presented as well as processed with a suitable language. To this end, we chose a language-oriented object, Mering II, usable with Apple and IBM 4 micro-computers. This project has already allowed to work out an operational model. PMID:3620732

Brunet, M; Durrleman, S; Ferber, J; Ganascia, J G; Hacene, K; Hirt, F; Jouniaux, F; Meeus, L

1987-01-01

203

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review  

Microsoft Academic Search

Background  Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions\\u000a on increasing the use of systematic reviews in clinical decision-making.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose  To systematically review the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic\\u000a reviews in decision-making by clinicians.\\u000a \\u000a \\u000a \\u000a \\u000a Data Sources  Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled

Laure Perrier; Kelly Mrklas; Sasha Shepperd; Maureen Dobbins; K. Ann McKibbon; Sharon E. Straus

2011-01-01

204

Hypertextual navigation operationalizing generic clinical practice guidelines for patient-specific therapeutic decisions.  

PubMed Central

Despite the proliferation of implemented clinical practice guidelines, there is still little evidence of physicians compliance to formal standards. The ONCODOC project proposes a framework for elaborating generic decision support guidelines in a document-based paradigm with a knowledge-based approach. It has been first applied to assist clinicians in the treatment of breast cancer patients. Therapeutic expertise has been encoded as a decision tree. The decision process is driven by the clinician who interactively browses a hypertext version of the decision tree. During the navigation, he incrementally assigns values to decision parameters on the basis of his free interpretation of his patient's condition and thus builds a clinical context leading to patient-specific therapeutic recommendations. These guidelines are distributed on a hospital intranet and are evaluated at the point of care in an oncology department. Images Figure 2 Figure 3 Figure 4

Bouaud, J.; SA(C)roussi, B.; Antoine, E. C.; Gozy, M.; Khayat, D.; Boisvieux, J. F.

1998-01-01

205

Orbital Fracture Clinical Decision Rule Development: Burden of Disease and Use of a Mandatory Electronic Survey Instrument  

PubMed Central

Objectives In preparation for development of a clinical decision rule (CDR) to promote more efficient use of computed tomography (CT) for diagnosing orbital fractures, the authors sought to estimate the annual incidence of orbital fractures in emergency departments (EDs), and the usage of CT to make these diagnoses. The authors also sought to evaluate a mandatory electronic data collection instrument (EDCI) administered to providers to facilitate CDR data collection. Methods National estimates were made by analyzing the 2007 National Hospital Ambulatory Medical Care Survey database, while hospital billing system and coding data were used to make local estimates. An EDCI was integrated into the CT ordering system such that providers had to complete the form in order to perform a CT. Because the EDCI had to be filled out for every CT ordered, data collection efficiency was measured by compliance (counting the number of unrealistic data collection instrument answers) and by timing a convenience sample of providers completing the EDCI. Results Out of 116.8 million ED visits in the United States in 2007, 4.1 million patients were treated for injuries of the eye and face. Of those, 820,252 patients underwent CT imaging, with 102,999 patients (12.5%) diagnosed with an orbital fracture. In our local hospital system with 122,500 annual ED visits, 752 CTs of orbits were performed, with 172 (23%) orbital fractures. The EDCI compliance rate was 94.9%, and took less than five minutes to complete. Conclusions National and local data demonstrate a low yield for CT imaging in identifying orbital fractures. Data collection using a mandatory electronic data collection instrument linked to computerized provider order entry can provide prospective, consecutive patient data that are needed to develop a CDR for the selective use of CT imaging in orbital trauma. Such a decision rule could increase the efficiency in diagnosing orbital fractures, thereby improving patient care, reducing radiation exposure, and decreasing costs.

Yadav, Kabir; Cowan, Ethan; Wall, Stephen; Gennis, Paul

2012-01-01

206

Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis.  

PubMed

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches. PMID:11095240

Buckingham, C D; Adams, A

2000-10-01

207

Pilot Study of a Point-of-use Decision Support Tool for Cancer Clinical Trials Eligibility  

PubMed Central

Many adults with cancer are not enrolled in clinical trials because caregivers do not have the time to match the patient's clinical findings with varying eligibility criteria associated with multiple trials for which the patient might be eligible. The authors developed a point-of-use portable decision support tool (DS-TRIEL) to automate this matching process. The support tool consists of a hand-held computer with a programmable relational database. A two-level hierarchic decision framework was used for the identification of eligible subjects for two open breast cancer clinical trials. The hand-held computer also provides protocol consent forms and schemas to further help the busy oncologist. This decision support tool and the decision framework on which it is based could be used for multiple trials and different cancer sites.

Breitfeld, Philip P.; Weisburd, Marina; Overhage, J. Marc; Sledge, George; Tierney, William M.

1999-01-01

208

Pilot study of a point-of-use decision support tool for cancer clinical trials eligibility.  

PubMed

Many adults with cancer are not enrolled in clinical trials because caregivers do not have the time to match the patient's clinical findings with varying eligibility criteria associated with multiple trials for which the patient might be eligible. The authors developed a point-of-use portable decision support tool (DS-TRIEL) to automate this matching process. The support tool consists of a hand-held computer with a programmable relational database. A two-level hierarchic decision framework was used for the identification of eligible subjects for two open breast cancer clinical trials. The hand-held computer also provides protocol consent forms and schemas to further help the busy oncologist. This decision support tool and the decision framework on which it is based could be used for multiple trials and different cancer sites. PMID:10579605

Breitfeld, P P; Weisburd, M; Overhage, J M; Sledge, G; Tierney, W M

209

Visual Cluster Analysis in Support of Clinical Decision Intelligence  

PubMed Central

Electronic health records (EHRs) contain a wealth of information about patients. In addition to providing efficient and accurate records for individual patients, large databases of EHRs contain valuable information about overall patient populations. While statistical insights describing an overall population are beneficial, they are often not specific enough to use as the basis for individualized patient-centric decisions. To address this challenge, we describe an approach based on patient similarity which analyzes an EHR database to extract a cohort of patient records most similar to a specific target patient. Clusters of similar patients are then visualized to allow interactive visual refinement by human experts. Statistics are then extracted from the refined patient clusters and displayed to users. The statistical insights taken from these refined clusters provide personalized guidance for complex decisions. This paper focuses on the cluster refinement stage where an expert user must interactively (a) judge the quality and contents of automatically generated similar patient clusters, and (b) refine the clusters based on his/her expertise. We describe the DICON visualization tool which allows users to interactively view and refine multidimensional similar patient clusters. We also present results from a preliminary evaluation where two medical doctors provided feedback on our approach.

Gotz, David; Sun, Jimeng; Cao, Nan; Ebadollahi, Shahram

2011-01-01

210

Effect of Malpractice Experience on Physicians' Clinical Decision-Making.  

National Technical Information Service (NTIS)

In a cross sectional study of internists, cardiologists, general surgeons and obstetricians, the authors tested by using clinical scenarios, whether personal malpractice experience was associated with resource use, defined by management and test ordering ...

P. A. Glassman L. P. Petersen M. A. Bradley J. E. Rolph

1994-01-01

211

Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score  

Microsoft Academic Search

ObjectiveFew previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful.DesignSets of differential

Padmanabhan Ramnarayan; Ritika R Kapoor; Michael Coren; Vasantha Nanduri; Amanda L Tomlinson; Paul M Taylor; Jeremy C Wyatt; Joseph F Britto

2003-01-01

212

Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations  

Microsoft Academic Search

Objectives: Only half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation. Measurements: The tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N 20) and intervention (after pilot;

GREG ABERNATHY; SIU L. HUI; CAROL KEMPF; MICHAEL WEINER

213

"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

214

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

215

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

216

Investigating Drug Classes in Biomedical Terminologies From the Perspective of Clinical Decision Support  

Microsoft Academic Search

Objectives: To assess whether 1) the necessary drug classes and 2) the necessary drug-class membership relations are represented in biomedical terminologies in order to support clinical decision regarding drug- drug interactions. Methods: In order to investigate drug classes and drug-class membership in clinical terminologies, we start by establishing a reference list of these entities. Then, we map drugs and classes

Olivier Bodenreider; Dina Demner Fushman

2010-01-01

217

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials  

Microsoft Academic Search

BACKGROUND  Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision\\u000a making at the point of care are promising strategies for closing these practice gaps.\\u000a \\u000a \\u000a \\u000a OBJECTIVE  To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision\\u000a making in osteoporosis disease management.\\u000a \\u000a \\u000a \\u000a DATA SOURCES  Medline, EMBASE, CINAHL, and EBM Reviews

Monika Kastner; Sharon E. Straus

2008-01-01

218

Intensity-modulated radiation therapy (IMRT) for locally advanced paranasal sinus tumors: incorporating clinical decisions in the optimization process  

Microsoft Academic Search

Purpose: Intensity-modulated radiotherapy (IMRT) plans require decisions about priorities and tradeoffs among competing goals. This study evaluates the incorporation of various clinical decisions into the optimization system, using locally advanced paranasal sinus tumors as a model.Methods and Materials: Thirteen patients with locally advanced paranasal sinus tumors were retrospectively replanned using inverse planning. Two clinical decisions were assumed: (1) Spare both

Christina Tsien; Avraham Eisbruch; Daniel McShan; Marc Kessler; Robin Marsh; Benedick Fraass

2003-01-01

219

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

220

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

221

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

222

Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial.  

PubMed

IMPORTANCE There is consensus that incorporating clinical decision support into electronic health records will improve quality of care, contain costs, and reduce overtreatment, but this potential has yet to be demonstrated in clinical trials. OBJECTIVE To assess the influence of a customized evidence-based clinical decision support tool on the management of respiratory tract infections and on the effectiveness of integrating evidence at the point of care. DESIGN, SETTING, AND PARTICIPANTS In a randomized clinical trial, we implemented 2 well-validated integrated clinical prediction rules, namely, the Walsh rule for streptococcal pharyngitis and the Heckerling rule for pneumonia. INTERVENTIONS AND MAIN OUTCOMES AND MEASURES The intervention group had access to the integrated clinical prediction rule tool and chose whether to complete risk score calculators, order medications, and generate progress notes to assist with complex decision making at the point of care. RESULTS The intervention group completed the integrated clinical prediction rule tool in 57.5% of visits. Providers in the intervention group were significantly less likely to order antibiotics than the control group (age-adjusted relative risk, 0.74; 95% CI, 0.60-0.92). The absolute risk of the intervention was 9.2%, and the number needed to treat was 10.8. The intervention group was significantly less likely to order rapid streptococcal tests compared with the control group (relative risk, 0.75; 95% CI, 0.58-0.97; P?=?.03). CONCLUSIONS AND RELEVANCE The integrated clinical prediction rule process for integrating complex evidence-based clinical decision report tools is of relevant importance for national initiatives, such as Meaningful Use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01386047. PMID:23896675

McGinn, Thomas G; McCullagh, Lauren; Kannry, Joseph; Knaus, Megan; Sofianou, Anastasia; Wisnivesky, Juan P; Mann, Devin M

2013-09-23

223

A Decision Analysis for Treatment of Clinically Localized Prostate Cancer  

Microsoft Academic Search

OBJECTIVE: To determine the preferred treatment of clinically localized prostate cancer. DESIGN: Cancer grade, patient age,\\u000a and comorbidities are considered in a Markov model with Monte Carlo sensitivity analyses. Large and recent pooled analyses\\u000a and patient-derived utilities are included. RESULTS: Principal findings suggest benefit for radical prostatectomy relative\\u000a to watchful waiting for men under 70 years of age with low

Michael W. Kattan; Mark E. Cowen; Brian J. Miles

1997-01-01

224

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

225

Implementation of workflow engine technology to deliver basic clinical decision support functionality  

Microsoft Academic Search

Background  Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge.\\u000a We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision\\u000a support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly\\u000a based on healthcare-specific representation standards and execution engines

Vojtech Huser; Luke V Rasmussen; Ryan Oberg; Justin B Starren

2011-01-01

226

Autonomy, religion and clinical decisions: findings from a national physician survey  

Microsoft Academic Search

Background:Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined.Methods:Mailed survey in 2007

R E Lawrence; F A Curlin

2009-01-01

227

Clinical validated computer-aided decision system to the clubfeet deformities  

Microsoft Academic Search

A Computer-Aided Decision System (CADS) was developed in order to assess the abnormalities of the clubfeet deformities. Our system consists of four components: (1) a diagnosis-based ontology of the musculoskeletal system of the lower limbs (2) a database for collecting clinical observations of the clubfeet deformities, e.g. the birth classification (3) the decision tree method and a diagnosis algorithm in

Tien Tuan Dao; F. Marin; M. C. H. B. Tho

2009-01-01

228

Can shared decision making increase the uptake of evidence in clinical practice?  

Microsoft Academic Search

Despite copious research and clear policies in many healthcare systems, evidence based practice has yet to be widely adopted. Part of the problem is insufficient consideration of the patient–clinician consultation, which lies at the heart of clinical practice and is where most decisions are made. Shared decision making (SDM)—the interactive process in which patients and clinicians decide on healthcare together—capitalises

Michèle Shemilt; Dawn Stacey

2011-01-01

229

GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support  

PubMed Central

GELLO is a purpose-specific, object-oriented (OO) query and expression language [1]. GELLO is the result of a concerted effort of the Decision Systems Group (DSG) working with the HL7 Clinical Decision Support Technical Committee (CDSTC) to provide the HL7 community with a common format for data encoding and manipulation. GELLO will soon be submitted for ballot to the HL7 CDSTC for consideration as a standard.

Sordo, Margarita; Ogunyemi, Omolola; Boxwala, Aziz A.; Greenes, Robert A.

2003-01-01

230

Dysphagia Evaluation Practices: Inconsistencies in Clinical Assessment and Instrumental Examination Decision-Making  

Microsoft Academic Search

The purpose of this study was to determine the nature of swallowing evaluation practices in western Washington, specifically in terms of (a) components of the clinical examination most commonly used, (b) consistency of clinical examination practices across clinicians, and (c) consistency of clinical decision-making (instrumental vs. noninstrumental) given specific patient scenarios. A 21-question survey was sent to 150 speech-language pathologists

Mary Kurlinski

2003-01-01

231

Is there a link between the hospital-acquired injurious fall rates in US acute care hospitals and these institutions' implementation levels of computerized systems?  

PubMed

Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study's findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes. PMID:21825973

Tzeng, Huey-Ming; Hu, Hsou Mei; Yin, Chang-Yi

2011-12-01

232

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

2010-03-18

233

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

234

Streptococcal pharyngitis in children: a meta-analysis of clinical decision rules and their clinical variables  

PubMed Central

Objective To identify the best clinical decision rules (CDRs) for diagnosing group A streptococcal (GAS) pharyngitis in children. A combination of symptoms could help clinicians exclude GAS infection in children with pharyngitis. Design Systematic review and meta-analysis of original articles involving CDRs in children. The Pubmed, OVID, Institute for Scientific and Technical Information and Cochrane databases from 1975 to 2010 were screened for articles that derived or validated a CDR on a paediatric population: 171 references were identified. Setting Any reference including primary care for children with pharyngitis. Data extraction The methodological quality of the articles selected was analysed according to published quality standards. A meta-analysis was performed to assess the statistical performance of the CDRs and their variables for the diagnosis of GAS pharyngitis. Primary outcome measure The main criterion was a false-negative rate in the whole population not any worse than that of a rapid diagnostic test strategy for all patients (high sensitivity and low negative likelihood ratio). Results 4 derived and 12 validated CDRs for this diagnosis in children. These articles involved 10?523 children (mean age, 7?years; mean prevalence of GAS pharyngitis, 34%). No single variable was sufficient for diagnosis. Among the CDRs, that of Joachim et al had a negative likelihood ratio of 0.3 (95% CI 0.2 to 0.5), resulting in a post-test probability of 13%, which leads to 3.6% false-negative rate among low-risk patients and 10.8% overall, equivalent to rapid diagnostic tests in some studies. Conclusions The rule of Joachim et al could be useful for clinicians who do not use rapid diagnostic tests and should allow avoiding antibiotic treatment for the 35% of children identified by the rule as not having GAS pharyngitis. Owing to its poor specificity, such CDR should be used to focus rapid diagnostic tests to children with high risk of GAS pharyngitis to reduce the antibiotic consumption.

Le Marechal, Flore; Martinot, Alain; Duhamel, Alain; Pruvost, Isabelle; Dubos, Francois

2013-01-01

235

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

236

[Investigation of nurses' pain related knowledge, attitude and clinical decision making skills].  

PubMed

The purpose of this study was to investigate the nurses' ain related knowledge, attitude and clinical decision making skills. Three instruments were used in the study: (1) Nurses' Introduction Form, (2) The Nurses' Knowledge and Attitudes Questionnaire and (3) Clinical Decision Making Survey Questionnaire developed by McCaffery and Ferrell was translated into Turkish and used with permission. The results showed that many nurses have inadequate knowledge about pain assessment and management, nurses' (% 47.4) did not observe patient's behaviors to determine/assess the patient's intensity of pain and % 74.5 of nurses' did not use pain assessment scales to measure the patient's pain. PMID:17457712

Ozer, Serap; Akyürek, Banu; Ba?bakkal, Zümrüt

2006-10-01

237

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

238

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

239

A clinical decision support needs assessment of community-based physicians  

PubMed Central

Objective To conduct a grounded needs assessment to elicit community-based physicians' current views on clinical decision support (CDS) and its desired capabilities that may assist future CDS design and development for community-based practices. Materials and methods To gain insight into community-based physicians' goals, environments, tasks, and desired support tools, we used a human–computer interaction model that was based in grounded theory. We conducted 30 recorded interviews with, and 25 observations of, primary care providers within 15 urban and rural community-based clinics across Oregon. Participants were members of three healthcare organizations with different commercial electronic health record systems. We used a grounded theory approach to analyze data and develop a user-centered definition of CDS and themes related to desired CDS functionalities. Results Physicians viewed CDS as a set of software tools that provide alerts, prompts, and reference tools, but not tools to support patient management, clinical operations, or workflow, which they would like. They want CDS to enhance physician–patient relationships, redirect work among staff, and provide time-saving tools. Participants were generally dissatisfied with current CDS capabilities and overall electronic health record usability. Discussion Physicians identified different aspects of decision-making in need of support: clinical decision-making such as medication administration and treatment, and cognitive decision-making that enhances relationships and interactions with patients and staff. Conclusion Physicians expressed a need for decision support that extended beyond their own current definitions. To meet this requirement, decision support tools must integrate functions that align time and resources in ways that assist providers in a broad range of decisions.

Ash, Joan S

2011-01-01

240

Pediatric use of complementary and alternative medicine: legal, ethical, and clinical issues in decision-making.  

PubMed

In this article we introduce a series of 8 case scenarios and commentaries and explore the complex legal, ethical, and clinical concerns that arise when pediatric patients and their parents or health care providers use or are interested in using complementary and alternative medicine (CAM). People around the world rely on CAM, so similar issues face clinicians in many countries. In law, few cases have dealt with CAM use. The few that have apply the same general legal principles used in cases that involved conventional care while taking into account considerations unique to CAM. In ethics, as with conventional care, the issues surrounding pediatric CAM use usually involve questions about who the appropriate decision-makers are, on what ethical principles should clinical decision-making rely, and what obligations arise on the part of physicians and other health care providers. Clinical decision-making is made more complex by the relatively limited research on the efficacy and safety of CAM compared with conventional medicine, especially in children, which requires clinicians to make decisions under conditions of uncertainty. The clinical scenarios presented focus on patients who represent a range of ages, clinical conditions, and settings. They act as anchors to explore particular CAM policy issues and illustrate the application of and shortcomings in existing guidance and intervention principles. Although the focus on a pediatric population adds another layer of complexity to the analysis, many of the concepts, issues, principles, and recommendations also apply to adults. PMID:22045856

Gilmour, Joan; Harrison, Christine; Cohen, Michael H; Vohra, Sunita

2011-11-01

241

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

Microsoft Academic Search

BackgroundClinical 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.MethodsWe built a logistic regression model to predict alert acceptance of drug–drug interaction (DDI)

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

2011-01-01

242

A group decision making process for facility layout in hospital clinical laboratories.  

PubMed

While quantitative and computer-based models can be used for developing alternative clinical laboratory layout plans, consideration should be given to qualitative and personal factors during the layout finalization phase. Described here is a group decision making process used for planning facility layout. The process is applied to a case study Chemistry/Hematology department. PMID:10276153

Levary, R R; Schmitt, A

1986-02-01

243

A Mixed Methodological Analysis of the Role of Culture in the Clinical Decision-Making Process  

ERIC Educational Resources Information Center

Even though literature indicates that particular cultural groups receive more severe diagnoses at disproportionate rates, there has been minimal research that addresses how culture interfaces specifically with clinical decision making. This mixed methodological study of 41 counselors indicated that cultural characteristics of both counselors and…

Hays, Danica G.; Prosek, Elizabeth A.; McLeod, Amy L.

2010-01-01

244

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

245

CAN INTERNET BASED SCENARIOS ENHANCE CRITICAL CARE NURSES CLINICAL DECISION MAKING SKILLS?  

Microsoft Academic Search

Nurses need to be trained to make rapid and accurate clinical decisions in a rapidly changing and complex environment. Unfortunately, a reliance on traditional training methods (lectures, small group sessions, experiential learning) will probably prove inadequate in a context characterised by increasing pressures of time and limited resources. The injection of market forces into the National Health Service in the

Carole Boulanger; Jon Yorke

246

Knowledge-based systems and neural networks for clinical decision making  

Microsoft Academic Search

This paper presents two knowledge-based systems (KBS) and an artificial neural network (ANN) system for clinical decision-making in electrocardiogram (ECG) signal interpretation. Among these systems, a KBS contains “shallow” knowledge in declarative forms and employs fuzzy set theory to deal with vagueness in the encoded knowledge and imprecise ECG measurements. The other KBS uses “deep” knowledge encoded in a qualitative

N. B Jones; J. T Wang; A. S Sehmi; D. P de Bono

1995-01-01

247

Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'  

PubMed Central

Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

2012-01-01

248

Compartmental models for glycaemic prediction and decision-support in clinical diabetes care: promise and reality  

Microsoft Academic Search

This paper reviews and critically appraises the application of compartmental models for generating glycaemic predictions and offering clinical decision support in diabetes care. Comparisons are made with alternative algorithmic-based approaches. Unresolved issues raised for model-based techniques include the relative lack of input data necessary for generating reasonable blood glucose predictions, and the high level of uncertainty associated with such predictions

E. D. Lehmann; T. Deutsch

1998-01-01

249

The Contribution of Polysyllabic Words in Clinical Decision Making about Children's Speech  

ERIC Educational Resources Information Center

Poor polysyllabic word (PSW) production seems to mark paediatric speech impairment as well as impairment in language, literacy and phonological processing. As impairment in these domains may only manifest in PSWs, PSW production may provide unique information that is often excluded from clinical decision making because insufficient PSWs are…

James, Deborah G. H.; van Doorn, Jan; McLeod, Sharynne

2008-01-01

250

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

251

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

252

Clinical Decision Support Tools: Performance of Personal Digital Assistant versus Online Drug Information Databases  

Microsoft Academic Search

Study Objectives. To evaluate personal digital assistant (PDA) drug information databases used to support clinical decision-making, and to compare the performance of PDA databases with their online versions. Design. Prospective evaluation with descriptive analysis. Methods. Five drug information databases available for PDAs and online were evaluated according to their scope (inclusion of correct answers), completeness (on a 3-point scale), and

Kevin A. Clauson; Hyla H. Polen; Wallace A. Marsh

2007-01-01

253

Measuring outcomes in children's rehabilitation: A decision protocol  

Microsoft Academic Search

Objective: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation.Design: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge

Mary Law; Gillian King; Dianne Russell; Elizabeth MacKinnon; Patricia Hurley; Christine Murphy

1999-01-01

254

Electronic Clinical Decision Support for Management of Depression in Primary Care: A Prospective Cohort Study  

PubMed Central

Objective: To assess the utility of an electronic clinical decision support tool for management of depression in primary care. Method: This prospective study was conducted in a national network of ambulatory practices over a 1-year period (October 2007–October 2008). A clinical decision support tool was embedded into the electronic health record of 19 primary care practices with 119 providers. The main components included (1) the 9-item Patient Health Questionnaire (PHQ-9), with 9 questions paralleling the 9 DSM-IV criteria for the diagnosis of major depressive disorder; (2) a suicide assessment form; and (3) brief patient and provider education. Use of each component was tracked in the electronic health record. Providers completed baseline and postintervention surveys regarding their depression management practices and their perceptions of the clinical decision support tool. Results: According to electronic health record tracking, the PHQ-9 form was used in 45.6% of the 16,052 adult patients with depression and in 73.7% of the 1,422 patients with new depression. The suicide assessment form was used in 62.0% of patients with possible suicidality. Education modules were rarely used. From before to after the study, providers reported increased use of standardized tools for depression diagnosis (47% to 80%, P?clinical decision support tool was extensively used and perceived as very helpful for assessment of patients’ symptoms but not for provider education. These findings can help guide national efforts incorporating clinical decision support for quality improvement.

Chen, Ying Xia; Grimes, Angela; Diamond, James J.; Lieberman, Michael I.; Klinkman, Michael S.

2012-01-01

255

Application of the Stockholm Hierarchy to Defining the Quality of Reference Intervals and Clinical Decision Limits  

PubMed Central

The Stockholm Hierarchy is a professional consensus created to define the preferred approaches to defining analytical quality. The quality of a laboratory measurement can also be classified by the quality of the limits that the value is compared with, namely reference interval limits and clinical decision limits. At the highest level in the hierarchy would be placed clinical decision limits based on clinical outcome studies. The second level would include both formal reference interval studies (studies of intra and inter-individual variations) and clinical decision limits based on clinician survey. While these approaches are commonly used, they require a lot of resources to define accurately. Placing laboratory experts on the third level would suggest that although they can also define reference intervals by consensus, theirs aren’t as well regarded as clinician defined limits which drive clinical behaviour. Ideally both analytical and clinical considerations should be made, with clinicians and laboratorians both having important information to consider. The fourth level of reference intervals would be for those defined by survey or by regulatory authorities because of the focus on what is commonly achieved rather than what is necessarily correct. Finally, laboratorians know that adopting reference limits from kit inserts or textbook publications is problematic because both methodological issues and reference populations are often not the same as their own. This approach would rank fifth and last. When considering which so called ‘common’ or ‘harmonised reference intervals’ to adopt, both these characteristics and the quality of individual studies need to be assessed. Finally, we should also be aware that reference intervals describe health and physiology while clinical decision limits focus on disease and pathology, and unless we understand and consider the two corresponding issues of test specificity and test sensitivity, we cannot assure the quality of the limits that we report.

Sikaris, Ken

2012-01-01

256

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

2012-06-13

257

Ethics and the Computerization of Pharmacy.  

ERIC Educational Resources Information Center

|The current and potential impact of computerization on pharmacy practice is discussed, focusing on ethical dilemmas in the pharmacist-patient relationship, confidentiality of records, and the role of artificial intelligence in decision making about drug therapy. Case studies for use by teachers of pharmaceutical ethics are provided. (Author/MSE)|

McCarthy, Robert L.; Perrolle, Judith A.

1991-01-01

258

Use of a common computerized program for echocardiogram archiving and reporting over a regional territory: feasibility and clinical and research impact during a 5-year experience.  

PubMed

The aims of this study were to optimize interlaboratory standardization of echocardiographic reporting (qualitative terms and quantitative parameters) and to evaluate the feasibility and clinical and research impact of collecting echocardiographic data in a standard computerized format over a geographical territory. In April 1992, a computer program of echocardiogram archiving and reporting (ARCE) was distributed at no cost to the 23 hospital echocardiographic laboratories operating in our region (Liguria). In April 1993 (1-year survey), 16 (70%) of the 23 hospital echo laboratories operating in our region were routinely using ARCE. In April 1997 (4-year survey ), 21 (87%) of the 24 echo laboratories were routinely using the system and 128,642 echocardiograms had been databased. ARCE is a powerful tool both for education and training in cardiac ultrasound and for undertaking multicenter studies by 95% of the users. Regarding the quality improvement process, we achieved 3 main goals: (1) a unique report format from 87% of Ligurian echo laboratories, which improved the communication between echocardiographers and other physicians; (2) development of specific, Ligurian population-based reference limits for M-mode and 2-dimensional quantitative parameters; and (3) interlaboratory comparison and standardization of both quantitative and semiquantitative evaluation of heart valve disease, left ventricular systolic and diastolic function, valve prosthesis function, and left ventricular hypertrophy. Regarding the scientific activity in Liguria, 9 multicenter studies in which 15 Ligurian echo laboratories took part were organized and completed in 5 years. Our 5-year experience shows that it is possible to create a large database of echocardiographic data that uses a fast, easy-access, and easy-to-use program of echo archiving and reporting that contains standardized variables. The use of this program on a regional territory scale appeared feasible and useful both for educational and training purposes. In addition, it stimulated the quality improvement process in echocardiography as well as performance of epidemiologic and clinical multicenter studies. PMID:10441224

Badano, L P; Domenicucci, S

1999-08-01

259

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

260

Clinical decision making involved in secluding and restraining an adult psychiatric patient: an integrative literature review.  

PubMed

ACCESSIBLE SUMMARY: ??Understanding the factors associated with the decision to use seclusion or restraint may help to reduce the use of coercive measures through the implementation of appropriate measures. ??This integrative literature review brings together a broad view of factors associated with decision making in the use of seclusion or restraint and discusses decision-making process in practice. ??The results suggest that decisions to use seclusion or restraint are based on both observed behaviour of patient and previous clinical experiences of staff. ABSTRACT: The purpose of this integrative literature review was to describe different factors involved in the decision-making process of using seclusion or restraint, and to discuss the process in practice. The data used in this review were systematically retrieved from the following databases: CINAHL, Medline and PsycINFO. Manual data retrieval was conducted from the reference lists of the papers that came up in the original database search. A total of 32 studies were selected. Results suggest that the situations that lead to the use of seclusion or restraint are always dynamic and circumstantial. During the decision-making process staff observe a patient's behaviour, assesses risk and chooses and uses interventions that aim to de-escalate the situation. This process is affected by the previous experiences and history of staff as well as the behaviour and previous experience of the patient. PMID:23217004

Laiho, T; Kattainen, E; Astedt-Kurki, P; Putkonen, H; Lindberg, N; Kylmä, J

2012-12-10

261

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

PubMed Central

Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1–2 rotation and alignment. Mean follow-up was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2° and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1–2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1–2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and new onset atlantoaxial arthritis had worse clinical outcomes and significantly reduced rotation C1–2. The current study offers detailed insight into the radiographical, functional and clinical outcome of C2-fractures. It significantly adds to the understanding of C2-fractures. Electronic supplementary material The online version of this article (doi:10.1007/s00586-009-0901-4) contains supplementary material, which is available to authorized users.

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

2009-01-01

262

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

263

Understanding clinical work practices for cross-boundary decision support in e-health.  

PubMed

One of the major concerns of research in integrated healthcare information systems is to enable decision support among clinicians across boundaries of organizations and regional workgroups. A necessary precursor, however, is to facilitate the construction of appropriate awareness of local clinical practices, including a clinician's actual cognitive capabilities, peculiar workplace circumstances, and specific patient-centered needs based on real-world clinical contexts across work settings. In this paper, a user-centered study aimed to investigate clinical practices across three different geographical areas-the U.K., the UAE and Nigeria-is presented. The findings indicate that differences in clinical practices among clinicians are associated with differences in local work contexts across work settings, but are moderated by adherence to best practice guidelines and the need for patient-centered care. The study further reveals that an awareness especially of the ontological, stereotypical, and situated practices plays a crucial role in adapting knowledge for cross-boundary decision support. The paper then outlines a set of design guidelines for the development of enterprise information systems for e-health. Based on the guidelines, the paper proposes the conceptual design of CaDHealth, a practice-centered framework for making sense of clinical practices across work settings for effective cross-boundary e-health decision support. PMID:22345549

Tawfik, Hissam; Anya, Obinna; Nagar, Atulya K

2012-02-13

264

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

265

Design and application of a generic clinical decision support system for multiscale data.  

PubMed

Medical research and clinical practice are currently being redefined by the constantly increasing amounts of multiscale patient data. New methods are needed to translate them into knowledge that is applicable in healthcare. Multiscale modeling has emerged as a way to describe systems that are the source of experimental data. Usually, a multiscale model is built by combining distinct models of several scales, integrating, e.g., genetic, molecular, structural, and neuropsychological models into a composite representation. We present a novel generic clinical decision support system, which models a patient's disease state statistically from heterogeneous multiscale data. Its goal is to aid in diagnostic work by analyzing all available patient data and highlighting the relevant information to the clinician. The system is evaluated by applying it to several medical datasets and demonstrated by implementing a novel clinical decision support tool for early prediction of Alzheimer's disease. PMID:21990325

Mattila, Jussi; Koikkalainen, Juha; Virkki, Arho; van Gils, Mark; Lötjönen, Jyrki

2011-10-10

266

Computerizing the medical staff office.  

PubMed

To assist its medical staff in making appointments and reappointments to the medical staff, delineating clinical privileges, and maintaining quality assurance information, as well as to streamline clerical duties in the medical staff office, El Camino Hospital (a 460-bed acute care facility in Mountain View, California) developed a comprehensive, computerized medical staff quality assurance database (MESQUAD). This article describes MESQUAD as a program developed by one hospital to meet its unique needs. PMID:3095762

Lu, S L; Lozier, B; Pettingill, R R; Small, M

1986-09-01

267

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

268

Clinical applications of infant lung function testing: does it contribute to clinical decision making?  

Microsoft Academic Search

Infant lung function testing is important in clinical research and recent standardisation efforts have enabled measurements to be made in infants in different laboratories throughout the world. Thus, the theoretical conditions are now fulfilled for use of these techniques in clinical practice. This review discusses the usefulness of various infant lung function techniques in a clinical setting and their potential

U. Frey

2001-01-01

269

The utility of clinical decision tools for diagnosing osteoporosis in postmenopausal women with rheumatoid arthritis  

PubMed Central

Background Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. Methods A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA) bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score < -2.5). Sensitivity, specificity, positive predictive and negative predictive values and area under the curve were assessed. The diagnostic attributes of the clinical decision tools were compared by examination of the area under the receiver-operator-curve. Results One hundred and twenty seven women participated. The median age was 62 (IQR 56–71) years. Median disease duration was 108 (60–168) months. Seventy two (57%) women had no record of a previous DXA examination. Eighty (63%) women had T scores at femoral neck or lumbar spine less than -1. The area under the ROC curve for clinical decision tool prediction of T score <-2.5 varied between 0.63 and 0.76. The rheumatoid arthritis specific decision tools did not perform better than generic tools, however, the National Osteoporosis Foundation score could potentially reduce the number of unnecessary DXA tests by approximately 45% in this population. Conclusion There was limited utility of clinical decision tools for predicting osteoporosis in this patient population. Fracture prediction tools that include risk factors independent of BMD are needed.

Brand, Caroline; Lowe, Adrian; Hall, Stephen

2008-01-01

270

Computerized tool mark comparison  

NASA Astrophysics Data System (ADS)

The computerized toolmark comparison system is based on a cross correlation between a striation mark left by a tool on a lock and a test mark made by a suspect or the data base. The cross correlation is applied in the frequency domain for time saving. The area to be correlated is defined by the toolmark expert. A profile line is calculated and displayed based on the defined area. The two compared images may appear relatively shifted to one another, or only part of the toolmark that appears in the other. The same length of profiles is chosen from the two samples for entering to the updated correlation process. All possible correlations are checked by cutting and shifting through all cobinations. The database contains the defined images and the profiles calculated from them. The system consists of a 486 PC with a frame grabber and a video camera attached to a microscope. Results show that if the striation marks are clear and are wider than a minimum pixel limit, the correlation result higher than 0.6 is a possible match and has to be checked by the expert for a final decision. Future plans are to implement a 2D correlation. This method will enable us to deal with combinations of striations which are found frequently in real case work.

Feigin, Gavriel; Aperman, Arie; Springer, Eliot; Jungmann, Noam

1995-09-01

271

Effects of a computerized cardiac teletriage decision support system on nurse performance: results of a controlled human factors experiment using a mid-fidelity prototype.  

PubMed

A gap exists in cardiac care between known best practices and the actual level of care administered. To help bridge this gap, a proof of concept interface for a PDA-based decision support system (DSS) was designed for cardiac care nurses engaged in teletriage. This interface was developed through a user-centered design process. Quality of assessment, quality of recommendations, and number of questions asked were measured. Cardiac floor nurses' assessment quality performance, but not their recommendation quality performance, improved with the DSS. Nurses asked more questions with the DSS than without it, and these additional questions were predominantly classifiable as essential or beneficial to a good assessment. The average participant satisfaction score with the DSS was above neutral. PMID:17911686

Somoza, Kirsten Carroll; Momtahan, Kathryn; Lindgaard, Gitte

2007-01-01

272

Innovations in Computerized Assessment.  

ERIC Educational Resources Information Center

|Chapters in this book present the challenges and dilemmas faced by researchers as they created new computerized assessments, focusing on issues addressed in developing, scoring, and administering the assessments. Chapters are: (1) "Beyond Bells and Whistles; An Introduction to Computerized Assessment" (Julie B. Olson-Buchanan and Fritz Drasgow);…

Drasgow, Fritz, Ed.; Olson-Buchanan, Julie B., Ed.

273

Computerized Business Technologies.  

ERIC Educational Resources Information Center

This document contains materials developed for and about the computerized business technologies tech prep program of the South-Western City Schools in Ohio. Part 1 begins with a map of the program, which begins with a computerized business technologies program in grades 11 and 12 that leads to entry-level employment or one of two 2-year programs…

Columbus State Community Coll., OH.

274

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

275

A Descriptive Analysis of a Nursing Home Clinical Information System with Decision Support  

PubMed Central

Clinical information systems are absent in most nursing homes. Therefore, the vast numbers of elderly people who reside in the facilities are not reaping the benefits that these systems are thought to have, including better management of chronic conditions, greater efficiencies, and improved access to information. It is important for early adopters of nursing home information systems to share experiences to foster implementation of other systems and improve design and evaluation of these systems. The purpose of this study is to describe the activity of clinical decision support alerts and associated triggers during an analysis of an information system implemented in three nursing homes. The proportion of triggers used for each active alert in each alert category is described across resident diagnoses within the nursing home decision support system during six months of data collection.

Alexander, Gregory L.

2008-01-01

276

Verbal protocols for assessing the usability of clinical decision support: the retrospective sense making protocol.  

PubMed

We compare the effectiveness of two types of verbal protocol, concurrent think aloud vs. retrospective sense making, for evaluating the usability of a clinical decision support tool. Thirty-five medical and nursing students participated in a usability experiment. Participants were asked to complete seven tasks using the system under evaluation. Eighteen students were allocated to the concurrent think aloud group and the remainder followed the retrospective protocol. The retrospective protocol was significantly more sensitive than the concurrent protocol in recording unique usability problems related to users' cognitive behaviour. These problems concerned the interpretation and comprehension of statistical output, search results and system messages. These findings can be explained by the retrospective protocol's greater ability to detect compound usability problems, capturing the cognitive dimensions of users' interactions with the interface in greater depth. Evaluations of clinical decision support systems should take an evidence-based approach to selecting protocols. PMID:23920561

Balatsoukas, Panagiotis; Ainsworth, John; Williams, Richard; Carruthers, Emma; Davies, Colin; McGrath, James; Akbarov, Artur; Soiland-Reyes, Claudia; Badiyani, Saurin; Buchan, Iain

2013-01-01

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

Impact of Court-Mandated Substance Abuse Treatment on Clinical Decision Making  

PubMed Central

California’s Proposition 36 offers nonviolent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. The study objective was to examine how substance abuse treatment providers perceive the impact of Proposition 36 on their clinical decision making. Program surveys were completed by 115 treatment programs in five California counties to assess the impact of the law on clinical decision making, and five focus groups were conducted with 37 treatment providers to better understand their perspectives. Compared to residential programs, outpatient programs reported that the policy impacted them to a greater extent in terms of drug testing, reporting to criminal justice personnel, and determining client discharge. Providers in the focus groups particularly highlighted their changing roles in assessing clients’ treatment needs and determining the best routes of care for them. The findings indicate that alternate strategies for determining treatment placement and continuing care should be developed.

Hamilton, Alison; Hser, Yih-Ing

2010-01-01

279

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

280

Enhancing Clinical Practice Guideline Compliance by Involving Physicians in the Decision Process  

Microsoft Academic Search

Despite the proliferation of implemented clinical practice guidelines (CPGs) as decision support systems, there is still little\\u000a evidence of changes in physicians behavior. The reasons usually evoked to explain the low physicians compliance consider the\\u000a incompleteness of guidelines knowledge, the impreciseness of the terms used and the physicians psychological reluctance. Another\\u000a reason comes from the original verbal design of CPGs

Brigitte Séroussi; Jacques Bouaud; Éric-charles Antoine

1999-01-01

281

Using Brain-Based Cognitive Measures to Support Clinical Decisions in ADHD  

Microsoft Academic Search

Measures of cognition support diagnostic and treat- ment decisions in attention deficit hyperactivity disor- der. We used an integrative neuroscience framework to assess cognition and associated brain-function corre- lates 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

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

2010-01-01

282

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

283

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

284

Using An Electronic Clinical Decision Support System to Reduce the Risk of Epidural Hematoma.  

PubMed

Epidural hematoma is a major complication that can occur when neuraxial anesthesia is used concurrently with newer anticoagulation and antiplatelet medications. In complex hospital environments, the opportunity of performing a neuraxial procedure in an anticoagulated patient or starting potent anticoagulants on a patient with existing epidural catheter still exists. We describe a technique to use an electronic clinical decision support ordering system that helps reduce this risk of epidural hematoma. Through a series of automated warnings that bring to light existing anticoagulant or antiplatelet medications at the time of doing the procedure or a secondary warning system to those practitioners initiating anticoagulant medications on a patient with an existing epidural, we hope to reduce the number of medication errors. Before initiating the alert system, we had 26 events noted in the medical chart over a 3-month period. We noted only 11 events after the initiation of the new alert systems and clinical decision support in a similar 3-month period. Using electronic clinical decision support systems can help reduce medication errors related to neuraxial anesthesia and anticoagulation medications in a large hospital system. PMID:22878410

Gupta, Rajnish K

2012-10-19

285

Use of computerized tomography for diagnosis and follow-up after endodontic surgery: clinical case report with 8 years of follow-up.  

PubMed

Computerized tomography (CT) is a valuable tool for diagnosis and planning in conventional and surgical endodontic therapy. This case report describes the use of CT in the diagnosis of a periapical lesion undetected by periapical radiography in the mandibular molar area. The CT also showed a possible mesial root perforation associated with the lesion. Following CT, surgical planning, periradicular curettage, and sealing of the root perforation were performed. Eight years after surgery, cone beam CT revealed periapical bone repair. Computerized tomography can be an important resource for diagnosis and planning in conventional and surgical endodontic therapy, as well as for evaluation of post-treatment bone repair. PMID:20303059

Tanomaru-Filho, Mario; Lima, Regina K P; Nakazone, Paula A; Tanomaru, Juliane M G

2010-04-01

286

Eye tracking users of a visual diagnostic clinical decision support system to discover decision-making strategies and to inform user interface design.  

PubMed

Clinical decision support systems (CDSS) assist physicians and other medical professionals in tasks such as differential diagnosis. End users may use different decision-making strategies depending on medical training. Study of eye movements reveals information processing strategies that are executed at a level below consciousness. Eye tracking of student physician assistants and medical residents, while using a visual diagnostic CDSS in diagnostic tasks, showed adoption of distinct strategies and informed recommendations for effective user interface design. PMID:18999126

Haake, Anne R; Pelz, Jeff B; Smagner, Jessica; Colombo, Daniel; Lindsay, Laura; Papier, Art

2008-11-06

287

The role of biomedical knowledge in clinical reasoning: A lexical decision study  

Microsoft Academic Search

Purpose\\u000aTo investigate the role of biomedical and\\u000adiagnostic inferences in clinical reasoning\\u000aof advanced medical students and\\u000aexperienced family physicians using a\\u000alexical decision task.\\u000aMethod\\u000aIn 2002, 15 family physicians and 20\\u000afourth-year medical students at\\u000aMaastricht University medical school in\\u000aThe Netherlands were instructed to\\u000acarefully study 60 short clinical texts\\u000aconsisting of signs and symptoms\\u000aassociated

Remy M. J. P. Rikers; Sofie Loyens; Wilco te Winkel; Henk G. Schmidt; Patrick H. M. Sins

2005-01-01

288

A framework for evaluating the appropriateness of clinical decision support alerts and responses  

PubMed Central

Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. Methods Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). Results Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. Conclusion The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types.

Waitman, Lemuel R; Lewis, Julia B; Wright, Julie A; Choma, David P; Miller, Randolph A; Peterson, Josh F

2011-01-01

289

Governance for clinical decision support: case studies and recommended practices from leading institutions  

PubMed Central

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

290

Impact of clinical and health services research projects on decision-making: a qualitative study  

PubMed Central

Background This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. Methods A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. Results Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. Conclusions In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved.

2013-01-01

291

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials  

PubMed Central

BACKGROUND Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps. OBJECTIVE To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management. DATA SOURCES Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field. REVIEW METHODS Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. RESULTS Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17). CONCLUSION Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0812-9) contains supplementary material, which is available to authorized users.

Straus, Sharon E.

2008-01-01

292

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

293

Evaluation of Computerized Medicinal Chemistry Case Study Modules as Tools to Enhance Student Learning and Clinical Problem-Solving Skills1  

Microsoft Academic Search

This national controlled study assesses the impact of computerized case studies that emphasize medici- nal chemistry content on pharmacy students' ability to learn and apply chemical information and principles to solve complex therapeutic problems. Eighty-six student volunteers from five schools or colleges of phar- macy were assigned to Control and Experimental groups. There was no significant difference between these study

Victoria F. Roche; Marlene J. Aitken

1999-01-01

294

Using Decision Analysis to Assess Comparative Clinical Efficacy of Surgical Treatment of Unstable Ankle Fractures.  

PubMed

BACKGROUND/OBJECTIVE:: The development of a robust treatment algorithm for ankle fractures based on well-established stability criteria has been shown to be prognostic with respect to treatment and outcomes. In parallel with the development of improved understanding of the biomechanical rationale of ankle fracture treatment has been an increased emphasis placed on assessing the effectiveness of medical and surgical interventions. The purpose of this study was to investigate the utility of using decision analysis in the assessment of the cost-effectiveness of operative treatment of ankle fractures based on the existing clinical data in the literature. METHODS:: Using the data obtained from a previous structured review of the ankle fracture literature, decision analysis trees were constructed using standard software. The decision nodes for the trees were based on ankle fracture stability criteria previously published. The outcomes were assessed by calculated Quality-Adjusted Life Years (QALYs) assigned to achieving normal ankle function, developing post-traumatic arthritis, or sustaining a post-operative infection. Sensitivity analysis was undertaken by varying the patient's age, incidence of arthritis, and incidence or infection. RESULTS:: Decision analysis trees captured the essential aspects of clinical decision-making in ankle fracture treatment in a clinically useful manner. In general, stable fractures yielded better outcomes with non-operative treatment while unstable fractures had better outcomes with surgery. These were consistent results over a wide range of post-operative infection rates. Varying the age of the patient did not qualitatively change the results. Between the ages of 30 and 80 years, surgery yielded higher expected QALYs than non-operative care for unstable fractures, and generated lower QALYs than non-operative care for stable fractures. Using local cost estimates for operative and non-operative treatment, the incremental cost of surgery for unstable fractures was less than $40,000/QALY (the usual cut-off for the determination of cost-effectiveness) for patients up to 90 years old. DISCUSSION/CONCLUSIONS:: Decision analysis is a useful methodology in developing treatment guidelines. Numerous previous studies have indicated superior clinical outcomes when unstable ankle fractures underwent operative reduction and stabilization. What has been lacking was an examination of the cost effectiveness of such an approach, particularly in older patients who have fewer expected years of life. In light of the evidence for satisfactory outcomes for surgery of severe ankle fractures in older people, the justification for operative intervention is an obvious question that can be asked in the current increasingly cost-conscious environment. Using a decision tree decision analysis structured around the stability-based ankle fracture classification system, in conjunction with a relatively simple cost effectiveness analysis, this study was able to demonstrate that surgical treatment of unstable ankle fractures in elderly patients is, in fact, cost-effective. SIGNIFICANCE:: The clinical implication of the current analysis is that these existing treatment protocols for ankle fracture treatment are also cost effective when quality of life outcome measures are taken into account. LEVEL OF EVIDENCE:: Economic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23481924

Michelson, James D

2013-03-11

295

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

296

The integration of surface electromyography in the clinical decision making process: a case report  

PubMed Central

Objective: To demonstrate how the findings of surface electromyography (S.E.M.G.) were integrated into the clinical decision-making process. Clinical Features: This is a retrospective review of the file of a 27-year-old male suffering from mechanical low back pain. He was evaluated on 3 separate occasions over a 3 year period. History, radiography, functional outcome studies, visual-numerical pain score, pain drawing, physical examination and surface electromyography were utilized in evaluating this patient. Intervention and Outcome: The two clinical interventions of spinal manipulative therapy (S.M.T.) had positive results in that the patient achieved an asymptomatic state and returned to his position of employment. The S.E.M.G. data collected during the industrial assessment, did not provide the outcome that the patient had anticipated. Conclusion: Surface electromyography is a useful clinical tool in the author’s decision-making process for the treatment of mechanical lower back pain. Therapeutic intervention by S.M.T., therapeutic exercises and rating risk factors were influenced by the S.E.M.G. findings.

Nicholson, W Reg

1998-01-01

297

The role of analogy-guided learning experiences in enhancing students' clinical decision-making skills.  

PubMed

The purpose of this study was to address the need for effective educational interventions to promote students' clinical decision making (CDM) within clinical practice environments. Researchers used a quasi-experimental, non-equivalent groups, posttest-only design to assess differences in CDM ability between intervention group students who participated in analogy-guided learning activities and control group students who participated in traditional activities. For the intervention, analogy-guided learning activities were incorporated into weekly group discussions, reflective journal writing, and questioning with clinical faculty. The researcher-designed Assessment of Clinical Decision Making Rubric was used to assess indicators of CDM ability in all students' reflective journal entries. Results indicated that the intervention group demonstrated significantly higher levels of CDM ability in their journals compared with the control group (ES(sm) = 0.52). Recommendations provide nurse educators with strategies to maximize students' development of CDM ability, better preparing students for the demands they face when they enter the profession. PMID:21598858

Edelen, Bonnie Gilbert; Bell, Alexandra Alice

2011-05-17

298

The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration.  

PubMed

The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes. PMID:16764558

Considine, Julie; Botti, Mari; Thomas, Shane

2006-06-01

299

Oxygen use for preterm infants: factors that may influence clinical decisions surrounding oxygen titration.  

PubMed

Preterm infants in neonatal intensive care units frequently require oxygen therapy. Clinicians are responsible for titrating oxygen to maximize the benefits and minimize the risks of this therapy. Studies have identified various toxic effects of oxygen on the developing tissues of the preterm infant; however, optimal target SpO(2) ranges have not been identified. Current trends in neonatology are focusing on defining optimal oxygen saturation ranges to improve infant outcomes and to decrease complications associated with the oxygen use. Consequently, research-based guidelines are being developed in neonatal intensive care units to guide oxygen administration. As target oxygen saturation ranges are developed, issues regarding health care professional compliance with these ranges have been identified. The specific reasons for this noncompliance have not been widely explored. However, factors such as nursing shortages, staffing issues, and a de-emphasis on staff education surrounding oxygen use have been offered as possible reasons. Understanding factors shaping clinical decision-making about oxygen titration is critical when designing policies and educational programs to change oxygen titration practice and ultimately improve patient outcomes. In this article, the literature outlining the importance of oxygen titration for preterm infants is reviewed. Discussion then focuses on factors that influence clinical decision-making and how these factors may influence decisions surrounding the use of oxygen for preterm infants. PMID:21285649

Johnson, Krystal; Scott, Shannon D; Fraser, Kimberly D

2011-02-01

300

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

PubMed Central

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.

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

2011-01-01

301

The Influence of Actuarial Risk Assessment in Clinical Judgments and Tribunal Decisions about Mentally Disordered Offenders in Maximum Security  

Microsoft Academic Search

Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report

N. Zoe Hilton; Janet L. Simmons

2001-01-01

302

Virtual Interactive Practice™: Utilising Healthcare Information Systems to Contextualise the Skills associated with Clinical Decision making within Nurse Education  

Microsoft Academic Search

This paper reports on a Virtual Interactive Practice™ (VIP) project that has the potential to revolutionise the educational de- livery and learning of clinical skills complementing real' prac- tice. The focus is currently on nurse learning but the principles could equally be applied to multi and inter-professional learning and clinical decision-making. This project represents a new model to enhance clinical

Graham Watkinson; Anne Spencer; Eloise Monger; Mike Weaver; Mary Gobbi; Judith Lathlean; Stephanie Bryant

303

Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial  

Microsoft Academic Search

Summary objectives To assess if the clinical outcome of patients treated after performing a Rapid Diagnostic Test for malaria (RDT) is at least equivalent to that of controls (treated presumptively without test) and to determine the impact of the introduction of a malaria RDT on clinical decisions. methods Randomized, multi-centre, open clinical trial in two arms in 2006 at the

Zeno Bisoffi; Bienvenu Sodiomon Sirima; Andrea Angheben; Claudia Lodesani; Federico Gobbi; Halidou Tinto; Jef Van den Ende

2009-01-01

304

Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study  

PubMed Central

Background United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. Methods We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). Results We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds. Conclusions On a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians’ cognitive processes contributed to the under-triage of trauma patients.

2012-01-01

305

Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus  

PubMed Central

Background Computer-based clinical decision support (CDS) systems have been shown to improve quality of care and workflow efficiency, and health care reform legislation relies on electronic health records and CDS systems to improve the cost and quality of health care in the United States; however, the heterogeneity of CDS content and infrastructure of CDS systems across sites is not well known. Objective We aimed to determine the scope of CDS content in diabetes care at six sites, assess the capabilities of CDS in use at these sites, characterize the scope of CDS infrastructure at these sites, and determine how the sites use CDS beyond individual patient care in order to identify characteristics of CDS systems and content that have been successfully implemented in diabetes care. Methods We compared CDS systems in six collaborating sites of the Clinical Decision Support Consortium. We gathered CDS content on care for patients with diabetes mellitus and surveyed institutions on characteristics of their site, the infrastructure of CDS at these sites, and the capabilities of CDS at these sites. Results The approach to CDS and the characteristics of CDS content varied among sites. Some commonalities included providing customizability by role or user, applying sophisticated exclusion criteria, and using CDS automatically at the time of decision-making. Many messages were actionable recommendations. Most sites had monitoring rules (e.g. assessing hemoglobin A1c), but few had rules to diagnose diabetes or suggest specific treatments. All sites had numerous prevention rules including reminders for providing eye examinations, influenza vaccines, lipid screenings, nephropathy screenings, and pneumococcal vaccines. Conclusion Computer-based CDS systems vary widely across sites in content and scope, but both institution-created and purchased systems had many similar features and functionality, such as integration of alerts and reminders into the decision-making workflow of the provider and providing messages that are actionable recommendations.

Kantor, M.; Wright, A.; Burton, M.; Fraser, G.; Krall, M.; Maviglia, S.; Mohammed-Rajput, N.; Simonaitis, L.; Sonnenberg, F.; Middleton, B.

2011-01-01

306

Health technology assessment review: Computerized glucose regulation in the intensive care unit - how to create artificial control  

PubMed Central

Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many ICUs have implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (Cuss) use more complex logic to provide an insulin infusion rate based on previous blood glucose levels and other parameters. A computerized CDSS for glucose control has the potential to reduce overall workload, reduce the chance of human cognitive failure, and improve glucose control. Several computer-assisted glucose regulation programs have been published recently. In order of increasing complexity, the three main types of algorithms used are computerized flowcharts, Proportional-Integral-Derivative (PID), and Model Predictive Control (MPC). PID is essentially a closed-loop feedback system, whereas MPC models the behavior of glucose and insulin in ICU patients. Although the best approach has not yet been determined, it should be noted that PID controllers are generally thought to be more robust than MPC systems. The computerized Cuss that are most likely to emerge are those that are fully a part of the routine workflow, use patient-specific characteristics and apply variable sampling intervals.

2009-01-01

307

Computerized infrared spectroradiometry - A computerized systems approach  

Microsoft Academic Search

A computerized IR spectroradiometer system, SR-5000, is described. The SR-5000 is composed of an optical head, the same as that used in the SR-1000 model, and a new PV\\/TX computer system. Besides the capability to acquire and process the spectroradiometer's signals, the PC\\/XT system can store and calibrate curves in the memory, control and display the radiometer parameters, and calibrate

Z. Kopolovich; E. Sapir; R. A. Buckwald; D. Cabib; L. S. Balfour

1985-01-01

308

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

309

Who Can Afford a Computerized Bookstore? Almost Anyone.  

ERIC Educational Resources Information Center

The decision to computerize operations in the DeAnza Community College bookstore was followed by a number of decisions about financing options (purchase, lease/purchase, lease, timesharing). A timesharing agreement was reached with a local bank, with no capital outlay and at a cost equivalent to an accountant's position. (MSE)

Miller, Charles

1982-01-01

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

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

312

Access to augmentative and alternative communication: new technologies and clinical decision-making.  

PubMed

Children with severe physical impairments require a variety of access options to augmentative and alternative communication (AAC) and computer technology. Access technologies have continued to develop, allowing children with severe motor control impairments greater independence and access to communication. This article will highlight new advances in access technology, including eye and head tracking, scanning, and access to mainstream technology, as well as discuss future advances. Considerations for clinical decision-making and implementation of these technologies will be presented along with case illustrations. PMID:22543893

Fager, Susan; Bardach, Lisa; Russell, Susanne; Higginbotham, Jeff

2012-01-01

313

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

314

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

315

Recommendations for Clinical Decision Support Deployment: Synthesis of a Roundtable of Medical Directors of Information Systems  

PubMed Central

Background: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. Objective: Develop practical advice to aid CDS implementation in order to improve clinician performance. Method: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. Results: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization’s clinical goals. Conclusion: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS.

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

2007-01-01

316

Clinician Perspectives on the Quality of Patient Data Used for Clinical Decision Support: A Qualitative Study  

PubMed Central

Objective: Clinical decision support (CDS), defined broadly as patient-specific information and knowledge provided at the point of care, depends on a foundation of high quality electronic patient data. Little is known about how clinicians perceive the quality and value of data used to support CDS within an electronic health record (EHR) environment. Methods: During a three-year research study, we collected ethnographic data from ten diverse organizations, including community hospitals, academic medical centers and ambulatory clinics. Results: An in-depth analysis of the theme “data as a foundation for CDS” yielded a descriptive framework incorporating five subthemes related to data quality: completeness, accessibility, context specificity, accuracy, and reliability. Conclusion: We identified several multi-dimensional models that might be used to conceptualize data quality characteristics for future research. These results could provide new insights to system designers and implementers on the importance clinicians place on specific data quality characteristics regarding electronic patient data for CDS.

McCormack, James L.; Ash, Joan S.

2012-01-01

317

The contribution of polysyllabic words in clinical decision making about children's speech.  

PubMed

Poor polysyllabic word (PSW) production seems to mark paediatric speech impairment as well as impairment in language, literacy and phonological processing. As impairment in these domains may only manifest in PSWs, PSW production may provide unique information that is often excluded from clinical decision making because insufficient PSWs are included in speech tests. A 5-stage model of PSW acquisition is described. The model, grounded in optimality theory, expresses a reciprocal relationship between the relaxation of markedness constraints and the contraction of faithfulness constraints from 12 months of age to adolescence. The markedness constraints that persist to the age of 7;11 years are associated with non-final weak syllables and within-word consonant sequences. Output changes are argued to reflect increasing specification of phonological representations with age, liberating information for motor planning and execution, resulting in increasingly accurate output. The clinical implications of PSWs in assessment and therapy are discussed. PMID:18415734

James, Deborah G H; van Doorn, Jan; McLeod, Sharynne

318

Application of a diagnosis-based clinical decision guide in patients with neck pain  

PubMed Central

Background Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG.

2011-01-01

319

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

320

Valuing structured professional judgment: predictive validity, decision-making, and the clinical-actuarial conflict.  

PubMed

Structured professional judgment (SPJ) has received considerable attention as an alternative to unstructured clinical judgment and actuarial assessment, and as a means of resolving their ongoing conflict. However, predictive validity studies have typically relied on receiver operating characteristic (ROC) analysis, the same technique commonly used to validate actuarial assessment tools. This paper presents SPJ as distinct from both unstructured clinical judgment and actuarial assessment. A key distinguishing feature of SPJ is the contribution of modifiable factors, either dynamic or protective, to summary risk ratings. With modifiable factors, the summary rating scheme serves as a prognostic model rather than a classification procedure. However, prognostic models require more extensive and thorough predictive validity testing than can be provided by ROC analysis. It is proposed that validation should include calibration and reclassification techniques, as well as additional measures of discrimination. Several techniques and measures are described and illustrated. The paper concludes by tracing the limitations of ROC analysis to its philosophical foundation and its origin as a statistical theory of decision-making. This foundation inhibits the performance of crucial tasks, such as determining the sufficiency of a risk assessment and examining the evidentiary value of statistical findings. The paper closes by noting a current effort to establish a viable and complementary relationship between SPJ and decision-making theory. PMID:23339121

Falzer, Paul R

2013-01-21

321

Evaluation of Clinical Decision Rules for Bone Mineral Density Testing among White Women  

PubMed Central

Background. Osteoporosis is a devastating, insidious disease that causes skeletal fragility. Half of women will suffer osteoporotic fractures during their lifetimes. Many fractures occur needlessly, because of inattentiveness to assessment, diagnosis, prevention, and treatment of osteoporosis. Study Purpose. Study Purpose. To evaluate the discriminatory performance of clinical decision rules to determine the need to undergo bone mineral density testing. Methods. A nationally representative sample from the Third National Health and Nutrition Examination Survey consisted of 14,060 subjects who completed surveys, physical examinations, laboratory tests, and bone mineral density exams. Multivariable linear regression tested the correlation of covariates that composed the clinical decision rules with bone mineral density. Results. Increased age and decreased weight were variables in the final regression models for each gender and race/ethnicity. Among the indices, the Osteoporosis Self-Assessment Tool, which is composed of age and weight, performed best for White women. Study Implications. These results have implications for the prevention, assessment, diagnosis, and treatment of osteoporosis. The Osteoporosis Self-Assessment Tool performed best and is inexpensive and the least time consuming to implement.

Anders, Michael E.; Turner, Lori; Freeman, Jeanne

2013-01-01

322

Assessment of the sunk-cost effect in clinical decision-making.  

PubMed

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment. PMID:22503839

Braverman, Jennifer A; Blumenthal-Barby, J S

2012-04-02

323

Computerized Reporting in a Public School Program.  

ERIC Educational Resources Information Center

|Clinicians in a public school clinical speech program designed and adopted a system of computerized reporting which generates required due process paperwork, provides student reports and copies of Individualized Educational Programs, and stores data for administrative and research purposes. Preliminary data indicate both time and financial…

Krueger, Beverly

1985-01-01

324

Computerized infrared spectroradiometry - A computerized systems approach  

NASA Astrophysics Data System (ADS)

A computerized IR spectroradiometer system, SR-5000, is described. The SR-5000 is composed of an optical head, the same as that used in the SR-1000 model, and a new PV/TX computer system. Besides the capability to acquire and process the spectroradiometer's signals, the PC/XT system can store and calibrate curves in the memory, control and display the radiometer parameters, and calibrate and display the calibrated spectra in Watt/sq cm per sr and other units. In addition, the new computer system offers the capabilities of automatic control of position and temperature of samples to be measured and modularity of subsystems and software packages.

Kopolovich, Z.; Sapir, E.; Buckwald, R. A.; Cabib, D.; Balfour, L. S.

1985-01-01

325

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

326

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

327

The impact of the hospital library on clinical decision making: the Rochester study.  

PubMed Central

In these times of economic constraint, libraries of all types are under increasing pressure to evaluate their services. Hospital libraries face a particular challenge because the goals of the health care system demand that the relevance of library services to patient care be determined. The hospital librarians in Rochester, New York, responded to this challenge by developing a research project that explored the impact of library services on clinical decision making. A systematically sampled group of 448 physicians in the Rochester area agreed to participate in the study between September 1990 and March 1991. The physicians were asked to request some information related to a current clinical case and then to evaluate its impact on the care of their patients. Senior medical staff or administrators acted as study facilitators in each of the fifteen participating hospitals. As a result of the information provided by the library, 80% of the 208 physicians who returned their questionnaires said that they probably or definitely handled some aspect of patient care differently than they would have handled it otherwise. Changes in the following specific aspects of care were reported by the physicians: diagnosis (29%), choice of tests (51%), choice of drugs (45%), reduced length of hospital stay (19%), and advice given to the patient (72%). Physicians also said that the information provided by the library contributed to their ability to avoid the following: hospital admission (12%), patient mortality (19%), hospital-acquired infection (8%), surgery (21%), and additional tests or procedures (49%). The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues. In addition to confirming earlier research findings that information provided by hospital libraries is perceived by physicians as having a significant impact on clinical decision making, the results increase our store of scientific knowledge about the specific nature and extent of the impact of information provided by the hospital library.

Marshall, J G

1992-01-01

328

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

PubMed Central

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.

Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

2011-01-01

329

Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score  

PubMed Central

Objective: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. Design: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. Measurements: A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. Results: Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman ? 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). Conclusion: The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Ramnarayan, Padmanabhan; Kapoor, Ritika R.; Coren, Michael; Nanduri, Vasantha; Tomlinson, Amanda L.; Taylor, Paul M.; Wyatt, Jeremy C.; Britto, Joseph F.

2003-01-01

330

Are Chinese Dentists Ready for the Computerization of Dentistry? A Population Investigation of China's Metropolises  

PubMed Central

The authors studied current levels of computerization in dental clinics and the attitudes of dentists towards dental computerization in metropolises in China. A survey consisting of 22 questions was e-mailed or mailed to a random sample of 354 dentists. Of all respondents, 80.5% reported using a computer in their practice. The authors found that administrative tasks were the first to be computerized. A majority of respondents supported the statement that computerization is a benefit to patient care. The authors found that the computerization of dental clinics in Chinese metropolises is a few years behind that of western nations.

Hu, Jian; Yu, Hao; Luo, En; Song, Enmin; Xu, Xiangyang; Tan, Hongbao; Wang, Yining

2009-01-01

331

Autonomy, religion and clinical decisions: findings from a national physician survey  

PubMed Central

Background Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature.

Lawrence, R E; Curlin, F A

2010-01-01

332

[From library to clinical decision support systems: access of general practitioner to quality information].  

PubMed

Since 2003, the following tools have been implemented in Belgium for improving the access of general practioners to the EBM literature: the Digital Library for Health and the evidence-linker of the CEBAM, the portal EBMPracticeNet.be and the multidimensional electronic clinical decision support EBMeDS. The aim of this article is to show the progress achieved in the information dissemination toward the belgian general practioners, particularly the access from the electronic health record. From the literature published these last years, the opportunities cited by the users are for using EBM and the strong willingness for using these literature access in the future; the limits are the medical data coding, the irrelevance of the search results, the alerts fatigue induced by EBMeDS. The achievements done and planned for the new EBMPracticeNet guidelines portal and the EBMeDS system are explained in the aim of informing belgian healthcare professionals. These projects are claiming for lauching a participatory process in the production and dissemination of EBM information. The discussion is focused on the belgian healthcare system advantages, the solutions for a reasonable implementation of these projects and for increasing the place of an evidence-based information in the healthcare decision process. Finally the input of these projects to the continuing medical education and to the healthcare quality are discussed, in a context of multifactorial interaction healthcare design (complexity design). PMID:23091948

Fauquert, B

2012-09-01

333

Research Paper: Clinical Decision Velocity is Increased when Meta-search Filters Enhance an Evidence Retrieval System  

Microsoft Academic Search

ObjectiveTo test whether the use of an evidence retrieval system that uses clinically targeted meta-search filters can enhance the rate at which clinicians make correct decisions, reduce the effort involved in locating evidence, and provide an intuitive match between clinical tasks and search filters.DesignA laboratory experiment under controlled conditions asked 75 clinicians to answer eight randomly sequenced clinical questions, using

Enrico W. Coiera; Johanna I. Westbrook; Kris Rogers

2008-01-01

334

Statistics for critical clinical decision making based on readings of pairs of implanted sensors.  

PubMed

Low error rates are essential if lives of patients are to depend on readings of implanted sensors, such as glucose sensors in insulin-dependent diabetic patients. To verify the operation and to calibrate on demand an implanted sensor, it is necessary that calibration through a single, independent measurement involving withdrawal of only one sample of blood and its independent analysis be feasible. Such a one-point calibration must be accurate. Borrowing from nuclear reactor safety assurance, where a likelihood ratio test is applied to readings of pairs of pressure sensors for shutdown/no shutdown decisions, we apply a similar test to sensor pairs implanted in rats. We show, for five sets of glucose sensor pairs, calibrated in vivo by withdrawal of a single sample of blood, that application of the likelihood ratio test increases the fraction of the clinically correct readings from 92.4% for their averaged readings to 98.8%. PMID:8794921

Schmidtke, D W; Pishko, M V; Quinn, C P; Heller, A

1996-09-01

335

Migrating toward a Next-Generation Clinical Decision Support Application: The BJC HealthCare Experience  

PubMed Central

The next-generation model outlined in the AMIA Roadmap for National Action on Clinical Decision Support (CDS) is aimed to optimize the effectiveness of CDS interventions, and to achieve widespread adoption. BJC HealthCare re-engineered its existing CDS system in alignment with the AMIA roadmap and plans to use it for guidance on further enhancements. We present our experience and discuss an incremental approach to migrate towards the next generation of CDS applications from the viewpoint of a healthcare institution. Specifically, a CDS rule engine service with a standards-based rule representation format was built to simplify maintenance and deployment. Rules were separated from execution code and made customizable for multi-facility deployment. Those changes resulted in system improvements in the short term while aligning with long-term strategic objectives.

Huang, Yan; Noirot, Laura A.; Heard, Kevin M.; Reichley, Richard M.; Dunagan, Wm. Claiborne; Bailey, Thomas C.

2007-01-01

336

Clinical decision support and acute low back pain: evidence-based order sets.  

PubMed

Low back pain is one of the most common reasons for visits to physicians in the ambulatory care setting. Estimated medical expenditures related to low back pain have increased disproportionately relative to the more modest increase in the prevalence of self-reported low back pain in the past decade. The increase in spine care expenditures has not been associated with improved patient outcomes. Evidence-based order templates presented in this article are designed to assist practitioners through the process of managing patients with acute low back pain. A logical method of choosing, developing, and implementing clinical decision support interventions is presented that is based on the best available scientific evidence. These templates may be reasonably expected to improve patient care, decrease inappropriate imaging utilization, reduce the inappropriate use of steroids and narcotics, and potentially decrease the number of inappropriate invasive procedures. PMID:23025864

Forseen, Scott E; Corey, Amanda S

2012-10-01

337

Recurrent Neural Networks in Computer-Based Clinical Decision Support for Laryngopathies: An Experimental Study  

PubMed Central

The main goal of this paper is to give the basis for creating a computer-based clinical decision support (CDS) system for laryngopathies. One of approaches which can be used in the proposed CDS is based on the speech signal analysis using recurrent neural networks (RNNs). RNNs can be used for pattern recognition in time series data due to their ability of memorizing some information from the past. The Elman networks (ENs) are a classical representative of RNNs. To improve learning ability of ENs, we may modify and combine them with another kind of RNNs, namely, with the Jordan networks. The modified Elman-Jordan networks (EJNs) manifest a faster and more exact achievement of the target pattern. Validation experiments were carried out on speech signals of patients from the control group and with two kinds of laryngopathies.

Szkola, Jaroslaw; Pancerz, Krzysztof; Warchol, Jan

2011-01-01

338

Optimization of the decision-making process for the selection of therapeutics to undergo clinical testing for spinal cord injury in the North American Clinical Trials Network.  

PubMed

The North American Clinical Trials Network (NACTN) includes 9 clinical centers funded by the US Department of Defense and the Christopher Reeve Paralysis Foundation. Its purpose is to accelerate clinical testing of promising therapeutics in spinal cord injury (SCI) through the development of a robust interactive infrastructure. This structure includes key committees that serve to provide longitudinal guidance to the Network. These committees include the Executive, Data Management, and Neurological Outcome Assessments Committees, and the Therapeutic Selection Committee (TSC), which is the subject of this manuscript. The NACTN brings unique elements to the SCI field. The Network's stability is not restricted to a single clinical trial. Network members have diverse expertise and include experts in clinical care, clinical trial design and methodology, pharmacology, preclinical and clinical research, and advanced rehabilitation techniques. Frequent systematic communication is assigned a high value, as is democratic process, fairness and efficiency of decision making, and resource allocation. This article focuses on how decision making occurs within the TSC to rank alternative therapeutics according to 2 main variables: quality of the preclinical data set, and fit with the Network's aims and capabilities. This selection process is important because if the Network's resources are committed to a therapeutic, alternatives cannot be pursued. A proposed methodology includes a multicriteria decision analysis that uses a Multi-Attribute Global Inference of Quality matrix to quantify the process. To rank therapeutics, the TSC uses a series of consensus steps designed to reduce individual and group bias and limit subjectivity. Given the difficulties encountered by industry in completing clinical trials in SCI, stable collaborative not-for-profit consortia, such as the NACTN, may be essential to clinical progress in SCI. The evolution of the NACTN also offers substantial opportunity to refine decision making and group dynamics. Making the best possible decisions concerning therapeutics selection for trial testing is a cornerstone of the Network's function. PMID:22985376

Guest, James; Harrop, James S; Aarabi, Bizhan; Grossman, Robert G; Fawcett, James W; Fehlings, Michael G; Tator, Charles H

2012-09-01

339

Computerized training management system  

Microsoft Academic Search

A Computerized Training Management System (CTMS) is disclosed for providing a procedurally defined process that is employed to develop accreditable performance based training programs for job classifications that are sensitive to documented regulations and technical information. CTMS is a database that links information needed to maintain a five-phase approach to training-analysis, design, development, implementation, and evaluation independent of training program

H. B. Rice; R. C. McNair; K. White; T. Maugeri

1998-01-01

340

Computerized training management system  

Microsoft Academic Search

A Computerized Training Management System (CTMS) for providing a procedurally defined process that is employed to develop accreditable performance based training programs for job classifications that are sensitive to documented regulations and technical information. CTMS is a database that links information needed to maintain a five-phase approach to training-analysis, design, development, implementation, and evaluation independent of training program design. CTMS

Harold B. Rice; Robert C. McNair; Kenneth White; Terry Maugeri

1998-01-01

341

Adaptive Computerized Instruction.  

ERIC Educational Resources Information Center

Describes an artificially intelligent multimedia computerized instruction system capable of developing a conceptual image of what a student is learning while the student is learning it. It focuses on principles of learning and adaptive behavioral control systems theory upon which the system is designed and demonstrates multiple user modes.…

Ray, Roger D.; And Others

1995-01-01

342

Preliminary steps to computerization.  

PubMed

Selecting a computer system for a dental office is a complicated process and the author recommends that this be preceded by a careful practice analysis. Examples of the practicality of computerization are typified in several examples and many common pre-purchase suggestions and guidelines are provided. The need for staff involvement and adequate product review prior to purchase is discussed. PMID:9517341

Nowakowski, A R

1994-01-01

343

[Subjectivity, decision and neurodegenerative diseases: reflexions on the role of the clinical psychologist in medical decision making].  

PubMed

Should a patient be forced to accept a treatment, especially when suffering from a neurodegenerative disease? We argue that physicians, nurses and care givers should instead accept his or her choice in accordance with the principle that every patient is an autonomous person able to make a choice, even in case of declined cognition. Beside the legal obligation, we suggest a theoretical approach and focus on the practical impacts of the patient's decision. Our objective is to promote the value of ethical doubt and attentive listening to individual opinions, so as to improve the quality of the medical staff's work and reduce patients' distress when affected by fatal diseases. PMID:23398961

Brocq, H; Liarte, A; Soriani, M-H; Desnuelle, C

2013-02-08

344

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 thee-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 iterationsof 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. Usabilityof 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 intothe physician's daily routine. PMID:23377779

Buenestado, David; Elorz, Javier; Pérez-Yarza, Eduardo G; Iruetaguena, Ander; Segundo, Unai; Barrena, Raúl; Pikatza, Juan M

2013-02-03

345

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

346

The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support  

PubMed Central

The Morningside Initiative is a public-private activity that has evolved from an August, 2007, meeting at the Morningside Inn, in Frederick, MD, sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) of the US Army Medical Research Materiel Command. Participants were subject matter experts in clinical decision support (CDS) and included representatives from the Department of Defense, Veterans Health Administration, Kaiser Permanente, Partners Healthcare System, Henry Ford Health System, Arizona State University, and the American Medical Informatics Association (AMIA). The Morningside Initiative was convened in response to the AMIA Roadmap for National Action on Clinical Decision Support and on the basis of other considerations and experiences of the participants. Its formation was the unanimous recommendation of participants at the 2007 meeting which called for creating a shared repository of executable knowledge for diverse health care organizations and practices, as well as health care system vendors. The rationale is based on the recognition that sharing of clinical knowledge needed for CDS across organizations is currently virtually non-existent, and that, given the considerable investment needed for creating, maintaining and updating authoritative knowledge, which only larger organizations have been able to undertake, this is an impediment to widespread adoption and use of CDS. The Morningside Initiative intends to develop and refine (1) an organizational framework, (2) a technical approach, and (3) CDS content acquisition and management processes for sharing CDS knowledge content, tools, and experience that will scale with growing numbers of participants and can be expanded in scope of content and capabilities. Intermountain Healthcare joined the initial set of participants shortly after its formation. The efforts of the Morningside Initiative are intended to serve as the basis for a series of next steps in a national agenda for CDS. It is based on the belief that sharing of knowledge can be highly effective as is the case in other competitive domains such as genomics. Participants in the Morningside Initiative believe that a coordinated effort between the private and public sectors is needed to accomplish this goal and that a small number of highly visible and respected health care organizations in the public and private sector can lead by example. Ultimately, a future collaborative knowledge sharing organization must have a sustainable long-term business model for financial support.

Greenes, Robert; Bloomrosen, Meryl; Brown-Connolly, Nancy E.; Curtis, Clayton; Detmer, Don E; Enberg, Robert; Fridsma, Douglas; Fry, Emory; Goldstein, Mary K; Haug, Peter; Hulse, Nathan; Hongsermeier, Tonya; Maviglia, Saverio; Robbins, Craig W; Shah, Hemant

2010-01-01

347

Initial implementation and evaluation of a Hepatitis C treatment clinical decision support system (CDSS)  

PubMed Central

Background Clinician compliance with clinical guidelines in the treatment of patients with Hepatitis C (HCV) has been reported to be as low as 18.5%. Treatment is complex and patient compliance is often inconsistent thus, active clinician surveillance and support is essential to successful outcomes. A clinical decision support system (CDSS) embedded within an electronic health record can provide reminders, summarize key data, and facilitate coordination of care. To date, the literature is bereft of information describing the implementation and evaluation of a CDSS to support HCV treatment. Objective The purpose of this case report is to describe the design, implementation, and initial evaluation of an HCV-specific CDSS while piloting data collection metrics and methods to be used in a larger study across multiple practices. Methods The case report describes the design and implementation processes with preliminary reporting on impact of the CDSS on quality indicator completion by comparing the pre-CDSS group to the post-CDSS group. Results The CDSS was successfully designed and implemented using an iterative, collaborative process. Pilot testing of the clinical outcomes of the CDSS revealed high rates of quality indicator completion in both the pre- and post-CDSS; although the post-CDSS group received a higher frequency of reminders (4.25 per patient) than the pre-CDSS group (.25 per patient). Conclusions This case report documents the processes used to successfully design and implement an HCV CDSS. While the small sample size precludes generalizability of findings, results did positively demonstrate the feasibility of comparing quality indicator completion rates pre-CDSS and post-CDSS. It is recommended that future studies include a larger sample size across multiple providers with expanded outcomes measures related to patient outcomes, staff satisfaction with the CDSS, and time studies to evaluate efficiency and cost effectiveness of the CDSS.

Fathauer, L; Meek, J.

2012-01-01

348

Standards for Scalable Clinical Decision Support: Need, Current and Emerging Standards, Gaps, and Proposal for Progress  

PubMed Central

Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS.

Kawamoto, Kensaku; Del Fiol, Guilherme; Lobach, David F.; Jenders, Robert A

2010-01-01

349

The Effect of a Computerized Review on NCLEX-RN Scores  

PubMed Central

This presentation will describe a pilot study being conducted at Ball State University. The study is attempting to determine the effect of a computerized review experience on the clinical subscale scores of NCLEX-RN. Relationships between the computerized review clinical subscores and the NCLEX-RN clinical subscale scores are also being investigated.

Worrell, Pamela J.; Hodson, Kay E.; Henriksen, Larry

1985-01-01

350

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

351

The influence of the law on clinical decisions affecting life and death.  

PubMed

The purpose of this lecture is to review the justification for legal interference in physicians' clinical decisions and the consequences of that interference to patients. Discussion covers contraception, abortion, negligence, and defensive medicine. Contraception is normally interpreted as the prevention or inhibition of fertilization or of implantation of the fertilized ovum in the uterus. The extra corporeal or in vitro fertilization program has raised the question of the legal and ethical status of the fertilized ovum before implantation. This is turn has raised questions about contraceptive devices or procedures whose purpose it is to prevent the implantation of a fertilized ovum, of which the IUd is the most common in use in the UK. Congressman Doonan of California moved to amend the US Constitution to provide that "life begins when a sperm cell fertilizes an egg." It may be assumed that this amendment is designed to prevent unacceptable experiments on spare embryos, but the consequences to family planning could be enormous unless some exception is included in favor of IUDs inserted for purposes of contraception. This leads to the issue of abortion and a reminder that until the 19th century it was not regarded as a crime in English common law to abort a fetus before "quickening" had occurred, as this was the point at which the embryo was regarded as having been animated. The Offenses Against the Person Act of 1861 established the current criminal offense of induced abortion to which the Abortion Act of 1967 now provides a defense. Recent developments in life support mechanisms have created difficulties over the extent to which such measures should be employed in the management of children born with life threatening abnormalities. A draft bill has been introduced requiring doctors to take all possible steps to feed defective neonates with life threatening abnormalities who are experiencing serious feeding problems. This means that these infants would have to be force fed irrespective of their prospects of survival and suffering which this will cause them and their parents. Clinical decisions have been most seriously affected by recent developments in the law of negligence. 1 of the main reasons for this has been the unsatisfactory way in which the adversary system of law ldeals with expert evidence. Attempts have been made to provide courts of law in the UK an agreed statement on expert medical matters, there is a long way to go before reaching the position achieved in many civil law countries on the continent of Europe where the experts recognized by the court hammer out an agreed upon opinion through scientific discourse and without the restrictions of evidentiary rules which are aimed more at the establishment of facts than the validity of scientific opinion. Those who attack the medical profession as being paternalistic and authoritative in making clinical decisions involving life and death fail to realize that the easy way out for the medical profession is to treat every case, however hopeless, with the full technology available, disregarding the patient's and family's interests, the costs in resources, and ignoring the stark reality of the problem. PMID:6633202

Havard, J D

1983-07-01

352

iSyNCC: an intelligent system for patient monitoring & clinical decision support in Neuro-Critical-Care.  

PubMed

Close monitoring and timely treatment are extremely crucial in Neuro Intensive/Critical Care Units (NICUs) to prevent patients from secondary brain damages. However, the current clinical practice is labor-intensive, prone to human errors and ineffective. To address this, we developed an integrated and intelligent system, namely iSyNCC, to enhance the effectiveness of patient monitoring and clinical decision makings in NICUs. The requirements of the system were investigated through interviews and discussions with neurosurgeons, neuroclinicians and nurses. Based on the summarized requirements, a modular 2-tier system is developed. iSyNCC integrates and stores crucial patient information ranging from demographic details, clinical & treatment records to continuous physiological monitoring data. iSyNCC enables remote and centralized patient monitoring and provides computational intelligence to facilitate clinical decision makings. PMID:22255809

Feng, Mengling; Zhang, Zhuo; Zhang, Feng; Ge, Yu; Loy, Liang Yu; Vellaisamy, Kuralmani; Guo, Wenyuan; Chin, Pei Loon; King, Nicolas Kon Kam; Ang, Beng Ti; Guan, Cuntai

2011-01-01

353

Computerized forensic facial reconstruction  

Microsoft Academic Search

Forensic investigations frequently utilize facial reconstructions\\/approximations to stimulate recognition and identification.\\u000a Over the past 25 years, many computer-based systems have been developed, and with the recent rapid advances in medical imaging\\u000a and computer technology, the current systems claim high levels of efficiency, objectivity, and flexibility. The history of\\u000a computerized facial approximation\\/reconstruction is presented, along with a discussion of the advantages

Caroline Wilkinson

2005-01-01

354

Bayesian decision-theoretic group sequential clinical trial design based on a quadratic loss function: a frequentist evaluation  

Microsoft Academic Search

The decision to terminate a controlled clinical trial at the time of an interim analysis is perhaps best made by weighing the value of the likely additional information to be gained if further subjects are enrolled against the various costs of that further enrollment. The most commonly used statistical plans for interim analysis (eg, O'Brien–Fleming), however, are based on a

Roger J Lewis; Ari M Lipsky; Donald A Berry

2007-01-01

355

Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups  

Microsoft Academic Search

BACKGROUND: Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence

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

2010-01-01

356

Critical Thinking about Adverse Drug Effects: Lessons from the Psychology of Risk and Medical Decision-Making for Clinical Psychopharmacology  

Microsoft Academic Search

Systematic biases in decision-making have been well characterized in medical and nonmedical fields but mostly ignored in clinical psychopharmacology. The purpose of this paper is to sensitize clinicians who prescribe psychiatric drugs to the issues of the psychology of risk, especially as they pertain to the risk of side effects. Specifically, the present analysis focuses on heuristic organization and framing

Andrew A. Nierenberg; Jordan W. Smoller; Polina Eidelman; Yelena P. Wu; Claire A. Tilley

2008-01-01

357

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components  

Microsoft Academic Search

Problem: Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with

Marcel Lucas Müller; Thomas Ganslandt; Hans-peter Eich; Konrad Lang; Christian Ohmann; Hans-ulrich Prokosch

2001-01-01

358

Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR): Study protocol  

Microsoft Academic Search

BACKGROUND: A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. METHODS\\/DESIGN: The study entitled \\

Bernd Puschner; Sabine Steffen; Mike Slade; Helena Kaliniecka; Mario Maj; Andrea Fiorillo; Povl Munk-Jørgensen; Jens Ivar Larsen; Anikó Égerházi; Zoltan Nemes; Wulf Rössler; Wolfram Kawohl; Thomas Becker

2010-01-01

359

USING SET OF EXPERIENCE KNOWLEDGE STRUCTURE TO EXTEND A RULE SET OF CLINICAL DECISION SUPPORT SYSTEM FOR ALZHEIMER'S DISEASE DIAGNOSIS  

Microsoft Academic Search

In this article we present an experience-based clinical decision support system (CDSS) for the diagnosis of Alzheimer's disease, which enables the discovery of new knowledge in the system and the generation of new rules that drive reasoning. In order to evolve an initial set of production rules given by medical experts we make use of the Set of Experience Knowledge

Carlos Toro; Eider Sanchez; Eduardo Carrasco; Leonardo Mancilla-Amaya; Cesar Sanín; Edward Szczerbicki; Manuel Graña; Patricia Bonachela; Carlos Parra; Gloria Bueno; Frank Guijarro

2012-01-01

360

Impact of a Clinical Decision Support System on the Management of Patients with Hypercholesterolemia in the Primary Healthcare Setting  

Microsoft Academic Search

Introduction and objectives: The Optimcare study objective was to assess the impact on effectiveness and costs of a practice guideline implemented through a clinical decision support system (CDSS) for the management of patients with hypercholesterolemia in the primary healthcare setting. Study design and perspective: The study design was a prospective, naturalistic, single-center (Vila Olimpica Primary Health Care Center, Barcelona, Spain),

Alex Bassa; Miguel del Val; Albert Cobos; Salvador Bergonon; Carlos Crespo; Max Brosa; Silvia Munio; Cristina Espinosa

2005-01-01

361

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

362

Clinical Information System Services and Capabilities Desired for Scalable, Standards-Based, Service-oriented Decision Support: Consensus Assessment of the Health Level 7 Clinical Decision Support Work Group  

PubMed Central

A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service.

Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M.; Huser, Vojtech; Paterno, Marilyn D.; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R.; Haug, Peter J.; Liu, Zhijing; Jenders, Robert A.; Rowed, David W.; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A. Clayton

2012-01-01

363

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

364

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

365

Four principles for user interface design of computerised clinical decision support systems.  

PubMed

The paper presents results from a design research project of a user interface (UI) for a Computerised Clinical Decision Support System (CDSS). The ambition has been to design Human-Computer Interaction (HCI) that can minimise medication errors. Through an iterative design process a digital prototype for prescription of medicine has been developed. This paper presents results from the formative evaluation of the prototype conducted in a simulation laboratory with ten participating physicians. Data from the simulation is analysed by use of theory on how users perceive information. The conclusion is a model, which sum up four principles of interaction for design of CDSS. The four principles for design of user interfaces for CDSS are summarised as four A's: All in one, At a glance, At hand and Attention. The model emphasises integration of all four interaction principles in the design of user interfaces for CDSS, i.e. the model is an integrated model which we suggest as a guide for interaction design when working with preventing medication errors. PMID:21685612

Kanstrup, Anne Marie; Christiansen, Marion Berg; Nøhr, Christian

2011-01-01

366

The impact of anticipatory patient data displays on physician decision making: a pilot study.  

PubMed Central

Computerized patient records have long offered the promise of facilitated access to patient data for clinical decision-making. Nonetheless, the decision process benefits of improved patient data access have been poorly quantified by prior informatics research. We conducted a pilot study to test the feasibility of study methods and gather data for the planning of a future clinical trial designed to assess the impact of patient data summary displays on serum lipid test interpretation time, on targeted data retrieval time for related data, and on decision quality. The pilot demonstrated feasibility and high face validity of the decision-making simulation methods used. Problem-focused patient data summaries appear to reduce time-based decision performance measures by 40-50%, and may improve decision quality even without the inclusion of knowledge-based recommendations or guideline representations.

Elson, R. B.; Connelly, D. P.

1997-01-01

367

Quantitative imaging biomarkers: the application of advanced image processing and analysis to clinical and preclinical decision making.  

PubMed

The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for diagnostic and therapeutic decisions. An important component of the discovery, characterization, validation and application of quantitative imaging biomarkers is the extraction of information and meaning from images through image processing and subsequent analysis. However, many advanced image processing and analysis methods are not applied directly to questions of clinical interest, i.e., for diagnostic and therapeutic decision making, which is a consideration that should be closely linked to the development of such algorithms. This article is meant to address these concerns. First, quantitative imaging biomarkers are introduced by providing definitions and concepts. Then, potential applications of advanced image processing and analysis to areas of quantitative imaging biomarker research are described; specifically, research into osteoarthritis (OA), Alzheimer's disease (AD) and cancer is presented. Then, challenges in quantitative imaging biomarker research are discussed. Finally, a conceptual framework for integrating clinical and preclinical considerations into the development of quantitative imaging biomarkers and their computer-assisted methods of extraction is presented. PMID:22415112

Prescott, Jeffrey William

2013-02-01

368

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

PubMed Central

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, Current Contents, Dissertation Abstracts and Sociological Abstracts were searched for original studies in English or French. Reference lists from retrieved studies were also consulted. Studies were included if they reported a self-administered instrument evaluating physicians' perceptions of the decision-making process within specific clinical encounters, contained sufficient description to permit critical appraisal and presented quantitative results based on administering the instrument. Two individuals independently assessed the eligibility of the instruments and abstracted information on their conceptual underpinnings, main evaluation domain, development, format, reliability, validity and responsiveness. They also assessed the quality of the studies that reported on the development of the instruments with a modified version of STARD. Results Out of 3431 records identified and screened for evaluation, 26 potentially relevant instruments were assessed; 11 met the inclusion criteria. Five instruments were published before 1995. Among those published after 1995, five offered a corresponding patient version. Overall, the main evaluation domains were: satisfaction with the clinical encounter (n = 2), mutual understanding between health professional and patient (n = 2), mental workload (n = 1), frustration with the clinical encounter (n = 1), nurse-physician collaboration (n = 1), perceptions of communication competence (n = 2), degree of comfort with a decision (n = 1) and information on medication (n = 1). For most instruments (n = 10), some reliability and validity criteria were reported in French or English. Overall, the mean number of items on the modified version of STARD was 12.4 (range: 2 to 18). Conclusion This systematic review provides a critical appraisal and repository of instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. More research is needed to pursue the validation of the existing instruments and the development of patient versions. This will help researchers capture the complexity of the decision-making process within specific clinical encounters.

Legare, France; Moher, David; Elwyn, Glyn; LeBlanc, Annie; Gravel, Karine

2007-01-01

369

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

370

Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions.  

PubMed

Developing effective clinical decision support (CDS) systems for the highly complex and dynamic domain of clinical medicine is a serious challenge for designers. Poor usability is one of the core barriers to adoption and a deterrent to its routine use. We reviewed reports describing system implementation efforts and collected best available design conventions, procedures, practices and lessons learned in order to provide developers a short compendium of design goals and recommended principles. This targeted review is focused on CDS related to medication prescribing. Published reports suggest that important principles include consistency of design concepts across networked systems, use of appropriate visual representation of clinical data, use of controlled terminology, presenting advice at the time and place of decision making and matching the most appropriate CDS interventions to clinical goals. Specificity and contextual relevance can be increased by periodic review of trigger rules, analysis of performance logs and maintenance of accurate allergy, problem and medication lists in health records in order to help avoid excessive alerting. Developers need to adopt design practices that include user-centered, iterative design and common standards based on human-computer interaction (HCI) research methods rooted in ethnography and cognitive science. Suggestions outlined in this report may help clarify the goals of optimal CDS design but larger national initiatives are needed for systematic application of human factors in health information technology (HIT) development. Appropriate design strategies are essential for developing meaningful decision support systems that meet the grand challenges of high-quality healthcare. PMID:22995208

Horsky, Jan; Schiff, Gordon D; Johnston, Douglas; Mercincavage, Lauren; Bell, Douglas; Middleton, Blackford

2012-09-17

371

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

372

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

PubMed Central

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 queries. Methods Eight subscription drug information databases: American Hospital Formulary Service Drug Information (AHFS), Clinical Pharmacology (CP), Epocrates Online Premium (EOP), Facts & Comparisons 4.0 Online (FC), Lexi-Comp (LC), Lexi-Comp with AHFS (LC-AHFS), Micromedex (MM), and PEPID PDC (PPDC) and six freely accessible: DailyMed (DM), DIOne (DIO), Epocrates Online Free (EOF), Internet Drug Index (IDI), Johns Hopkins ABX Guide (JHAG), and Medscape Drug Reference (MDR) were evaluated for their scope (presence of an answer) and completeness (on a 3-point scale) in answering 147 infectious disease-specific questions. Questions were divided among five classifications: antibacterial, antiviral, antifungal, antiparasitic, and vaccination/immunization. Classifications were further divided into categories (e.g., dosage, administration, emerging resistance, synergy, and spectrum of activity). Databases were ranked based on scope and completeness scores. ANOVA and Chi-square were used to determine differences between individual databases and between subscription and free databases. Results Scope scores revealed three discrete tiers of database performance: Tier 1 (82-77%), Tier 2 (73-65%) and Tier 3 (56-41%) which were significantly different from each other (p < 0.05). The top tier performers: MM (82%), MDR (81%), LC-AHFS (81%), AHFS (78%), and CP (77%) answered significantly more questions compared to other databases (p < 0.05). Top databases for completeness were: MM (97%), DM (96%), IDI (95%), and MDR (95%). Subscription databases performed better than free databases in all categories (p = 0.03). Databases suffered from 37 erroneous answers for an overall error rate of 1.8%. Conclusion Drug information databases used in ID practice as CDSTs can be valuable resources. MM, MDR, LC-AHFS, AHFS, and CP were shown to be superior in their scope and completeness of information, and MM, AHFS, and MDR provided no erroneous answers. There is room for improvement in all evaluated databases.

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

2008-01-01

373

An agenda for clinical decision making and judgement in nursing research and education.  

PubMed

Nurses' judgements and decisions have the potential to help healthcare systems allocate resources efficiently, promote health gain and patient benefit and prevent harm. Evidence from healthcare systems throughout the world suggests that judgements and decisions made by clinicians could be improved: around half of all adverse events have some kind of error at their core. For nursing to contribute to raising quality though improved judgements and decisions within health systems we need to know more about the decisions and judgements themselves, the interventions likely to improve judgement and decision processes and outcomes, and where best to target finite intellectual and educational resources. There is a rich heritage of research into decision making and judgement, both from within the discipline of nursing and from other perspectives, but which focus on nurses. Much of this evidence plays only a minor role in the development of educational and technological efforts at decision improvement. This paper presents nine unanswered questions that researchers and educators might like to consider as a potential agenda for the future of research into this important area of nursing practice, training and development. PMID:23747201

Thompson, Carl; Aitken, Leanne; Doran, Diane; Dowding, Dawn

2013-06-05

374

Design of Activation Functions for Inference of Fuzzy Cognitive Maps: Application to Clinical Decision Making in Diagnosis of Pulmonary Infection  

PubMed Central

Objectives Fuzzy cognitive maps (FCMs) representing causal knowledge of relationships between medical concepts have been used as prediction tools for clinical decision making. Activation functions used for inferences of FCMs are very important factors in helping physicians make correct decision. Therefore, in order to increase the visibility of inference results, we propose a method for designing certain types of activation functions by considering the characteristics of FCMs. Methods The activation functions, such as the sinusoidal-type function and linear function, are designed by calculating the domain range of the functions to be reached during the inference process of FCMs. Moreover, the designed activation functions were applied to the decision making process with the inference of an FCM model representing the causal knowledge of pulmonary infections. Results Even though sinusoidal-type functions oscillate and linear functions monotonously increase within the entire range of the domain, the designed activation functions make the inference stable because the proposed method notices where the function is used in the inference. And, the designed functions provide more visible numeric results than do other functions. Conclusions Comparing inference results derived using activation functions designed with the proposed method and results derived using activation functions designed with the existing method, we confirmed that the proposed method could be more appropriately used for designing activation functions for the inference process of an FCM for clinical decision making.

Lee, In Keun; Kim, Hwa Sun

2012-01-01

375

Computerized systems for heat treating  

Microsoft Academic Search

The application of computer technology to make furnace operation more efficient and cost effective foreshadows a more productive era for the heat treating industry. This paper discusses the growing need for computerization in heat treating; a primer on computers; a look at a typical microprocessor based control system; and a description of how one forge shop has computerized the control

T. K. Thomas; R. I. Gruber

1981-01-01

376

Using a Service Oriented Architecture Approach to Clinical Decision Support: Performance Results from Two CDS Consortium Demonstrations  

PubMed Central

The Clinical Decision Support Consortium has completed two demonstration trials involving a web service for the execution of clinical decision support (CDS) rules in one or more electronic health record (EHR) systems. The initial trial ran in a local EHR at Partners HealthCare. A second EHR site, associated with Wishard Memorial Hospital, Indianapolis, IN, was added in the second trial. Data were gathered during each 6 month period and analyzed to assess performance, reliability, and response time in the form of means and standard deviations for all technical components of the service, including assembling and preparation of input data. The mean service call time for each period was just over 2 seconds. In this paper we report on the findings and analysis to date while describing the areas for further analysis and optimization as we continue to expand our use of a Services Oriented Architecture approach for CDS across multiple institutions.

Paterno, Marilyn D.; Goldberg, Howard S.; Simonaitis, Linas; Dixon, Brian E.; Wright, Adam; Rocha, Beatriz H.; Ramelson, Harley Z.; Middleton, Blackford

2012-01-01

377

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists  

Microsoft Academic Search

Background  Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical\\u000a microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results\\u000a will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious\\u000a disease management. The

Marjan J Bruins; Gijs JHM Ruijs; Maurice JHM Wolfhagen; Peter Bloembergen; Jos ECM Aarts

2011-01-01

378

Overview of the First Workshop on Medical Content-Based Retrieval for Clinical Decision Support at MICCAI 2009  

Microsoft Academic Search

\\u000a In this paper, we provide an overview of the first workshop on Medical Content–Based Retrieval for Clinical Decision Support\\u000a (MCBR–CDS), which was held in conjunction with the Medical Image Computing and Computer Assisted Intervention (MICCAI) conference\\u000a in 2009 in London, UK. The goal of the workshop was to bring together researchers from diverse communities including medical\\u000a image analyses, text and

Henning Müller; Jayashree Kalpathy-Cramer; Barbara Caputo; Tanveer Fathima Syeda-Mahmood; Fei Wang

2009-01-01

379

Exploration of the factors influencing parental decisions to allow their children to participate in clinical trials in paediatric infectious diseases  

Microsoft Academic Search

AimsTo explore the reasons behind parental decisions about participation of their children in specific paediatric infection clinical research scenarios in order to improve recruitment strategies.MethodsParents of children aged 0–10 years were asked to complete a 20-page researcher-assisted semi-quantitative semi-structured questionnaire while waiting for their child's appointment in the outpatient waiting area. Socio-demographic information was collected. Open-ended and closed questions based

S J Douglas; M Casey; C Liossi; S N Faust

2011-01-01

380

Reimbursement Decisions of the All Wales Medicines Strategy Group: Influence of Policy and Clinical and Economic Factors  

Microsoft Academic Search

Background:Background: There have been several explorations of factors influencing the reimbursement decisions of the National Institute for Health and Clinical Excellence (NICE) but not of other UK-based health technology assessment (HTA) organizations. Abstract: Objective:Objective: This study aimed to explore the factors influencing the recommendations of the All Wales Medicines Strategy Group (AWMSG) on the use of new medicines in Wales.

Warren G. Linley; Dyfrig A. Hughes

2012-01-01

381

Revisiting the p-value: a comparison of statistical evidence in clinical and legal medical decision making†  

Microsoft Academic Search

While the use of p-values in evidence-based medicine (EBM) is consistent and well-defined, the application of statistical information in health law varies greatly. A comparative literature review of clinical and legal medical decision making using Medline (PubMed) and LexisNexis reveals large disparities in the mode and frequency with which statistical evidence is used in EBM when compared with health law.

Kelly H. Zou; L. M. DeTora; S. J. Haker; R. V. Mulkern

2009-01-01

382

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

383

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

384

Development of an Electronic Medical Record-Based Clinical Decision Support Tool to Improve HIV Symptom Management  

PubMed Central

Abstract Common symptoms associated with HIV disease and its management are often underrecognized and undertreated. A clinical decision support tool for symptom management was developed within the Veterans Health Administration electronic medical record (EMR), aiming at increasing provider awareness of and response to common HIV symptoms. Its feasibility was studied in March to May 2007 by implementing it within a weekly HIV clinic, comparing a 4-week intervention period with a 4-week control period. Fifty-six patients and their providers participated in the study. Patients' perceptions of providers' awareness of their symptoms, proportion of progress notes mentioning any symptom(s) and proportion of care plans mentioning any symptom(s) were measured. The clinical decision support tool used portable electronic “tablets” to elicit symptom information at the time of check-in, filtered, and organized that information into a concise and clinically relevant EMR note available at the point of care, and facilitated clinical responses to that information. It appeared to be well accepted by patients and providers and did not substantially impact workflow. Although this pilot study was not powered to detect effectiveness, 25 (93%) patients in the intervention group reported that their providers were very aware of their symptoms versuas 27 (75%) control patients (p = 0.07). The proportion of providers' notes listing symptoms was similar in both periods; however, there was a trend toward including a greater number of symptoms in intervention period progress notes. The symptom support tool seemed to be useful in clinical HIV care. The Veterans Health Administration EMR may be an effective “laboratory” for developing and testing decision supports.

Tsevat, Joel; Justice, Amy C.; Mrus, Joseph M.; Levin, Forrest; Kozal, Michael J.; Mattocks, Kristin; Farber, Steven; Rogers, Michelle; Erdos, Joseph; Brandt, Cynthia; Kudel, Ian; Braithwaite, Ronald

2009-01-01

385

Computerized audio processor  

NASA Astrophysics Data System (ADS)

The Computerized Audio Processor (CAP) is a computer synthesized electronic filter that removes interference from received or recorded speech signals. The CAP automatically detects and attenuates impulse sounds and tones (e.g., ignition noise, switching transients, whistles, chirps, hum, buzzes, FSK telegraphy, etc). It also attenuates wideband random noise. All operations of the CAP are fully automatic. Input signals are processed in real time, with a maximum lag of 340 msec. The CAP implements three proven signal processing techniques. One of these (IMP) virtually eliminates most loud impulse noises. A second technique (DSS) automatically detects tones and attenuates them by up to 46 dB. The third technique (INTEL) provides up to 18 dB attenuation of wideband random noise.

Weiss, M. R.; Aschkenasy, E.

1983-05-01

386

Computerizing natural history collections.  

PubMed

Computers are ubiquitous in the life sciences and are associated with many of the practical and conceptual changes that characterize biology's twentieth-century transformation. Yet comparatively little has been written about how scientists use computers. Despite this relative lack of scholarly attention, the claim that computers revolutionized the life sciences by making the impossible possible is widespread, and relatively unchallenged. How did the introduction of computers into research programs shape scientific practice? The Museum of Vertebrate Zoology (MVZ) at the University of California, Berkeley provides a tractable way into this under-examined question because it is possible to follow the computerization of data in the context of long-term research programs. PMID:23664113

Sunderland, Mary E

2013-05-07

387

Computerized training management system  

DOEpatents

A Computerized Training Management System (CTMS) is disclosed for providing a procedurally defined process that is employed to develop accreditable performance based training programs for job classifications that are sensitive to documented regulations and technical information. CTMS is a database that links information needed to maintain a five-phase approach to training-analysis, design, development, implementation, and evaluation independent of training program design. CTMS is designed using R-Base{trademark}, an-SQL compliant software platform. Information is logically entered and linked in CTMS. Each task is linked directly to a performance objective, which, in turn, is linked directly to a learning objective; then, each enabling objective is linked to its respective test items. In addition, tasks, performance objectives, enabling objectives, and test items are linked to their associated reference documents. CTMS keeps all information up to date since it automatically sorts, files and links all data; CTMS includes key word and reference document searches. 18 figs.

Rice, H.B.; McNair, R.C.; White, K.; Maugeri, T.

1998-08-04

388

Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care  

PubMed Central

Objectives There is variation in antibiotic prescribing for lower respiratory tract infections (LRTI) in primary care that does not benefit patients. This study aims to investigate clinicians' accounts of clinical influences on antibiotic prescribing decisions for LRTI to better understand variation and identify opportunities for improvement. Design Multi country qualitative interview study. Semi-structured interviews using open-ended questions and a patient scenario. Data were subjected to five-stage analytic framework approach (familiarisation, developing a thematic framework from the interview questions and emerging themes, indexing, charting and mapping to search for interpretations), with interviewers commenting on preliminary reports. Setting Primary care. Participants 80 primary care clinicians randomly selected from primary care research networks based in nine European cities. Results Clinicians reported four main individual clinical factors that guided their antibiotic prescribing decision: auscultation, fever, discoloured sputum and breathlessness. These were considered alongside a general impression of the patient derived from building a picture of the illness course, using intuition and familiarity with the patient. Comorbidity and older age were considered main risk factors for poor outcomes. Clinical factors were similar across networks, apart from C reactive protein near patient testing in Tromsø. Clinicians developed ways to handle diagnostic and management uncertainty through their own clinical routines. Conclusions Clinicians emphasised the importance of auscultation, fever, discoloured sputum and breathlessness, general impression of the illness course, familiarity with the patient, comorbidity, and age in informing their antibiotic prescribing decisions for LRTI. As some of these factors may be overemphasised given the evolving evidence base, greater standardisation of assessment and integration of findings may help reduce unhelpful variation in management. Non-clinical influences will also need to be addressed.

Hood, Kerenza; Cooper, Lucy; Coenen, Samuel; Little, Paul; Verheij, Theo; Godycki-Cwirko, Maciek; Melbye, Hasse; Krawczyk, Jaroslaw; Borras-Santos, Alicia; Jakobsen, Kristin; Worby, Patricia; Goossens, Herman; Butler, Christopher C

2012-01-01

389

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

390

Clinical heterogeneity and molecular findings in five Polish patients with glycerol kinase deficiency: investigation of two splice site mutations with computerized splice junction analysis and Xp21 gene-specific mRNA analysis.  

PubMed

Five cases of glycerol kinase deficiency are presented with clinical, biochemical, and genetic results. Two had the glycerol kinase deficiency as part of an Xp21 contiguous gene deletion syndrome-complex form-and three had an isolated form of the enzyme deficiency. In these we found two splice site mutations (IVS1+4A>G, IVS9-1G>T) and one insertion (1393_1394insG). In patients with the complex form, a deletion of the DAX1, GK genes and the distal part of the DMD gene was found. A computerized study was performed to predict the effects of the splice site mutations. It showed that the IVS9-1G>T mutation substantially altered and removed the wild-type site and enhanced a cryptic site seven nucleotides downstream, and that the IVS1+4A>G diminished the strength of the wild-type donor site from strong to leaky. To verify these predictions, we developed an RT-PCR system with gene-specific primers that exclusively amplifies the Xp21 glycerol kinase gene transcript. Identification of individuals at risk is motivated by a need to avoid delay in a correct diagnosis. For reliable identification of heterozygotes for isolated glycerol kinase deficiency, knowledge of the specific mutation in the proband is required. This is easily obtained with the RT-PCR analyses developed in this study. PMID:12855219

Hellerud, Christina; Adamowicz, Maciej; Jurkiewicz, Dorota; Taybert, Joanna; Kubalska, Jolanta; Ciara, Elzbieta; Popowska, Ewa; Ellis, James R; Lindstedt, Sven; Pronicka, Ewa

2003-07-01

391

"Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management  

PubMed Central

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

392

Computerized optometric records and the law.  

PubMed

Today, most computerized optometric records contain the financial and business data for a practice. As technology advances in both optometric instrumentation and computerization, data for the optometric examination is also becoming part of the computerized recordkeeping system. This paper discusses legal aspects of computerized optometric examination records with respect to content, patient confidentiality, authentication for litigation defense, and proper handling by staff. PMID:2915110

Dister, R E; Harris, M G

1989-01-01

393

Computerized performance monitoring systems: use and abuse  

Microsoft Academic Search

An exploratory study of computerized performance monitoring and control systems reveals both positive and negative effects. Responses of 50 clerical workers from 2 organizations with computerized monitoring were compared to 94 individuals from 3 organizations in similar jobs without computerized monitoring. The results indicate that computerized monitoring is associated with perceived increases in office productivity, more accurate and complete assessment

R. H. Irving; Christopher A. Higgins; Frank R. Safayeni

1986-01-01

394

Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers.  

PubMed

Purpose To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. Methods Population-based historical cohort design. Data were extracted from a Canadian provincial workers' compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. Results The population included 8,611 unique claimants. Subjects were predominantly employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. Conclusions The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample. PMID:23468410

Gross, Douglas P; Zhang, Jing; Steenstra, Ivan; Barnsley, Susan; Haws, Calvin; Amell, Tyler; McIntosh, Greg; Cooper, Juliette; Zaiane, Osmar

2013-12-01

395

Reimbursement and clinical guidance for pharmaceuticals in Sweden: do health-economic evaluations support decision making?  

PubMed

Introduction of the new Pharmaceutical Benefits Board (LFN; 1 October 2002) has markedly changed the principles of pricing and reimbursement of drugs in Sweden. The Board is required to make decisions based on information on cost-effectiveness, and pharmaceutical companies must submit economic evaluations when relevant as part of their applications for reimbursement. This study examined experience to date regarding the use of health-economic evaluations and cost-effectiveness information by the LFN. We also describe activities and the use of cost-effectiveness analysis by Swedish local formulary committees organized by the 21 county councils. It is concluded that economic evaluations have supported decision making by LFN, although cost-effectiveness seems to be of varying importance in different situations. While the use of health-economic evaluations and the outcome of decision making by LFN are similar to comparable committees in other countries, there is presently a gap in this sense between the LFN and Swedish local formulary committees. Coordinated decision making is much needed but may be difficult to implement as the perspective, expertise, and objectives of the two public authorities differ. PMID:15968561

Anell, Anders; Persson, Ulf

2005-09-01

396

The Role of Supervisors in Developing Clinical Decision-Making Skills in Child Protective Services (CPS)  

Microsoft Academic Search

Due to the often chaotic and overwhelmed work environment of most CPS units in the state of Tennessee, staff are concerned that critical decisions made throughout the life of any given case are made quickly, with scant information, and with little time given to thoughtful analysis of information that is known. Since the eyes and ears of the frontline case

Jenny L. Jones; Gregory Washington; Susan Steppe

2007-01-01

397

A Survey of Agent-Based Intelligent Decision Support Systems to Support Clinical Management and Research  

Microsoft Academic Search

The research into agent-based intelligent decision support systems is important to the medical industry because these systems can be used to improve the quality of healthcare in many ways. The areas these systems can be used in are diverse from the storage of medical records to the examination and evaluation of real-time data gathered from monitors. These systems are helpful

Darren Foster; Carolyn McGregor; Samir El-Masri

398

Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.  

ERIC Educational Resources Information Center

|Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

Beisecker, Analee E.; And Others

1994-01-01

399

Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.  

ERIC Educational Resources Information Center

Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

Beisecker, Analee E.; And Others

1994-01-01

400

Modeling search in group decision support systems  

Microsoft Academic Search

Groups using group decision support systems (GDSS) to address particular tasks can be viewed as performing a search. Such tasks involve arriving at a solution or decision within the context of a complex search space, warranting the use of computerized decision support tools. The type of search undertaken by the groups appears to be a form of adaptive, rather than

Jackie Rees; Gary J. Koehler

2004-01-01

401

The effect of attitude to risk on decisions made by nurses using computerised decision support software in telephone clinical assessment: an observational study  

Microsoft Academic Search

BACKGROUND: There is variation in the decisions made by telephone assessment nurses using computerised decision support software (CDSS). Variation in nurses' attitudes to risk has been identified as a possible explanatory factor. This study was undertaken to explore the effect of nurses' attitudes to risk on the decisions they make when using CDSS. The setting was NHS 24 which is

Alicia O'Cathain; James Munro; Iain Armstrong; Catherine O'Donnell; David Heaney

2007-01-01

402

Computerized international geothermal information systems  

SciTech Connect

The computerized international geothermal energy information system is reviewed. The review covers establishment of the Italy - United States linked data centers by the NATO Committee on Challenges of Modern Society, through a bilateral agreement, and up to the present time. The result of the information exchange project is given as the bibliographic and numerical data available from the data centers. Recommendations for the exchange of computerized geothermal information at the international level are discussed.

Phillips, S.L.; Lawrence, J.D.; Lepman, S.R.

1980-03-01

403

Clinical Decision Support System and Incidence of Delirium in Cognitively Impaired Older Adults Transferred to Intensive Care  

PubMed Central

Background Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit. Objective To evaluate the efficacy of a computer-based clinical decision support system that recommends consulting a geriatrician and discontinuing use of urinary catheters, physical restraints, and unnecessary anticholinergic drugs in reducing the incidence of delirium. Methods Data for a subgroup of patients enrolled in a large clinical trial who were transferred to the intensive care units of a tertiary-care, urban public hospital in Indianapolis were analyzed. Data were collected on frequency of orders for consultation with a geriatrician; discontinuation of urinary catheterization, physical restraints, or anticholinergic drugs; and the incidence of delirium. Results The sample consisted of 60 adults with cognitive impairment. Mean age was 74.6 years; 45% were African American, and 52% were women. No differences were detected between the intervention and the control groups in orders for consultation with a geriatrician (33% vs 40%; P = .79) or for discontinuation of urinary catheters (72% vs 76%; P = .99), physical restraints (12% vs 0%; P=.47), or anticholinergic drugs (67% vs 36%; P=.37). The 2 groups did not differ in the incidence of delirium (27% vs 29%; P = .85). Conclusion Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium.

Khan, Babar A.; Calvo-Ayala, Enrique; Campbell, Noll; Perkins, Anthony; Ionescu, Ruxandra; Tricker, Jason; Campbell, Tiffany; Zawahiri, Mohammed; Buckley, John D.; Farber, Mark O.; Boustani, Malaz A.

2013-01-01

404

Improving awareness of cancer clinical trials among Hispanic patients and families: audience segmentation decisions for a media intervention.  

PubMed

Clinical trials hold great promise for cancer treatment; yet, Hispanic cancer patients have low rates of clinical trial participation. Lack of awareness and knowledge of clinical trials and language barriers may account for low participation rates. Patient education through audiovisual materials can improve knowledge of and attitudes toward clinical trials among Hispanic populations. In this study, 36 Hispanic cancer patients/survivors and caregivers in Florida and Puerto Rico participated in focus groups to aid in developing a Spanish-language DVD and booklet intervention designed to increase knowledge about clinical trials. Focus group results showed (a) low levels of knowledge about clinical trials, (b) uncertainty about why a physician would expect a patient to make a choice about treatment, and (c) desire for family participation in decision making. Respondents expressed various preferences for aspects of the DVD such as showing extended family in the DVD and physician explanations about key terms. On the basis of these preferences, the authors developed a creative brief for a DVD. The content of the DVD was reviewed by Hispanic community leaders and key stakeholders. A final DVD was created, in Spanish, using Hispanic patients and physicians, which contained the information deemed important from the focus groups and stakeholder interviews. The DVD is complete with companion booklet and currently undergoing a randomized control trial. PMID:23639101

Quinn, Gwendolyn P; McIntyre, Jessica; Gonzalez, Luis E; Antonia, Teresita Muñoz; Antolino, Prado; Wells, Kristen J

2013-05-02

405

The use of computerized transaxial tomography in the diagnosis of tuberous sclerosis.  

PubMed

Computerized transaxial tomography is a useful test for the recognition of tuberous sclerosis when this diagnosis has not been firmly established by clinical methods. In addition, computerized transaxial tomography may demonstrate the location of obstruction in patients with tuberous sclerosis who have developed signs of increased intracranial presure. These generalizations are supported by evidence from four patients investigated by this test. PMID:1099348

Gomez, M R; Mellinger, J F; Reese, D F

1975-09-01

406

treatment planningEvaluation of computer aided learning in developing clinical decision-making skills  

Microsoft Academic Search

Aim The aim of this study was to determine whether an educational intervention delivered by a computer aided learning package improved the sensitivity and specificity of dentists' restorative treatment decisionsMethod The study was a randomised controlled study using a Solomon three-group design. Ninety-five dentists were randomly allocated to the three study groups. One group of dentists read the radiographs pre

B Silkstone; H V Worthington; E J Kay

2001-01-01

407

Mining Hierarchical Decision Rules from Clinical Databases Using Rough Sets aaand Medical Diagnostic Model  

Microsoft Academic Search

One of the most important problems on rule induction methods is that they cannot extract rules, which plausibly represent\\u000a experts’ decision processes. On one hand, rule induction methods induce probabilistic rules, the description length of which\\u000a is too short, compared with the experts’ rules. On the other hand, construction of Bayesian networks generates too lengthy\\u000a rules. In this paper, the

Shusaku Tsumoto

2002-01-01

408

Ethically Justified, Clinically Applicable Criteria for Physician Decision-Making in Psychopharmacological Enhancement  

Microsoft Academic Search

Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention,\\u000a memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in\\u000a the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making\\u000a still remain highly unclear. Here it will be argued that also in the medical domain

Matthis Synofzik

2009-01-01

409

Implementation of Virtual Medical Record Object Model for a Standards-Based Clinical Decision Support Rule Engine  

PubMed Central

The Virtual Medical Record (vMR) is a structured data model for representing individual patient informations1. Our implementation of vMR is based on HL7 Reference Information Model (RIM) v2.13 from which a minimum set of objects and attributes are selected to meet the requirement of a clinical decision support (CDS) rule engine. Our success of mapping local patient data to the vMR model and building a vMR adaptor middle layer demonstrate the feasibility and advantages of implementing a vMR in a portable CDS solution.

Huang, Christine; Noirot, Laura A.; Heard, Kevin M.; Reichley, Richard M.; Dunagan, Wm Claiborne; Bailey, Thomas C.

2006-01-01

410

EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 2: Exploring decision rules for clinical utility  

PubMed Central

Background: Synovial inflammation (as defined by hypertrophy and effusion) is common in osteoarthritis (OA) and may be important in both pain and structural progression. Objective: To determine if decision rules can be devised from clinical findings and ultrasonography (US) to allow recognition of synovial inflammation in patients with painful knee OA. Methods: A EULAR-ESCISIT cross sectional, multicentre study enrolled subjects with painful OA knee who had clinical, radiographic, and US evaluations. A classification and regression tree (CART) analysis was performed to find combinations of predictor variables that would provide high sensitivity and specificity for clinically detecting synovitis and effusion in individual subjects. A range of definitions for the two key US variables, synovitis and effusion (using different combinations of synovial thickness, depth, and appearance), were also included in exploratory analyses. Results: 600 patients with knee OA were included in the analysis. For both knee synovitis and joint effusion, the sensitivity and specificity were poor, yielding unsatisfactory likelihood ratios (75% sensitivity, 45% specificity, and positive LR of 1.36 for knee synovitis; 71.6% sensitivity, 43.2% specificity, and positive LR of 1.26 for joint effusion). The exploratory analyses did not improve the sensitivity and specificity (demonstrating positive LRs of between 1.26 and 1.57). Conclusion: Although it is possible to determine clinical and radiological predictors of OA inflammation in populations, CART analysis could not be used to devise useful clinical decision rules for an individual subject. Thus sensitive imaging techniques such as US remain the most useful tool for demonstrating synovial inflammation of the knee at the individual level.

Conaghan, P; D'Agostino, M; Ravaud, P; Baron, G; Le Bars, M; Grassi, W; Martin-Mola, E; Wakefield, R; Brasseur, J; So, A; Backhaus, M; Malaise, M; Burmester, G; Schmidely, N; Emery, P; Dougados, M

2005-01-01

411

Computerized training of cryosurgery - a system approach.  

PubMed

The objective of the current study is to provide the foundation for a computerized training platform for cryosurgery. Consistent with clinical practice, the training process targets the correlation of the frozen region contour with the target region shape, using medical imaging and accepted criteria for clinical success. The current study focuses on system design considerations, including a bioheat transfer model, simulation techniques, optimal cryoprobe layout strategy, and a simulation core framework. Two fundamentally different approaches were considered for the development of a cryosurgery simulator, based on a finite-elements (FE) commercial code (ANSYS) and a proprietary finite-difference (FD) code. Results of this study demonstrate that the FE simulator is superior in terms of geometric modeling, while the FD simulator is superior in terms of runtime. Benchmarking results further indicate that the FD simulator is superior in terms of usage of memory resources, pre-processing, parallel processing, and post-processing. It is envisioned that future integration of a human-interface module and clinical data into the proposed computer framework will make computerized training of cryosurgery a practical reality. PMID:23995400

Keelan, R; Yamakawa, S; Shimada, K; Rabin, Y

412

Successful clinical trial research in nursing homes: the Improving Decision-Making Study  

Microsoft Academic Search

Background One in four Americans, and 70% of people who have dementia, will spend their final days in nursing home care. Clinical research, particularly clinical trials, rarely includes this population due to unique challenges in research methods and ethics. Families of advanced dementia patients make choices about tube feeding and other feeding options with limited access to information or communication.

Laura C Hanson; Robin Gilliam; Tae Joon Lee

2010-01-01

413

Developing a Computerized Scheduling System for the Steelmaking–Continuous Casting Process  

Microsoft Academic Search

\\u000a Scheduling problems in manufacturing have been studied extensively in the literature. Nevertheless, the development and implementation\\u000a of a computerized scheduling system in industry can raise a number of scientific questions that are still unsolved, concerning\\u000a both the scheduling algorithms for special environments and the design decisions of the scheduling system. This paper presents\\u000a a case study where a computerized scheduling

Hubert Missbauer; Wolfgang Hauber; Werner Stadler

414

Development of a generic computerized nuclear material accountability system  

Microsoft Academic Search

A computerized nuclear material accountability system (NucMAS) has been developed jointly by DuPont at Savannah River Plant (SRP) and Los Alamos National Laboratory (LANL). The SRP is faced with the goal of improving the accuracy and timeliness of nuclear material accountability. Limited manpower, funding, and time led to the decision to develop a single, generic, process-independent computer system for use

M. D. Cornell; J. M. OLeary; S. H. McCutcheon

1987-01-01

415