These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
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

Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients  

Microsoft Academic Search

A prospective controlled intervention cohort study in cancer pain patients (n=50 per group) admitted to radiation oncology wards (62 beds, 3 wards) was conducted in a 1621-bed university hospital. We investigated the effect of an intervention consisting of daily pain assessment using the numeric visual analog scale (NVAS) and pain therapy counseling to clinicians based on a computerized clinical decision

Thilo Bertsche; Vasileios Askoxylakis; Gregor Habl; Friederike Laidig; Jens Kaltschmidt; Simon P. W. Schmitt; Hamid Ghaderi; Angelika Zabel-du Bois; Stefanie Milker-Zabel; Jürgen Debus; Hubert J. Bardenheuer; Walter E. Haefeli

2009-01-01

3

Evaluating the Effectiveness of Nurse-Focused Computerized Clinical Decision Support on Urinary Catheter Practice Guidelines  

ERIC Educational Resources Information Center

A growing national emphasis has been placed on health information technology (HIT) with robust computerized clinical decision support (CCDS) integration into health care delivery. Catheter-associated urinary tract infection is the most frequent health care-associated infection in the United States and is associated with high cost, high volumes and…

Lang, Robin Lynn Neal

2012-01-01

4

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

PubMed Central

There is wide variability in the use and adoption of recommendations generated by computerized clinical decision support systems (CDSSs) despite the benefits they may bring to clinical practice. We conducted a systematic review to explore the barriers to, and facilitators of, CDSS uptake by physicians to guide prescribing decisions. We identified 58 studies by searching electronic databases (1990–2007). Factors impacting on CDSS use included: the availability of hardware, technical support and training; integration of the system into workflows; and the relevance and timeliness of the clinical messages. Further, systems that were endorsed by colleagues, minimized perceived threats to professional autonomy, and did not compromise doctor-patient interactions were accepted by users. Despite advances in technology and CDSS sophistication, most factors were consistently reported over time and across ambulatory and institutional settings. Such factors must be addressed when deploying CDSSs so that improvements in uptake, practice and patient outcomes may be achieved. PMID:20064798

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

2010-01-01

5

Patient-oriented Computerized Clinical Guidelines for Mobile Decision Support in Gestational Diabetes.  

PubMed

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system. PMID:24876573

García-Sáez, Gema; Rigla, Mercedes; Martínez-Sarriegui, Iñaki; Shalom, Erez; Peleg, Mor; Broens, Tom; Pons, Belén; Caballero-Ruíz, Estefanía; Gómez, Enrique J; Hernando, M Elena

2014-03-01

6

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. PMID:22333210

2012-01-01

7

Improving appropriateness of acid-suppressive medication use via computerized clinical decision support.  

PubMed

As part of the Choosing Wisely Campaign, the Society of Hospital Medicine identified reducing inappropriate use of acid-suppressive medication for stress ulcer prophylaxis as 1 of 5 key opportunities to improve the value of care for hospitalized patients. We designed a computerized clinical decision support intervention to reduce use of acid-suppressive medication for stress ulcer prophylaxis in hospitalized patients outside of the intensive care unit at an academic medical center. Using quasiexperimental interrupted time series analysis, we found that the decision support intervention resulted in a significant reduction in use of acid-suppressive medication with stress ulcer prophylaxis selected as the only indication, a nonsignificant reduction in overall use, and no change in use on discharge. We found low rates of use of acid-suppressive medication for the purpose of stress ulcer prophylaxis even before the intervention, and continuing preadmission medication was the most commonly selected indication throughout the study. Our results suggest that attention should be focused on both the inpatient and outpatient settings when designing future initiatives to improve the appropriateness of acid-suppressive medication use. Journal of Hospital Medicine 2015;10:41-45. © 2015 Society of Hospital Medicine. PMID:25603790

Herzig, Shoshana J; Guess, Jamey R; Feinbloom, David B; Adra, May; Afonso, Kevin A; Howell, Michael D; Marcantonio, Edward R

2015-01-01

8

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. PMID:21824382

2011-01-01

9

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. PMID:21824386

2011-01-01

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. PMID:21824383

2011-01-01

11

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

12

Coupling Clinical Decision Support System with Computerized Prescriber Order Entry and their Dynamic Plugging in the Medical Workflow System  

E-print Network

This work deals with coupling Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE) and their dynamic plugging in the medical Workflow Management System (WfMS). First, in this paper we argue some existing CDSS representative of the state of the art in order to emphasize their inability to deal with coupling with CPOE and medical WfMS. The multi-agent technology is at the basis of our proposition since (i) it provides natural abstractions to deal with distribution, heterogeneity and autonomy which are inherent to the previous systems (CDSS, CPOE and medical WfMS), and (ii) it introduces powerful concepts such as organizations, goals and roles useful to describe in details the coordination of the different components involved in these systems. In this paper, we also propose a Multi-Agent System (MAS) to support the coupling CDSS with CPOE. Finally, we show how we integrate the proposed MAS in the medical workflow management system which is also based on collaborating agents

Bouzguenda, Lotfi

2012-01-01

13

Computerized Clinical Electroencephalography in Perspective  

Microsoft Academic Search

Recent developments in the field of computerized clinical electroencephalography (EEG) are surveyed, with particular reference to techniques of analysis of background (stationary) EEG activity, transient (nonstationary) activity, and to integrated systems for multichannel clinical EEG's. A variety of approaches have been used for the basic EEG analyses. For background activity, the fast Fourier transform (FFT) and autoregressive approaches have predominated.

John S. Barlow

1979-01-01

14

Computerized Clinical Simulations.  

ERIC Educational Resources Information Center

Describes technique involved in designing a clinical simulation problem for the allied health field of respiratory therapy; discusses the structure, content, and scoring categories of the simulation; and provides a sample program which illustrates a programming technique in BASIC, including a program listing and a sample flowchart. (MBR)

Reinecker, Lynn

1985-01-01

15

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support  

PubMed Central

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p?

2014-01-01

16

Computerized clinical dietetics management system.  

PubMed

A computerized Clinical Dietetics Management System (CDMS) was designed to support and facilitate accurate and timely delivery of clinical dietetics services. The CDMS is an integral part of a comprehensive hospital computer system that interfaces with 17 data bases. Thirty-one functions provide order processing, inquiry, calculations, message sending, charge capture, data base maintenance, and management reporting capabilities. System features include immediate and continuous access to the most current patient information, automatic routing of messages, a complete diet-order history for each patient and minimal printed output. Since implementation of the CDMS, users report benefits such as smoothing of workload peaks, fewer interruptions, fewer wasted trays, better and faster problem solving, and increased visibility in clinical dietetics services. The dynamic nature of the system allows additional applications to be added as they are developed. PMID:3745746

Weathers, B J; Hoover, L W; Warriner, W J; Dillon, J D

1986-09-01

17

Computerization of a colposcopy clinic.  

PubMed

The first phase of a paperless computer record has been developed at Hammersmith Hospital. The system was designed around the work practices of the clinic staff. In this phase the data are collected on forms which replace the normal case notes. This information is entered onto an IBM compatible computer by the secretary using a quick, user-friendly program written in a dBASE dialect and compiled with Quicksilver. The program produces letters to patients and their doctors and a printed record of the clinic findings for the case sheet to replace the handwritten form. When funding for hardware becomes available the data will be entered directly into the system by the medical staff in the clinic. Clinic appointment lists are maintained and patients "lost to follow-up' can be identified. Ad hoc enquiries can be made using dBASE III Plus or any similar program. This approach has integrated the computerized recording of data in a colposcopy clinic with the normal work of the staff involved so that no extra effort is required from medical or secretarial staff. The immediate accessibility of patient data and the ability to audit the work of the clinic have been particularly useful. PMID:1911593

Soutter, W P

1991-08-01

18

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

19

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

PubMed

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. PMID:22058640

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

2011-07-01

20

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

PubMed Central

Background Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. Methods A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. Results We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. Conclusions We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems. PMID:24083548

2013-01-01

21

Computerized decision support in adult and pediatric critical care.  

PubMed

Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future. PMID:24701413

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

2013-11-01

22

Computerized Decision Support for EPO Dosing in Hemodialysis Patients  

PubMed Central

Background Anemia management in hemodialysis patients poses significant challenges. The present study explored the hypothesis that computerized dosing of intravenous erythropoietin (EPO) would increase the percentage of hemoglobin (Hb) values within the target range and reduce staff time spent on anemia management. Study Design Retrospective cohort Setting and Participants In-center hemodialysis patients who received EPO at Dialysis Clinic Inc dialysis units for at least 3 months between Oct 1, 2005 and April 30, 2006 Quality Improvement Plan Computerized decision support (CDS) for EPO dosing is compared with manual physician-directed dosing. Outcomes and Measurements Achieved monthly Hb values, quantity of EPO administered, and time spent by dialysis unit personnel Measurements Monthly Hb values and the quantity of EPO administered to 1118 patients from 18 dialysis units treated by CDS and 7823 patients from 125 dialysis units treated by manual dosing. Results There was no difference in the likelihood of a monthly Hb of 11–12 g/dl or 10–12 g/dl with CDS as compared with manual dosing. The likelihood of Hb > 12 g/dL decreased and the likelihood of Hb < 10g/dl increased with CDS. EPO use was 4% lower with CDS, although the difference was not statistically significant. CDS was associated with a nearly 50% reduction (p<0.001) in the time spent by dialysis unit staff on anemia management. Limitations Retrospective, non-randomized Conclusion The number of monthly Hb values in a 11 (and 10)–12 g/dl target range and EPO use did not differ with EPO dosing by a CDS as compared with manual dosing. The staff resources devoted to anemia management declined significantly with CDS. PMID:19781831

Miskulin, Dana C.; Weiner, Daniel E.; Tighiouart, Hocine; Ladik, Vladimir; Servilla, Karen; Zager, Philip G.; Martin, Alice; Johnson, HK; Meyer, Klemens B.

2009-01-01

23

Evaluation of a Computerized Clinical Information System (Micromedex).  

PubMed

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database. PMID:1807583

Lundsgaarde, H P; Moreshead, G E

1991-01-01

24

Research Paper: Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System  

Microsoft Academic Search

ObjectiveTo measure critical order check override rates in VA Puget Sound Health Care System's computerized practitioner order entry (CPOE) system and to compare 2006 results to a similar 2001 study.DesignAnalysis of ordering and order check data gathered by a post-hoc logging program. Use of Pearson's chi-square contingency table test comparing results from this study and the earlier study.MeasurementsFactors measured were

Ching-Ping Lin; Thomas H. Payne; W. Paul Nichol; Patricia J. Hoey; Curtis L. Anderson; John H. Gennari

2008-01-01

25

Clinical decision modeling system  

Microsoft Academic Search

BACKGROUND: Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint) probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives

Haiwen Shi; James Lyons-Weiler

2007-01-01

26

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

PubMed

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

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

2014-01-01

27

The clinical decision analysis using decision tree  

PubMed Central

The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients’ value. PMID:25358466

Bae, Jong-Myon

2014-01-01

28

Computerized clinical documentation system in the pediatric intensive care unit  

PubMed Central

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 normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs. PMID:11604105

2001-01-01

29

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

Microsoft Academic Search

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

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

2009-01-01

30

Computerization of tool-replacement decision making in flexible manufacturing systems: a human-systems perspective  

Microsoft Academic Search

In this article, a framework is proposed for computerization of tool-replacement decision making in flexible manufacturing systems (FMSs). Specifically, a procedure is outlined that addresses the decision of whether a tool should or should not be replaced prior to its processing of a workpart. The proposed procedure attempts to minimize the tool-related economic losses associated with these decisions while maximizing

JOSEPH SHARIT; SHARAD ELHENCE

1989-01-01

31

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

32

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. PMID:22738381

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

2012-01-01

33

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

34

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

Microsoft Academic Search

BACKGROUND: Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are

Femke Ongenae; Femke De Backere; Kristof Steurbaut; Kirsten Colpaert; Wannes Kerckhove; Johan Decruyenaere; Filip De Turck

2010-01-01

35

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. PMID:19683066

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

2009-01-01

36

Intelligent marketing information systems: : computerized intelligence for marketing decision making  

Microsoft Academic Search

Marketing knowledge and expertise are a critical corporate resource for carrying out strategic decision making that supports marketing functions. Intelligent marketing information systems (IMkIS) can offer a way for marketing managers to share knowledge and expertise. Such sharing could help improve the economics and effectiveness of the marketing function. Traditional marketing information systems (MkIS) are limited in their managerial support

Chandra S. Amaravadi; Subhashish Samaddar; Siddhartha Dutta

1995-01-01

37

A computerized medical record with direct data entry for community clinics in Israel.  

PubMed Central

CLINIC is a computerized medical record system currently being used in two primary care clinics in Israel. Clinic features direct coded data-entry by the medical personnel via a system based on categories of problems and complaints with common signs and symptoms. PMID:1807725

Urkin, J.; Margolis, C. Z.; Warshawsky, S. S.

1991-01-01

38

The Adolescent Health Review: Test of a Computerized Screening Tool in School-Based Clinics.  

ERIC Educational Resources Information Center

Implemented a computerized screening instrument, the Adolescent Health Review, in urban school-based clinics to test the viability of a stand-alone screening process and its acceptance by patients and providers, examining the relationship between health risks and the stated purpose for the clinic visit. Patients and providers readily accepted the…

Harrison, Patricia A.; Beebe, Timothy J.; Funk, Eunkyung; Rancome, Jeanne

2003-01-01

39

Computerized Neuropsychological Assessment in Aging: Testing Efficacy and Clinical Ecology of Different Interfaces  

PubMed Central

Digital technologies have opened new opportunities for psychological testing, allowing new computerized testing tools to be developed and/or paper and pencil testing tools to be translated to new computerized devices. The question that rises is whether these implementations may introduce some technology-specific effects to be considered in neuropsychological evaluations. Two core aspects have been investigated in this work: the efficacy of tests and the clinical ecology of their administration (the ability to measure real-world test performance), specifically (1) the testing efficacy of a computerized test when response to stimuli is measured using a touch-screen compared to a conventional mouse-control response device; (2) the testing efficacy of a computerized test with respect to different input modalities (visual versus verbal); and (3) the ecology of two computerized assessment modalities (touch-screen and mouse-control), including preference measurements of participants. Our results suggest that (1) touch-screen devices are suitable for administering experimental tasks requiring precise timings for detection, (2) intrinsic nature of neuropsychological tests should always be respected in terms of stimuli presentation when translated to new digitalized environment, and (3) touch-screen devices result in ecological instruments being proposed for the computerized administration of neuropsychological tests with a high level of preference from elderly people. PMID:25147578

Della Rosa, Pasquale Anthony; Catricalà, Eleonora; Castiglioni, Isabella

2014-01-01

40

Decision support for clinical laboratory capacity planning.  

PubMed

The design of a decision support system for capacity planning in clinical laboratories is discussed. The DSS supports decisions concerning the following questions: how should the laboratory be divided into job shops (departments/sections), how should staff be assigned to workstations and how should samples be assigned to workstations for testing. The decision support system contains modules for supporting decisions at the overall laboratory level (concerning the division of the laboratory into job shops) and for supporting decisions at the job shop level (assignment of staff to workstations and sample scheduling). Experiments with these modules are described showing both the functionality and the validity. PMID:7705917

van Merode, G G; Hasman, A; Derks, J; Goldschmidt, H M; Schoenmaker, B; Oosten, M

1995-01-01

41

Clinical Decision Making of Rural Novice Nurses  

ERIC Educational Resources Information Center

The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

Seright, Teresa J.

2010-01-01

42

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

PubMed Central

Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions The framework is an effective solution for computerizing clinical guidelines as it allows for quick development, evaluation and human-readable visualization of the Rules and has a good performance. By monitoring the parameters of the patient to automatically detect exceptional situations and problems and by notifying the medical staff of tasks that need to be performed, the computerized sedation guideline improves the execution of the guideline. PMID:20082700

2010-01-01

43

Effectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis  

PubMed Central

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR]?=?0.96; 95% confidence interval [CI]?=?0.85, 1.08; I2?=?41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR?=?0.82; 95% CI?=?0.68, 0.99; I2?=?64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

Kwag, Koren H.; Lytras, Theodore; Bertizzolo, Lorenzo; Brandt, Linn; Pecoraro, Valentina; Rigon, Giulio; Vaona, Alberto; Ruggiero, Francesca; Mangia, Massimo; Iorio, Alfonso; Kunnamo, Ilkka; Bonovas, Stefanos

2014-01-01

44

Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis.  

PubMed

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR]?=?0.96; 95% confidence interval [CI]?=?0.85, 1.08; I(2)?=?41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR?=?0.82; 95% CI?=?0.68, 0.99; I(2)?=?64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

Moja, Lorenzo; Kwag, Koren H; Lytras, Theodore; Bertizzolo, Lorenzo; Brandt, Linn; Pecoraro, Valentina; Rigon, Giulio; Vaona, Alberto; Ruggiero, Francesca; Mangia, Massimo; Iorio, Alfonso; Kunnamo, Ilkka; Bonovas, Stefanos

2014-12-01

45

Clinical Decision Support at Intermountain Healthcare  

Microsoft Academic Search

Decision support technologies are becoming increasingly available to medical practitioners. A variety of programs designed\\u000a to assist with drug dosing, health maintenance, diagnosis, and other clinically relevant healthcare decisions have been developed\\u000a for the medical workplace. Increasing ease of access to personal computers is partially responsible for this growth. More\\u000a important, however, is the growing dependency on computers to maintain

Peter J. Haug; Reed M. Gardner; R. Scott Evans; Beatriz H. Rocha; Roberto A. Rocha

46

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

47

Computerizing Clinical Pathways: Ontology-Based Modeling and Execution  

E-print Network

, Canada Abstract. Clinical Pathways (CP) stipulate an evidence-based patient care workflow for a specific that they can be executed at the point-of- care. We present our CP modeling approach that features. Introduction In Canada, the management of prostate cancer follows an integrated care approach involving

Abidi, Syed Sibte Raza

48

Parkinson's disease, cognition and aging Clinical, neuropsychological, electrophysiological and cranial computerized tomographic assessment  

Microsoft Academic Search

Forty-three patients with Parkinson's disease (PD) and thirty-seven normal volunteers were subjected to clinical, neuropsychological, neurophysiological (P300 component of the event-related potentials ERP) and radiological (cranial computerized tomographic scanning CCT) evaluation. Intentional memory was more impaired in PD than in normal controls, more so in the demented group of patients, and was related to enlargement of third ventricular size in

Osamah H. Elwan; Osamah H. Baradah; Obsis Madkour; Hassan Elwan; Azza A. H. Hassan; Fadya Elwan; Mamdouh Mahfouz; Ann Ali; Manal Fahmy

1996-01-01

49

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

Microsoft Academic Search

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

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

2003-01-01

50

Computerized Tomography Scans in Severe Asthma: Utility and Clinical Implications  

PubMed Central

Purpose of Review Asthma is a global burden, affecting 5% of the general adult population, of whom approximately 5-10% suffer from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Increasingly novel techniques in computerised tomography are being used to understand the pathophysiology of severe asthma. The utility and clinical implications of these CT techniques are the focus of this review. Recent Findings Novel qualitative and quantitative CT imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure, and perform functional analysis of regional ventilation. Summary Despite advances in CT imaging techniques, there is an urgent need for both proof-of-concept studies, large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure-function relationship, with the potential to discover novel severe asthma phenotypes, predict mortality, morbidity, and response to existing and novel pharmacological and non-pharmacological therapies. PMID:22112997

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

2012-01-01

51

Acknowledging Intuition in Clinical Decision Making  

Microsoft Academic Search

The purpose of this study was to develop and validate a scale to measure nurses’ acknowledgment of using intuition in clinical decision making. Development and validation of the scale was carried out in three phases. In Phase 1, scale items were generated from the published literature in nursing and management and a Content Validity Index (CVI) of .96 was computed

Lynn Rew

2000-01-01

52

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.  

PubMed

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. PMID:20356794

Gillespie, Mary

2010-11-01

53

Dynamic decision models for clinical diagnosis.  

PubMed

A unified approach to clinical decision-making is presented. This combines partially observable Markovian decision processes (Markov or semi-Markov) with cause-effect models as a probabilistic representation of the diagnostic process. Pattern recognition techniques are used in a first stage of system state identification. This new class of dynamic models has a direct application to medical diagnosis and treatment and specific physiological examples are emphasised. The methodology is given for combining the patient state of health, the clinician's state of knowledge of the cause-effect representation from the observation space (measurements), feature selection using pattern recognition techniques and, finally, the treatment decisions with which to restore the patient to a more desirable state of health. A cost functional for the decision process has then to be optimised according to some pre-assigned objective function (social return from the patient state of health or treatment cost for the patient), when the process has an infinite time horizon. PMID:773846

Gheorghe, A V; Bali, H N; Hill, W J; Carson, E R

1976-04-01

54

Driving and dementia: a clinical decision pathway  

PubMed Central

Objective This study aimed to develop a pathway to bring together current UK legislation, good clinical practice and appropriate management strategies that could be applied across a range of healthcare settings. Methods The pathway was constructed by a multidisciplinary clinical team based in a busy Memory Assessment Service. A process of successive iteration was used to develop the pathway, with input and refinement provided via survey and small group meetings with individuals from a wide range of regional clinical networks and diverse clinical backgrounds as well as discussion with mobility centres and Forum of Mobility Centres, UK. Results We present a succinct clinical pathway for patients with dementia, which provides a decision-making framework for how health professionals across a range of disciplines deal with patients with dementia who drive. Conclusions By integrating the latest guidance from diverse roles within older people's health services and key experts in the field, the resulting pathway reflects up-to-date policy and encompasses differing perspectives and good practice. It is potentially a generalisable pathway that can be easily adaptable for use internationally, by replacing UK legislation for local regulations. A limitation of this pathway is that it does not address the concern of mild cognitive impairment and how this condition relates to driving safety. © 2014 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. PMID:24865643

Carter, Kirsty; Monaghan, Sophie; O'Brien, John; Teodorczuk, Andrew; Mosimann, Urs; Taylor, John-Paul

2015-01-01

55

Placement Decisions for First-Time-in-College Students Using the Computerized Placement Test. Information Capsule.  

ERIC Educational Resources Information Center

This information capsule explores the effectiveness of score ranges on the Computerized Placement Test (CPT), used to assess the skills of entry-level students at Miami-Dade Community College and place first-time-in-college students in classes. Data are provided for students entering in Fall terms 1996 and 1997 showing the number of students…

Bashford, Joanne

56

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

PubMed Central

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study. PMID:24910564

Murphy, Elizabeth V.

2014-01-01

57

Engineering of a clinical decision support framework for the point of care use.  

PubMed

Computerized decision support for use at the point of care has to be comprehensive. It means that clinical information stored in electronic health records needs to be integrated with various forms of clinical knowledge (elicited from experts, discovered from data or summarized in systematic reviews of clinical trials). In order to provide such comprehensive support we created the MET-A3Support framework for constructing clinical applications aimed at various medical conditions. We employed the multiagent system paradigm and the O-MaSE methodology to define an engineering process involving three main activities: requirements engineering, analysis and design. Then we applied the process to build MET-A3Support. The paper describes the engineering process and its results, including models representing selected elements of our framework. PMID:18999068

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

2008-01-01

58

Clinical decision-making and pediatric bipolar disorder.  

E-print Network

?? Clinical decision-making in mental health could greatly benefit from evidence-based decision tools, particularly in diagnosing challenging, high-stakes conditions such as pediatric bipolar disorder. The… (more)

Jenkins, Melissa M.

2010-01-01

59

Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial.  

PubMed

This study was aimed to investigate the effects of computerized decision support system in improving the prescription of drugs for cardiovascular prevention. A total of 197 Italian general practitioners were randomly allocated to receive either the alerting computerized decision support system integrated into standard software (intervention arm) or the standard software alone (control arm). Data on 21230 patients with diabetes, 3956 with acute myocardial infarction, and 2158 with stroke were analysed. The proportion of patients prescribed with cardiovascular drugs and days of drug-drug interaction exposure were evaluated. Computerized decision support system significantly increased the proportion of patients with diabetes prescribed with antiplatelet drugs (intervention: +2.7% vs. control: +0.15%; p < 0.001) or lipidlowering drugs (+4.2% vs. +2.8%; p = 0.001). A statistically significant decrease in days of potential interactions has been observed only among patients with stroke (-1.2 vs. -0.5 days/person-year; p = 0.001). In conclusion, computerized decision support system significantly increased the use of recommended cardiovascular drugs in diabetic patients, but it did not influence the exposure to potential interactions. PMID:25210009

Mazzaglia, Giampiero; Piccinni, Carlo; Filippi, Alessandro; Sini, Giovanna; Lapi, Francesco; Sessa, Emiliano; Cricelli, Iacopo; Cutroneo, Paola; Trifirò, Gianluca; Cricelli, Claudio; Caputi, Achille Patrizio

2014-09-10

60

Ontology Engineering to Model Clinical Pathways: Towards the Computerization and Execution of Clinical Pathways  

E-print Network

pathways translate evidence-based recommendations into locally practicable, process-specific algorithms Clinical Pathways (CPs) are evidence-based patient care algorithms that describe the process of care (CPG), clinical evidence and best practices. CPs transform practice recommendations into locally

Abidi, Syed Sibte Raza

61

Strategies for teaching clinical decision-making  

Microsoft Academic Search

Nursing today requires clinicians who are autonomous decision-makers. It is therefore essential that nurses develop effective problem-solving and decision-making skills. The authors have found, both in practice and in searches of the literature, that registered nurses (RNs) appear to lack the skills necessary to make effective decisions. RNs demonstrate a propensity to stereotype, to be influenced by cultural bias and

Jo Boney; Jacqueline D. Baker

1997-01-01

62

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. PMID:21109619

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

2011-01-01

63

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. PMID:19898682

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

2009-01-01

64

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

PubMed Central

Objective Computerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care. Materials and methods Quantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices. Results 132 prescriptions were issued in the course of 73 of the consultations, of which 81 (61%) attracted at least one alert. Of the total of 117 alerts, only three resulted in the GP checking, but not altering, the prescription. CDSS provided information and safety alerts at the point of generating a prescription. This was ‘too much, too late’ as the majority of the ‘work’ of prescribing occurred prior to using the computer. By the time an alert appeared, the GP had formulated the problem(s), potentially spent several minutes considering, explaining, negotiating, and reaching agreement with the patient about the proposed treatment, and had possibly given instructions and printed an information leaflet. Discussion CDSS alerts do not coincide with the prescribing workflow throughout the whole GP consultation. Current systems interrupt to correct decisions that have already been taken, rather than assisting formulation of the management plan. Conclusions CDSS are likely to be more acceptable and effective if the prescribing support is provided much earlier in the process of generating a prescription. PMID:23470696

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

2013-01-01

65

Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine.  

PubMed

Integrated hybrid single photon emission computerized tomography (SPECT)/computer tomography (CT) is a promising new diagnostic imaging modality for orthopedic patients. A high diagnostic yield is available from combining the detection of abnormal bone metabolism with SPECT, to the precise anatomical detail available in high resolution CT. With this review, we endeavor to illustrate the clinical value and future perspectives of SPECT/CT in sports medicine. PMID:21540716

Hirschmann, Michael Tobias; Davda, Kinner; Rasch, Helmut; Arnold, Markus P; Friederich, Niklaus F

2011-06-01

66

Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care: protocol for a large-scale cluster randomized controlled trial.  

PubMed

BackgroundComputerized decision support systems (CDSSs) are increasingly used to improve quality of care. There is evidence for moderate to large effects from randomized controlled trials (RCTs), but evidence on their effectiveness when implemented at a national level is lacking. In the Netherlands, the Dutch College of General Practitioners (NHG) initiated their successful guideline program already 30 years ago. NHGDoc, a CDSS based on these NHG guidelines, covering multiple disease areas for general practice, was developed in 2006 with the aim to improve quality of primary care. In this paper, a protocol is presented to evaluate the uptake and effects of NHGDoc.MethodsA cluster RCT will be conducted among 120 general practices in the Netherlands. Eligible general practices will be randomized to receive either the regular NHGDoc decision support modules (control arm) or the regular modules plus an additional module on heart failure (intervention arm). The heart failure module consists of patient-specific alerts concerning the treatment of patients with heart failure. The effect evaluation will focus on performance indicators (e.g., prescription behavior) as well as on patient outcomes (e.g., hospital admissions) relevant in the domain of heart failure. Additionally, a process evaluation will be conducted to gain insight into the barriers and facilitators that affect the uptake and impact of NHGDoc.DiscussionResultsof this study will provide insight in the uptake and impact of a multiple-domain covering CDSS for primary care implemented by a national guideline organization to improve the quality of primary care. Whereas the trial focuses on a specific domain of care¿heart failure¿conclusions of this study will shed light on the functioning of CDSSs covering multiple disease areas for primary care, particularly as this study also explores the factors contributing to the system¿s uptake and effectiveness.Trial registrationClinical trials NCT01773057. PMID:25322766

Lugtenberg, Marjolein; Westert, Gert P; Pasveer, Dennis; van der Weijden, Trudy; Kool, Rudolf B

2014-10-17

67

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

68

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. PMID:22382386

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

2012-01-01

69

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology.  

PubMed

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. PMID:22394228

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

2012-01-01

70

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology.  

PubMed

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. PMID:22382386

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

2012-05-01

71

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. PMID:20540907

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

2010-01-01

72

Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review  

PubMed Central

Background Greater use of computerized decision support (DS) systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS). Methods Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1) provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2) involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Results Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. The DS literature also emphasizes the importance of organizational culture and training in implementation success. The literature contrasts “rational-analytic” vs. “naturalistic-intuitive” decision-making styles, but the best approach is often a balanced approach that combines both styles. It is also important for DS systems to enable exploration of multiple assumptions, and incorporation of new information in response to changing circumstances. Conclusions Complex, high-level decision-making has common features across disciplines as seemingly disparate as defense, business, and healthcare. National efforts to advance the health information technology agenda through broader CDS adoption could benefit by applying the DS principles identified in this review. PMID:22900537

2012-01-01

73

Improving clinical decisions and outcomes with information: a review  

Microsoft Academic Search

The clinical information available to clinicians is expanding rapidly. It can enhance clinical decision-making, but it can also confuse the process. To be most useful, information should be available at the time and place it is needed and be specific to the task at hand. In the new paradigm of medicine, one based on continuous quality improvement, useful information must

William M. Tierney

2001-01-01

74

Mining Diabetes Complication and Treatment Patterns for Clinical Decision Support  

E-print Network

Mining Diabetes Complication and Treatment Patterns for Clinical Decision Support Lu Liu , Jie Tang to utilize the heterogeneous medical records to aid the clinical treatments of diabetes mellitus. Diabetes mellitus, simply diabetes, is a group of metabolic diseases, which is often accompa- nied with many

75

Medical Decision Making in Clinical Care: Avoiding Common Errors  

E-print Network

4/8/13 1 Medical Decision Making in Clinical Care: Avoiding Common Errors Misbah Keen, MD, MBI, MPH University of Washington School of Medicine 04/2013 Objectives · Describe types of cognitive errors · Illustrate error types with exercises and clinical examples · Discuss strategies for avoiding cognitive

Maxwell, Bruce D.

76

Clinical decision making for caries management in children  

Microsoft Academic Search

The aim of this review of clinical decision making for caries management in children is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures. Current evidence regarding the carious process and caries risk assess- ment allows the practitioner to go beyond traditional surgical management of dental caries. Therapy should focus on patient-specific approaches that

Norman Tinanoff; Joanna M. Douglass

2002-01-01

77

Clinical Decision-Making for Caries Management in Primary Teeth  

Microsoft Academic Search

The aim of this review of clinical decision-making for caries management in primary teeth is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures to aid in the diagnosis and therapy of dental caries in primary teeth. The evidence for this paper is derived from other manuscripts of this conference; computer and hand searches

Joanna M. Douglass

2001-01-01

78

ORIGINAL CONTRIBUTION Clinical Decision Support and  

E-print Network

new antimicro- bial agent development.1 Overuse of an- timicrobial agents fosters the spread infections and therefore are not clinically indicated.9-12 Behavioral fa- cilitators of antimicrobial overuse in the antibiotics "never-indicated" category during the post- intervention period was 32% in CDSS communities and 5

Campbell, A. Malcolm

79

Clinical Decision-Making: Applications of the MARI System  

PubMed Central

The Medical Aggregate Record Inquiry (MARI) system, developed over the past five years, represents empirical decision processes as they occur in the daily practice of medicine. As of this time, MARI provides data on the decision-making practices of physicians relating to 1913 diagnoses, 1150 special diagnostic tests, and 1296 drug therapies on 650 consecutive patients of a major metropolitan hospital, representative of the entire field of Internal Medicine. The MARI software provides for powerful aggregate analyses of the patient records, allowing for the identification and study of clinical decision processes relevant to health care research, practice, education, and administration.

Hall, W. Dallas; Camp, Henry N.; Reynolds, Karen D.; Slamecka, Vladimir

1979-01-01

80

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

81

Clinical decision making regarding endodontics versus implants.  

PubMed

This article discusses the current considerations in treatment planning for retention of the natural tooth through endodontic therapy (including orthograde first-time treatment, retreatment, and endodontic surgery) versus extraction and placement of a dental implant. As a secondary goal, the article describes several specific cases in which the best option is either an implant or retention of the natural tooth. The issue of tooth retention versus implant therapy is also addressed with regard to the specific clinical diagnosis of resorption in all of its various forms. Emphasis has been placed on practical strategies for treatment of cases involving internal and external root resorption using a comprehensive evidence-based approach. PMID:21661658

Derhalli, Munib; Mounce, Richard E

2011-05-01

82

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

83

Clinical Decision-making Processes in Perioperative Nursing  

Microsoft Academic Search

The purpose of this phenomenological study was to reveal the processes of clinical decision making by expert perioperative nurses. Six nurses with a minimum of five years experience who considered themselves to be experts in OR nursing were asked to describe perioperative situations in which they had made a difference in patient outcomes. In every situation described, an intricate pattern

Cheryl B. Parker; Ptlene Minick; Carolyn C. Kee

1999-01-01

84

Developing an Instrument for Information Quality for Clinical Decision Making  

Microsoft Academic Search

This study develops a questionnaire to measure nurses' perceptions of information quality for clinical decision making in hospital settings. The instrument is developed through a pretest, pilot test, and full survey process. A total of 214 questionnaires were received from chief nursing officers in the full survey process. Principal component analysis and Cronbach's alpha are used to confirm the validity

Linda W. Byrd; Terry Anthony Byrd

2012-01-01

85

Thinking Processes Used by Nurses in Clinical Decision Making.  

ERIC Educational Resources Information Center

Interviews with eight medical and surgical nurses and audits of patient charts investigated clinical decision-making processes. Predominant thinking processes were description of facts, selection of information, inference, syntheses, and verification, with differences between medical and surgical specialties. Exemplars of thinking processes…

Higuchi, Kathryn A. Smith; Donald, Janet G.

2002-01-01

86

Adoption of Clinical Decision Support in Multimorbidity: A Systematic Review  

PubMed Central

Background Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks. Objective The aim of this review was to identify to what extent CDS is adopted in multimorbidity. Methods This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness. Results A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients’ clinical records (n=19), clinical practice guidelines (n=12), and clinicians’ knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the decision maker(s). For articles reviewed, there were no studies referring to the active involvement of the patient in the decision-making process or to patient self-management. None of the articles reviewed adopted mobile technologies. There were no rigorous evaluations of usability or effectiveness of the CDS systems reported. Conclusions This review shows that multimorbidity is underinvestigated in the informatics of supporting clinical decisions. CDS interventions that systematize clinical practice guidelines without considering the interactions of different conditions and care processes may lead to unhelpful or harmful clinical actions. To improve patient safety in multimorbidity, there is a need for more evidence about how both conditions and care processes interact. The data needed to build this evidence base exist in many electronic health record systems and are underused.

Arguello Casteleiro, Mercedes; Ainsworth, John; Buchan, Iain

2015-01-01

87

Can patient decision aids help people make good decisions about participating in clinical trials? A study protocol  

Microsoft Academic Search

BACKGROUND: Evidence shows that the standard process for obtaining informed consent in clinical trials can be inadequate, with study participants frequently not understanding even basic information fundamental to giving informed consent. Patient decision aids are effective decision support tools originally designed to help patients make difficult treatment or screening decisions. We propose that incorporating decision aids into the informed consent

Jamie C Brehaut; Alison Lott; Dean A Fergusson; Kaveh G Shojania; Jonathan Kimmelman; Raphael Saginur

2008-01-01

88

Dynamic clinical data mining: search engine-based decision support.  

PubMed

The research world is undergoing a transformation into one in which data, on massive levels, is freely shared. In the clinical world, the capture of data on a consistent basis has only recently begun. We propose an operational vision for a digitally based care system that incorporates data-based clinical decision making. The system would aggregate individual patient electronic medical data in the course of care; query a universal, de-identified clinical database using modified search engine technology in real time; identify prior cases of sufficient similarity as to be instructive to the case at hand; and populate the individual patient's electronic medical record with pertinent decision support material such as suggested interventions and prognosis, based on prior outcomes. Every individual's course, including subsequent outcomes, would then further populate the population database to create a feedback loop to benefit the care of future patients. PMID:25600664

Celi, Leo Anthony; Zimolzak, Andrew J; Stone, David J

2014-01-01

89

Dynamic Clinical Data Mining: Search Engine-Based Decision Support  

PubMed Central

The research world is undergoing a transformation into one in which data, on massive levels, is freely shared. In the clinical world, the capture of data on a consistent basis has only recently begun. We propose an operational vision for a digitally based care system that incorporates data-based clinical decision making. The system would aggregate individual patient electronic medical data in the course of care; query a universal, de-identified clinical database using modified search engine technology in real time; identify prior cases of sufficient similarity as to be instructive to the case at hand; and populate the individual patient's electronic medical record with pertinent decision support material such as suggested interventions and prognosis, based on prior outcomes. Every individual's course, including subsequent outcomes, would then further populate the population database to create a feedback loop to benefit the care of future patients.

Zimolzak, Andrew J; Stone, David J

2014-01-01

90

Improving the implementation of clinical decision support systems.  

PubMed

Clinical decision support (CDS) systems promise to improve the quality of clinical care by helping physicians to make better, more informed decisions efficiently. However, the design and testing of CDS systems for practical medical use is cumbersome. It has been recognized that this may easily lead to a problematic mismatch between the developers' idea of the system and requirements from clinical practice. In this paper, we will present an approach to reduce the complexity of constructing a CDS system. The approach is based on an ontological annotation of data resources, which improves standardization and the semantic processing of data. This, in turn, allows to use data mining tools to automatically create hypotheses for CDS models, which reduces the manual workload in the creation of a new model. The approach is implemented in the context of EU research project p-medicine. A proof of concept implementation on data from an existing Leukemia study is presented. PMID:24110412

Rüping, Stefan; Anguita, Alberto; Bucur, Anca; Cirstea, Traian Cristian; Jacobs, Björn; Torge, Antje

2013-01-01

91

A Computerized Information System Model for Decision Making for the Oklahoma State Department of Vocational and Technical Education.  

ERIC Educational Resources Information Center

The objectives of the study presented in the dissertation were to identify present and anticipated information requirements of the various departments within the Oklahoma State Department of Vocational and Technical Education, to design a computerized information system model utilizing an integrated systems concept to meet information…

Smith, Hubert Gene

92

Operationalizing Prostate Cancer Clinical Pathways: An Ontological Model to Computerize, Merge and  

E-print Network

to be operationalized as a decision-support and care planning tool at the point-of-care. We applied a knowledge man be executed through a logic-based engine to realize a point-of-care decision-support system for managing prostate cancer care. 1 INTRODUCTION Prostate cancer is the most common type of cancer among Cana- dian men

Abidi, Syed Sibte Raza

93

Anti-3-[18F]FACBC Positron Emission Tomography-Computerized Tomography and 111In-Capromab Pendetide Single Photon Emission Computerized Tomography-Computerized Tomography for Recurrent Prostate Carcinoma: Results of a Prospective Clinical Trial  

PubMed Central

Purpose We prospectively evaluated the amino acid analogue positron emission tomography radiotracer anti-3-[18F]FACBC compared to ProstaScint® (111In-capromab pendetide) single photon emission computerized tomography-computerized tomography to detect recurrent prostate carcinoma. Materials and Methods A total of 93 patients met study inclusion criteria who underwent anti-3-[18F]FACBC positron emission tomography-computerized tomography plus 111In-capromab pendetide single photon emission computerized tomography-computerized tomography for suspected recurrent prostate carcinoma within 90 days. Reference standards were applied by a multidisciplinary board. We calculated diagnostic performance for detecting disease. Results In the 91 of 93 patients with sufficient data for a consensus on the presence or absence of prostate/bed disease anti-3-[18F]FACBC had 90.2% sensitivity, 40.0% specificity, 73.6% accuracy, 75.3% positive predictive value and 66.7% negative predictive value compared to 111In-capromab pendetide with 67.2%, 56.7%, 63.7%, 75.9% and 45.9%, respectively. In the 70 of 93 patients with a consensus on the presence or absence of extraprostatic disease anti-3-[18F]FACBC had 55.0% sensitivity, 96.7% specificity, 72.9% accuracy, 95.7% positive predictive value and 61.7% negative predictive value compared to 111In-capromabpendetide with10.0%, 86.7%, 42.9%, 50.0% and 41.9%, respectively. Of 77 index lesions used to prove positivity histological proof was obtained in 74 (96.1%). Anti-3-[18F]FACBC identified 14 more positive prostate bed recurrences (55 vs 41) and 18 more patients with extraprostatic involvement (22 vs 4). Anti-3-[18F]FACBC positron emission tomography-computerized tomography correctly up-staged 18 of 70 cases (25.7%) in which there was a consensus on the presence or absence of extraprostatic involvement. Conclusions Better diagnostic performance was noted for anti-3-[18F]FACBC positron emission tomography-computerized tomography than for 111In-capromab pendetide single photon emission computerized tomography-computerized tomography for prostate carcinoma recurrence. The former method detected significantly more prostatic and extraprostatic disease. PMID:24144687

Schuster, David M.; Nieh, Peter T.; Jani, Ashesh B.; Amzat, Rianot; Bowman, F. DuBois; Halkar, Raghuveer K.; Master, Viraj A.; Nye, Jonathon A.; Odewole, Oluwaseun A.; Osunkoya, Adeboye O.; Savir-Baruch, Bital; Alaei-Taleghani, Pooneh; Goodman, Mark M.

2014-01-01

94

Computerized videokeratoscopy contact lens software for RGP fitting in a bilateral postkeratoplasty patient: a clinical case report.  

PubMed

Computerized videokeratoscopy systems now allow interactive rigid gas permeable (RGP) fitting evaluation using fluorescein pattern simulations through updated software programs. We used Computed Anatomy's Topographic Modeling System-1 (TMS-1) Custom Design Contact Lens Program successfully to refit a symptomatic bilateral post-penetrating keratoplasty patient. No trial lenses were used. For each eye the base curve, optic zone size, and edge lift were chosen from the optimal fluorescein pattern designed and titrated on the TMS-1 unit. Lens powers were based on the patient's previous lenses and overrefraction. Dispensed lenses provided a clinically acceptable fit, good comfort, and maximal visual acuity, and no adjustments were necessary. Corneal videokeratoscopy can be successfully employed to titrate an RGP fit, even on irregular corneas. PMID:7712608

Szczotka, L B; Reinhart, W

1995-01-01

95

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

PubMed Central

Background Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. Methods We present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable. Results Despite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context. Conclusion The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety. PMID:24940129

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

2014-01-01

96

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

ERIC Educational Resources Information Center

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

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

2010-01-01

97

Clinical decision making of nurses working in hospital settings.  

PubMed

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. PMID:21994830

Bjørk, Ida Torunn; Hamilton, Glenys A

2011-01-01

98

IBM’s Health Analytics and Clinical Decision Support  

PubMed Central

Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

2014-01-01

99

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. PMID:23419428

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

2013-01-01

100

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

PubMed Central

Objective Recruitment of patients into time sensitive clinical trials in intensive care units (ICU) poses a significant challenge. Enrollment is limited by delayed recognition and late notification of research personnel. The objective of the present study was to evaluate the effectiveness of the implementation of electronic screening (septic shock sniffer) regarding enrollment into a time sensitive (24?h after onset) clinical study of echocardiography in severe sepsis and septic shock. Design We developed and tested a near-real time computerized alert system, the septic shock sniffer, based on established severe sepsis/septic shock diagnostic criteria. A sniffer scanned patients' data in the electronic medical records and notified the research coordinator on call through an institutional paging system of potentially eligible patients. Measurement The performance of the septic shock sniffer was assessed. Results The septic shock sniffer performed well with a positive predictive value of 34%. Electronic screening doubled enrollment, with 68 of 4460 ICU admissions enrolled during the 9?months after implementation versus 37 of 4149 ICU admissions before sniffer implementation (p<0.05). Efficiency was limited by study coordinator availability (not available at nights or weekends). Conclusions Automated electronic medical records screening improves the efficiency of enrollment and should be a routine tool for the recruitment of patients into time sensitive clinical trials in the ICU setting. PMID:21508415

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

2011-01-01

101

Counseling About Medication-Induced Birth Defects with Clinical Decision Support in Primary Care  

PubMed Central

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

Parisi, Sara M.; Handler, Steven M.; Koren, Gideon; Shevchik, Grant; Fischer, Gary S.

2013-01-01

102

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

Microsoft Academic Search

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

Adam Wright; Dean F. Sittig

2008-01-01

103

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

Microsoft Academic Search

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

Rishikesan Kawaleswaran; Mike Eklund

2011-01-01

104

Clinical decision making: describing the decision rules of practicing speech-language pathologists.  

PubMed

The diagnostic decision-making standards used by practicing clinicians to determine language impairment were investigated. Randomly selected ASHA members who worked with children were asked to review hypothetical and real case profiles of children ages 4 to 9:11 (years: months) with language performance skills ranging from slightly above average to substantially below average. Based on the child's age and language and intelligence test information, clinicians were asked to decide if the child was language impaired (LI) and, if so, to provide a severity rating. Results show significant interrater agreement among the 27 clinicians' LI decisions (generalized kappa = 0.14, p < .0001) and moderate intrarater reliability within clinician's LI decisions (phi = .68). Most of the clinicians' diagnostic decision-making standards could be modeled using stepwise logistic regression. These decision rules can provide guidance for those who wish to employ diagnostic standards that reflect those used in clinical practice. Also, these results provide insight into the manner in which clinicians use information for the determination of language impairment. PMID:8170120

Records, N L; Tomblin, J B

1994-02-01

105

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

106

The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity  

Microsoft Academic Search

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic

Neale R. Chumbler; Jack M. Geller; Andrew W. Weier

2000-01-01

107

Multiple Perspectives on the Meaning of Clinical Decision Support  

PubMed Central

Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects’ multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it even when those perspectives are competing and conflicting. PMID:21347119

Richardson, Joshua E.; Ash, Joan S.; Sittig, Dean F.; Bunce, Arwen; Carpenter, James; Dykstra, Richard H.; Guappone, Ken; McCormack, James; McMullen, Carmit K.; Shapiro, Michael; Wright, Adam; Middleton, Blackford

2010-01-01

108

Multiple Perspectives on the Meaning of Clinical Decision Support  

PubMed Central

Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of a consensus around what is meant by CDS represents a barrier to effective design, use, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects’ multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it; even at times when those perspectives are competing and conflicting. PMID:21347063

Richardson, Joshua E.; Ash, Joan S.; Sittig, Dean F.; Bunce, Arwen; Carpenter, James; Dykstra, Richard H.; Guappone, Ken; McMullen, Carmit K.; Shapiro, Michael; Wright, Adam

2010-01-01

109

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

Cancer.gov

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

110

Biostatistics in clinical decision making for cardiothoracic radiologists.  

PubMed

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

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

2013-11-01

111

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

112

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

113

Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users.  

PubMed

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 education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy. PMID:17934944

Jibaja-Weiss, Maria L; Volk, Robert J

2007-01-01

114

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

115

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

116

Clinical decision support system for the diagnosis of adolescence health.  

PubMed

It is common that children confront psychological problems when they reach puberty. These problems could easily be overcome, but in many cases they could be severe, leading to social estrangement or worse in madness or death. According to information collected we designed a questionnaire about the psychology of adolescents in order to help people in that age or their elders find out if they have health issues. We used already published researches and material concerning all the psychological problems a child can confront in order to make a reliable questionnaire and to develop the clinical decision support system. Our main objective is to publish and administrate a web-based free tool for sharing medical knowledge about any psychological disease a child can already have or develop during puberty. PMID:25417021

Moutsouri, Irene; Nikou, Amalia; Pampalou, Machi; Lentza, Maria; Spyridakis, Paulos; Mathiopoulou, Natassa; Konsoulas, Dimitris; Lampou, Marianna; Alexiou, Athanasios

2015-01-01

117

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

118

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

PubMed

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 at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization. PMID:18935982

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

2009-04-01

119

Do educational interventions improve nurses’ clinical decision making and judgement? A systematic review  

Microsoft Academic Search

ObjectivesDespite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions.

Carl Thompson; Sally Stapley

2011-01-01

120

A Computer Simulation for the Entry-Level Rn: Enhancing Clinical Decision Making  

Microsoft Academic Search

Staff development educators struggle to prepare today's entry-level RN for effective decision making in a new healthcare climate that demands both skill and expertise with patients with high acuity levels. The clinical decision making simulator is an innovative approach to teaching and learning decision-making skills. The authors discuss the development and use of a computer simulation that provides repeated opportunities

Marie N. Bremner; Jane D. Brannan

2000-01-01

121

Decision analysis in clinical cardiology: When is coronary angiography required in aortic stenosis  

Microsoft Academic Search

Decision analysis offers a reproducible, explicit approach to complex clinical decisions. It consists of developing a model, typically a decision tree, that separates choices from chances and that specifies and assigns relative values to outcomes. Sensitivity analysis allows exploration of alternative assumptions. Cost-effectiveness analysis shows the relation between dollars spent and improved health outcomes achieved. In a tutorial format, this

Steven Georgeson; Klemens B. Meyer; Stephen G. Pauker

1990-01-01

122

Use of a computerized decision support system for primary and secondary prevention of work-related MSD disability.  

PubMed

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues. The researchers investigated the utility and effectiveness of the software by analyzing its use over a 20-month period. Of the 197 comments entered by the users, 25% pertained to primary prevention, 75% pertained to secondary prevention, and 94 comments (47.7%) described ergonomic interventions. Use of the software tool improved primary and secondary prevention by improving the quality and efficiency of the ergonomic job analysis process. PMID:16119223

Womack, Sarah K; Armstrong, Thomas J

2005-09-01

123

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

PubMed Central

Purpose To identify the value of unilateral pedal lymphangiography (LAG) with non-contrast CT in the location and treatment decision of idiopathic chylothorax after failure of thoracic duct ligation. Materials and Methods Twenty four patients aged 9–84 year old (median 44 yr) who had idiopathic chylothorax were involved, and unilateral pedal LAG with non-contrast CT was performed in every patient. All patients failed to previous right supra-diaphragmatic thoracic duct ligation. Results The amount of iodized oil used was 6–14 ml with no related complications. LAG demonstrated 8 patients with thoracic duct leaks and 10 patients with leaks elsewhere, but no visible chylous leak in 6 patients. Ligation of thoracic duct was performed as the primary treatment in all 8 cases as having thoracic duct leakage and cured 7(87.5%) patients. For 8 patients not having thoracic duct lesion under LAG, the successful rate of thoracic duct ligation was 25% (2 out of 8 patients), which was significantly lower than patients due to thoracic duct lesions (P?=?0.02). Meanwhile, non-operative therapy had significantly higher successful rate (87.5% vs 25%, P?=?0.02). Conclusions Unilateral pedal LAG with non-contrast CT could identify the causes and locate the leaks of idiopathic chylothorax in 75% of patients after failure of thoracic duct ligation. Two thirds of patients were found not to have thoracic duct leakage and would be better managed by non-operative treatment. PMID:24393538

2014-01-01

124

Decision Making in the PICU: An Examination of Factors Influencing Participation Decisions in Phase III Randomized Clinical Trials  

PubMed Central

Background. In stressful situations, decision making processes related to informed consent may be compromised. Given the profound levels of distress that surrogates of children in pediatric intensive care units (PICU) experience, it is important to understand what factors may be influencing the decision making process beyond the informed consent. The purpose of this study was to evaluate the role of clinician influence and other factors on decision making regarding participation in a randomized clinical trial (RCT). Method. Participants were 76 children under sedation in a PICU and their surrogate decision makers. Measures included the Post Decision Clinician Survey, observer checklist, and post-decision interview. Results. Age of the pediatric patient was related to participation decisions in the RCT such that older children were more likely to be enrolled. Mentioning the sponsoring institution was associated with declining to participate in the RCT. Type of health care provider and overt recommendations to participate were not related to enrollment. Conclusion. Decisions to participate in research by surrogates of children in the PICU appear to relate to child demographics and subtleties in communication; however, no modifiable characteristics were related to increased participation, indicating that the informed consent process may not be compromised in this population. PMID:25161672

Slosky, Laura E.; Burke, Natasha L.; Siminoff, Laura A.

2014-01-01

125

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

126

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. PMID:21477364

2011-01-01

127

Clinical decision support systems for patient safety: a focus group needs assessment with Korean ICU nurses.  

PubMed

An ICU is known as a data-rich environment, and information technology can improve the quality of care by utilizing stored clinical data and providing decision support effectively and in a timely manner to clinicians. The necessity of clinical decision support systems is emphasized now more than ever because patient safety and nursing-sensitive outcomes in the clinical setting have become a critical issue. The purpose of this study was to explore nursing-sensitive outcomes issues related to patient safety in critical care and to understand the types and contents of clinical decision support systems that nurses desire in a clinical practice setting. Focus group interviews were conducted with 37 nurses who worked in one university hospital system in Korea. Our findings are summarized into threats to patient safety, nursing-sensitive outcomes, and the types and contents of clinical decision support systems, which are categorized into the following groups: (1) reminders, notification, alert, and warning systems; (2) point-of-care guidelines; and (3) references for information/guidelines. Nurses consistently stated that clinical decision support systems can help improve nursing outcomes by applying standardized nursing care. Our study is expected to provide a practical suggestion for developing and designing a new clinical decision support system or for refining an existing one. PMID:21415713

Choi, Mona; Choi, Ran; Bae, Young-Ran; Lee, Sun-Mi

2011-11-01

128

Interim monitoring of clinical trials: decision theory, dynamic programming and optimal stopping  

E-print Network

Interim monitoring of clinical trials: decision theory, dynamic programming and optimal stopping.S.A ABSTRACT It is standard practice to monitor clinical trials with a view to stopping early if results multipliers. Applications of these methods in clinical trial design include the derivation of optimal adaptive

Budd, Chris

129

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

130

Critical Thinking and Clinical Decision Making In Critical Care Nursing: A Pilot Study  

Microsoft Academic Search

ObjectiveThis pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity.

Frank D. Hicks; Sharon L. Merritt; Arthur S. Elstein

2003-01-01

131

A study of the use of past experiences in clinical decision making in emergency situations  

Microsoft Academic Search

Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses’ reliance on past experiences and identify associated

J Cioffi

2001-01-01

132

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

E-print Network

1 Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer , IO Ellis*1,4 1 Breast Cancer Pathology Research Group, Division of Oncology, School of Medicine and 2. This, in addition to numbers and complexity of available treatment options, has resulted in decision

Aickelin, Uwe

133

A phenomenologic study of flight nurses' clinical decision-making in emergency situations  

Microsoft Academic Search

Introduction: This article describes a phenomenologic study of Western Australian flight nurses' clinical decision-making in emergency situations in which they were the sole health professional. Method: Following a phenomenologic method, in-depth interviews were analyzed by the method Colaizzi described. The phenomenon of clinical decision-making in emergency situations was explicated and illustrated by a thematic analysis. Results: A gestalt of knowing

Dale Pugh

2002-01-01

134

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

135

Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.  

PubMed

This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise. PMID:20067358

Smith, Megan; Higgs, Joy; Ellis, Elizabeth

2010-02-01

136

Clinical diagnosis of pneumothorax is late: use of trend data and decision support might allow preclinical detection.  

PubMed

Pneumothorax in the newborn has a significant mortality and morbidity. Early diagnosis would be likely to improve the outlook. Forty-two consecutive cases of pneumothorax that developed after admission to a tertiary referral neonatal medical intensive care unit over 4 y from 1993 to 1996 were reviewed. The time of onset of the pneumothorax was determined by retrospective evaluation of the computerized trend of transcutaneous carbon dioxide (tcpCO2) and oxygen tensions. The timing of the occurrence in the notes and x-rays determined the time of clinical diagnosis noted at the time. The difference was the time the condition was undiagnosed. The overall mortality before discharge was 45% (19 cases), four patients succumbing within 2 h. The median time (range) between onset of pneumothorax and clinical diagnosis was 127 min (45-660 min). In most cases, the endotracheal tube was aspirated and the transcutaneous blood gas sensor was repositioned, and in at least 40% of the cases, the baby was reintubated before the diagnosis was made. Reference centiles were constructed for level of tcpCO2 and slope of the trended tcpCO2 over various time intervals (in minutes) from 729 infants from 23 to 42 wk gestation who needed intensive care during the first 7 d of life from the same time period. The 5-min tcpCO2 trend slopes were compared in index and matched control infants. The presence of five consecutive and overlapping 5-min slopes greater than the 90th centile showed good discrimination for a pneumothorax (area under the receiver operating characteristic curve, 89%). We concluded that 1) the clinical diagnosis of pneumothorax was late, occurring when infants decompensate; 2) trend monitoring of tcpCO2 might allow the diagnosis to be made earlier if used properly; and 3) use of reference centiles of the trended slopes of tcpCO2 might be used for automatic decision support in the future. PMID:10960511

McIntosh, N; Becher, J C; Cunningham, S; Stenson, B; Laing, I A; Lyon, A J; Badger, P

2000-09-01

137

Decision support for clinical trial eligibility determination in breast cancer.  

PubMed Central

We have developed a system for clinical trial eligibility determination where patients or primary care providers can enter clinical information about a patient and obtain a ranked list of clinical trials for which the patient is likely to be eligible. We used clinical trial eligibility information from the National Cancer Institute's Physician Data Query (PDQ) database. We translated each free-text eligibility criterion into a machine executable statement using a derivation of the Arden Syntax. Clinical trial protocols were then structured as collections of these eligibility criteria using XML. The application compares the entered patient information against each of the eligibility criteria and returns a numerical score. Results are displayed in order of likelihood of match. We have tested our system using all phase II and III clinical trials for treatment of metastatic breast cancer found in the PDQ database. Preliminary results are encouraging. Images Figure 3 Figure 4 Figure 5 Figure 6 PMID:10566377

Ohno-Machado, L.; Wang, S. J.; Mar, P.; Boxwala, A. A.

1999-01-01

138

Automated decision support and guideline verification in clinical practice  

Microsoft Academic Search

Applying international guidelines in medical, including cardiological, therapies is a guarantee of safe and modern treatment. Unfortunately, standards are often not obeyed. In this paper we present an experimental software program based on rough sets methods. The main aim of this application is to improve patient care and help the decision process using guidelines verification. We concentrate on the practical

R. Mlynarski; G. Ilczuk; E. Pilat; A. Wakulicz-Deja; W. Kargul

2005-01-01

139

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

140

Decision analysis in clinical cardiology: When is coronary angiography required in aortic stenosis  

SciTech Connect

Decision analysis offers a reproducible, explicit approach to complex clinical decisions. It consists of developing a model, typically a decision tree, that separates choices from chances and that specifies and assigns relative values to outcomes. Sensitivity analysis allows exploration of alternative assumptions. Cost-effectiveness analysis shows the relation between dollars spent and improved health outcomes achieved. In a tutorial format, this approach is applied to the decision whether to perform coronary angiography in a patient who requires aortic valve replacement for critical aortic stenosis.

Georgeson, S.; Meyer, K.B.; Pauker, S.G. (Tufts Univ. School of Medicine, Boston, MA (USA))

1990-03-15

141

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

Cancer.gov

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

142

Integrating clinical decision support and smart guidelines: a new approach to evidence based medicine  

E-print Network

. The movement for evidence based medicine is trying to mitigate this problem by maintaining up-to- date clinicalIntegrating clinical decision support and smart guidelines: a new approach to evidence based medicine John Fox1,2,3 , Ioannis Chronakis2,3 , David Glasspool4 , Vivek Patkar3 , Mor Peleg, Matt South

Peleg, Mor

143

The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study  

Microsoft Academic Search

While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM). The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its' manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were

Sarah Brien; Bridget Dibb; Alex Burch

2009-01-01

144

Current triage practice and influences affecting clinical decision-making in emergency departments in NSW, Australia  

Microsoft Academic Search

In Australia, as elsewhere, the nature of triage decision making, patient referral, investigations, physical resources, triage policies, educational requirements and clinical expertise is often unclear and differs between organizations (Gerdtz & Bucknell 2000; Standen 1998). The study described here was undertaken in order to explore current triage practices throughout New South Wales (NSW) and to describe the range of clinical

M. Fry; G. Burr

2001-01-01

145

Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study  

Microsoft Academic Search

BACKGROUND: The scope of practice of paramedics in Canada has steadily evolved to include increasingly complex interventions in the prehospital setting, which likely have repercussions on clinical outcome and patient safety. Clinical decision making has been evaluated in several health professions, but there is a paucity of work in this area on paramedics. This study will utilize the Delphi technique

Jan L Jensen; Pat Croskerry; Andrew H Travers

2009-01-01

146

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

PubMed

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

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

2013-01-01

147

A knowledge authoring tool for clinical decision support.  

PubMed

Anesthesiologists in the operating room are unable to constantly monitor all data generated by physiological monitors. They are further distracted by clinical and educational tasks. An expert system would ideally provide assistance to the anesthesiologist in this data-rich environment. Clinical monitoring expert systems have not been widely adopted, as traditional methods of knowledge encoding require both expert medical and programming skills, making knowledge acquisition difficult. A software application was developed for use as a knowledge authoring tool for physiological monitoring. This application enables clinicians to create knowledge rules without the need of a knowledge engineer or programmer. These rules are designed to provide clinical diagnosis, explanations and treatment advice for optimal patient care to the clinician in real time. By intelligently combining data from physiological monitors and demographical data sources the expert system can use these rules to assist in monitoring the patient. The knowledge authoring process is simplified by limiting connective relationships between rules. The application is designed to allow open collaboration between communities of clinicians to build a library of rules for clinical use. This design provides clinicians with a system for parameter surveillance and expert advice with a transparent pathway of reasoning. A usability evaluation demonstrated that anesthesiologists can rapidly develop useful rules for use in a predefined clinical scenario. PMID:18463794

Dunsmuir, Dustin; Daniels, Jeremy; Brouse, Christopher; Ford, Simon; Ansermino, J Mark

2008-06-01

148

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. PMID:22195102

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

2011-01-01

149

Decision Tree for Inclusion of Minorities in Clinical Research (not an NIH-Defined Phase III Clinical Trial)  

E-print Network

minority group(s); duplicative studies are unnecessary · geographical location has too few eligibleDecision Tree for Inclusion of Minorities in Clinical Research (not an NIH-Defined Phase III plan, any exclusions of minority groups, plans for analysis and outreach. State why

Bandettini, Peter A.

150

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

151

Resident uncertainty in clinical decision making and impact on patient care: a qualitative study  

Microsoft Academic Search

Background:Little is known regarding how internal medicine residents manage uncertainty during decision making and subsequent effects on patient care. The aims of this study were to describe types of uncertainty faced by residents, strategies employed to manage uncertainty and effects on patient care.Methods:Using critical incident technique, residents were asked to recall important clinical decisions during a recent call night, with

J M Farnan; J K Johnson; D O Meltzer; H J Humphrey; V M Arora

2008-01-01

152

Feasibility and clinical decision-making with 3D echocardiography in routine practice  

Microsoft Academic Search

Objective:To assess the feasibility and potential impact of routine three-dimensional (3D) echocardiographic assessment of left ventricular (LV) ejection fraction and volumes on clinical decision-making.Methods:Patients referred to three hospital-based echocardiography laboratories underwent 2D echocardiography (2DE) and 3D echocardiography (3DE). Feasibility was assessed in a group of 168 unselected patients and decision-making assessed within an expanded group of 220 patients. The time

J L Hare; C Jenkins; S Nakatani; A Ogawa; C-M Yu; T H Marwick

2008-01-01

153

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

PubMed

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

Guhde, Jacqueline

2010-01-01

154

Using clinical decision support to maintain medication and problem lists A pilot study to yield higher patient safety  

Microsoft Academic Search

To investigate whether clinical decision support that automates the matching of ordered drugs to problems (clinical diagnoses) on the problem list can enhance the maintenance of both medication and problem lists in the electronic medical record, we designed a clinical decision support system to match ordered drugs on the medication list and ongoing problems on the problem list. We evaluated

Chiang S Jao; Daniel B Hier; William L Galanter

2008-01-01

155

A service oriented approach for guidelines-based clinical decision support using BPMN.  

PubMed

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS). PMID:25160142

Rodriguez-Loya, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

156

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

157

Paying more wisely: effects of payment reforms on evidence-based clinical decision-making.  

PubMed

This article reviews the recent research, policy and conceptual literature on the effects of payment policy reforms on evidence-based clinical decision-making by physicians at the point-of-care. Payment reforms include recalibration of existing fee structures in fee-for-service, pay-for-quality, episode-based bundled payment and global payments. The advantages and disadvantages of these reforms are considered in terms of their effects on the use of evidence in clinical decisions made by physicians and their patients related to the diagnosis, testing, treatment and management of disease. The article concludes with a recommended pathway forward for improving current payment incentives to better support evidence-based decision-making. PMID:24236624

Lake, Timothy K; Rich, Eugene C; Valenzano, Christal Stone; Maxfield, Myles M

2013-05-01

158

Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice  

Microsoft Academic Search

Summary Background. There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH. Method. Standardized questionnaires with sections on

J. K. Krauss; B. Halve

2004-01-01

159

Lesson of the week Playing the odds in clinical decision making  

E-print Network

Lesson of the week Playing the odds in clinical decision making: lessons from berry aneurysms resonance angiography to miss sizeable intracranial aneurysms and to highlight the value of simple neurological deficits.1 2 Intra- cranial aneurysms, the commonest cause of subarach- noid haemorrhage, may

Penny, Will

160

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

161

Multimorbidity, service organization and clinical decision making in primary care: a qualitative study  

Microsoft Academic Search

BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions. OBJECTIVE: To explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making. METHODS: A qualitative interview study with primary care professionals in practices in Greater Manchester, U.K.

P. Bower; W. Macdonald; E. Harkness; L. Gask; T. Kendrick; J. M. Valderas; C. Dickens; T. Blakeman; B. S. Sibbald

2011-01-01

162

Clinical Decision for Strabotomy Based on Improved Nonlinear Mixture of Experts Neural Networks  

Microsoft Academic Search

An improved nonlinear mixture of experts model (ME) provides a modular approach wherein component neural networks are made specialists on subparts of a problem. This paper studied the application of improved ME variants to multivariate nonlinear systems of clinical decision problems, which are known to be difficult to be dealt with. The aim is to develop a new operation quantity

Wei Wang; Lan-Feng Yan; Bao-Wei Liu; Yan-Jun Shi

2006-01-01

163

[Presentation of a computerized clinical record for the study of risk factors and early diagnosis of breast neoplasia].  

PubMed

A new clinical report card is proposed for mass screening for the early diagnosis of breast cancer and the study of the risk factors involved. The card takes the form of a questionnaire on which information is coded for immediate transfer to punched cards. This system makes information easy to file and process on a computer. PMID:3211356

Senni, G A; Puce, E; Bevilacqua, A

1988-12-01

164

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

2012-01-01

165

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

Microsoft Academic Search

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

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

166

Is best interests a relevant decision making standard for enrolling non-capacitated subjects into clinical research?  

Microsoft Academic Search

The ‘best interests’ decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that

Jeffrey T Berger

2010-01-01

167

A controlled time-series trial of clinical reminders: using computerized firm systems to make quality improvement research a routine part of mainstream practice.  

PubMed Central

OBJECTIVE: To explore the feasibility of conducting unobtrusive interventional research in community practice settings by integrating firm-system techniques with time-series analysis of relational-repository data. STUDY SETTING: A satellite teaching clinic divided into two similar, but geographically separated, primary care group practices called firms. One firm was selected by chance to receive the study intervention. Forty-two providers and 2,655 patients participated. STUDY DESIGN: A nonrandomized controlled trial of computer-generated preventive reminders. Net effects were determined by quantitatively combining population-level data from parallel experimental and control interrupted time series extending over two-month baseline and intervention periods. DATA COLLECTION: Mean rates at which mammography, colorectal cancer screening, and cholesterol testing were performed on patients due to receive each maneuver at clinic visits were the trial's outcome measures. PRINCIPAL FINDINGS: Mammography performance increased on the experimental firm by 154 percent (0.24 versus 0.61, p = .03). No effect on fecal occult blood testing was observed. Cholesterol ordering decreased on both the experimental (0.18 versus 0.1 1, p = .02) and control firms (0.13 versus 0.07, p = .03) coincident with national guidelines retreating from recommending screening for young adults. A traditional uncontrolled interrupted time-series design would have incorrectly attributed the experimental-firm decrease to the introduction of reminders. The combined analysis properly indicated that no net prompting effect had occurred, as the difference between firms in cholesterol testing remained stochastically stable over time (0.05 versus 0.04, p = .75). A logistic-regression analysis applied to individual-level data produced equivalent findings. The trial incurred no supplementary data collection costs. CONCLUSIONS: The apparent validity and practicability of our reminder implementation study should encourage others to develop computerized firm systems capable of conducting controlled time-series trials. Images Fig. 1 PMID:10737451

Goldberg, H. I.; Neighbor, W. E.; Cheadle, A. D.; Ramsey, S. D.; Diehr, P.; Gore, E.

2000-01-01

168

Personalized versus non-personalized computerized decision support system to increase therapeutic quality control of oral anticoagulant therapy: an alternating time series analysis  

PubMed Central

Background The quality control of oral anticoagulant therapy (OAT) during the initiation and maintenance treatment is generally poor. Physicians' ordering of OAT (especially fluindione and warfarin) can be improved by dose adjustment algorithms, taking into account the results of International Normalized Ratio (INR). Reminders at the point of care, computerized or not, have been demonstrated to be effective in changing physicians prescription behavior. However, few studies have addressed the benefit of personalized reminders versus non personalized reminders, whereas the personalized reminders require more development to access patient record data and integrate with the computerized physician order entry system. The Hospital Information System of George Pompidou European Hospital integrates an electronic medical record, lab test and drugs order entry system. This system allows to evaluate such reminders and to consider their implementation for routine use as well as the continuous evaluation of their impact on medical practice quality indicators. The objective of this study is to evaluate the impact of two types of reminders on overtreatment by oral anticoagulant: a simple reminder of text formatted dose adjustment table and a personalized recommendation for oral anticoagulant dose and next date of INR control, adapted to patient data. Both types of reminders appear to the physician at the moment of drug ordering. Methods The study is an alternating time series experiment with three 6 months periods, each one including every 2 months according to a Latin square scheme: a control period without any reminder, a period with the simple non personalized reminder, a period with personalized reminder. All patients hospitalized in departments using the computerized physician order entry system and ordered fluindione or warfarin, will be included in the study between November 2004 and May 2006. Main outcome will be the proportion of overcoagulation, as expressed by the proportion of observation time with INR over 4.5, assuming INR change linearly. Secondary outcome is the incidence of major haemorrhagic events. Data will be collected thanks to Hospital Information Systems databases. Data will be analyzed taking into account patient and physician clustering effect. PMID:15456515

Colombet, Isabelle; Bura-Rivière, Alessandra; Chatila, Rémy; Chatellier, Gilles; Durieux, Pierre

2004-01-01

169

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

PubMed Central

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

Urquhart, C J; Hepworth, J B

1996-01-01

170

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients  

PubMed Central

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems. PMID:25471545

2014-01-01

171

Risks, dangers and competing clinical decisions on venous thromboembolism prophylaxis in hospital care.  

PubMed

Drawing on wider sociologies of risk, this article examines the complexity of clinical risks and their management, focusing on risk management systems, expert decision-making and safety standards in health care. At the time of this study preventing venous thromboembolism (VTE) among in-patients was one of the top priorities for hospital safety in the English National Health Service (NHS). An analysis of 50 interviews examining hospital professionals' perceptions about VTE risks and prophylaxis illuminates how National Institute for Health and Clinical Excellence (NICE) guidelines influenced clinical decision-making in four hospitals in one NHS region. We examine four themes: the identification of new risks, the institutionalisation and management of risk, the relationship between risk and danger and the tensions between risk management systems and expert decision-making. The implementation of NICE guidelines for VTE prevention extended managerial control over risk management but some irreducible clinical dangers remained that were beyond the scope of the new VTE risk management systems. Linking sociologies of risk with the realities of hospital risk management reveals the capacity of these theories to illuminate both the possibilities and the limits of managerialism in health care. PMID:24635764

Boiko, Olga; Sheaff, Rod; Child, Susan; Gericke, Christian A

2013-07-01

172

A new standard for incapacitated patient decision making: the clinical standard of surrogate empowerment.  

PubMed

Founded upon the primacy of the principle of respect for autonomy, three methods of surrogate decision making traditionally have been promoted to help the family and friends of incapacitated patients. Unfortunately, the standards of advance directives, substituted judgment, and best interests are often inadequate in practice. Studies report that few patients have formal, written advance directives; that patients often change their minds about treatment over time; that many patients are simply not ready or willing to plan ahead--in part, because some patients and families simply don't believe in autonomy; that those patients who do plan ahead often do not communicate their plans; and that while some patients want their directives followed strictly, many prefer that their surrogates use judgment in making decisions. After reviewing articles describing a variety of alternative approaches, a new clinical standard of surrogate empowerment is proposed to reconcile and integrate these observations and concepts. The "procedure" for this clinical standard is presented. PMID:23469692

Tunzi, Marc

2012-01-01

173

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. PMID:22195151

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

2011-01-01

174

THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKING  

PubMed Central

Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians’ behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians’ behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations. PMID:24761152

van Ryn, Michelle; Burgess, Diana J.; Dovidio, John F.; Phelan, Sean M.; Saha, Somnath; Malat, Jennifer; Griffin, Joan M.; Fu, Steven S.; Perry, Sylvia

2014-01-01

175

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

PubMed Central

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

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

2014-01-01

176

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

PubMed Central

The increasing use of endoscopy has led to more discernable abnormalities in the stomach, including polyps. Gastric polyps encompass a spectrum of pathologic conditions that can vary in histology, neoplastic potential, and management. Despite their high prevalence, there is a paucity of literature to support management and treatment decisions for endoscopists. The goal of this review is to summarize clinical, endoscopic, and histopathologic features of various polyps, review syndromes associated with such polyps, and provide management recommendations. PMID:24764778

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

2013-01-01

177

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

Microsoft Academic Search

This paper examines the value of using intelligent multimedia simulation for the teaching of nursing clinical decision-making skills. The possibilities of multimedia-based educational resources are examined and the rapid growth and questionable effectiveness of current multimedia computer-based learning applications for nursing students are discussed. The advantages and disadvantages of this technology and the problems developing intelligent agent-based systems are examined.

Bernard M. Garrett; David Callear

2001-01-01

178

Utilizing Case-Based Reasoning and Multimedia to Enhance Clinical Decision Making of Novice Practitioners  

Microsoft Academic Search

Abstract This paper describes the outcomes,of a self-paced multimedia learning environment,designed to enhance critical thinking skills in clinical decision making,of graduate nurses entering the workforce. The multimedia-learning environment represents a contrived situation that simulates the complexities of life in a typical hospital ward, which places the users in the role of problem-solvers. Problem solving in the simulation is based on

Mary Oliver; Som Naidu; Andy Koronios

179

The Utilization of a Clinical Decision Support System to Manage Adult Type 2 Diabetes: A Correlational Study  

ERIC Educational Resources Information Center

While the Institute of Medicine (2001) has promoted health information technology to improve the process of care such as compliance with clinical practice guidelines and quicker access to clinical information, diagnostic tests, and treatment results, very little was known about how a clinical decision support system can contribute to diabetes…

Faught, I. Charie

2012-01-01

180

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

181

Decision Tree for Data and Safety Monitoring for Clinical Trials Human Subjects involved? (even if exempted under 45 CFR 46)?  

E-print Network

Decision Tree for Data and Safety Monitoring for Clinical Trials YES NO YES NO YES NO Human not applyIs a Clinical Trial proposed (any Phase) ? Is the Data and Safety Monitoring Plan Acceptable? 1-site clinical trials of interventions with potential risk to participants. Plan not required UNACCEPTABLE

Rau, Don C.

182

Physician Attitudes toward Adopting Genome-Guided Prescribing through Clinical Decision Support  

PubMed Central

This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII). The survey also includes items to measure physicians’ characteristics (awareness, experience, and perceived usefulness), attitudes about personal genome testing (PGT) services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS). The majority were residency program trainees (~88%). Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions.

Overby, Casey Lynnette; Erwin, Angelika Ludtke; Abul-Husn, Noura S.; Ellis, Stephen B.; Scott, Stuart A.; Obeng, Aniwaa Owusu; Kannry, Joseph L.; Hripcsak, George; Bottinger, Erwin P.; Gottesman, Omri

2014-01-01

183

'In silico' oncology for clinical decision making in the context of nephroblastoma.  

PubMed

The present paper outlines the initial version of the ACGT (Advancing Clinico-Genomic Trials) -- an Integrated Project, partly funded by the EC (FP6-2005-IST-026996)I-Oncosimulator as an integrated software system simulating in vivo tumour response to therapeutic modalities within the clinical trials environment aiming to support clinical decision making in individual patients. Cancer treatment optimization is the main goal of the system. The document refers to the technology of the system and the clinical requirements and the types of medical data needed for exploitation in the case of nephroblastoma. The outcome of an initial step towards the clinical adaptation and validation of the system is presented and discussed. Use of anonymized real data before and after chemotherapeutic treatment for the case of the SIOP 2001/GPOH nephroblastoma clinical trial constitutes the basis of the clinical adaptation and validation process. By using real medical data concerning nephroblastoma for a single patient in conjunction with plausible values for the model parameters (based on available literature) a reasonable prediction of the actual tumour volume shrinkage has been made possible. Obviously as more and more sets of medical data are exploited the reliability of the model "tuning" is expected to increase. The successful performance of the initial combined ACGT Oncosimulator platform, although usable up to now only as a test of principle, has been a particularly encouraging step towards the clinical translation of the system, being the first of its kind worldwide. PMID:19437361

Graf, N; Hoppe, A; Georgiadi, E; Belleman, R; Desmedt, C; Dionysiou, D; Erdt, M; Jacques, J; Kolokotroni, E; Lunzer, A; Tsiknakis, M; Stamatakos, G

2009-01-01

184

Use of electronic health records and clinical decision support systems for antimicrobial stewardship.  

PubMed

Electronic health records (EHRs) and clinical decision support systems (CDSSs) have the potential to enhance antimicrobial stewardship. Numerous EHRs and CDSSs are available and have the potential to enable all clinicians and antimicrobial stewardship programs (ASPs) to more efficiently review pharmacy, microbiology, and clinical data. Literature evaluating the impact of EHRs and CDSSs on patient outcomes is lacking, although EHRs with integrated CDSSs have demonstrated improvements in clinical and economic outcomes. Both technologies can be used to enhance existing ASPs and their implementation of core ASP strategies. Resolution of administrative, legal, and technical issues will enhance the acceptance and impact of these systems. EHR systems will increase in value when manufacturers include integrated ASP tools and CDSSs that do not require extensive commitment of information technology resources. Further research is needed to determine the true impact of current systems on ASP and the ultimate goal of improved patient outcomes through optimized antimicrobial use. PMID:25261539

Forrest, Graeme N; Van Schooneveld, Trevor C; Kullar, Ravina; Schulz, Lucas T; Duong, Phu; Postelnick, Michael

2014-10-15

185

Structured representation for core elements of common clinical decision support interventions to facilitate knowledge sharing.  

PubMed

At present, there are no widely accepted, standard approaches for representing computer-based clinical decision support (CDS) intervention types and their structural components. This study aimed to identify key requirements for the representation of five widely utilized CDS intervention types: alerts and reminders, order sets, infobuttons, documentation templates/forms, and relevant data presentation. An XML schema was proposed for representing these interventions and their core structural elements (e.g., general metadata, applicable clinical scenarios, CDS inputs, CDS outputs, and CDS logic) in a shareable manner. The schema was validated by building CDS artifacts for 22 different interventions, targeted toward guidelines and clinical conditions called for in the 2011 Meaningful Use criteria. Custom style sheets were developed to render the XML files in human-readable form. The CDS knowledge artifacts were shared via a public web portal. Our experience also identifies gaps in existing standards and informs future development of standards for CDS knowledge representation and sharing. PMID:23920543

Zhou, Li; Hongsermeier, Tonya; Boxwala, Aziz; Lewis, Janet; Kawamoto, Kensaku; Maviglia, Saverio; Gentile, Douglas; Teich, Jonathan M; Rocha, Roberto; Bell, Douglas; Middleton, Blackford

2013-01-01

186

ASSESSMENT OF UPPER EXTREMITY IMPAIRMENT, FUNCTION, AND ACTIVITY FOLLOWING STROKE: FOUNDATIONS FOR CLINICAL DECISION MAKING  

PubMed Central

The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services. PMID:22975740

Lang, Catherine E.; Bland, Marghuretta D.; Bailey, Ryan R.; Schaefer, Sydney Y.; Birkenmeier, Rebecca L.

2012-01-01

187

Implementation of a clinical decision support system using a service model: results of a feasibility study.  

PubMed

Numerous studies have shown that the quality of health care is inadequate, and healthcare organizations are increasingly turning to clinical decision support systems (CDSS) to address this problem. In implementing CDSS, a highly promising architectural approach is the use of decision support services. However, there are few reported examples of successful implementations of operational CDSS using this approach. Here, we describe how Hospital Italiano de Buenos Aires evaluated the feasibility of using the SEBASTIAN clinical decision support Web service to implement a CDSS integrated with its electronic medical record system. The feasibility study consisted of three stages: first, end-user acceptability testing of the proposed CDSS through focus groups; second, the design and implementation of the system through integration of SEBASTIAN and the authoring of new rules; and finally, validation of system performance and accuracy. Through this study, we found that it is feasible to implement CDSS using a service-based approach. The CDSS is now under evaluation in a randomized controlled trial. The processes and lessons learned from this initiative are discussed. PMID:20841799

Borbolla, Damian; Otero, Carlos; Lobach, David F; Kawamoto, Kensaku; Gomez Saldaño, Ana M; Staccia, Gustavo; Lopez, Gastón; Figar, Silvana; Luna, Daniel; Bernaldo de Quiros, Fernan Gonzalez

2010-01-01

188

AptaCDSS-E: A classifier ensemble-based clinical decision support system for cardiovascular disease level prediction  

E-print Network

AptaCDSS-E: A classifier ensemble-based clinical decision support system for cardiovascular disease); Cardiovascular disease; Classifier ensemble; Support vector machines; Neural networks; Decision trees; Bayesian that cardiovascular disease (CVD), which includes heart disease and stroke, is one of the lead- ing causes of death

189

Influence of MRI field strength on clinical decision making in knee cartilage injury – A case study  

PubMed Central

Objective: To increase clinicians’ awareness of the differences in image resolution and potential diagnostic accuracy between small and large-field MR Scanners. To present an example of a clinical decision making challenge in how to proceed when knee MRI and clinical findings don’t agree. Clinical Features: A 38 year old female mountain biker presented with knee pain and clinical features strongly suggestive of a torn meniscus or loose bodies. An initial MRI using a small field strength (0.18T) scanner was reported as normal. Her clinical presentation was suspicious enough that a repeat MRI on a high-field (1.5T) scanner was ordered. The second MRI included high resolution 3D volumetric imaging which revealed cartilage damage and loose bodies. Intervention and Outcome: The patient was treated with arthroscopic surgery which confirmed the presence of meniscal and chondral injury and resulted in notable improvement in the patient’s symptoms. Conclusion: Clinicians should consider scanner quality and diagnostic accuracy before discounting strongly suggestive clinical history and examination findings when MRIs are reported as normal.

Cashman, Glenn; Attariwala, Raj

2014-01-01

190

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

PubMed Central

Background Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules. Methods The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools. Results While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users. Conclusions A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting. PMID:23145874

2012-01-01

191

Systematic review of clinical decision support interventions with potential for inpatient cost reduction  

PubMed Central

Background Healthcare costs are increasing rapidly and at an unsustainable rate in many countries, and inpatient hospitalizations are a significant driver of these costs. Clinical decision support (CDS) represents a promising approach to not only improve care but to reduce costs in the inpatient setting. The purpose of this study was to systematically review trials of CDS interventions with the potential to reduce inpatient costs, so as to identify promising interventions for more widespread implementation and to inform future research in this area. Methods To identify relevant studies, MEDLINE was searched up to July 2013. CDS intervention studies with the potential to reduce inpatient healthcare costs were identified through titles and abstracts, and full text articles were reviewed to make a final determination on inclusion. Relevant characteristics of the studies were extracted and summarized. Results Following a screening of 7,663 articles, 78 manuscripts were included. 78.2% of studies were controlled before-after studies, and 15.4% were randomized controlled trials. 53.8% of the studies were focused on pharmacotherapy. The majority of manuscripts were published during or after 2008. 70.5% of the studies resulted in statistically and clinically significant improvements in an explicit financial measure or a proxy financial measure. Only 12.8% of the studies directly measured the financial impact of an intervention, whereas the financial impact was inferred in the remainder of studies. Data on cost effectiveness was available for only one study. Conclusions Significantly more research is required on the impact of clinical decision support on inpatient costs. In particular, there is a remarkable gap in the availability of cost effectiveness studies required by policy makers and decision makers in healthcare systems. PMID:24344752

2013-01-01

192

A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature  

PubMed Central

Background Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented. Methods The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors' libraries were searched. Results A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity. Conclusion Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed. PMID:18694490

Murphy, Donald R; Hurwitz, Eric L; Nelson, Craig F

2008-01-01

193

An outcome of evidence-based practice education: sustained clinical decision-making among bedside nurses.  

PubMed

This research described factors related to incorporating evidence-based practice for clinical decision-making by staff nurses who completed an evidence-based practice (EBP) scholars program. A phenomenological approach was used with focus groups to collect data. A semi-structured questionnaire and field notes comprised study instruments. Audio tapes were transcribed and semantic content analysis was used to code data. Programs to teach bedside nurses how to incorporate EBP into care delivery not only result in better outcomes for patients but also greatly contribute to the sustained enculturation of EBP as a foundation for nursing practice. PMID:22999987

Balakas, Karen; Sparks, Laurie; Steurer, Lisa; Bryant, Terry

2013-01-01

194

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.

195

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

196

Clinical decision making in response to performance validity test failure in a psychiatric setting.  

PubMed

This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingering (TOMM) pass/fail (355/81) and secondary gain present/absent (181/255) to examine pass rates associated with patient demographic, clinical and forensic status characteristics. Of the 81 failed PVTs, 48 had secondary gain defined as active criminal legal charges; 33 failed PVTs with no secondary gain. These individuals tended to be older, female, Caucasian, and civilly committed compared with the group with secondary gain who failed. From estimations of TOMM False Positive Rate and True Positive Rate we estimated base rates of neurocognitive malingering for our clinical population using the Test Validation Summary (TVS; Frederick & Bowden, 2009 ). Although PVT failure is clearly more common in a group with secondary gain (31%), there were a number of false positives (11%). Clinical ratings of patients without gain who failed suggested cognitive deficits, behavioral issues, and inattention. Low scores on PVTs in the absence of secondary gain provide useful information on test engagement and can inform clinical decisions about testing. PMID:24678658

Marcopulos, Bernice A; Caillouet, Beth A; Bailey, Christopher M; Tussey, Chriscelyn; Kent, Julie-Ann; Frederick, Richard

2014-01-01

197

Impact of electronic health record clinical decision support on the management of pediatric obesity.  

PubMed

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. PMID:24418755

Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

2015-01-01

198

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

PubMed

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. PMID:19849827

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

2009-01-01

199

The Nijmegen Decision Tool for Chronic Low Back Pain. Development of a Clinical Decision Tool for Secondary or Tertiary Spine Care Specialists  

PubMed Central

Background In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP). Objective To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. Methods A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18–65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience). The pre-set threshold for general agreement was ?70%. The final indicator set was used to develop a clinical decision tool. Results A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence) was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. Conclusions This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps in clinical decision-making spine care, thereby improving efficient use of scarce sources and the outcomes of spinal interventions. PMID:25133645

van Hooff, Miranda L.; van Loon, Jan; van Limbeek, Jacques; de Kleuver, Marinus

2014-01-01

200

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

PubMed Central

The risk of mortality and morbidity of patients with congenital heart defects (CHDs) is highest during neonatal period and increases when diagnosis and proper management are delayed. Neonates with critical CHDs may present with severe cyanosis, respiratory distress, shock, or collapse, all of which are also frequent clinical presentations of various respiratory problems or sepsis in the newborn. Early diagnosis and stabilization and timely referral to a tertiary cardiac center are crucial to improve the outcomes in neonates with CHDs. In this review, the clinical presentation of critical and potentially life-threatening CHDs is discussed along with brief case reviews to help understand the hemodynamics of these defects and ensure proper decision-making in critically ill patients. PMID:21189937

2010-01-01

201

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. PMID:12463828

Fox, John; Thomson, Richard

2002-01-01

202

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. PMID:23304409

McCormack, James L.; Ash, Joan S.

2012-01-01

203

Explicit temporal models for decision-theoretic planning of clinical management.  

PubMed

The management of patients over a prolonged period of time is a complicated task involving both diagnostic and prognostic reasoning with incomplete and often uncertain knowledge. Various formalisations of this type of task exist, but these often conceal one or more essential ingredients of the problem. This article explores the suitability of partially observable Markov decision processes to formalising the planning of clinical management. These processes allow for explicit representation of clinical states of the patient, the management strategy employed, the objectives of treatment, and the role of time and change in reasoning. However, practical application is hampered by their coarse representational granularity and complex formulation. It is discussed how probabilistic network representations can be used to alleviate these obstacles. The resulting method is illustrated with a real-world example from the domain of paediatric cardiology. PMID:10082178

Peek, N B

1999-02-01

204

Principles of educational outreach ('academic detailing') to improve clinical decision making.  

PubMed

With the efficacy and costs of medications rising rapidly, it is increasingly important to ensure that drugs be prescribed as rationally as possible. Yet, physicians' choices of drugs frequently fall short of the ideal of precise and cost-effective decision making. Evidence indicates that such decisions can be improved in a variety of ways. A number of theories and principles of communication and behavior changes can be found that underlie the success of pharmaceutical manufacturers in influencing prescribing practices. Based on this behavioral science and several field trials, it is possible to define the theory and practice of methods to improve physicians' clinical decision making to enhance the quality and cost-effectiveness of care. Some of the most important techniques of such "academic detailing" include (1) conducting interviews to investigate baseline knowledge and motivations for current prescribing patterns, (2) focusing programs on specific categories of physicians as well as on their opinion leaders, (3) defining clear educational and behavioral objectives, (4) establishing credibility through a respected organizational identity, referencing authoritative and unbiased sources of information, and presenting both sides of controversial issues, (5) stimulating active physician participation in educational interactions, (6) using concise graphic educational materials, (7) highlighting and repeating the essential messages, and (8) providing positive reinforcement of improved practices in follow-up visits. Used by the nonprofit sector, the above techniques have been shown to reduce inappropriate prescribing as well as unnecessary health care expenditures. PMID:2104640

Soumerai, S B; Avorn, J

1990-01-26

205

Clinical applications of computerized tomography 3-D reconstruction imaging for diagnosis and surgery in children with large liver tumors or tumors at the hepatic hilum  

Microsoft Academic Search

The present study assessed the benefits of 3-D reconstruction of spiral computerized tomography (CT) scans for the diagnosis\\u000a of and surgical guidance to large liver tumors or tumors at the hepatic hilum. We retrospectively analyzed the cases of 18\\u000a children with large liver tumors or with tumors at the hepatic hilum treated in past 5 years. The ages ranged from 45 days

Qian Dong; Wenjian Xu; Buxian Jiang; Yun Lu; Xiwei Hao; Hong Zhang; Zhong Jiang; Hongting Lu; Chuanmin Yang; Yu Cheng; Xuedong Yang; Dapeng Hao

2007-01-01

206

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

PubMed Central

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered. PMID:7592154

Pfadt, A; Wheeler, D J

1995-01-01

207

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. PMID:20965900

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

2010-01-01

208

A proposed clinical decision support architecture capable of supporting whole genome sequence information.  

PubMed

Whole genome sequence (WGS) information may soon be widely available to help clinicians personalize the care and treatment of patients. However, considerable barriers exist, which may hinder the effective utilization of WGS information in a routine clinical care setting. Clinical decision support (CDS) offers a potential solution to overcome such barriers and to facilitate the effective use of WGS information in the clinic. However, genomic information is complex and will require significant considerations when developing CDS capabilities. As such, this manuscript lays out a conceptual framework for a CDS architecture designed to deliver WGS-guided CDS within the clinical workflow. To handle the complexity and breadth of WGS information, the proposed CDS framework leverages service-oriented capabilities and orchestrates the interaction of several independently-managed components. These independently-managed components include the genome variant knowledge base, the genome database, the CDS knowledge base, a CDS controller and the electronic health record (EHR). A key design feature is that genome data can be stored separately from the EHR. This paper describes in detail: (1) each component of the architecture; (2) the interaction of the components; and (3) how the architecture attempts to overcome the challenges associated with WGS information. We believe that service-oriented CDS capabilities will be essential to using WGS information for personalized medicine. PMID:25411644

Welch, Brandon M; Loya, Salvador Rodriguez; Eilbeck, Karen; Kawamoto, Kensaku

2014-04-01

209

A Proposed Clinical Decision Support Architecture Capable of Supporting Whole Genome Sequence Information  

PubMed Central

Whole genome sequence (WGS) information may soon be widely available to help clinicians personalize the care and treatment of patients. However, considerable barriers exist, which may hinder the effective utilization of WGS information in a routine clinical care setting. Clinical decision support (CDS) offers a potential solution to overcome such barriers and to facilitate the effective use of WGS information in the clinic. However, genomic information is complex and will require significant considerations when developing CDS capabilities. As such, this manuscript lays out a conceptual framework for a CDS architecture designed to deliver WGS-guided CDS within the clinical workflow. To handle the complexity and breadth of WGS information, the proposed CDS framework leverages service-oriented capabilities and orchestrates the interaction of several independently-managed components. These independently-managed components include the genome variant knowledge base, the genome database, the CDS knowledge base, a CDS controller and the electronic health record (EHR). A key design feature is that genome data can be stored separately from the EHR. This paper describes in detail: (1) each component of the architecture; (2) the interaction of the components; and (3) how the architecture attempts to overcome the challenges associated with WGS information. We believe that service-oriented CDS capabilities will be essential to using WGS information for personalized medicine. PMID:25411644

Welch, Brandon M.; Rodriguez Loya, Salvador; Eilbeck, Karen; Kawamoto, Kensaku

2014-01-01

210

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

PubMed Central

Background Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice. Methods First, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient’s preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics. Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables associated with the intention to use the decision aid. Discussion This study will evaluate the impact of the rectal cancer decision aid on patients and help with planning strategies to overcome barriers and facilitate implementation of the decision aid in routine clinical practice. To our knowledge this is the first study designed to evaluate a decision aid in the field of colorectal surgery. PMID:24655353

2014-01-01

211

Referring periodontal patients: clinical decision making by dental and dental hygiene students.  

PubMed

Referral of periodontal patients requires development of a complex set of decision making skills. This study was conducted to determine criteria used by dental and dental hygiene students regarding the referral of periodontal patients for specialty care. Using mixed methods, a thirteen-item survey was developed to elicit the students' perceptions of their knowledge, confidence regarding managing patients, and clinical reasoning related to periodontal patients. The instrument was administered during the summer prior to (T1) and at the end of the students' final year (T2) of training. Seventy-nine dental students (81 percent of total class) and thirty dental hygiene students (83 percent of total class) completed T1. At T2, forty-two dental (44 percent of total class) and twenty-six dental hygiene students (87 percent of total class) completed the questionnaire. While 90 percent of dental and 96 percent of dental hygiene respondents reported a willingness to refer patients with active disease to specialists, only 40 percent of dental and 36 percent of dental hygiene respondents reported confidence in diagnosing, treating, and appropriately referring such patients. The students' ability to recognize critical disease and risk factors influencing referral was good; however, clinical application of that knowledge indicated a gap between knowledge and applied reasoning. The students' attitudes about the importance of periodontal disease and their perceived competence to identify critical disease risk factors were not significantly related (p>0.05) to correct clinical decisions in the case scenarios. The study concludes that dental and dental hygiene curricula should emphasize both the acquisition and application of knowledge regarding criteria for referral of periodontal patients. PMID:24609346

Williams, Karen B; Burgardt, Grayson J; Rapley, John W; Bray, Kimberly K; Cobb, Charles M

2014-03-01

212

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

PubMed Central

In recent years, advanced magnetic resonance imaging (MRI) techniques, such as magnetic resonance spectroscopy, diffusion weighted imaging, diffusion tensor imaging and perfusion weighted imaging have been used in order to resolve demanding diagnostic problems such as brain tumor characterization and grading, as these techniques offer a more detailed and non-invasive evaluation of the area under study. In the last decade a great effort has been made to import and utilize intelligent systems in the so-called clinical decision support systems (CDSS) for automatic processing, classification, evaluation and representation of MRI data in order for advanced MRI techniques to become a part of the clinical routine, since the amount of data from the aforementioned techniques has gradually increased. Hence, the purpose of the current review article is two-fold. The first is to review and evaluate the progress that has been made towards the utilization of CDSS based on data from advanced MRI techniques. The second is to analyze and propose the future work that has to be done, based on the existing problems and challenges, especially taking into account the new imaging techniques and parameters that can be introduced into intelligent systems to significantly improve their diagnostic specificity and clinical application. PMID:24778769

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

2014-01-01

213

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

PubMed Central

Background: Current management of breast cancer (BC) relies on risk stratification based on well-defined clinicopathologic factors. Global gene expression profiling studies have demonstrated that BC comprises distinct molecular classes with clinical relevance. In this study, we hypothesised that molecular features of BC are a key driver of tumour behaviour and when coupled with a novel and bespoke application of established clinicopathologic prognostic variables can predict both clinical outcome and relevant therapeutic options more accurately than existing methods. Methods: In the current study, a comprehensive panel of biomarkers with relevance to BC was applied to a large and well-characterised series of BC, using immunohistochemistry and different multivariate clustering techniques, to identify the key molecular classes. Subsequently, each class was further stratified using a set of well-defined prognostic clinicopathologic variables. These variables were combined in formulae to prognostically stratify different molecular classes, collectively known as the Nottingham Prognostic Index Plus (NPI+). The NPI+ was then used to predict outcome in the different molecular classes. Results: Seven core molecular classes were identified using a selective panel of 10 biomarkers. Incorporation of clinicopathologic variables in a second-stage analysis resulted in identification of distinct prognostic groups within each molecular class (NPI+). Outcome analysis showed that using the bespoke NPI formulae for each biological BC class provides improved patient outcome stratification superior to the traditional NPI. Conclusion: This study provides proof-of-principle evidence for the use of NPI+ in supporting improved individualised clinical decision making. PMID:24619074

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

2014-01-01

214

Computerized Grading of Anatomy Laboratory Practical Examinations  

ERIC Educational Resources Information Center

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

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

2008-01-01

215

The 2013 symposium on pathology data integration and clinical decision support and the current state of field  

PubMed Central

Background: Pathologists and informaticians are becoming increasingly interested in electronic clinical decision support for pathology, laboratory medicine and clinical diagnosis. Improved decision support may optimize laboratory test selection, improve test result interpretation and permit the extraction of enhanced diagnostic information from existing laboratory data. Nonetheless, the field of pathology decision support is still developing. To facilitate the exchange of ideas and preliminary studies, we convened a symposium entitled: Pathology data integration and clinical decision support. Methods: The symposium was held at the Massachusetts General Hospital, on May 10, 2013. Participants were selected to represent diverse backgrounds and interests and were from nine different institutions in eight different states. Results: The day included 16 plenary talks and three panel discussions, together covering four broad areas. Summaries of each presentation are included in this manuscript. Conclusions: A number of recurrent themes emerged from the symposium. Among the most pervasive was the dichotomy between diagnostic data and diagnostic information, including the opportunities that laboratories may have to use electronic systems and algorithms to convert the data they generate into more useful information. Differences between human talents and computer abilities were described; well-designed symbioses between humans and computers may ultimately optimize diagnosis. Another key theme related to the unique needs and challenges in providing decision support for genomics and other emerging diagnostic modalities. Finally, many talks relayed how the barriers to bringing decision support toward reality are primarily personnel, political, infrastructural and administrative challenges rather than technological limitations. PMID:24672737

Baron, Jason M.; Dighe, Anand S.; Arnaout, Ramy; Balis, Ulysses J.; Black-Schaffer, W. Stephen; Carter, Alexis B.; Henricks, Walter H.; Higgins, John M.; Jackson, Brian R.; Kim, JiYeon; Klepeis, Veronica E.; Le, Long P.; Louis, David N.; Mandelker, Diana; Mermel, Craig H.; Michaelson, James S.; Nagarajan, Rakesh; Platt, Mihae E.; Quinn, Andrew M.; Rao, Luigi; Shirts, Brian H.; Gilbertson, John R.

2014-01-01

216

Clinical decision support in small community practice settings: a case study  

PubMed Central

Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12?years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation. PMID:21504995

Sittig, Dean F; Wright, Adam; McMullen, Carmit; Shapiro, Michael; Bunce, Arwen; Middleton, Blackford

2011-01-01

217

Clinical prediction models to inform individualized decision-making in subfertile couples: a stratified medicine approach.  

PubMed

Infertility is defined as failure to conceive after 1 year of unprotected intercourse. This dichotomization into fertile versus infertile, based on lack of conception over 12-month period, is fundamentally flawed. Time to conception is strongly influenced by factors such as female age and whilst a minority of couples have absolute infertility (sterility), many are able to conceive without intervention but may take longer to do so, reflecting the degree of subfertility. This natural variability in time to conception means that subfertility reflects a prognosis rather than a diagnosis. Current clinical prediction models in fertility only provide individualized estimates of the probability of either treatment-independent pregnancy or treatment-dependent pregnancy, but do not take account of both. Together, prognostic factors which are able to predict natural pregnancy and predictive factors of response to treatment would be required to estimate the absolute increase in pregnancy chances with treatment. This stratified medicine approach would be appropriate for facilitating personalized decision-making concerning whether or not to treat subfertile patients. Published models are thus far of little value for decisions regarding when to initiate treatment in patients who undergo a period of, ultimately unsuccessful, expectant management. We submit that a dynamic prediction approach, which estimates the change in subfertility prognosis over the course of follow-up, would be ideally suited to inform when the commencement of treatment would be most beneficial in those undergoing expectant management. Further research needs to be undertaken to identify treatment predictive factors and to identify or create databases to allow these approaches to be explored. In the interim, the most feasible approach is to use a combination of previously published clinical prediction models. PMID:25061025

McLernon, D J; te Velde, E R; Steyerberg, E W; Mol, B W J; Bhattacharya, S

2014-09-01

218

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

NASA Astrophysics Data System (ADS)

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

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

2008-01-01

219

A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation  

PubMed Central

Aims The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime for the prevention of stroke in patients who are newly diagnosed with non-valvular atrial fibrillation. Methods and results The CHA2DS2-VASc and HAS-BLED scoring systems were used to assess patients’ baseline risks of stroke and major bleeding, respectively. The relative risks of stroke and major bleeding for each antithrombotic agent were then used to identify the agent associated with the lowest net risk. Individual patient factors such as the treatment threshold, bleeding ratio, and cost threshold modified the recommendations in order to generate a final recommendation. By considering both patient factors and clinical research concurrently, this clinical decision aid is able to provide specific advice to clinicians regarding an optimal stroke prevention strategy. The resulting treatment recommendation tables are consistent with the recommendations of the European Society of Cardiology and Canadian Cardiovascular Society Guidelines, which can be incorporated into either a paper-based or electronic format to allow clinicians to have decision support at the point of care. Conclusion The use of a clinical decision aid that considers both patient factors and evidence-based medicine will serve to bridge the knowledge gap and provide practical guidance to clinicians in the prevention of stroke due to atrial fibrillation. PMID:22752615

LaHaye, Stephen Andrew; Gibbens, Sabra Lynn; Ball, David Gerald Andrew; Day, Andrew George; Olesen, Jonas Bjerring; Skanes, Allan Cameron

2012-01-01

220

Comparison of residents’ approaches to clinical decisions before and after the implementation of Evidence Based Medicine course  

PubMed Central

Introduction: It has been found that the decision-making process in medicine is affected, to a large extent, by one’s experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making. Methods: The present quasi-experimental study was carried out on 110 clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researcher-made questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents’ viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals’ viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14. Results: The results demonstrated that evidence-based medicine workshop significantly affected the residents’ decision-making approaches (p<0.001). The pre-test showed that principles-based, reference-based and routine model-based approaches were more preferred before the program (p<0.001). However, after the implementation of the program, the dominant approaches used by the residents in their decision making were evidence-based ones.  Conclusion: To develop the evidence-based approach, it is necessary for educational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should develop more in the medical departments. PMID:25512942

KARIMIAN, ZAHRA; KOJURI, JAVAD; SAGHEB, MOHAMMAD MAHDI; MAHBOUDI, ALI; SABER, MAHBOOBEH; AMINI, MITRA; DEHGHANI, MOHAMMAD REZA

2014-01-01

221

A framework for genomic biomarker actionability and its use in clinical decision making  

PubMed Central

The increasing scope and availability of genetic testing options for patients suffering from cancer has raised questions about how to use results of molecular diagnostics to inform patient care. For some biomarkers (e.g. BRAF mutations in melanoma), standards exist that outline treatments for individuals harboring aberrations in the biomarker; however for the vast majority of genomic abnormalities, few guidelines exist. Clinical decision making and the therapeutic approach for a patient with a given cancer characterized by aberrations in different genes may be aided by the use of a biomarker actionability framework that provides levels of evidence regarding whether and how a molecular abnormality can be considered a therapeutically relevant biomarker. A gene may be considered theoretically actionable if it has a basis of actionability, such that clinically available drugs can target a gene product that drives the cancer or is differentially expressed in tumor versus normal elements. Herein, we discuss a possible framework for developing guidelines for actionability, as they relate to genomically-based cancer therapeutics. PMID:25593991

Janku, Filip; Garrido-Laguna, Ignacio; Munoz, Javier; Schwab, Richard; Subbiah, Vivek; Rodon, Jordi; Kurzrock, Razelle

2014-01-01

222

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. PMID:21603282

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

223

Supporting clinical decision making during deep brain stimulation surgery by means of a stochastic dynamical model  

NASA Astrophysics Data System (ADS)

Objective. During deep brain stimulation (DBS) surgery for the treatment of advanced Parkinson's disease (PD), microelectrode recording (MER) in conjunction with functional stimulation techniques are commonly applied for accurate electrode implantation. However, the development of automatic methods for clinical decision making has to date been characterized by the absence of a robust single-biomarker approach. Moreover, it has only been restricted to the framework of MER without encompassing intraoperative macrostimulation. Here, we propose an integrated series of novel single-biomarker approaches applicable to the entire electrophysiological procedure by means of a stochastic dynamical model. Approach. The methods are applied to MER data pertinent to ten DBS procedures. Considering the presence of measurement noise, we initially employ a multivariate phase synchronization index for automatic delineation of the functional boundaries of the subthalamic nucleus (STN) and determination of the acceptable MER trajectories. By introducing the index into a nonlinear stochastic model, appropriately fitted to pre-selected MERs, we simulate the neuronal response to periodic stimuli (130 Hz), and examine the Lyapunov exponent as an indirect indicator of the clinical effectiveness yielded by stimulation at the corresponding sites. Main results. Compared with the gold-standard dataset of annotations made intraoperatively by clinical experts, the STN detection methodology demonstrates a false negative rate of 4.8% and a false positive rate of 0%, across all trajectories. Site eligibility for implantation of the DBS electrode, as implicitly determined through the Lyapunov exponent of the proposed stochastic model, displays a sensitivity of 71.43%. Significance. The suggested comprehensive method exhibits remarkable performance in automatically determining both the acceptable MER trajectories and the optimal stimulation sites, thereby having the potential to accelerate precise target finalization during DBS surgery for PD.

Karamintziou, Sofia D.; Tsirogiannis, George L.; Stathis, Pantelis G.; Tagaris, George A.; Boviatsis, Efstathios J.; Sakas, Damianos E.; Nikita, Konstantina S.

2014-10-01

224

Clinical benefits of a multivariable prediction model for bladder cancer: a decision analytic approach  

PubMed Central

Background Multivariable prediction models have been shown to predict cancer outcomes more accurately than cancer stage. The effects on clinical management are unclear. We aimed to determine whether a published multivariable prediction model for bladder cancer (“bladder nomogram”) improves medical decision making, using referral for adjuvant chemotherapy as a model. Methods We analyzed data from an international cohort study of 4462 patients undergoing cystectomy without chemotherapy 1969 – 2004. The number of patients eligible for chemotherapy was determined using pathologic stage criteria (lymph node positive or stage pT3 or pT4), and for three cut-offs on the bladder nomogram (10%, 25% and 70% risk of recurrence with surgery alone). The number of recurrences was calculated by applying a relative risk reduction to eligible patients' baseline risk. Clinical net benefit was then calculated by combining recurrences and treatments, weighting the latter by a factor related to drug tolerability. Results A nomogram cut-off outperformed pathologic stage for chemotherapy for every scenario of drug effectiveness and tolerability. For a drug with a relative risk of 0.80, where clinicians would treat no more than 20 patients to prevent one recurrence, use of the nomogram was equivalent to a strategy that resulted in 60 fewer chemotherapy treatments per 1000 patients without any increase in recurrence rates. Conclusions Referring cystectomy patients to adjuvant chemotherapy on the basis of a multivariable model is likely to lead to better patient outcomes than the use of pathological stage. Further research is warranted to evaluate the clinical effects of multivariable prediction models. PMID:19823979

Vickers, Andrew J; Cronin, Angel M; Kattan, Michael W; Gonen, Mithat; Scardino, Peter T; Milowsky, Matthew I.; Dalbagni, Guido; Bochner, Bernard H.

2009-01-01

225

Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters  

PubMed Central

Objective To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes. Methods Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions. Results Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD?=?23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p?=?0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter. Conclusion Clinicians’ fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended. PMID:24559190

2014-01-01

226

Student specialty plans, clinical decision-making, and health care reform  

PubMed Central

Background and objectives Health care reform aims to increase evidence based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost, comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims. Methods We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection or initial chronic disease management scenarios, representing in turn, evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses. Results Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost-conscious (p=.01) and more patient-centered (p<.001). We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes. Conclusions This study provides preliminary evidence suggesting that students planning to enter family practice may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes. PMID:24915476

Williams, Robert L.; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina; Sussman, Andrew L.; Zyzanski, Stephen J.

2014-01-01

227

A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making.  

PubMed

Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n?=?6), good (n?=?20), fair (n?=?0) or weak (n?=?3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p?

Stacey, Dawn; Brière, Nathalie; Robitaille, Hubert; Fraser, Kimberly; Desroches, Sophie; Légaré, France

2014-09-01

228

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

229

Impact of Patient Characteristics and Clinical Factors on the Decision to Initiate Growth Hormone Treatment in Turner Syndrome  

Microsoft Academic Search

Background\\/Aims: To evaluate factors contributing to the decision to initiate treatment with growth hormone (GH) in patients with Turner syndrome (TS). Methods: Data collected included ethnicity, parents’ education and work status, mid-parental height, age at diagnosis, karyotype, pubertal development, clinical severity score, bone age, height SDS and ages when GH was proposed and initiated. Results: GH was proposed to 59

Karine Khatchadourian; Céline Huot; Nathalie Alos; Guy Van Vliet; Cheri Deal

2008-01-01

230

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

231

Developing an instrument to measure and describe clinical decision making in different nursing fields  

Microsoft Academic Search

The purpose of this study was to develop and test a decision-making instrument for nursing, to consider the nursing decision-making models in different nursing fields, and to create a scoring system for the instrument. A 56-item instrument was developed on the basis of different decision-making theories and earlier studies about nursing decision making. The instrument was evaluated by using several

Sirkka Lauri; Sanna Salanterä

2002-01-01

232

[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

2013-01-01

233

Current Status and Future Prospects for Electronic Point-of-Care Clinical Decision Support in Diabetes Care  

PubMed Central

Early efforts to use point-of-care clinical decision support (CDS) were limited to the use of prompts and reminders, which improved test ordering but not intermediate outcomes of care such as glucose, blood pressure, or lipid levels. More sophisticated diabetes CDS tools are now available that use electronic medical record data to provide patient-specific advice on medication use based on previous treatment, distance from goal, and other clinical data. These tools have shown modest but significant improvement in glucose and blood pressure control. Promising next-generation developments will include prioritizing clinical actions that have maximum benefit to a given patient at the point of care and developing effective methods to communicate CDS information to patients to better incorporate patient preferences in care decisions. PMID:23225213

O’Connor, Patrick J.; Desai, Jay; Butler, John; Kharbanda, Elyse; Sperl-Hillen, JoAnn M.

2013-01-01

234

Clinical Decision Support System to Enhance Quality Control of Spirometry Using Information and Communication Technologies  

PubMed Central

Background We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings. Objective The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry. Methods The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes. Results The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity. Conclusions Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting. PMID:25600957

2014-01-01

235

Molecular profiling of liver tumors: classification and clinical translation for decision making.  

PubMed

Hepatocellular carcinoma (HCC) is a complex disease with a dismal prognosis. Consequently, a translational approach is required to personalized clinical decision making to improve survival of HCC patients. Molecular signatures from cirrhotic livers and single nucleotide polymorphism have been linked with HCC occurrence. Identification of high-risk populations will be useful to design chemopreventive trials. In addition, molecular signatures derived from tumor and nontumor samples are associated with early tumor recurrence due to metastasis and late tumor recurrence due to de novo carcinogenesis after curative treatment, respectively. Identification of patients with a high risk of relapse will guide adjuvant randomized trials. The genetic landscape drawn by next-generation sequencing has highlighted the genomic diversity of HCC. Genetic drivers recurrently mutated belong to different signaling pathways including telomere maintenance, cell-cycle regulators, chromatin remodeling, Wnt/b-catenin, RAS/RAF/MAPK kinase, and AKT/mTOR pathway. These cancer genes will be ideally targeted by biotherapies as a paradigm of stratified medicine adapted to tumor biology. PMID:25369299

Pinyol, Roser; Nault, Jean Charles; Quetglas, Iris M; Zucman-Rossi, Jessica; Llovet, Josep M

2014-11-01

236

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

237

Changing attitudes about end-of-life decision making of medical students during third-year clinical clerkships.  

PubMed

To better define the learning objectives of ethics curricula and evaluate changes in medical students' attitudes about end-of-life decision making, enrolled students (N = 96) of a pilot medical ethics program were surveyed at the beginning and end of their third-year clinical clerkship about their experiences and attitudes about end-of-life decision making. At the end of their clinical clerkship year, the majority of students had participated in end-of-life decisions, prioritized patient autonomy and quality-of-life issues, were concerned about legal liability, were polarized over issues such as physician-assisted suicide, and gained confidence in their ethical decision-making ability. To train future physicians such that clinical practice is consistent with ethical guidelines and legislation on end-of-life care, medical ethics curricula should focus on symptom relief, clarification of legal issues, and resolution of conflicts between personal beliefs and public opinion about such issues as physician-assisted suicide. Appropriate role-modeling and mentoring by residents and attending physicians should also be emphasized. PMID:10341532

Hayes, R P; Stoudemire, A S; Kinlaw, K; Dell, M L; Loomis, A

1999-01-01

238

Computerized Fleet Maintenance.  

ERIC Educational Resources Information Center

The computerization of school bus maintenance records by the Niskayuna (New York) Central School District enabled the district's transportation department to engage in management practices resulting in significant savings. The district obtains computer analyses of the work performed on all vehicles, including time spent, parts, labor, costs,…

Cataldo, John J.

239

Computerized geophysical tomography  

Microsoft Academic Search

Computerized tomography is used as an aid in geophysical exploration. With this method, detailed pictures of electromagnetic properties in the regions between pairs of boreholes can be reconstructed. The spatial distribution of attenuation or propagation velocity is calculated from line integrals along rays in the plane between boreholes, and displayed as a digital picture. In principle, the transmission of seismic

K. A. Dines; R. J. Lytle

1979-01-01

240

A 2014 Medical Informatics Perspective on Clinical Decision Support Systems: Do We Hit The Ceiling of Effectiveness?  

PubMed Central

Summary Objective To summarize recent research and propose a selection of best papers published in 2013 in the field of computer-based decision support in health care. Method Two literature reviews were performed by the two section editors from bibliographic databases with a focus on clinical decision support systems (CDSSs) and computer provider order entry in order to select a list of candidate best papers to be peer-reviewed by external reviewers. Results The full review process highlighted three papers, illustrating current trends in the domain of clinical decision support. The first trend is the development of theoretical approaches for CDSSs, and is exemplified by a paper proposing the integration of family histories and pedigrees in a CDSS. The second trend is illustrated by well-designed CDSSs, showing good theoretical performances and acceptance, while failing to show a clinical impact. An example is given with a paper reporting on scorecards aiming to reduce adverse drug events. The third trend is represented by research works that try to understand the limits of CDSS use, for instance by analyzing interactions between general practitioners, patients, and a CDSS. Conclusions CDSSs can achieve good theoretical results in terms of sensibility and specificity, as well as a good acceptance, but evaluations often fail to demonstrate a clinical impact. Future research is needed to better understand the causes of this observation and imagine new effective solutions for CDSS implementation. PMID:25123737

Lamy, J.-B.

2014-01-01

241

Electronic risk assessment for venous thromboembolism: investigating physicians’ rationale for bypassing clinical decision support recommendations  

PubMed Central

Objective The underutilisation of venous thromboembolism (VTE) prophylaxis is still a problem in the UK despite the emergence of national guidelines and incentives to increase the number of patients undergoing VTE risk assessments. Our objective was to examine the reasons doctors gave for not prescribing enoxaparin when recommended by an electronic VTE risk assessment alert. Design We used a qualitative research design to conduct a thematic analysis of free text entered into an electronic prescribing system. Setting The study took place in a large University teaching hospital, which has a locally developed electronic prescribing system known as PICS (Prescribing, Information and Communication System). Participants We extracted prescription data from all inpatient admissions over a 7-month period in 2012 using the audit database of PICS. Intervention The completion of the VTE risk assessment form introduced into the hospital-wide electronic prescribing and health records system is mandatory. Where doctors do not prescribe VTE prophylaxis when recommended, they are asked to provide a reason for this decision. The free-text field was introduced in May 2012. Primary and secondary outcome measures Free-text reasons for not prescribing enoxaparin when recommended were thematically coded. Results A total of 1136 free-text responses from 259 doctors were collected in the time period and 1206 separate reasons were analysed and coded. 389 reasons (32.3%) for not prescribing enoxaparin were coded as being due to ‘clinical judgment’; in 288 (23.9%) of the responses, doctors were going to reassess the patient or prescribe enoxaparin; and in 245 responses (20.3%), the system was seen to have produced an inappropriate alert. Conclusions In order to increase specificity of warnings and avoid users developing alert fatigue, it is essential that an evaluation of user responses and/or end user feedback as to the appropriateness and timing of alerts is obtained. PMID:25260369

Nwulu, Ugochi; Brooks, Hannah; Richardson, Suzanna; McFarland, Lorraine; Coleman, Jamie J

2014-01-01

242

The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making  

PubMed Central

Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient’s life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed. PMID:24618004

2014-01-01

243

Transforming User Needs into Functional Requirements for an Antibiotic Clinical Decision Support System  

PubMed Central

Summary Background Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. Objective To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). Methods The approach consisted of five steps: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. Results The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. Conclusion This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing needs. As a reusable approach, these techniques can be refined and applied to resolve unmet information needs with informatics interventions in additional domains. PMID:24454586

Bright, T.J.

2013-01-01

244

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. PMID:18990224

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

2008-01-01

245

Computerized Assessment Tool for Mouse Operating Proficiency  

Microsoft Academic Search

\\u000a This paper substantiates the process of developing a computerized mouse proficiency assessment tool (CAT-MP), which could\\u000a be used to measure proficiency of clients in mouse operating skills. Moreover, CAT-MP also helps evaluator to diagnose specific\\u000a difficulties and provide individual remedies for the persons with limitations to access computer. Based on the results of\\u000a task analysis of mouse operating, clinical experiences

Ming-chung Chen; Ling-Fu Meng; Cheng-feng Hsieh; Ting-fang Wu; Chi-Nung Chu; Tien-yu Li

2004-01-01

246

Clinical practice guidelines for the care and treatment of breast cancer: 3. Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer (2002 update)  

Microsoft Academic Search

Objective: To assist women and their physicians in making the most clinically effective and personally acceptable decision regarding the choice of primary surgery for potentially curable breast cancer. Options: Breast-conserving surgery (BCS; also referred to as lumpectomy or wide local excision) or mastectomy. Outcomes: Local recurrence, disease-free survival, overall survival, cosmetic results. Evidence: Systematic computerized search of MEDLINE (1980 to

Hugh Scarth; Jacques Cantin; Mark Levine

2002-01-01

247

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. PMID:22844646

Lee, In Keun; Kim, Hwa Sun

2012-01-01

248

Decision-making process in patients before entering phase III cancer clinical trials: a pilot study. | accrualnet.cancer.gov  

Cancer.gov

The findings of this pilot study with 14 cancer patients showed that patients, after receiving information from the medical oncologist, oncology nurse, or both, decided about participation in a clinical trial instantaneously. However, the information provided by the referring specialist may have been inadequate in the majority of cases. The emotional turmoil experienced after a cancer diagnosis may have contributed to the instantaneous decision making observed. Gathering further information and searching for alternatives should be encouraged.

249

Utilizing Case-Based Reasoning and Multimedia to Enhance Clinical Decision Making of Novice Practitioners: Product Implementation and Evaluation  

Microsoft Academic Search

This paper describes the outcomes of a self-paced multimedia learning environment designed to enhance critical thinking skills in clinical decision making of graduate nurses entering the workforce. The multimedia-learning environment represents a contrived situation that simulates the complexities of life in a typical hospital ward, which places the users in the role of problem-solvers. Problem solving in the simulation is

Mary Oliver; Som Naidu

250

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice  

PubMed Central

Objective: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians on the clinical decision making of general practitioners (GPs) in cardiovascular care. Design: Pragmatic cluster controlled trial with randomisation of practices to support (intervention group) or no special attention (control group); analysis after 2 years. Setting: 124 general practices in The Netherlands. Participants: 185 GPs. Main outcome measures: Compliance rates for 12 evidence-based indicators for the management of patients with hypertension, hypercholesterolaemia, angina pectoris, or heart failure. The evaluation relied on the prospective recording of patient encounters by the participating GPs. Results: The GPs reported 30 101 clinical decisions at baseline and 22 454 decisions after the intervention. A significant improvement was seen for five of the 12 indicators: assessment of risk factors in patients with hypercholesterolaemia (odds ratio 2.04; 95% CI 1.44 to 2.88) or angina pectoris (3.07; 1.08 to 8.79), provision of information and advice to patients with hypercholesterolaemia (1.58, 1.17 to 2.13) or hypertension (1.55, 1.35 to 1.77), and checking for clinical signs of deterioration in patients with heart failure (4.11, 2.17 to 7.77). Single handed practices, non-training practices, and practices with older GPs gained particular benefit from the intervention. Conclusions: Intensive support from trained non-physicians can alter certain aspects of the clinical decision making of GPs in cardiovascular care. The effect is small and the strategy needs further development. PMID:12792007

Frijling, B; Lobo, C; Hulscher, M; Akkermans, R; van Drenth, B B; Prins, A; van der Wouden, J C; Grol, R

2003-01-01

251

Understanding patient decisions about clinical trials and the associated communication process: a preliminary report. | accrualnet.cancer.gov  

Cancer.gov

This article presents a conceptual model of factors affecting patient decisions about participating in clinical trials and describes videotaping methods for observing interactions between patients, physicians, and family members. Preliminary findings suggest that awareness of the camera during videotaped conversations does not significantly alter the behavior of participants. Further study of this model and methodology may produce results that can be incorporated into provider training.

252

“Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice  

PubMed Central

Background Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. Methods An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. Results After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. Conclusions It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘referral model’ consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the ‘barriers’ and ‘facilitators’ approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment. PMID:24625083

2013-01-01

253

A Report on Project CVIS (Computerized Vocational Information System).  

ERIC Educational Resources Information Center

The Computerized Vocational Information System (CVIS) team, has designed a system utilizing a computer as a tool to help students explore occupations in the light of their own student records. This system aims at teaching a decision-making process in a way that interests students and allows counselors more time for counseling functions. The…

Willowbrook High School, Villa Park, IL. Computerized Vocational Information System Project.

254

Guidelines for the Development of Computerized Student Information Systems.  

ERIC Educational Resources Information Center

Designed to provide guidelines for the development of computerized student information systems, this report raises policy issues and questions to be resolved at the campus level and describes a variety of computer-generated reports and records that can assist in educational decision making and planning. Introductory material discusses the…

Armes, Nancy, Ed.; And Others

255

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

2013-12-01

256

Mentoring in the Clinical Setting to Improve Student Decision-Making Competence  

Microsoft Academic Search

INTRODUCTION: The physician-intern relationship can be difficult to develop. A new chiropractic intern in a teaching clinic undergoes a major transition from classroom to clinical practice and must learn to turn classroom knowledge into clinical application. The ability to start formulating clinical techniques and apply them on a patient is daunting. Developing a mentor relationship is difficult to do in

Misty Stick-Mueller; Ron Boesch; Steven Silverman; Scott Carpenter; Robert Illingworth; Countryman James

2010-01-01

257

Clinical evaluation of a high-resolution new peripheral quantitative computerized tomography (pQCT) scanner for the bone densitometry at the lower limbs  

NASA Astrophysics Data System (ADS)

Precision, long-term stability, linearity and accuracy of the x-ray peripheral quantitative computerized tomographic (pQCT) bone scanner XCT 3000 (Norland-Stratec Medical Sys.) were evaluated using the European Forearm Phantom (EFP). In vivo measurements were assessed using a standardized procedure at the distal femur and the distal tibia. In the patient-scan mode, the spatial resolution of the system was lp/mm as measured at the 10% level of the modulation transfer function (MTF). The contrast-detail diagram (CDD) yielded a minimal difference in attenuation coefficient (AC) of 0.07 at an object size of 0.5 mm. The effective dose for humans was calculated to be less than 1.5 Sv per scan. Short-term precision in vivo was expressed as root mean square standard deviation of paired measurements of 20 healthy volunteers (%). At the distal femur total volumetric density (ToD) and total cross-sectional area (ToA) were found to be less sensitive to positioning errors than at the distal tibia. Structural parameters like the polar cross-sectional moment of inertia or the polar cross-sectional moment of resistance showed a good short-term precision at the distal femur ( and 1.4%). The relation between the two skeletal sites with respect to or showed a high coefficient of determination ( and 0.74).

Braun, M. J.; Meta, M. D.; Schneider, P.; Reiners, Chr

1998-08-01

258

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. PMID:22619265

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

259

Clinical, technical, and social contingencies and the decisions of adults with HIV/AIDS to enroll in clinical trials.  

PubMed

In this article, the author draws on interview data collected during an ethnographic field study of the informed consent process and HIV/AIDS clinical trial work. She held interviews to explore how individuals decide to enroll in a clinical trial and uses the concept of contingency to illustrate how individuals interpret and act on the uncertainties of clinical research. Findings show that people with HIV/AIDS consider three kinds of contingencies--clinical, social, and technical--before enrolling in a clinical trial. The author offers suggestions for how the concept of contingency might be used in future studies on informed consent and for how the concept might be used in discussions between research professionals and patients on human subject research. PMID:15107172

Mueller, Mary-Rose

2004-05-01

260

Helping patients make better decisions: how to apply behavioral economics in clinical practice.  

PubMed

Clinicians are committed to effectively educating patients and helping them to make sound decisions concerning their own health care. However, how do clinicians determine what is effective education? How do they present information clearly and in a manner that patients understand and can use to make informed decisions? Behavioral economics (BE) is a subfield of economics that can assist clinicians to better understand how individuals actually make decisions. BE research can help guide interactions with patients so that information is presented and discussed in a more deliberate and impactful way. We can be more effective providers of care when we understand the factors that influence how our patients make decisions, factors of which we may have been largely unaware. BE research that focuses on health care and medical decision making is becoming more widely known, and what has been reported suggests that BE interventions can be effective in the medical realm. The purpose of this article is to provide clinicians with an overview of BE decision science and derived practice strategies to promote more effective behavior change in patients. PMID:25378915

Courtney, Maureen Reni; Spivey, Christy; Daniel, Kathy M

2014-01-01

261

Bioabsorbable interference screws for bone-patellar tendon-bone anterior cruciate ligament reconstruction: clinical and computerized tomography results of four different models. A prospective study  

Microsoft Academic Search

We investigated the effectiveness of four bioabsorbable interference screws for bone block fixation in ACL reconstruction, and assessed their complete absorption and graft integration. We performed a prospective clinical evaluation with the IKDC form and computed tomography (CT) scans 3, 6, 9, 12, 18 and 24 months after arthroscopic ACL reconstruction with the bonepatellar tendon-bone (BPTB) technique. A total of

M. Denti; P. Randelli; D. Lo Vetere; M. Moioli; M. Tagliabue

2004-01-01

262

Multicenter Validation of a Computer-Based Clinical Decision Support Tool for Glucose Control in Adult and Pediatric Intensive Care Units  

PubMed Central

Introduction Hyperglycemia during critical illness is common, and intravenous insulin therapy (IIT) to normalize blood glucose improves outcomes in selected populations. Methods differ widely in complexity, insulin dosing approaches, efficacy, and rates of hypoglycemia. We developed a simple bedside-computerized decision support protocol (eProtocol-insulin) that yields promising results in the development center. We examined the effectiveness and safety of this tool in six adult and five pediatric intensive care units (ICUs) in other centers. Methods We required attending physicians of eligible patients to independently intend to use intravenous insulin to normalize blood glucose. We used eProtocol-insulin for glucose control for a duration determined by the clinical caregivers. Adults had an anticipated length of stay of 3 or more days. In pediatric ICUs, we also required support or intended support with mechanical ventilation for greater than 24 hours or with a vasoactive infusion. We recorded all instances in which eProtocol-insulin instructions were not accepted and all blood glucose values. An independent data safety and monitoring board monitored study results and subject safety. Bedside nurses were selected randomly to complete a paper survey describing their perceptions of quality of care and workload related to eProtocol-insulin use. Results Clinicians accepted 93% of eProtocol-insulin instructions (11,773/12,645) in 100 adult and 48 pediatric subjects. Forty-eight percent of glucose values were in the target range. Both of these results met a priori-defined efficacy thresholds. Only 0.18% of glucose values were ?40 mg/dl. This is lower than values reported in prior IIT studies. Although nurses reported eProtocol-insulin required as much work as managing a mechanical ventilator, most nurses felt eProtocol-insulin had a low impact on their ability to complete non-IIT nursing activities. Conclusions A multicenter validation demonstrated that eProtocol-insulin is a valid, exportable tool that can assist clinicians in achieving control of glucose in critically ill adults and children. PMID:19885199

Thompson, B. Taylor; Orme, James F.; Zheng, Hui; Luckett, Peter M.; Truwit, Jonathon D.; Willson, Douglas F.; Duncan Hite, R.; Brower, Roy G.; Bernard, Gordon R.; Curley, Martha A. Q.; Steingrub, Jay S.; Sorenson, Dean K.; Sward, Kathy; Hirshberg, Ellie; Morris, Alan H.

2008-01-01

263

“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. PMID:18436911

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

2008-01-01

264

Understanding the decisions of cancer clinical trial participants to enter research studies: factors associated with informed consent, patient satisfaction, and decisional regret. | accrualnet.cancer.gov  

Cancer.gov

This study shows that participants who enroll in clinical trials quickly (early signers) may not believe they fully understand the implications of participation. In general, participants who do not believe they fully understand the implications of trial participation, or who are less satisfied with their decision to enroll in the trial, may ultimately feel regret about their decision to participate.

265

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

266

Patient-reported Outcomes in Randomised Controlled Trials of Prostate Cancer: Methodological Quality and Impact on Clinical Decision Making  

PubMed Central

Context Patient-reported outcomes (PRO) data from randomised controlled trials (RCTs) are increasingly used to inform patient-centred care as well as clinical and health policy decisions. Objective The main objective of this study was to investigate the methodological quality of PRO assessment in RCTs of prostate cancer (PCa) and to estimate the likely impact of these studies on clinical decision making. Evidence acquisition A systematic literature search of studies was undertaken on main electronic databases to retrieve articles published between January 2004 and March 2012. RCTs were evaluated on a predetermined extraction form, including (1) basic trial demographics and clinical and PRO characteristics; (2) level of PRO reporting based on the recently published recommendations by the International Society for Quality of Life Research; and (3) bias, assessed using the Cochrane Risk of Bias tool. Studies were systematically analysed to evaluate their relevance for supporting clinical decision making. Evidence synthesis Sixty-five RCTs enrolling a total of 22 071 patients were evaluated, with 31 (48%) in patients with nonmetastatic disease. When a PRO difference between treatments was found, it related in most cases to symptoms only (n = 29, 58%). Although the extent of missing data was generally documented (72% of RCTs), few reported details on statistical handling of this data (18%) and reasons for dropout (35%). Improvements in key methodological aspects over time were found. Thirteen (20%) RCTs were judged as likely to be robust in informing clinical decision making. Higher-quality PRO studies were generally associated with those RCTs that had higher internal validity. Conclusions Including PRO in RCTs of PCa patients is critical for better evaluating the treatment effectiveness of new therapeutic approaches. Marked improvements in PRO quality reporting over time were found, and it is estimated that at least one-fifth of PRO RCTs have provided sufficient details to allow health policy makers and physicians to make critical appraisals of results. Patient summary In this report, we have investigated the methodological quality of PCa trials that have included a PRO assessment. We conclude that including PRO is critical to better evaluating the treatment effectiveness of new therapeutic approaches from the patient's perspective. Also, at least one-fifth of PRO RCTs in PCa have provided sufficient details to allow health policy makers and physicians to make a critical appraisal of results. PMID:24210091

Efficace, Fabio; Feuerstein, Michael; Fayers, Peter; Cafaro, Valentina; Eastham, James; Pusic, Andrea; Blazeby, Jane

2014-01-01

267

A web-based system for clinical decision support and knowledge maintenance for deterioration monitoring of hemato-oncological patients.  

PubMed

We introduce a web-based clinical decision support system (CDSS) and knowledge maintenance based on rules and a set covering method focusing on the problem of detecting serious comorbidities in hemato-oncological patients who are at high risk of developing serious infections and life threatening complications. We experienced that diagnostic problems which are characterized by fuzzy, uncertain knowledge and overlapping signs, still reveal some kind of patterns that can be transferred into a computer-based decision model. We applied a multi-stage evaluation process to assess the system's diagnostic performance. Depending on how system behavior was compared to presumably correct judgment of a case the correctness rate for closed cases with all data available varied between 58% and 71%, the overall rate after critical review was 84%. However, the real time behavior of our approach which data becoming available as time passes still has to be evaluated and observational studies need to be conducted. PMID:23522434

Wicht, Andreas; Wetter, Thomas; Klein, Ulrike

2013-07-01

268

Application of best practice approaches for designing decision support tools: The preparatory education about clinical trials (PRE-ACT) study  

PubMed Central

Objective This article describes the rigorous development process and initial feedback of the PRE-ACT (Preparatory Education About Clinical Trials) web-based- intervention designed to improve preparation for decision making in cancer clinical trials. Methods The multi-step process included stakeholder input, formative research, user testing and feedback. Diverse teams (researchers, advocates and developers) participated including content refinement, identification of actors, and development of video scripts. Patient feedback was provided in the final production period and through a vanguard group (N = 100) from the randomized trial. Results Patients/advocates confirmed barriers to cancer clinical trial participation, including lack of awareness and knowledge, fear of side effects, logistical concerns, and mistrust. Patients indicated they liked the tool’s user-friendly nature, the organized and comprehensive presentation of the subject matter, and the clarity of the videos. Conclusion The development process serves as an example of operationalizing best practice approaches and highlights the value of a multi-disciplinary team to develop a theory-based, sophisticated tool that patients found useful in their decision making process. Practice implications Best practice approaches can be addressed and are important to ensure evidence-based tools that are of value to patients and supports the usefulness of a process map in the development of e-health tools. PMID:24813474

Fleisher, Linda; Ruggieri, Dominique G.; Miller, Suzanne M.; Manne, Sharon; Albrecht, Terrance; Buzaglo, Joanne; Collins, Michael A.; Katz, Michael; Kinzy, Tyler G.; Liu, Tasnuva; Manning, Cheri; Charap, Ellen Specker; Millard, Jennifer; Miller, Dawn M.; Poole, David; Raivitch, Stephanie; Roach, Nancy; Ross, Eric A.; Meropol, Neal J.

2014-01-01

269

A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.  

PubMed

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context. PMID:25170939

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

270

Decision Tree for Inclusion of Women in Clinical Research (not an NIH-Defined Phase III Clinical Trial)  

E-print Network

strongly suggests no gender difference · Data exists for excluded gender; duplicative studies does not apply Is a NIH-Defined Phase III Clinical Trial proposed? Is gender representation acceptable? 1. Both genders are included in scientifically appropriate numbers? (Code G1) or 2. One gender

Bandettini, Peter A.

271

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

Microsoft Academic Search

BACKGROUND: Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on

Mohsen Adib Hagbaghery; Mahvash Salsali; Fazlolah Ahmadi

2004-01-01

272

Professional autonomy in 21st century healthcare: Nurses’ accounts of clinical decision-making  

Microsoft Academic Search

Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus

Michael Traynor; Maggie Boland; Niels Buus

2010-01-01

273

Exploring a Clinically Friendly Web-Based Approach to Clinical Decision Support Linked to the Electronic Health Record: Design Philosophy, Prototype Implementation, and Framework for Assessment  

PubMed Central

Background Computer-based clinical decision support (CDS) is an important component of the electronic health record (EHR). As an increasing amount of CDS is implemented, it will be important that this be accomplished in a fashion that assists in clinical decision making without imposing unacceptable demands and burdens upon the provider’s practice. Objective The objective of our study was to explore an approach that allows CDS to be clinician-friendly from a variety of perspectives, to build a prototype implementation that illustrates features of the approach, and to gain experience with a pilot framework for assessment. Methods The paper first discusses the project’s design philosophy and goals. It then describes a prototype implementation (Neuropath/CDS) that explores the approach in the domain of neuropathic pain and in the context of the US Veterans Administration EHR. Finally, the paper discusses a framework for assessing the approach, illustrated by a pilot assessment of Neuropath/CDS. Results The paper describes the operation and technical design of Neuropath/CDS, as well as the results of the pilot assessment, which emphasize the four areas of focus, scope, content, and presentation. Conclusions The work to date has allowed us to explore various design and implementation issues relating to the approach illustrated in Neuropath/CDS, as well as the development and pilot application of a framework for assessment. PMID:25580426

Phipps, Michael; Chatterjee, Sharmila; Rajeevan, Nallakkandi; Levin, Forrest; Frawley, Sandra; Tokuno, Hajime

2014-01-01

274

Reliability of Repeated Cognitive Assessment of Dementia Using a Brief Computerized Battery  

Microsoft Academic Search

Objective: The aim of this study was to evaluate the short-term stability and reliability of a brief computerized cognitive battery in established dementia types. Method: Patients were administered the computerized battery twice with administrations approximately 2 hours apart, with intervening conventional neuropsychological tests. Patients were classified clinically, via consensus conference, as healthy controls (n = 23), mild cognitive impairment (n

Dustin Hammers; Elizabeth Spurgeon; Kelly Ryan; Carol Persad; Judith Heidebrink; Nancy Barbas; Roger Albin; Kirk Frey; David Darby; Bruno Giordani

2011-01-01

275

Computerized detection of diffuse lung disease in MDCT: the usefulness of statistical texture features  

Microsoft Academic Search

Accurate detection of diffuse lung disease is an important step for computerized diagnosis and quantification of this disease. It is also a difficult clinical task for radiologists. We developed a computerized scheme to assist radiologists in the detection of diffuse lung disease in multi-detector computed tomography (CT). Two radiologists selected 31 normal and 37 abnormal CT scans with ground glass

Jiahui Wang; Feng Li; Kunio Doi; Qiang Li

2009-01-01

276

Multiparametric MRI followed by targeted prostate biopsy for men with suspected prostate cancer: a clinical decision analysis  

PubMed Central

Objective To compare the diagnostic outcomes of the current approach of transrectal ultrasound (TRUS)-guided biopsy in men with suspected prostate cancer to an alternative approach using multiparametric MRI (mpMRI), followed by MRI-targeted biopsy if positive. Design Clinical decision analysis was used to synthesise data from recently emerging evidence in a format that is relevant for clinical decision making. Population A hypothetical cohort of 1000 men with suspected prostate cancer. Interventions mpMRI and, if positive, MRI-targeted biopsy compared with TRUS-guided biopsy in all men. Outcome measures We report the number of men expected to undergo a biopsy as well as the numbers of correctly identified patients with or without prostate cancer. A probabilistic sensitivity analysis was carried out using Monte Carlo simulation to explore the impact of statistical uncertainty in the diagnostic parameters. Results In 1000 men, mpMRI followed by MRI-targeted biopsy ‘clinically dominates’ TRUS-guided biopsy as it results in fewer expected biopsies (600 vs 1000), more men being correctly identified as having clinically significant cancer (320 vs 250), and fewer men being falsely identified (20 vs 50). The mpMRI-based strategy dominated TRUS-guided biopsy in 86% of the simulations in the probabilistic sensitivity analysis. Conclusions Our analysis suggests that mpMRI followed by MRI-targeted biopsy is likely to result in fewer and better biopsies than TRUS-guided biopsy. Future research in prostate cancer should focus on providing precise estimates of key diagnostic parameters. PMID:24934207

Willis, Sarah R; Ahmed, Hashim U; Moore, Caroline M; Donaldson, Ian; Emberton, Mark; Miners, Alec H; van der Meulen, Jan

2014-01-01

277

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

278

Utility of an automated blood pressure (BP) measuring device (BPTRU) in clinical decision making  

Microsoft Academic Search

Hypothesis: Accurate BP measurement is critical to decision making in the hypertensive patient. It often is poorly done because of time constraints. The BpTRU is an automated multiple BP measuring device that could replace the gold standard nurse (GSN) JNC VI-recommended multiple office BP measurement.Methods: 106 pts referred for ambulatory monitoring had 3 GSN ausculted BP in the same arm

John W. Graves; Carol Nash; Kent R. Bailey; Sheldon G. Sheps

2003-01-01

279

Removal of C-spine protection by A&E triage nurses: a prospective trial of a clinical decision making instrument  

Microsoft Academic Search

Objective: To investigate if triage nurses could safely apply a set of clinical criteria, removing hard collars and spinal boards at initial triage assessment.Methods: The Nexus clinical decision rules were applied by trained triage nurses to patients who attended the department with cervical collars and \\/or on spinal boards. Patients were excluded if they were felt to be in need

E Pitt; D K Pedley; A Nelson; M Cumming; M Johnston

2006-01-01

280

Computerized training management system  

DOEpatents

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 is designed using R-Base.RTM., 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.

Rice, Harold B. (Franklin Furnace, OH); McNair, Robert C. (East Setauket, NY); White, Kenneth (Shirley, NY); Maugeri, Terry (Wading River, NY)

1998-08-04

281

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

282

Development and initial evaluation of a treatment decision dashboard  

PubMed Central

Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Conclusions Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making. PMID:23601912

2013-01-01

283

Minimally invasive surgery and clinical decision-making for pediatric malignancy  

Microsoft Academic Search

Background: Minimally invasive surgery (MIS) is an ideal way to obtain biopsy specimens in children with cancer. We examined the safety,\\u000a reliability and outcome of decisions made based on tissue obtained using MIS.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Fifty-nine oncology patients underwent 62 MIS procedures between January 1994 and July 1998. Complications, biopsy results,\\u000a and outcomes were reviewed.\\u000a \\u000a \\u000a \\u000a \\u000a Results: The study population comprised 32

J. H. T. Waldhausen; D. Tapper; R. S. Sawin

2000-01-01

284

The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?  

PubMed

Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making. PMID:20382461

Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

2010-06-01

285

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

2013-01-01

286

Computerized molecular modeling of carbohydrates  

Technology Transfer Automated Retrieval System (TEKTRAN)

Computerized molecular modleing continues to increase in capability and applicability to carbohydrates. This chapter covers nomenclature and conformational aspects of carbohydrates, perhaps of greater use to carbohydrate-inexperienced computational chemists. Its comments on various methods and studi...

287

Rapid Computerized Assessment of Neurocognitive Deficits in Bipolar Disorder  

Microsoft Academic Search

The purpose of this study is to illustrate the clinical usefulness of a computerized neuropsychological battery for identifying neurocognitive deficits in adults with bipolar disorder. Participants were 47 outpatients with bipolar disorder who were individually matched on age, education, sex, and ethnicity to 47 control subjects from the Central Nervous System (CNS) Vital Signs normative database. CNS Vital Signs is

Grant L. Iverson; Brian L. Brooks; Allan H. Young

2009-01-01

288

Validity of a Brief Computerized Cognitive Screening Test in Dementia  

Microsoft Academic Search

Background: While preliminary evidence supports the criterion validity of the CogState computerized brief battery in mild cognitive impairment (MCI) and Alzheimer disease (AD), definitive validation studies examining a wider range of dementia-related disorders relative to conventional neuropsychological techniques are necessary. Methods: Participants satisfying clinical consensus criteria for dementia (AD, n = 37; frontotemporal dementia, n = 7; and dementia with

Dustin Hammers; Elizabeth Spurgeon; Kelly Ryan; Carol Persad; Nancy Barbas; Judith Heidebrink; David Darby; Bruno Giordani

2012-01-01

289

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

290

Adaptive Multilevel FEM as Decisive Tools in the Clinical Cancer Therapy Hyperthermia  

Microsoft Academic Search

ntroduction The paper surveys recent progress in a joint mathematicalmedical project on cancer therapy planning. Within so-called regional hyperthermia the computa­ tional task is to tune a set of coupled radiofrequency antennas such that a care­ fully measured tumor is locally heated, but any outside hot spots are avoided. A mathematical model of the whole clinical system - air, applicator

M. Seebass; P. Deuflhard

1998-01-01

291

Decision-making and breast cancer clinical trials: How experience challenges attitudes. | accrualnet.cancer.gov  

Cancer.gov

Mancini J,Genève J,Dalenc F,Genre D,Monnier A,Kerbrat P,Largillier R,Serin D,Rios M,Roche H,Jimenez M,Tarpin C,the Patients’ Committee for Clinical trials of the Ligue Nationale,Reynier CJ. Contemp Clin Trials. 2007. 28. 6. 684-94.

292

A decision support system for lower back pain diagnosis: Uncertainty management and clinical evaluations  

Microsoft Academic Search

Lower back pain (LBP) is a common medical problem that deprives many individuals of their normal lifestyles and keeps them from routine activities. Diagnosing LBP is challenging because it requires highly specialized knowledge involving a complex anatomical and physiological structure as well as diverse clinical considerations. Although a handful of studies have proposed or developed systems to support LBP diagnosis

Lin Lin; Paul Jen-hwa Hu; Olivia R. Liu Sheng

2006-01-01

293

Integrating clinical data with information transmitted by implantable cardiac defibrillators to support medical decision in telecardiology  

E-print Network

their patients depends to a large extent on programming of the alerts and data triage [2]. The objective in health care delivery and clinical outcomes in the field of heart failure. This implies a shift from strictly device-centered follow-up to perspectives centered on the patient. In the AKENATON project, we

Zweigenbaum, Pierre

294

Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts  

PubMed Central

Objective To identify key principles for establishing a national clinical decision support (CDS) knowledge sharing framework. Materials and methods As part of an initiative by the US Office of the National Coordinator for Health IT (ONC) to establish a framework for national CDS knowledge sharing, key stakeholders were identified. Stakeholders' viewpoints were obtained through surveys and in-depth interviews, and findings and relevant insights were summarized. Based on these insights, key principles were formulated for establishing a national CDS knowledge sharing framework. Results Nineteen key stakeholders were recruited, including six executives from electronic health record system vendors, seven executives from knowledge content producers, three executives from healthcare provider organizations, and three additional experts in clinical informatics. Based on these stakeholders' insights, five key principles were identified for effectively sharing CDS knowledge nationally. These principles are (1) prioritize and support the creation and maintenance of a national CDS knowledge sharing framework; (2) facilitate the development of high-value content and tooling, preferably in an open-source manner; (3) accelerate the development or licensing of required, pragmatic standards; (4) acknowledge and address medicolegal liability concerns; and (5) establish a self-sustaining business model. Discussion Based on the principles identified, a roadmap for national CDS knowledge sharing was developed through the ONC's Advancing CDS initiative. Conclusion The study findings may serve as a useful guide for ongoing activities by the ONC and others to establish a national framework for sharing CDS knowledge and improving clinical care. PMID:22865671

Hongsermeier, Tonya; Wright, Adam; Lewis, Janet; Bell, Douglas S; Middleton, Blackford

2013-01-01

295

Ten commandments for effective clinical decision support: makingthe practice of evidence-based medicine a reality  

Microsoft Academic Search

While evidence-based medicine has increasingly broad-based support\\u000d\\u000a\\u0009in health care, it remains difficult to get physicians to actually\\u000d\\u000a\\u0009practice it. Across most domains in medicine, practice has lagged\\u000d\\u000a\\u0009behind knowledge by at least several years. The authors believe that\\u000d\\u000a\\u0009the key tools for closing this gap will be information systems that\\u000d\\u000a\\u0009provide decision support to users at the time they

DAVID W. BATES; G ILAD J. KUPERMAN; Samuel Wang; Tejal Gandhi; Anne Kittler; Lynn Volk; Cynthia Spurr; Ramin Khorasani; Milenko Tanasijevic; Blackford Middleton

2003-01-01

296

Cardiological database management system as a mediator to clinical decision support.  

PubMed

An object-oriented medical database management system is presented for a typical cardiologic center, facilitating epidemiological trials. Object-oriented analysis and design were used for the system design, offering advantages for the integrity and extendibility of medical information systems. The system was developed using object-oriented design and programming methodology, the C++ language and the Borland Paradox Relational Data Base Management System on an MS-Windows NT environment. Particular attention was paid to system compatibility, portability, the ease of use, and the suitable design of the patient record so as to support the decisions of medical personnel in cardiovascular centers. The system was designed to accept complex, heterogeneous, distributed data in various formats and from different kinds of examinations such as Holter, Doppler and electrocardiography. PMID:8992225

Pappas, C; Mavromatis, A; Maglaveras, N; Tsikotis, A; Pangalos, G; Ambrosiadou, V

1996-03-01

297

Clinical Decision Making With Myocardial Perfusion Imaging in Patients With Known or Suspected Coronary Artery Disease  

PubMed Central

Myocardial perfusion imaging (MPI) to diagnose coronary artery disease (CAD) is best performed in patients with intermediate pretest likelihood of disease; unfortunately, pretest likelihood is often overestimated, resulting in the inappropriate use of perfusion imaging. A good functional capacity often predicts low risk, and MPI for diagnosing CAD should be reserved for individuals with poor exercise capacity, abnormal resting electrocardiography, or an intermediate or high probability of CAD. With respect to anatomy-based testing, coronary CT angiography has a good negative predictive value, but stenosis severity correlates poorly with ischemia. Therefore decision making with respect to revascularization may be limited when a purely noninvasive anatomical test is used. Regarding perfusion imaging, the diagnostic accuracies of SPECT, PET, and cardiac magnetic resonance are similar, though fewer studies are available with cardiac magnetic resonance. PET coronary flow reserve may offer a negative predictive value sufficiently high to exclude severe CAD such that patients with mild to moderate reversible perfusion defects can forego invasive angiography. In addition, combined anatomical and perfusion-based imaging may eventually offer a definitive evaluation for diagnosing CAD, even in higher risk patients. Any remarkable findings on single-photon emission computed tomography and PET MPI studies are valuable for prognostication. Furthermore, assessment of myocardial blood flow with PET is particularly powerful for prognostication as it reflects the end result of many processes that lead to atherosclerosis. Decision making with respect to revascularization is limited for cardiac MRI and PET MPI. In contrast, retrospective radionuclide studies have identified an ischemic threshold, but randomized trials are needed. In patients with at least moderately reduced left ventricular systolic function, viable myocardium as assessed by PET or MRI, appears to identify patients who benefit from revascularization, but well-executed randomized trials are lacking. PMID:24948154

Cremer, Paul; Hachamovitch, Rory; Tamarappoo, Balaji

2015-01-01

298

Documentation of Nursing Practice Using a Computerized Medical Information System  

PubMed Central

This paper discusses a definition of the content of the computerized nursing data base developed by the Nursing Department for the Clinical Center Medical Information System at the National Institutes of Health in Bethesda, Maryland. The author describes the theoretical framework for the content and presents a model to describe the organization of the nursing data components in relation to the process of nursing care delivery. Nursing documentation requirements of Nurse Practice Acts, American Nurses Association Standards of Practice and the Joint Commission on Accreditation of Hospitals are also addressed as they relate to this data base. The advantages and disadvantages of such an approach to computerized documentation are discussed.

Romano, Carol

1981-01-01

299

Optimizing the txt2MEDLINE Search Portal for Low-Resource Clinical Decision Support  

PubMed Central

txt2MEDLINE provides access to high-quality medical evidence via text-messaging in settings with inadequate Internet access. We optimized the txt2MEDLINE search technique by parsing queries for MeSH (Medical Subject Heading) terms and searching MEDLINE for articles containing these terms in their titles or abstracts. We compared our results to the existing txt2MEDLINE tool by compiling benchmark queries from low-income and low-middle-income countries, and asking doctors and nurses with practice experience in low-resource areas to evaluate them. The median scores on a 5-point Likert scale were 2.9 for the existing txt2MEDLINE vs. 3.8 for the modified version (p=0.015). This reached our predefined criterion for clinical significance, a difference of 0.5 standard deviations. Improving this technology could improve clinical information resources in the world’s most medically underserved communities. PMID:24551407

Sheets, Lincoln; Liu, Fang; Sarmiento, Raymond Francis; Gavino, Alex; Fontelo, Paul

2013-01-01

300

Semi-automated construction of decision rules to predict morbidities from clinical texts.  

PubMed

OBJECTIVE In this study the authors describe the system submitted by the team of University of Szeged to the second i2b2 Challenge in Natural Language Processing for Clinical Data. The challenge focused on the development of automatic systems that analyzed clinical discharge summary texts and addressed the following question: "Who's obese and what co-morbidities do they (definitely/most likely) have?". Target diseases included obesity and its 15 most frequent comorbidities exhibited by patients, while the target labels corresponded to expert judgments based on textual evidence and intuition (separately). DESIGN The authors applied statistical methods to preselect the most common and confident terms and evaluated outlier documents by hand to discover infrequent spelling variants. The authors expected a system with dictionaries gathered semi-automatically to have a good performance with moderate development costs (the authors examined just a small proportion of the records manually). MEASUREMENTS Following the standard evaluation method of the second Workshop on challenges in Natural Language Processing for Clinical Data, the authors used both macro- and microaveraged Fbeta=1 measure for evaluation. RESULTS The authors submission achieved a microaverage F(beta=1) score of 97.29% for classification based on textual evidence (macroaverage F(beta=1) = 76.22%) and 96.42% for intuitive judgments (macroaverage F(beta=1) = 67.27%). CONCLUSIONS The results demonstrate the feasibility of the authors approach and show that even very simple systems with a shallow linguistic analysis can achieve remarkable accuracy scores for classifying clinical records on a limited set of concepts. PMID:19390097

Farkas, Richárd; Szarvas, György; Hegedus, István; Almási, Attila; Vincze, Veronika; Ormándi, Róbert; Busa-Fekete, Róbert

2009-01-01

301

Clinical decision-making in hypertension using an automated (BpTRU™) measurement device  

Microsoft Academic Search

Mercury sphygmomanometers are being removed from clinical practice in the United States due to environmental concerns about mercury toxicity. Accurate blood pressure measurement is central to high-quality hypertension management. In this study of 106 patients, the BpTRUTM device was compared to nurse blood pressure measurements that complied with all the JNC VII\\/American Heart Association guidelines in evaluation of a random

J W Graves; C Nash; K Burger; K Bailey; S G Sheps

2003-01-01

302

Clinical decision-support systems for intensive care units using case-based reasoning.  

PubMed

The artificial intelligence approach used in this work focusses on case-based reasoning techniques for the estimation of medical outcomes and resource utilization. The systems were designed with a view to help medical and nursing personnel to assess patient status, assist in making a diagnosis, and facilitate the selection of a course of therapy. The initial prototype provided information on the closest-matching patient cases to the newest patient admission in an adult intensive care unit (ICU). The system was subsequently re-designed for use in a neonatal ICU. The results of a short clinical pilot evaluation performed in both adult and neonatal units are reported and have led to substantial improvement of the prototype. Future work will include longer-term clinical trials for both adult and neonatal ICUs, once all the software changes have been made to both prototypes in response to the comments of the users made during the preliminary evaluations. To date, the results are very encouraging and physician interest in the potential clinical usefulness of these two systems remains high, and particularly so in the new testing environment in Ottawa. PMID:11259936

Frize, M; Walker, R

2000-11-01

303

Integration of heterogeneous clinical decision support systems and their knowledge sets: feasibility study with drug-drug interaction alerts  

PubMed Central

There exist limitations in both commercial and in-house clinical decision support systems (CDSSs) and issues related to the integration of different knowledge sources and CDSSs. We chose Standard-based Shareable Active Guideline Environment (SAGE) as a new architecture with knowledge integration and a centralized knowledge base which includes authoring/management functions and independent CDSS, and applied it to Drug-Drug Interaction (DDI) CDSS. The aim of this study was to evaluate the feasibility of the newly integrated DDI alerting CDSS into a real world hospital information system involving construction of an integrated CDSS derived from two heterogeneous systems and their knowledge sets. The proposed CDSS was successfully implemented and compensated for the weaknesses of the old CDSS from knowledge integration and management, and its applicability in actual situations was verified. Although the DDI CDSS was constructed as an example case, the new CDS architecture might prove applicable to areas of CDSSs. PMID:22195122

Kam, Hye Jin; Kim, Jeong Ah; Cho, InSook; Kim, Yoon; Park, Rae Woong

2011-01-01

304

A multiresolution clinical decision support system based on fractal model design for classification of histological brain tumours.  

PubMed

Tissue texture is known to exhibit a heterogeneous or non-stationary nature; therefore using a single resolution approach for optimum classification might not suffice. A clinical decision support system that exploits the subbands' textural fractal characteristics for best bases selection of meningioma brain histopathological image classification is proposed. Each subband is analysed using its fractal dimension instead of energy, which has the advantage of being less sensitive to image intensity and abrupt changes in tissue texture. The most significant subband that best identifies texture discontinuities will be chosen for further decomposition, and its fractal characteristics would represent the optimal feature vector for classification. The performance was tested using the support vector machine (SVM), Bayesian and k-nearest neighbour (kNN) classifiers and a leave-one-patient-out method was employed for validation. Our method outperformed the classical energy based selection approaches, achieving for SVM, Bayesian and kNN classifiers an overall classification accuracy of 94.12%, 92.50% and 79.70%, as compared to 86.31%, 83.19% and 51.63% for the co-occurrence matrix, and 76.01%, 73.50% and 50.69% for the energy texture signatures; respectively. These results indicate the potential usefulness as a decision support system that could complement radiologists' diagnostic capability to discriminate higher order statistical textural information; for which it would be otherwise difficult via ordinary human vision. PMID:24962336

Al-Kadi, Omar S

2014-06-01

305

Clinical Characteristics and Surgical Decision Making for Infants with Metopic Craniosynostosis in Conjunction with Other Congenital Anomalies  

PubMed Central

Background: Metopic craniosynostosis can occur in isolation or in conjunction with other congenital anomalies. The surgical decision making and outcomes between these 2 groups are analyzed. Methods: A retrospective review of all children evaluated in the craniofacial clinic at Seattle Children’s Hospital for metopic craniosynostosis between 2004 and 2009 was performed. Physical examination and CT scan characteristics were analyzed as were the treatment decisions and surgical outcomes. Results: From 2004 to 2009, 282 patients were evaluated and 100 were determined to have metopic craniosynostosis. Of these, 19 patients were found to have additional congenital anomalies. Review of these patients’ CT scans revealed 13 with classic trigonencephaly, 3 with microcephaly, and 3 with narrow frontal bones, abnormal orbits, and small anterior fossa. Patients (90%) with isolated metopic craniosynostosis underwent cranial vault expansion, whereas only 63% of the complex group did so. The complex metopic group had a longer hospital stay (5 d vs 3.4 d), more intraoperative complications, and required more repeat surgery. Conclusion: Patients with metopic craniosynostosis and additional anomalies require special consideration when deciding upon surgical intervention and should be cared for by a multidisciplinary team to address their additional needs. PMID:25289257

Heike, Carrie L.; Saltzman, Babette S.; Hing, Anne V.

2013-01-01

306

Computerizing Your Program.  

ERIC Educational Resources Information Center

This paper summarizes information about using computer hardware and software to aid in making purchase decisions that are based on user needs. The two major options in hardware are IBM-compatible machines and the Apple Macintosh line. The three basic software applications include word processing, database management, and spreadsheet applications.…

Curtis, Rick

307

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

PubMed Central

Background Computerised clinical decision support systems (CDSSs) are used widely to improve quality of care and patient outcomes. This systematic review evaluated the impact of CDSSs in targeting specific aspects of prescribing, namely initiating, monitoring and stopping therapy. We also examined the influence of clinical setting (institutional vs ambulatory care), system- or user-initiation of CDSS, multi-faceted vs stand alone CDSS interventions and clinical target on practice changes in line with the intent of the CDSS. Methods We searched Medline, Embase and PsychINFO for publications from 1990-2007 detailing CDSS prescribing interventions. Pairs of independent reviewers extracted the key features and prescribing outcomes of methodologically adequate studies (experiments and strong quasi-experiments). Results 56 studies met our inclusion criteria, 38 addressing initiating, 23 monitoring and three stopping therapy. At the time of initiating therapy, CDSSs appear to be somewhat more effective after, rather than before, drug selection has occurred (7/12 versus 12/26 studies reporting statistically significant improvements in favour of CDSSs on = 50% of prescribing outcomes reported). CDSSs also appeared to be effective for monitoring therapy, particularly using laboratory test reminders (4/7 studies reporting significant improvements in favour of CDSSs on the majority of prescribing outcomes). None of the studies addressing stopping therapy demonstrated impacts in favour of CDSSs over comparators. The most consistently effective approaches used system-initiated advice to fine-tune existing therapy by making recommendations to improve patient safety, adjust the dose, duration or form of prescribed drugs or increase the laboratory testing rates for patients on long-term therapy. CDSSs appeared to perform better in institutional compared to ambulatory settings and when decision support was initiated automatically by the system as opposed to user initiation. CDSSs implemented with other strategies such as education were no more successful in improving prescribing than stand alone interventions. Cardiovascular disease was the most studied clinical target but few studies demonstrated significant improvements on the majority of prescribing outcomes. Conclusion Our understanding of CDSS impacts on specific aspects of the prescribing process remains relatively limited. Future implementation should build on effective approaches including the use of system-initiated advice to address safety issues and improve the monitoring of therapy. PMID:19715591

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

2009-01-01

308

Clinical decision-making tools for exam selection, reporting and dose tracking.  

PubMed

Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to "as low as reasonably achievable," efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. PMID:25304698

Brink, James A

2014-10-01

309

Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems  

PubMed Central

Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations. PMID:23620646

Gholami, Behnood; Bailey, James M.; Haddad, Wassim M.; Tannenbaum, Allen R.

2013-01-01

310

Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.  

PubMed

Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations. PMID:23620646

Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

2012-03-01

311

Evaluation of the effectiveness of diagnostic & management decision by teleophthalmology using indigenous equipment in comparison with in-clinic assessment of patients  

PubMed Central

Background & objectives: There is a concern on the quality and the usefulness of teleophthalmology images, particularly those using indigenous equipment, in making a diagnosis and treatment decisions in ophthalmology. The present study was done to compare the level of agreement and sensitivity and specificity of diagnosis and management decisions of various eye diseases by teleophthalmology using indigenous equipment, compared to the in-clinic assessment. Methods: Patients having different eye diseases were evaluated by two ophthalmologists – one ophthalmologist examined the patient in clinic setting while the other ophthalmologist made the diagnosis and management decision based on images sent by teleophthalmology. The images were taken by the ophthalmic technician using digital imaging system and fundus camera. The clinical findings and management decisions by the two ophthalmologists were masked to each others. Results: In diagnosis of anterior segment eye diseases such as cataract and corneal diseases there was good to very good agreement (kappa values of 0.68 and 0.91 for cataract and corneal diseases respectively) between in-clinic assessment and assessment by teleophthalmology. There was moderate agreement (kappa values of 0.52 and 0.48 for glaucoma and retinal diseases respectively) between in-clinic assessment and assessment by teleophthalmology for the diagnosis of glaucoma and retinal diseases. For the management decisions of patients, there was moderate level of agreement in all groups of eye diseases. Interpretation & conclusions: Teleophthalmology, using indigenous equipment was found to be effective in diagnosis and management decision of anterior segment eye diseases such as cataract and cornea, and with some modification and continuous training to the technicians could become an effective tool for screening and referral of glaucoma and retinal diseases. PMID:24434260

Gupta, S.C.; Sinha, Subodh Kumar; Dagar, Abhishek B.

2013-01-01

312

Informing sequential clinical decision-making through reinforcement learning: an empirical study  

PubMed Central

This paper highlights the role that reinforcement learning can play in the optimization of treatment policies for chronic illnesses. Before applying any off-the-shelf reinforcement learning methods in this setting, we must first tackle a number of challenges. We outline some of these challenges and present methods for overcoming them. First, we describe a multiple imputation approach to overcome the problem of missing data. Second, we discuss the use of function approximation in the context of a highly variable observation set. Finally, we discuss approaches to summarizing the evidence in the data for recommending a particular action and quantifying the uncertainty around the Q-function of the recommended policy. We present the results of applying these methods to real clinical trial data of patients with schizophrenia. PMID:21799585

Shortreed, Susan M.; Laber, Eric; Lizotte, Daniel J.; Stroup, T. Scott; Pineau, Joelle; Murphy, Susan A.

2011-01-01

313

AN ADDITIONAL CAUSE OF HEALTH CARE DISPARITIES—THE VARIABLE CLINICAL DECISIONS OF PRIMARY CARE DOCTORS  

PubMed Central

Rationale, Aims and Objectives Decades of work on health disparities have culminated in identification of three contributors to variability in diagnosis and management of disease: 1) patient attributes, 2) physician characteristics, and 3) organizational. Understanding the relative influence of different contributors to variability in diagnosis and management of diabetes is important to improving quality and reducing disparities. This study was designed to examine the influence of patient, provider, and organizational factors on the diagnosis and management of a major chronic disease: diabetes. Method A factorial experiment using video vignettes was conducted among n=192 primary care physicians. Physicians were interviewed after viewing vignettes of (1) a “patient” with symptoms strongly suggestive of diabetes and (2) an already diagnosed diabetes “patient” with emerging peripheral neuropathy. Results 60.9 percent of physicians identified diabetes as the correct diagnosis, with significant variations depending on the patients’ race/ethnicity. Many physicians offered competing diagnoses with high levels of certainty. For the “patient” with emerging peripheral neuropathy, 42.2 percent of physicians would do all essential components of a foot examination, while 21.9 percent would do none. Conclusions That half of all diabetes in the US remains undiagnosed is unsurprising given only 60.9 percent of physicians would diagnose it when the condition is strongly suggested, and nearly one quarter suspecting diabetes would not order tests necessary to confirm it. The diagnosis of diabetes is significantly influenced by a patient’s race/ethnicity and clinical management (specifically for foot neuropathy), is influenced by patient SES, physician gender, and access to clinical guidelines. PMID:23216876

McKinlay, John; Piccolo, Rebecca; Marceau, Lisa

2013-01-01

314

Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment  

PubMed Central

Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development. PMID:22443712

2012-01-01

315

Computerized Cognitive Testing in the Management of Youth Sports-Related Concussion.  

PubMed

Computerized neurocognitive testing has become a growing practice across medical populations, but particularly within sports medicine and the management of sports-related concussion. Although traditional neuropsychological measures are solely administered and interpreted by neuropsychologists, computerized cognitive tests are marketed to and utilized by a wide range of professionals involved in the management of sports-related concussions, many of whom lack specialized psychometric training. Although the benefits of computerized testing allow for many youth athletes to be evaluated quickly, professionals implementing their use should be aware of the potential pitfalls and the high potential for misuse. After briefly reviewing the recommended guidelines set forth by the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology, we review the benefits/limitations of computerized testing in the management of sports-related concussion and the basic psychometric properties of some of the more widely used computerized measures. Lastly, we discuss the practical application of these devices. PMID:25477270

De Marco, Anthony P; Broshek, Donna K

2014-12-01

316

Criteria for assessing high-priority drug-drug interactions for clinical decision support in electronic health records  

PubMed Central

Background High override rates for drug-drug interaction (DDI) alerts in electronic health records (EHRs) result in the potentially dangerous consequence of providers ignoring clinically significant alerts. Lack of uniformity of criteria for determining the severity or validity of these interactions often results in discrepancies in how these are evaluated. The purpose of this study was to identify a set of criteria for assessing DDIs that should be used for the generation of clinical decision support (CDS) alerts in EHRs. Methods We conducted a 20-year systematic literature review of MEDLINE and EMBASE to identify characteristics of high-priority DDIs. These criteria were validated by an expert panel consisting of medication knowledge base vendors, EHR vendors, in-house knowledge base developers from academic medical centers, and both federal and private agencies involved in the regulation of medication use. Results Forty-four articles met the inclusion criteria for assessing characteristics of high-priority DDIs. The panel considered five criteria to be most important when assessing an interaction- Severity, Probability, Clinical Implications of the interaction, Patient characteristics, and the Evidence supporting the interaction. In addition, the panel identified barriers and considerations for being able to utilize these criteria in medication knowledge bases used by EHRs. Conclusions A multi-dimensional approach is needed to understanding the importance of an interaction for inclusion in medication knowledge bases for the purpose of CDS alerting. The criteria identified in this study can serve as a first step towards a uniform approach in assessing which interactions are critical and warrant interruption of a provider’s workflow. PMID:23763856

2013-01-01

317

Clinical Influences on Nurse-Academics' Instructional Planning Decisions in the Implementation of Basic Nursing Curricula in Colleges of Advanced Education in New South Wales.  

ERIC Educational Resources Information Center

A study examined the clinical influences on the instructional planning decisions made by registered nurses who are lecturers in basic nursing at colleges of advanced education (CAEs) in New South Wales, Australia. Data were collected from a questionnaire that was completed by 98 nurse-academics from 12 of New South Wales' 15 CAEs offering basic…

Roberts, Kathryn L.

318

Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis  

PubMed Central

A complex decision path with a careful evaluation of the risk–benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included in clinical decision-making paths to better assess the benefits and risks of different drug treatments in advanced age. We performed a scoping review of principal hospital- and community-based prognostic indices in older age. Mortality prognostic tools could help clinical decision-making in diagnostics and therapeutics, tailoring appropriate intervention for older patients. The effectiveness of drug treatments may be significantly different in older patients with different risk of mortality. Clinicians need to consider the prognostic information obtained through well-validated, accurate, and calibrated predictive tools to identify those patients who may benefit from drug treatments given with the aim of increasing survival.

Pilotto, Alberto; Sancarlo, Daniele; Daragjati, Julia; Panza, Francesco

2015-01-01

319

La valutazione degli outcomes e le implicazioni etiche e gestionali nella nutrizione enterale The analysis of clinical outcomes and the ethical aspects in tube feeding decision  

Microsoft Academic Search

Objective: Deciding whether to iniziate artificial enteral nutrition (EN) in pa- tients with severe cognitive impairment or with permanent vegetative state is a common dilemma. The decision is based not only an clinical grounds but also on ethical aspects. Recent studies have not demonstrated that tube feeding can improve important outcomes; many authors discourage this practice in severe- ly demented

A. ATTANASIO; M. BEDIN; G. MANTINEO; S. STOCCO; M. TAGLIAPIETRA; G. CECCHETTO; E. VECCHIATO; M. Zanocchi; M. Bo; E. Giona; E. Martinelli; E. Nicola; L. Corsinovi; F. Francisetti; F. Cerrato; E. Ponte; A. Luppino; M. Molaschi

2006-01-01

320

Computerized technology for restorative dentistry.  

PubMed

Computers have had a meaningful impact on the dental office and dental practice leading to significant changes in communication, financial accounting, and administrative functions. Computerized systems have more recently generated increasing diversity of application for the delivery of patient treatment. Digital impression systems and chairside CAD/CAM systems offer opportunities to integrate digital impressions and full contour restorations in the dental office. Systems rely on single image and video cameras to record the digital file that is the foundation for an accurate outcome. This article presents key aspects of computerized technology using the CAD/CAM process. PMID:23986956

Fasbinder, Dennis J

2013-06-01

321

Improving prostate cancer detection in veterans through the development of a clinical decision rule for prostate biopsy  

PubMed Central

Background We sought to improve prostate cancer (PC) detection through developing a prostate biopsy clinical decision rule (PBCDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after initial PC screening, providing the patient and clinician information to consider prior to biopsy. Methods This case–control study evaluated men from the Tampa, Florida, James A. Haley (JH) Veteran’s Administration (VA) (N = 1,378), from January 1, 1998, through April 15, 2005. To assess the PBCDR we did all of the following: 1) Identified biomarkers that are related to PC and have the capability of improving the efficiency of PC screening; 2) Developed statistical models to determine which can best predict the probability of PC; 3) Compared each potential model to PSA alone using Receiver Operator Characteristic (ROC) curves, to evaluate for improved overall effectiveness in PC detection and reduction in (negative) biopsies; and 4) Evaluated dose–response relationships between specified lab biomarkers (surrogates for extra-prostatic disease development) and PC progression. Results The following biomarkers were related to PC: hemoglobin (HGB) (OR = 1.42 95% CI 1.27, 1.59); red blood cell (RBC) count (OR = 2.52 95% CI 1.67, 3.78); PSA (OR = 1.04 95% CI 1.03, 1.05); and, creatinine (OR = 1.55 95% CI 1.12, 2.15). Comparing all PC stages versus non-cancerous conditions, the ROC curve area under the curve (AUC) enlarged (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); PBCDR model 0.68 (95% CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; PBCDR model 61.8%. Comparing PC (stages II, III, IV) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); PBCDR model 0.72 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); PBCDR model 55.3%. Conclusions These results suggest evaluating certain common biomarkers in conjunction with PSA may improve PC prediction prior to biopsy. Moreover, these biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA patients involving multiple practices. PMID:23356551

2013-01-01

322

Arkansas' Curriculum Guide. Competency Based Computerized Accounting.  

ERIC Educational Resources Information Center

This guide contains the essential parts of a total curriculum for a one-year secondary-level course in computerized accounting. Addressed in the individual sections of the guide are the following topics: the complete accounting cycle, computer operations for accounting, computerized accounting and general ledgers, computerized accounts payable,…

Arkansas State Dept. of Education, Little Rock. Div. of Vocational, Technical and Adult Education.

323

DOE transporation programs - computerized techniques  

Microsoft Academic Search

One of the major thrusts of the transportation programs at the Oak Ridge National Laboratory has been the development of a number of computerized transportation programs and data bases. The U.S. Department of Energy (DOE) is supporting these efforts through the Transportation Technology Center at Sandia National Laboratories and the Tranportation Operations and Traffic Management (TOTM) organization at DOE Headquarters.

D. S. Joy; P. E. Johnson; C. S. Fore; B. E. Peterson

1983-01-01

324

Computerized molecular modeling of carbohydrates.  

PubMed

Computerized molecular modeling continues to increase in capability and applicability to carbohydrates. This chapter covers nomenclature and conformational aspects of carbohydrates, perhaps of greater use to carbohydrate-inexperienced computational chemists. Its comments on various methods and studies might be of more use to computation-inexperienced carbohydrate chemists. New work on intrinsic variability of glucose, an overall theme, is described. PMID:21222074

French, Alfred D; Johnson, Glenn P

2011-01-01

325

Differences in pneumonia treatment between high-minority and low-minority neighborhoods with clinical decision support system implementation.  

PubMed

Background: The relationship between clinical decision support systems (CDSS) and quality is a relatively new, and in light of the new health information technology (HIT) legislation, policy-relevant area. Moreover, very few studies exist examining the link between HIT and healthcare disparities. The purpose of this article is to examine the association between CDSS and the treatment of pneumonia care within high-minority (?29.1% non-white, non-Hispanic) and low-minority (<29.1%) Zip Code Tabulation Areas (ZCTAs). Research design: This study employed a cross-sectional design and used 2009 data from the American Hospital Association, the Centers for Medicare and Medicaid Services and the Research Triangle Institute. Adjusted analysis controlled for a hospital's propensity to use CDSS. Results: In the unadjusted analysis, hospitals in high-minority ZCTAs had lower pneumonia quality composite scores than their low-minority counterparts. When adjusting for other hospital and ZCTA-level variables, we found that CDSS use had stronger positive associations with quality in high-minority hospitals. Conclusions: Results support policy directives may support higher quality improvements by focusing CDSS adoption in high-minority hospitals. PMID:25325354

Mitchell, Jordan; Probst, Janice C; Bennett, Kevin J; Glover, Saundra; Martin, Amy Brock; Hardin, James W

2014-10-17

326

Enhancements in healthcare information technology systems: customizing vendor-supplied clinical decision support for a high-risk patient population  

PubMed Central

Healthcare organizations continue to adopt information technologies with clinical decision support (CDS) to prevent potential medication-related adverse drug events. End-users who are unfamiliar with certain high-risk patient populations are at an increased risk of unknowingly causing medication errors. The following case describes a heart transplant recipient exposed to supra-therapeutic concentrations of tacrolimus during co-administration of ritonavir as a result of vendor supplied CDS tools that omitted an interaction alert. After review of 4692 potential tacrolimus-based DDIs between 329 different drug pairs supplied by vendor CDS, the severity of 20 DDIs were downgraded and the severity of 62 were upgraded. The need for institution-specific customization of vendor-provided CDS is paramount to ensure avoidance of medication errors. Individualized care will become more important as patient populations and institutions become more specialized. In the future, vendors providing integrated CDS tools must be proactive in developing institution-specific and easily customizable CDS tools. PMID:22813760

Tiwari, Ruchi; Tsapepas, Demetra S; Powell, Jaclyn T

2013-01-01

327

Model-based decision making in early clinical development: minimizing the impact of a blood pressure adverse event.  

PubMed

We describe how modeling and simulation guided program decisions following a randomized placebo-controlled single-rising oral dose first-in-man trial of compound A where an undesired transient blood pressure (BP) elevation occurred in fasted healthy young adult males. We proposed a lumped-parameter pharmacokinetic-pharmacodynamic (PK/PD) model that captured important aspects of the BP homeostasis mechanism. Four conceptual units characterized the feedback PD model: a sinusoidal BP set point, an effect compartment, a linear effect model, and a system response. To explore approaches for minimizing the BP increase, we coupled the PD model to a modified PK model to guide oral controlled-release (CR) development. The proposed PK/PD model captured the central tendency of the observed data. The simulated BP response obtained with theoretical release rate profiles suggested some amelioration of the peak BP response with CR. This triggered subsequent CR formulation development; we used actual dissolution data from these candidate CR formulations in the PK/PD model to confirm a potential benefit in the peak BP response. Though this paradigm has yet to be tested in the clinic, our model-based approach provided a common rational framework to more fully utilize the limited available information for advancing the program. PMID:19199043

Stroh, Mark; Addy, Carol; Wu, Yunhui; Stoch, S Aubrey; Pourkavoos, Nazaneen; Groff, Michelle; Xu, Yang; Wagner, John; Gottesdiener, Keith; Shadle, Craig; Wang, Hong; Manser, Kimberly; Winchell, Gregory A; Stone, Julie A

2009-03-01

328

SMARTHealth India: Development and Field Evaluation of a Mobile Clinical Decision Support System for Cardiovascular Diseases in Rural India  

PubMed Central

Background Cardiovascular disease (CVD) is the major cause of premature death and disability in India and yet few people at risk of CVD are able to access best practice health care. Mobile health (mHealth) is a promising solution, but very few mHealth interventions have been subjected to robust evaluation in India. Objective The objectives were to develop a multifaceted, mobile clinical decision support system (CDSS) for CVD management and evaluate it for use by public nonphysician health care workers (NPHWs) and physicians in a rural Indian setting. Methods Plain language clinical rules were developed based on standard guidelines and programmed into a computer tablet app. The algorithm was validated and field-tested in 11 villages in Andhra Pradesh, involving 11 NPHWs and 3 primary health center (PHC) physicians. A mixed method evaluation was conducted comprising clinical and survey data and in-depth patient and staff interviews to understand barriers and enablers to the use of the system. Then this was thematically analyzed using NVivo 10. Results During validation of the algorithm, there was an initial agreement for 70% of the 42 calculated variables between the CDSS and SPSS software outputs. Discrepancies were identified and amendments were made until perfect agreement was achieved. During field testing, NPHWs and PHC physicians used the CDSS to screen 227 and 65 adults, respectively. The NPHWs identified 39% (88/227) of patients for referral with 78% (69/88) of these having a definite indication for blood pressure (BP)-lowering medication. However, only 35% (24/69) attended a clinic within 1 month of referral, with 42% (10/24) of these reporting continuing medications at 3-month follow-up. Physicians identified and recommended 17% (11/65) of patients for BP-lowering medications. Qualitative interviews identified 3 interrelated interview themes: (1) the CDSS had potential to change prevailing health care models, (2) task-shifting to NPHWs was the central driver of change, and (3) despite high acceptability by end users, actual transformation was substantially limited by system-level barriers such as patient access to doctors and medicines. Conclusions A tablet-based CDSS implemented within primary health care systems has the potential to help improve CVD outcomes in India. However, system-level barriers to accessing medical care limit its full impact. These barriers need to be actively addressed for clinical innovations to be successful. Trial Registration Clinical Trials Registry of India: CTRI/2013/06/003753; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=6259&EncHid=51761.70513&userName=CTRI/2013/06/003753 (Archived by WebCite at http://www.webcitation.org/6UBDlrEuq). PMID:25487047

Patel, Anushka; Raghu, Arvind; Clifford, Gari D; Maulik, Pallab K; Mohammad Abdul, Ameer; Mogulluru, Kishor; Tarassenko, Lionel; MacMahon, Stephen; Peiris, David

2014-01-01

329

Quality Improvement in Multidisciplinary Cancer Teams: An Investigation of Teamwork and Clinical Decision-Making and Cross-Validation of Assessments  

Microsoft Academic Search

Purpose  Teamworking and clinical decision-making are important in multidisciplinary cancer teams (MDTs). Our objective is to assess\\u000a the quality of information presentation and MDT members’ contribution to decision-making via expert observation and self-report,\\u000a aiming to cross-validate the two methods and assess the insight of MDT members into their own team performance.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  Behaviors were scored using (i) a validated observational

B. W. Lamb; N. Sevdalis; H. Mostafid; C. Vincent; J. S. A. Green

330

An exploration of the influences on clinical decision making and the culture of blood transfusion practise in cancer-related anaemia using an ethnographic methodology  

Microsoft Academic Search

Purpose  This study seeks to explore the cultural practises, which shape the culture of transfusion, and to identify the key elements,\\u000a which influence clinical decision making in blood transfusion in haemato-oncology and lung cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The assessment and decision making processes for blood transfusion were explored using fieldwork observation, six patient\\u000a and nine clinician interviews based on ethnographic methodology. Data were

Liz Bishop; Sara Faithfull; Helen Allan

2010-01-01

331

Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.  

PubMed

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. PMID:23892207

Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

2013-10-01

332

Clinical Effectiveness and Cost-Effectiveness of HIV Pre-Exposure Prophylaxis in Men Who Have Sex with Men: Risk Calculators for Real-World Decision-Making  

PubMed Central

Background Oral pre-exposure prophylaxis (PrEP) can be clinically effective and cost-effective for HIV prevention in high-risk men who have sex with men (MSM). However, individual patients have different risk profiles, real-world populations vary, and no practical tools exist to guide clinical decisions or public health strategies. We introduce a practical model of HIV acquisition, including both a personalized risk calculator for clinical management and a cost-effectiveness calculator for population-level decisions. Methods We developed a decision-analytic model of PrEP for MSM. The primary clinical effectiveness and cost-effectiveness outcomes were the number needed to treat (NNT) to prevent one HIV infection, and the cost per quality-adjusted life-year (QALY) gained. We characterized patients according to risk factors including PrEP adherence, condom use, sexual frequency, background HIV prevalence and antiretroviral therapy use. Results With standard PrEP adherence and national epidemiologic parameters, the estimated NNT was 64 (95% uncertainty range: 26, 176) at a cost of $160,000 (cost saving, $740,000) per QALY – comparable to other published models. With high (35%) HIV prevalence, the NNT was 35 (21, 57), and cost per QALY was $27,000 (cost saving, $160,000), and with high PrEP adherence, the NNT was 30 (14, 69), and cost per QALY was $3,000 (cost saving, $200,000). In contrast, for monogamous, serodiscordant relationships with partner antiretroviral therapy use, the NNT was 90 (39, 157) and cost per QALY was $280,000 ($14,000, $670,000). Conclusions PrEP results vary widely across individuals and populations. Risk calculators may aid in patient education, clinical decision-making, and cost-effectiveness evaluation. PMID:25285793

Chen, Anders; Dowdy, David W.

2014-01-01

333

Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?  

PubMed Central

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians’ resistance to change. PMID:25593568

Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

2014-01-01

334

[The establishment of a computerized growth prediction system].  

PubMed

Natural craniofacial growth plays an important role in the etiology of malocclusion. So, craniofacial growth prediction is very necessary in orthodontics. The present author have developed a new-typed computerized craniofacial growth predition system, which was designed in the general sense of craniofacial growth. According to a unique method, the system could automatically predict of craniofacial growth to different craniofacial growth pattern. It can be used as an auxilliary tool in clinical, teaching and researches in orthodontics. PMID:12545851

Zhou, J; Luo, S; Li, Y; Yu, X

2000-09-01

335

Accuracy and Quality of Clinical Decision Rules for Syncope in the Emergency Department: A Systematic Review and Meta-analysis  

PubMed Central

Objectives We assessed the methodological quality and prognostic accuracy of clinical decision rules (CDR) in emergency department (ED) syncope patients. Methods We searched 5 electronic databases, reviewed reference lists of included studies and contacted content experts to identify articles for review. Studies that derived or validated CDRs in ED syncope patients were included. Two reviewers independently screened records for relevance, selected studies for inclusion, assessed study quality and abstracted data. Random effects meta-analysis was used to pool diagnostic performance estimates across studies that derived or validated the same CDR. Between study heterogeneity was assessed with I-squared statistic (I2), and subgroup hypotheses were tested using a test of interaction. Results We identified 18 eligible studies. Deficiencies in outcome (blinding) and inter-rater reliability assessment were the most common methodological weaknesses. Meta-analysis of the San Francisco Syncope Rule (SFSR) [sensitivity 86% (95%CI 83-89); specificity 49% (95%CI 48-51)] and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score [sensitivity 95% (95%CI 88-98); specificity 31% (95%CI 29-34)]. Subgroup analysis identified study design [prospective, diagnostic odds ratio (DOR) 8.82 (95%CI 3.5-22) vs. retrospective, DOR 2.45 (95%CI 0.96-6.21)] and ECG determination [by evaluating physician, DOR 25.5 (95%CI 4.41-148) vs. researcher or cardiologist, DOR 4 (95%CI 2.15-7.55)] as potential explanations for the variability in SFSR performance. Conclusion The methodological quality and prognostic accuracy of CDRs for syncope is limited. Differences in study design and ECG interpretation may account for the variable prognostic performance of the SFSR when validated in different practice settings. PMID:20868906

Serrano, Luis A.; Hess, Erik P.; Bellolio, M. Fernanda; Murad, Mohammed H.; Montori, Victor M.; Erwin, Patricia J.; Decker, Wyatt W.

2010-01-01

336

[Computerized analysis of esophageal manometry].  

PubMed

Computerized analysis of esophageal manometry should consider the following objectives: a) objectivation of data acquisition; b) precision in calculating the various parameters; c) speed of analysis; d) an easy-to-read and promptly understandable graphic display of the manometric data; e) computation of new parameters capable of defining normal and pathologic function. It is with these objectives in mind that we launched our research project. Five normal subjects and 10 patients, of whom 5 presented esophageal achalasia and 5 gastroesophageal reflux disease, underwent computerized esophageal manometry and were evaluated on the basis of both traditional and innovative parameters, of our own inception. Among the various indexes tested, the "Esophageal transport" parameter, calculated as the ratio of momentum (dp*dT) over speed of propagation of the esophageal contractions, gave rise to particular interest. In our opinion, this parameter can be used as an index of the dynamic function of the organ. PMID:2067691

Spigno, L; Pandolfo, N; Guiddo, G; Calci, G; Mattioli, G; De Salvo, L

1991-04-15

337

Computerized Pork Quality Evaluation System  

Microsoft Academic Search

\\u000a Pork quality assessment is important in the pork industry application. However, traditional pork quality assessment is conducted\\u000a by experienced workers and thereby is subjective. In this paper, a computerized system scheme based on hyperspectral imaging\\u000a technique is proposed for objective pork quality evaluation. This hyperspectral imaging technique used texture characteristics\\u000a to develop an accurate system of pork quality evaluation. Hypercube,

Li Liu; Michael O. Ngadi

2010-01-01

338

Computerized Assessment of Competence-Related Abilities in Living Liver Donors: The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL)  

PubMed Central

Background Despite its importance, determination of competence to consent to organ donation varies widely based on local standards. We piloted a new tool to aid transplant centers in donor assessment. Methods We assessed competence-related abilities among potential living liver donors (LDs) in the 9-center A2ALL study. Prospective LDs viewed an educational video, and were queried to assess Understanding, Appreciation, Reasoning, and ability to express a Final Choice using the MacArthur Competence Assessment Tool for Clinical Research, adapted for computerized administration in LDs (“MacLiver”). Videotaped responses were scored by a clinical neuropsychologist (JF). Results Ninety-three LDs were assessed. Mean (standard deviation; domain maximum) scores were: Understanding: 18.1 (2.6; max=22), Appreciation: 5.1 (1.0; max=6), Reasoning: 3.1 (0.8; max=4), and Final Choice: 3.8 (0.5; max=4). Scores did not differ by demographics, relationship to the recipient, eligibility to donate, or eventual donation (p>0.4). Higher education was associated with greater Understanding (p=0.004) and Reasoning (p=0.03). Conclusion Standardized, computerized education with independent ratings of responses may (1) alert the clinical staff to potential donors who may not be competent to donate, and (2) highlight areas needing further assessment and education, leading to better informed decision-making. PMID:23859354

Freeman, Jason; Emond, Jean; Gillespie, Brenda W.; Appelbaum, Paul S.; Weinrieb, Robert; Hill-Callahan, Peg; Gordon, Elisa J.; Terrault, Norah; Trotter, James; Ashworth, April; Dew, Mary Amanda; Pruett, Timothy

2014-01-01

339

APEX: A Computerized Simulation Game as the Basis for an Undergraduate Interdisciplinary Course.  

ERIC Educational Resources Information Center

APEX is a computerized gaming simulation; it is also the name of an interdisciplinary course in environmental problems in urban areas introduced at the School of Health Science, Hunter College of the City University of New York. In the course, students assume the roles of decision makers in both the private and public sectors. They receive data…

Tannenbaum, Robert S.

340

Impact of Computerized Prescriber Order Entry on the Incidence of Adverse Drug Events in Pediatric Inpatients  

Microsoft Academic Search

OBJECTIVES.This study was conducted to determine the impact of a computerized physician order entry system with substantial decision support on the incidence and types of adverse drug events in hospitalized children. METHODS.A prospective methodology was used for the collection of adverse drug events and potential adverse drug events from all patients admitted to the pediatric intensive care and general pediatric

Mark T. Holdsworth; Richard E. Fichtl; Dennis W. Raisch; Adrianne Hewryk; Maryam Behta; Elena Mendez-Rico; Cindy L. Wong; Jennifer Cohen; Susan Bostwick; Bruce M. Greenwald

2010-01-01

341

A multimedia electronic patient record (ePR) system to improve decision support in pre- and rehabilitation through clinical and movement analysis  

NASA Astrophysics Data System (ADS)

Clinical decisions for improving motor function in patients both with disability as well as improving an athlete's performance are made through clinical and movement analysis. Currently, this analysis facilitates identifying abnormalities in a patient's motor function for a large amount of neuro-musculoskeletal pathologies. However definitively identifying the underlying cause or long-term consequences of a specific abnormality in the patient's movement pattern is difficult since this requires information from multiple sources and formats across different times and currently relies on the experience and intuition of the expert clinician. In addition, this data must be persistent for longitudinal outcomes studies. Therefore a multimedia ePR system integrating imaging informatics data could have a significant impact on decision support within this clinical workflow. We present the design and architecture of such an ePR system as well as the data types that need integration in order to develop relevant decision support tools. Specifically, we will present two data model examples: 1) A performance improvement project involving volleyball athletes and 2) Wheelchair propulsion evaluation of patients with disabilities. The end result is a new frontier area of imaging informatics research within rehabilitation engineering and biomechanics.

Liu, Brent; Documet, Jorge; McNitt-Gray, Sarah; Requejo, Phil; McNitt-Gray, Jill

2011-03-01

342

Clinical Care Improvement with Use of Health Information Technology Focusing on Evidence Based Medicine  

PubMed Central

Objectives Healthcare institutions need timely patient information from various sources at the point-of-care. Evidence-based medicine (EBM) is a tool for proper and efficient incorporation of the results of research in decision-making. Characteristics of medical treatment processes and practical experience concerning the effect of EBM in the clinical process are surveyed. Methods A cross sectional survey conducted in Tehran hospitals in February-March 2012 among 51 clinical residents. The respondents were asked to apply EBM in clinical decision-making to answer questions about the effect of EBM in the clinical process. A valid and reliable questionnaire was used in this study. Results EBM provides a framework for problem solving and improvement of processes. Most residents (76%) agreed that EBM could improve clinical decision making. Eighty one percent of the respondents believed that EBM resulted in quick updating of knowledge. They believed that EBM was more useful for diagnosis than for treatment. There was a significant association between out-patients and in-patients in using electronic EBM resources. Conclusions Research findings were useful in clinical practice and decision making. The computerized guidelines are important tools for improving clinical process quality. When learning how to use IT, methods of search and evaluation of evidence for diagnosis, treatment and medical education are necessary. Purposeful use of IT in clinical processes reduces workload and improves decision-making. PMID:23115738

Peyman, Rezaei Hachesu; Ahmadi, Maryam; Aziz, Rezapoor; Farahnaz, Sadughi; Nader, Maroufi

2012-01-01

343

Methods of decision analysis: Protocols, decision trees, and algorithms in medicine  

Microsoft Academic Search

Algorithms, decision trees, and protocols are defined and explained since they constitute an accepted part of clinical decision analysis and application to clinical care. Algorithms are particularly useful for common clinical problems where uncertainties are unlikely. Decision trees are helpful when—as usually occurs in difficult clinical decisions—there are problems in probability. Clinical protocols, which, at best, are based on algorithms

J. M. Greep; L. M. L. C. Siezenis

1989-01-01

344

Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators  

PubMed Central

Objective Clinical documentation is central to the medical record and so to a range of healthcare and business processes. As electronic health record adoption expands, computerized provider documentation (CPD) is increasingly the primary means of capturing clinical documentation. Previous CPD studies have focused on particular stakeholder groups and sites, often limiting their scope and conclusions. To address this, we studied multiple stakeholder groups from multiple sites across the USA. Methods We conducted 14 focus groups at five Department of Veterans Affairs facilities with 129 participants (54 physicians or practitioners, 34 nurses, and 37 administrators). Investigators qualitatively analyzed resultant transcripts, developed categories linked to the data, and identified emergent themes. Results Five major themes related to CPD emerged: communication and coordination; control and limitations in expressivity; information availability and reasoning support; workflow alteration and disruption; and trust and confidence concerns. The results highlight that documentation intertwines tightly with clinical and administrative workflow. Perceptions differed between the three stakeholder groups but remained consistent within groups across facilities. Conclusions CPD has dramatically changed documentation processes, impacting clinical understanding, decision-making, and communication across multiple groups. The need for easy and rapid, yet structured and constrained, documentation often conflicts with the need for highly reliable and retrievable information to support clinical reasoning and workflows. Current CPD systems, while better than paper overall, often do not meet the needs of users, partly because they are based on an outdated ‘paper-chart’ paradigm. These findings should inform those implementing CPD systems now and future plans for more effective CPD systems. PMID:23355462

Embi, Peter J; Weir, Charlene; Efthimiadis, Efthimis N; Thielke, Stephen M; Hedeen, Ashley N; Hammond, Kenric W

2013-01-01

345

39 CFR 501.15 - Computerized Meter Resetting System.  

... 2014-07-01 false Computerized Meter Resetting System. 501.15 Section...EVIDENCING SYSTEMS § 501.15 Computerized Meter Resetting System. (a) Description. The Computerized Meter Resetting System (CMRS) permits...

2014-07-01

346

39 CFR 501.15 - Computerized Meter Resetting System.  

Code of Federal Regulations, 2012 CFR

... 2012-07-01 false Computerized Meter Resetting System. 501.15 Section...EVIDENCING SYSTEMS § 501.15 Computerized Meter Resetting System. (a) Description. The Computerized Meter Resetting System (CMRS) permits...

2012-07-01

347

39 CFR 501.15 - Computerized Meter Resetting System.  

Code of Federal Regulations, 2010 CFR

... 2010-07-01 false Computerized Meter Resetting System. 501.15 Section...EVIDENCING SYSTEMS § 501.15 Computerized Meter Resetting System. (a) Description. The Computerized Meter Resetting System (CMRS) permits...

2010-07-01

348

39 CFR 501.15 - Computerized Meter Resetting System.  

Code of Federal Regulations, 2013 CFR

... 2013-07-01 false Computerized Meter Resetting System. 501.15 Section...EVIDENCING SYSTEMS § 501.15 Computerized Meter Resetting System. (a) Description. The Computerized Meter Resetting System (CMRS) permits...

2013-07-01

349

39 CFR 501.15 - Computerized Meter Resetting System.  

Code of Federal Regulations, 2011 CFR

... 2011-07-01 false Computerized Meter Resetting System. 501.15 Section...EVIDENCING SYSTEMS § 501.15 Computerized Meter Resetting System. (a) Description. The Computerized Meter Resetting System (CMRS) permits...

2011-07-01

350

Computerized assessment of verbal skill.  

PubMed

This paper describes a computerized diagnostic test for the assessment of basic literacy skills in Dutch. Central in this test is a skill labeled word image, referring to the subject's implicit knowledge of orthographic structure. Test norms were obtained in a group of reference subjects. The most notable trend found in the standardization study was that the development of word image performance showed a nonlinear, U-shaped trend. Two case studies are reported. A supplementary validation study, based on test data collected from standard reference groups of normal and poor readers, demonstrated that word image performance is significantly related to between-group differences. PMID:8229899

Assink, E; Kattenberg, G

1993-07-01

351

Decision making and neuropsychiatry  

Microsoft Academic Search

Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neuropsychiatric disorders such as mania, substance abuse and personality disorders. A neural network involving the orbitofrontal cortex, ventral striatum and

Shibley Rahman; Barbara J. Sahakian; Rudolf N. Cardinal; Robert D. Rogers; Trevor W. Robbins

2001-01-01

352

Computerized Classification Testing with the Rasch Model  

ERIC Educational Resources Information Center

If classification in a limited number of categories is the purpose of testing, computerized adaptive tests (CATs) with algorithms based on sequential statistical testing perform better than estimation-based CATs (e.g., Eggen & Straetmans, 2000). In these computerized classification tests (CCTs), the Sequential Probability Ratio Test (SPRT) (Wald,…

Eggen, Theo J. H. M.

2011-01-01

353

The Evaluation of SISMAKOM (Computerized SDI Project).  

ERIC Educational Resources Information Center

A survey of 88 users of SISMAKOM, a computerized selective dissemination of information (SDI) and document delivery service provided by the Universiti Sains Malaysia and four other Malaysian universities, was conducted in August 1982 in order to collect data about SISMAKOM and to assess the value of a computerized SDI service in a developing…

University of Science, Penang (Malaysia).

354

Computerized Adaptive Testing under Nonparametric IRT Models  

ERIC Educational Resources Information Center

Nonparametric item response models have been developed as alternatives to the relatively inflexible parametric item response models. An open question is whether it is possible and practical to administer computerized adaptive testing with nonparametric models. This paper explores the possibility of computerized adaptive testing when using…

Xu, Xueli; Douglas, Jeff

2006-01-01

355

DOE transporation programs - computerized techniques  

SciTech Connect

One of the major thrusts of the transportation programs at the Oak Ridge National Laboratory has been the development of a number of computerized transportation programs and data bases. The U.S. Department of Energy (DOE) is supporting these efforts through the Transportation Technology Center at Sandia National Laboratories and the Tranportation Operations and Traffic Management (TOTM) organization at DOE Headquarters. Initially this project was centered upon research activities. However, since these tools provide traffic managers and key personnel involved in preshipment planning with a unique resource for ensuring that the movement of radioactive materials can be properly accomplished, additional interest and support is coming from the operational side of DOE. The major accomplishments include the development of two routing models (one for rail shipments and the other for highway shipments), an emergency response assistance program, and two data bases containing pertinent legislative and regulatory information. This paper discusses the mose recent advances in, and additions to, these computerized techniques and provides examples of how they are used.

Joy, D.S.; Johnson, P.E.; Fore, C.S.; Peterson, B.E.

1983-01-01

356

Influence of computerized sounding out on spelling performance for children who do and do not rely on AAC.  

PubMed

Abstract Purpose: Spelling is an important skill for individuals who rely on augmentative and alternative communication (AAC). The purpose of this study was to investigate how computerized sounding out influenced spelling accuracy of pseudo-words. Computerized sounding out was defined as a word elongated, thus providing an opportunity for a child to hear all the sounds in the word at a slower rate. Methods: Seven children with cerebral palsy, four who use AAC and three who do not, participated in a single subject AB design. Results: The results of the study indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words produced by participants. Conclusion: The study provides preliminary evidence for the use of computerized sounding out during spelling tasks for children with cerebral palsy who do and do not use AAC. Future directions and clinical implications are discussed. Implications for Rehabilitation We investigated how computerized sounding out influenced spelling accuracy of pseudowords for children with complex communication needs who did and did not use augmentative and alternative communication (AAC). Results indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words by participants, suggesting that computerized sounding out might assist in more accurate spelling for children who use AAC. Future research is needed to determine how language and reading abilities influence the use of computerized sounding out with children who have a range of speech intelligibilityabilities and do and do not use AAC. PMID:24512195

McCarthy, Jillian H; Hogan, Tiffany P; Beukelman, David R; Schwarz, Ilsa E

2014-02-11

357

Computerized axial tomography in the diagnosis of internal derangements of the temporomandibular joint.  

PubMed

Fourteen patients with a history of pain, clicking and locking of the temporomandibular joint were assessed clinically and by using computerized axial tomography (CAT). The findings of the clinical and CAT scan assessment were correlated and compared with surgical observations. Computerized axial tomography scanning proved to be a highly accurate method of assessing meniscal position. With the advent of more sophisticated methods of CAT scanning, it provides an accurate, non-invasive method of assessing the temporomandibular joint and providing a basis for more effective treatment planning of problems related to internal derangements. PMID:2393362

Anker, A H; D'Rozario, R H; Li, S

1990-06-01

358

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study  

PubMed Central

Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions. PMID:25317266

Nuss, Michelle A.; Hill, Janette R.; Cervero, Ronald M.; Gaines, Julie K.; Middendorf, Bruce F.

2014-01-01

359

Computerized decision support systems: improving patient safety in nephrology  

Microsoft Academic Search

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

Jamison Chang; Claudio Ronco; Mitchell H. Rosner

2011-01-01

360

Current Status of Computerized Decision Support Systems in Mammography  

Microsoft Academic Search

Breast cancer is one of the most devastating and deadly diseases for women today. Despite advances in cancer treatment, early mammographic detection remains the first line of defense in the battle against breast cancer. Patients with early-detected malignancies have a significantly lower mortality rate. Nevertheless, it is reported that up to 30% of breast lesions go undetected in screening mammograms

G. D. Tourassi

361

13 N-ammonia myocardial perfusion imaging with a PET\\/CT scanner: impact on clinical decision making and cost-effectiveness  

Microsoft Academic Search

Purpose  The purpose of the study is to determine the impact of 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) on clinical decision making and its cost-effectiveness.\\u000a \\u000a \\u000a \\u000a Materials and methods  One hundred consecutive patients (28 women, 72 men; mean age 60.9?±?12.0 years; range 24–85 years) underwent 13N-ammonia PET scanning (and computed tomography, used only for attenuation correction) to assess myocardial perfusion in patients

Patrick T. Siegrist; Lars Husmann; Martina Knabenhans; Oliver Gaemperli; Ines Valenta; Tobias Hoefflinghaus; Hans Scheffel; Paul Stolzmann; Hatem Alkadhi; Philipp A. Kaufmann

2008-01-01

362

A Study Comparing Endoscopic Ultrasound (EUS) and Computed Tomography (CT) in Staging Oesophageal Cancer and their Role in Clinical Decision Making  

Microsoft Academic Search

Background and Aim  Computed tomography (CT) and endoscopic ultrasound (EUS) are part of the regular preoperative staging protocol in oesophageal\\u000a cancer. At present, EUS is increasingly being used for preoperative locoregional staging of oesophageal cancer. The aim of\\u000a this study is to compare EUS and CT findings and their role in clinical decision making.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The CT staging of 30 patients with

Duminda Subasinghe; Dharmabandhu Nandadeva Samarasekera

2010-01-01

363

Computerized Neurocognitive Test Performance in Schizophrenia: A Lifespan Analysis  

PubMed Central

Objective Computerized neurocognitive batteries based on advanced behavioral neuroscience methods are increasingly used in large-scale clinical and genomic studies. Favorable construct validity in younger schizophrenia patients has been reported, but not in older patients. New variables afforded by computerized assessments were used to clarify age-associated cognitive impairment across the lifespan. Methods 624 patients with schizophrenia and 624 healthy comparison (HC) subjects aged 16–75 completed a 1–2 hour computerized neurocognitive battery (CNB) that assessed abstraction and mental flexibility, attention, working memory, recognition memory (verbal, facial, spatial), language, visuospatial and emotion processing. Linear mixed effects models tested for group differences in accuracy, response time, and efficiency scores. Contrasts were stratified by age. Results 91% of older (45+) and 94% of younger (<45) groups provided “good” data quality. After controlling for parental education and project, there were significant three-way interactions for diagnosis x domain x age group on all three outcome variables. Patients performed worse than HC across all neurocognitive domains, except in the oldest group of 60+ patients. Age-stratified analyses did not show differences between younger (16–45) and older patients (45–60, 60+), except for the attention domain. Older patients’ reduced working memory efficiency was due to worse speed, not accuracy. Older patients were quicker than younger patients in processing emotions. Conclusions Computerized assessments are feasible in large cohorts of schizophrenia patients. There is stable and generalized neurocognitive dysfunction across the lifespan in schizophrenia, albeit with fewer differences in some domains between older patients and HC after age 60. Speed-accuracy tradeoff strategies suggest deceleration of some frontal networks and improvements in speed of emotional processing. PMID:22183011

Irani, Farzin; Brensinger, Colleen M.; Richard, Jan; Calkins, Monica E.; Moberg, Paul J.; Bilker, Waren; Gur, Raquel E.; Gur, Ruben C.

2011-01-01

364

Computerized tongue diagnosis based on Bayesian networks.  

PubMed

Tongue diagnosis is an important diagnostic method in traditional Chinese medicine (TCM). However, due to its qualitative, subjective and experience-based nature, traditional tongue diagnosis has a very limited-application in clinical medicine. Moreover, traditional tongue diagnosis is always concerned with the identification of syndromes rather than with the connection between tongue abnormal appearances and diseases. This is not well understood in Western medicine, thus greatly obstruct its wider use in the world. In this paper, we present a novel computerized tongue inspection method aiming to address these problems. First, two kinds of quantitative features, chromatic and textural measures, are extracted from tongue images by using popular digital image processing techniques. Then, Bayesian networks are employed to model the relationship between these quantitative features and diseases. The effectiveness of the method is tested on a group of 455 patients affected by 13 common diseases as well as other 70 healthy volunteers, and the diagnostic results predicted by the previously trained Bayesian network classifiers are reported. PMID:15490827

Pang, Bo; Zhang, David; Li, Naimin; Wang, Kuanquan

2004-10-01

365

Relationships between brain-derived neurotrophic factor, clinical symptoms, and decision-making in chronic schizophrenia: data from the Iowa Gambling Task.  

PubMed

The levels of brain-derived neurotrophic factor (BDNF) are significantly decreased in patients with schizophrenia and correlate with impairments in cognitive function. However, no study has investigated the relationship between the serum BDNF levels and decision-making. We compared patients with schizophrenia to healthy controls with respect to their decision-making ability and serum BDNF levels. Eighty-six chronic schizophrenia patients and 51 healthy controls participated in this study. We controlled for gender, age, and estimated intelligence quotient (IQ), and we investigated the differences in decision-making performance on the Iowa Gambling Task (IGT) between the schizophrenia patient and control groups. We also compared the IGT scores, the serum BDNF levels, and the clinical symptoms between the groups. The IGT scores of the schizophrenia patients were lower than those of the controls. A negative correlation was detected between the mean net scores on the trials in the final two blocks and the serum BDNF levels (p < 0.05). Multiple regression analysis revealed that depressive symptoms and the serum BDNF levels were significantly associated with the mean net scores on the trials in the final two blocks. Based on these results, impaired sensitivity to both reward and punishment is associated with depressive symptoms and reduced serum BDNF levels in chronic schizophrenia patients and may be related to their poor performance on the IGT. PMID:25538582

Hori, Hikaru; Yoshimura, Reiji; Katsuki, Asuka; Atake, Kiyokazu; Nakamura, Jun

2014-01-01

366

Relationships between brain-derived neurotrophic factor, clinical symptoms, and decision-making in chronic schizophrenia: data from the Iowa Gambling Task  

PubMed Central

The levels of brain-derived neurotrophic factor (BDNF) are significantly decreased in patients with schizophrenia and correlate with impairments in cognitive function. However, no study has investigated the relationship between the serum BDNF levels and decision-making. We compared patients with schizophrenia to healthy controls with respect to their decision-making ability and serum BDNF levels. Eighty-six chronic schizophrenia patients and 51 healthy controls participated in this study. We controlled for gender, age, and estimated intelligence quotient (IQ), and we investigated the differences in decision-making performance on the Iowa Gambling Task (IGT) between the schizophrenia patient and control groups. We also compared the IGT scores, the serum BDNF levels, and the clinical symptoms between the groups. The IGT scores of the schizophrenia patients were lower than those of the controls. A negative correlation was detected between the mean net scores on the trials in the final two blocks and the serum BDNF levels (p < 0.05). Multiple regression analysis revealed that depressive symptoms and the serum BDNF levels were significantly associated with the mean net scores on the trials in the final two blocks. Based on these results, impaired sensitivity to both reward and punishment is associated with depressive symptoms and reduced serum BDNF levels in chronic schizophrenia patients and may be related to their poor performance on the IGT. PMID:25538582

Hori, Hikaru; Yoshimura, Reiji; Katsuki, Asuka; Atake, Kiyokazu; Nakamura, Jun

2014-01-01

367

Practical aspects of decision making in clinical trials: the coronary drug project as a case study. The Coronary Drug Project Research Group.  

PubMed

Arriving at a decision for early termination of a treatment group or of an entire clinical trial, due to either beneficial or adverse results, is a complex process. It may involve, among other things, the necessity to (1) determine whether the observed treatment differences are likely to represent real effects and are not due to chance; (2) weigh the importance of many different response variables, some possible trending in favor of the treatment and some against it; (3) adjust for differences in distributions of baseline characteristics among the treatment groups; (4) discern possible biases (due to the study not being double-blind) in the medical management of patients or in the diagnosis of events; and (5) evaluate treatment effects in subgroups of the study participants. Experiences in the Coronary Drug Project are described in making decisions for early termination of treatment groups. Special methods applied in conjunction with reaching these decisions included: (1) analyses designed to detect possible biases in diagnosing a major endpoint--nonfatal myocardial infarction, e.g.--biases that may have arisen because of unblinding by side effects of the estrogen treatment group; (2) a simulation study to assess the statistical significance of mortality differences between the dextrothyroxine and placebo participants in certain subgroups identified a posteriori; and (3) the development, on the basis of the accumulated data, or new hypotheses relating to treatment differences in specific subgroups and the testing of these hypotheses a few months later on the basis of new events occurring during that interval. PMID:7261627

1981-05-01

368

A collaborative framework for contributing DICOM RT PHI (Protected Health Information) to augment data mining in clinical decision support  

NASA Astrophysics Data System (ADS)

We have built a decision support system that provides recommendations for customizing radiation therapy treatment plans, based on patient models generated from a database of retrospective planning data. This database consists of relevant metadata and information derived from the following DICOM objects - CT images, RT Structure Set, RT Dose and RT Plan. The usefulness and accuracy of such patient models partly depends on the sample size of the learning data set. Our current goal is to increase this sample size by expanding our decision support system into a collaborative framework to include contributions from multiple collaborators. Potential collaborators are often reluctant to upload even anonymized patient files to repositories outside their local organizational network in order to avoid any conflicts with HIPAA Privacy and Security Rules. We have circumvented this problem by developing a tool that can parse DICOM files on the client's side and extract de-identified numeric and text data from DICOM RT headers for uploading to a centralized system. As a result, the DICOM files containing PHI remain local to the client side. This is a novel workflow that results in adding only relevant yet valuable data from DICOM files to the centralized decision support knowledge base in such a way that the DICOM files never leave the contributor's local workstation in a cloud-based environment. Such a workflow serves to encourage clinicians to contribute data for research endeavors by ensuring protection of electronic patient data.

Deshpande, Ruchi; Thuptimdang, Wanwara; DeMarco, John; Liu, Brent J.

2014-03-01

369

An ontology model for clinical documentation templates  

E-print Network

There are various kinds of clinical documents used in a hospital or clinic setting. With the emergence of Electronic Medical Records, efforts are being made to computerize these documents in a structured fashion in order ...

George, Joyce, S.M. Massachusetts Institute of Technology

2005-01-01

370

Using computational modeling to assess the impact of clinical decision support on cancer screening improvement strategies within the community health centers.  

PubMed

Our conceptual model demonstrates our goal to investigate the impact of clinical decision support (CDS) utilization on cancer screening improvement strategies in the community health care (CHC) setting. We employed a dual modeling technique using both statistical and computational modeling to evaluate impact. Our statistical model used the Spearman's Rho test to evaluate the strength of relationship between our proximal outcome measures (CDS utilization) against our distal outcome measure (provider self-reported cancer screening improvement). Our computational model relied on network evolution theory and made use of a tool called Construct-TM to model the use of CDS measured by the rate of organizational learning. We employed the use of previously collected survey data from community health centers Cancer Health Disparities Collaborative (HDCC). Our intent is to demonstrate the added valued gained by using a computational modeling tool in conjunction with a statistical analysis when evaluating the impact a health information technology, in the form of CDS, on health care quality process outcomes such as facility-level screening improvement. Significant simulated disparities in organizational learning over time were observed between community health centers beginning the simulation with high and low clinical decision support capability. PMID:24953241

Carney, Timothy Jay; Morgan, Geoffrey P; Jones, Josette; McDaniel, Anna M; Weaver, Michael; Weiner, Bryan; Haggstrom, David A

2014-10-01

371

A scalable architecture for incremental specification and maintenance of procedural and declarative clinical decision-support knowledge.  

PubMed

Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians' assessment was significantly lower than the assessment of the knowledge engineers. PMID:21611137

Hatsek, Avner; Shahar, Yuval; Taieb-Maimon, Meirav; Shalom, Erez; Klimov, Denis; Lunenfeld, Eitan

2010-01-01

372

Linear models in decision making  

Microsoft Academic Search

A review of the literature indicates that linear models are frequently used in situations in which decisions are made on the basis of multiple codable inputs. These models are sometimes used (a) normatively to aid the decision maker, (b) as a contrast with the decision maker in the clinical vs statistical controversy, (c) to represent the decision maker \\

Robyn M. Dawes; Bernard Corrigan

1974-01-01

373

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

E-print Network

for Breast Cancer Follow-up Interventions at Primary Care Settings Samina R. Abidi, Syed SR. Abidi, Sajjad, Canada Abstract Breast cancer follow-up care can be provided by family phy- sicians after specialists complete the primary treatment. Can- cer Care Nova Scotia has developed a breast cancer follow- up Clinical

Abidi, Syed Sibte Raza

374

The role of informatics and decision support in utilization management.  

PubMed

Information systems provide a critical link between clinical laboratories and the clinicians and patients they serve. Strategic deployment of informatics resources can enable a wide array of utilization initiatives and can substantially improve the appropriateness of test selection and results interpretation. In this article, we review information systems including computerized provider order entry (CPOE) systems, laboratory information systems (LISs), electronic health records (EHRs), laboratory middleware, knowledge management systems and systems for data extraction and analysis, and describe the role that each can play in utilization management. We also discuss specific utilization strategies that laboratories can employ within these systems, citing examples both from our own institution and from the literature. Finally, we review how emerging applications of decision support technologies may help to further refine test utilization, "personalize" laboratory diagnosis, and enhance the diagnostic value of laboratory testing. PMID:24084507

Baron, Jason M; Dighe, Anand S

2014-01-01

375

Computerized tomography using video recorded fluoroscopic images  

NASA Technical Reports Server (NTRS)

A computerized tomographic imaging system is examined which employs video-recorded fluoroscopic images as input data. By hooking the video recorder to a digital computer through a suitable interface, such a system permits very rapid construction of tomograms.

Kak, A. C.; Jakowatz, C. V., Jr.; Baily, N. A.; Keller, R. A.

1975-01-01

376

Computerizing a house organ: recharting familiar territory  

SciTech Connect

Computerization can offer great advantages. But one publication ideally suited to computerization was slow to take advantage of the new technology. The main reason was reluctance to try an unfamiliar way of doing things. Having now switched to computerization, the publication has reaped many benefits. Among them: production time is faster; costs are lower; errors are fewer. Computerization has not been without minor problems. The most obvious is vulnerability to the rarity of a system failure. Others include the technology's potential reinforcement of overediting and of excessive reliance on extremely rapid response. Such problems, however, do not indicate weaknesses in the technology itself; rather, they reflect an incomplete adaption to it and the need for more realistic expectations. An unwarranted reluctance to innovate can slow advances in communication. Technical communicators must be willing to rechart their own familiar territory.

none,

1982-01-01

377

HUMAN RELIABILITY ANALYSIS FOR COMPUTERIZED PROCEDURES  

SciTech Connect

This paper provides a characterization of human reliability analysis (HRA) issues for computerized procedures in nuclear power plant control rooms. It is beyond the scope of this paper to propose a new HRA approach or to recommend specific methods or refinements to those methods. Rather, this paper provides a review of HRA as applied to traditional paper-based procedures, followed by a discussion of what specific factors should additionally be considered in HRAs for computerized procedures. Performance shaping factors and failure modes unique to computerized procedures are highlighted. Since there is no definitive guide to HRA for paper-based procedures, this paper also serves to clarify the existing guidance on paper-based procedures before delving into the unique aspects of computerized procedures.

Ronald L. Boring; David I. Gertman; Katya Le Blanc

2011-09-01

378

Graphical Models and Computerized Adaptive Testing.  

ERIC Educational Resources Information Center

Considers computerized adaptive testing from the perspective of graphical modeling (GM). GM provides methods for making inferences about multifaceted skills and knowledge and for extracting data from complex performances. Provides examples from language-proficiency assessment. (SLD)

Almond, Russell G.; Mislevy, Robert J.

1999-01-01

379

Computerized Anatomy Atlas Of The Human Brain  

NASA Astrophysics Data System (ADS)

A software for developing, editing and displaying a 3-D computerized anatomic atlas of a human brain is described. The objective of this atlas is to serve as a reference in identifying various structures in CT scans.

Adair, Taylor; Bajcsy, Ruzena; Karp, Peter; Stein, Alan

1981-10-01

380

Can access limits on sales representatives to physicians affect clinical prescription decisions? A study of recent events with diabetes and lipid drugs.  

PubMed

The authors explored to what extent important medical decisions by practitioners can be influenced by pharmaceutical representatives and, in particular, whether restricting such access could delay appropriate changes in clinical practice. Medical practices were divided into four categories based on the degree of sales representative access to clinicians: very low, low, medium, and high from a database compiled by ZS Associates called AccessMonitor (Evanston, IL) used extensively by many pharmaceutical companies. Clinical decisions of 58,647 to 72,114 physicians were statistically analyzed using prescription data from IMS Health (Danbury, CT) in three critical areas: an innovative drug for type 2 diabetes (sitagliptin), an older diabetes drug with a new Food and Drug Administration-required black box warning for cardiovascular safety (rosiglitazone), and a combination lipid therapy that had reported negative outcomes in a clinical trial (simvastatin+ezetimbe). For the uptake of the new diabetes agent, the authors found that physicians with very low access to representatives had the lowest adoption of this new therapy and took 1.4 and 4.6 times longer to adopt than physicians in the low- and medium-access restriction categories, respectively. In responding to the black box warning for rosiglitazone, the authors found that physicians with very low access were?4.0 times slower to reduce their use of this treatment than those with low access. Likewise, there was significantly less response in terms of changing prescribing to the negative news with the lipid therapy for physicians in more access-restricted offices. Overall, cardiologists were the most responsive to information changes relative to primary care physicians. These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs. PMID:22747616

Chressanthis, George A; Khedkar, Pratap; Jain, Nitin; Poddar, Prashant; Seiders, Michael G

2012-07-01

381

The Impact of Interactive, Computerized Educational Modules on Preclinical Medical Education  

ERIC Educational Resources Information Center

Interactive computerized modules have been linked to improved retention of material in clinical medicine. This study examined the effects of a new series of interactive learning modules for preclinical medical education, specifically in the areas of quiz performance, perceived difficulty of concepts, study time, and perceived stress level. We…

Bryner, Benjamin S.; Saddawi-Konefka, Daniel; Gest, Thomas R.

2008-01-01

382

Comparing Assessments of Students' Knowledge by Computerized Open-Ended and Multiple-Choice Tests.  

ERIC Educational Resources Information Center

Interactive computerized tests accepting unrestricted natural-language input were used to assess knowledge of clinical biophysics at the State University of New York at Buffalo. Comparison of responses to open-ended sequential questions and multiple-choice questions on the same material found the two formats test different aspects of competence.…

Anbar, Michael

1991-01-01

383

Building a web-based tool to support clinical decisions in the control of Chlamydia trachomatis and Neisseria gonorrhoeae infections  

PubMed Central

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the agents of two common, sexually transmitted diseases afflicting women in the United States (http://www.cdc.gov). We designed a novel web-based application that offers simple recommendations to help optimize medical outcomes with CT and GC prevention and control programs. This application takes population groups, prevalence rates, parameters for available screening assays and treatment regimens (costs, sensitivity, and specificity), as well as budget limits as inputs. Its output suggests optimal screening and treatment strategies for selected at-risk groups, commensurate with the clinic's budget allocation. Development of this tool illustrates how a clinical informatics application based on rigorous mathematics might have a significant impact on real-world clinical issues. PMID:24564848

2013-01-01

384

Reflecting on the ethical administration of computerized medical records  

NASA Astrophysics Data System (ADS)

This presentation examines the ethical issues raised by computerized image management and communication systems (IMAC), the ethical principals that should guide development of policies, procedures and practices for IMACS systems, and who should be involved in developing a hospital's approach to these issues. The ready access of computerized records creates special hazards of which hospitals must beware. Hospitals must maintain confidentiality of patient's records while making records available to authorized users as efficiently as possible. The general conditions of contemporary health care undermine protecting the confidentiality of patient record. Patients may not provide health care institutions with information about themselves under conditions of informed consent. The field of information science must design sophisticated systems of computer security that stratify access, create audit trails on data changes and system use, safeguard patient data from corruption, and protect the databases from outside invasion. Radiology professionals must both work with information science experts in their own hospitals to create institutional safeguards and include the adequacy of security measures as a criterion for evaluating PACS systems. New policies and procedures on maintaining computerized patient records must be developed that obligate all members of the health care staff, not just care givers. Patients must be informed about the existence of computerized medical records, the rules and practices that govern their dissemination and given the opportunity to give or withhold consent for their use. Departmental and hospital policies on confidentiality should be reviewed to determine if revisions are necessary to manage computer-based records. Well developed discussions of the ethical principles and administrative policies on confidentiality and informed consent and of the risks posed by computer-based patient records systems should be included in initial and continuing staff system training. Administration should develop ways to monitor staff compliance with confidentiality policies and should assess diligence in maintaining patient record confidentiality as part of staff annual performance evaluations. Ethical management of IMAC systems is the business of all members of the health care team. Computerized patient records management (including IMAC) should be scrutinized as any other clinical medial ethical issue. If hospitals include these processes in their planning for RIS, IMACS, and HIS systems, they should have time to develop institutional expertise on these questions before and as systems are installed rather than only as ethical dilemmas develop during their use.

Collmann, Jeff R.

1995-05-01

385

Successful clinical trial research in nursing homes: the Improving Decision-Making Study. | accrualnet.cancer.gov  

Cancer.gov

Most clinical researchers (and, in fact, most physicians) have limited experiences in the nursing home setting. This is a highly regulated environment in which staff spend large amounts of time on quality oversight and are often wary of the demands of research participation.

386

One Size Doesn't Fit All: The Efficiency of Graphical, Numerical and Textual Clinical Decision Support for Nurses  

E-print Network

the potential of significantly improving the quality and efficiency of patient care, but they need to present information in a way that is easily understandable by health care personnell. In the clinical setting, nurses are often tasked with the care of a large number of patients, and in specific scenarios are in charge

Johnson, Andrew

387

Projecting the clinical benefits of adjuvant radiotherapy versus observation and selective salvage radiotherapy after radical prostatectomy: a decision analysis  

Microsoft Academic Search

Our purpose was to project and compare clinical and quality-adjusted life year (QALY) outcomes of adjuvant radiotherapy (ART) versus salvage RT (SRT) after radical prostatectomy for men with locally advanced prostate cancer. We constructed a Markov model to simulate the randomized studies of observation versus ART, assuming 75% of observation patients would receive SRT at PSA recurrence. Transition probabilities and

S P Elliott; T J Wilt; K M Kuntz

2011-01-01

388

A Prospective Analysis of the Influence of Older Age on Physician and Patient Decision-Making When Considering Enrollment in Breast Cancer Clinical Trials (SWOG S0316)  

PubMed Central

Purpose. Patients older than 65 years are underrepresented in clinical trials. We conducted a prospective study (SWOG S0316) to determine physician- and patient-perceived barriers to breast cancer clinical trial enrollment for older patients. Methods. Eight geographically diverse SWOG institutions participated. The study assessed patients' and physicians' decisions to enroll in or decline clinical treatment trials, including demographics, trial availability, and eligibility. Patient and physician questionnaires elicited concerns related to treatment, medical status, age, family, and financial or transportation concerns. Results. A total of 1,079 patients were registered and eligible and 909 (84%) returned for follow-up. The major reason for nonaccrual was either trial unavailability or ineligibility (60%). Older patients were less likely to be eligible for trials (65% for age ?65 years vs. 78% for age <65 years). If eligible, trial participation rates did not differ significantly by age (34% for age ?65 years vs. 40% for age <65 years). Patients ?65 years more often were concerned about side effects, had friends opposed to participation, or believed that participation would not benefit other generations. When trials were available and patients were eligible, physicians discussed trial participation with 76% of patients <65 years versus 58% of patients ?65 years of age. For patients ?65 years, 11% of physicians indicated age as a reason they did not enroll a patient in a clinical trial. Conclusion. Trial unavailability or patient ineligibility were the major reasons for lack of enrollment in breast cancer clinical trials for patients of all ages in this prospective study. Older patients were less likely to be eligible for trials, but if eligible they participated at similar rates to younger patients. PMID:22723506

Unger, Joseph M.; Gralow, Julie R.; Moinpour, Carol M.; Wozniak, Antoinette J.; Goodwin, J. Wendall; Lara, Primo N.; Williams, Pamela A.; Hutchins, Laura F.; Gotay, Carolyn C.; Albain, Kathy S.

2012-01-01

389

The development and implementation of a computerized on-line obstetric record.  

PubMed

We developed and implemented a completely paperless and on-line obstetric record in the high-risk obstetric clinics at Columbia Presbyterian Medical Center. Patient care and interactions are input directly into the computer by the health care providers. Laboratory information is transferred automatically from the Laboratory Information Service into the computerized prenatal record. The system has been in continuous operation for 2 years and is highly regarded. Problems such as illegible handwriting, missing records, and missing laboratory data have disappeared. Research and data query capabilities have been facilitated. The feasibility and applicability of a computerized record replacing the paper record has been demonstrated. PMID:2611172

Gonzalez, F A; Fox, H E

1989-11-01

390

78 FR 17940 - Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...  

Federal Register 2010, 2011, 2012, 2013

...Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...computerized orthopedic surgical devices, software, implants, and components...

2013-03-25

391

Computerized database on dielectric materials  

SciTech Connect

This computerized, interactive database provides technical, application, and commercial data on more than a thousand solid, liquid, and gaseous dielectric materials. The information is readily accessible to designers, engineers, scientists, researchers, and others via user-friendly on-line operation. This project was carried out in two phases. In the proof-of-concept phase, a pilot database was developed by the contractor and then tested and critiqued by a small group of users. In the second phase, the pilot database was expanded to the size needed. Constructing the database required (1) developing a database management system, (2) extracting numerical data from the worldwide literature on dielectric materials, (3) compiling other information on materials, (4) formatting and inserting into the database the numerical data and information, and (5) critically evaluating numerical data and developing recommended values. The database is operational and accessible 24 hours a day. Interested users can, from their computer terminals, extract data on materials properties in tabular or graphical form and perform unit conversions, graphical manipulations, and other analyses. The database now contains information on more than 1300 materials and is periodically updated.

Ho, C.Y.; Li, H.H.; Marinescu, G.M. (Purdue Univ., Lafayette, IN (United States). Center for Information and Numerical Data Analysis and Synthesis)

1992-05-01

392

Data Mining Session-Based Patient Reported Outcomes (PROs) in a Mental Health Setting: Toward Data-Driven Clinical Decision Support and Personalized Treatment  

E-print Network

The CDOI outcome measure - a patient-reported outcome (PRO) instrument utilizing direct client feedback - was implemented in a large, real-world behavioral healthcare setting in order to evaluate previous findings from smaller controlled studies. PROs provide an alternative window into treatment effectiveness based on client perception and facilitate detection of problems/symptoms for which there is no discernible measure (e.g. pain). The principal focus of the study was to evaluate the utility of the CDOI for predictive modeling of outcomes in a live clinical setting. Implementation factors were also addressed within the framework of the Theory of Planned Behavior by linking adoption rates to implementation practices and clinician perceptions. The results showed that the CDOI does contain significant capacity to predict outcome delta over time based on baseline and early change scores in a large, real-world clinical setting, as suggested in previous research. The implementation analysis revealed a number of critical factors affecting successful implementation and adoption of the CDOI outcome measure, though there was a notable disconnect between clinician intentions and actual behavior. Most importantly, the predictive capacity of the CDOI underscores the utility of direct client feedback measures such as PROs and their potential use as the basis for next generation clinical decision support tools and personalized treatment approaches.

Casey Bennett; Thomas Doub; April Bragg; Jason Luellen; Christina Van Regenmorter; Jennifer Lockman; Randall Reiserer

2011-12-07

393

The Impact of Computerized Physician Order Entry on Medication Error Prevention  

Microsoft Academic Search

BackgroundMedication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events.ObjectiveTo evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors.DesignProspective time series analysis,

David W Bates; J ONATHAN M. TEICH; JOSHUA LEE; Diane Seger; Gilad J Kuperman; Nell MaLuf; Deborah Boyle; Lucian Leape

1999-01-01

394

A Computerized Implementation of a Flexilevel Test and Its Comparison with a Bayesian Computerized Adaptive Test.  

ERIC Educational Resources Information Center

A computerized flexilevel test was implemented and its ability estimates were compared with those of a Bayesian estimation based computerized adaptive test (CAT) as well as with known true ability estimates. Results showed that when the flexilevel test was terminated according to Lord's criterion, its ability estimates were highly and…

DeAyala, R. J.; Koch, William R.

395

A Randomized Experiment to Compare Conventional, Computerized, and Computerized Adaptive Administration of Ordinal Polytomous Attitude Items  

ERIC Educational Resources Information Center

A total of 520 high school students were randomly assigned to a paper-and-pencil test (PPT), a computerized standard test (CST), or a computerized adaptive test (CAT) version of the Dutch School Attitude Questionnaire (SAQ), consisting of ordinal polytomous items. The CST administered items in the same order as the PPT. The CAT administered all…

Hol, A. Michiel; Vorst, Harrie C. M.; Mellenbergh, Gideon J.

2005-01-01

396

Patient-specific modelling in drug design, development and selection including its role in clinical decision-making.  

PubMed

Genomics has made enormous progress in the twelve years since the publication of the first draft human genome sequence, but it has not yet been translated into the clinic. Despite spiralling development costs, the number of new drug registrations is not increasing. One reason for this lies in the genetic complexity of disease. Most diseases involve dysregulation in pathways that involve many genes, and many (including most cancers) are themselves genetically heterogeneous. Systems biology involves the multi-level simulation of physiology, cell biology and biochemistry using complex computational techniques. We show here using case studies in cancer and HIV how such computational models, and particularly models based on individual patient data, can be used for drug design and development, and in the selection of the appropriate treatment for a given patient in the face of resistance mutations. If these techniques are to be adopted in routine clinical practice, clinicians will need better training in modern approaches to the integrated analysis of large-scale heterogeneous data and multi-scale models, while developers will need to provide much more usable tools. Investment in computational infrastructure is needed so that results can be returned on clinically relevant timescales and data warehouses designed with data protection as well as accessibility in mind. PMID:22765044

Shublaq, Nour; Sansom, Clare; Coveney, Peter V

2013-01-01

397

Cognitive evaluation of the predictors of use of computerized protocols by clinicians.  

PubMed

We describe a cognitive approach to evaluating the factors that motivate clinicians to use computerized protocols. Using Value-Expectancy theories we developed an open-ended interview to assess clinicians' beliefs and experiences about the use of computerized protocols. Using a qualitative methodology, 3 reviewers independently identified key concepts raised by 13 interviewees. These concepts were aggregated and independently sorted into 39 categories. Then final categories were chosen by consensus. Analysis of the concepts showed consistency across clinician specialties of physicians, nurses and respiratory therapists. Inter-rater reliability calculated using Cohen's Kappa was 0.474. Identified constructs from Value-Expectancy and Intrinsic Motivation theories were: Work Importance, Perception of Situation, Role Relevance, Beliefs regarding Control, Beliefs regarding Normative Expectations, Beliefs regarding Self-Efficacy, Attitude, Habit, Environmental Support and Pre-Behavior. This model will form the basis for an instrument to assess the beliefs and expectations of clinical use regarding the use of computerized protocols. PMID:14728238

Satsangi, Shobba; Weir, Charlene R; Morris, Alan H; Warner, Homer R

2003-01-01

398

Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury.  

PubMed

Imaging utilization in emergency departments (EDs) has increased significantly. More than half of the 1.2 million patients with mild traumatic brain injury (MTBI) presenting to US EDs receive head CT. While evidence-based guidelines can help emergency clinicians decide whether to obtain head CT in these patients, adoption of these guidelines has been highly variable. Promulgation of imaging efficiency guidelines by the National Quality Forum has intensified the need for performance reporting, but measuring adherence to these imaging guidelines currently requires labor-intensive and potentially inaccurate manual chart review. We implemented clinical decision support (CDS) based on published evidence to guide emergency clinicians towards appropriate head CT use in patients with MTBI and automated data capture needed for unambiguous guideline adherence metrics. Implementation of the CDS was associated with a 56% relative increase in documented adherence to evidence-based guidelines for imaging in ED patients with MTBI. PMID:24534635

Gupta, Anurag; Ip, Ivan K; Raja, Ali S; Andruchow, James E; Sodickson, Aaron; Khorasani, Ramin

2014-10-01

399

Personalizing risk stratification by addition of PAK1 expression to TNM staging: Improving the accuracy of clinical decision for gastroesophageal junction adenocarcinoma.  

PubMed

Gastroesophageal junction adenocarcinoma (GEJA) is an aggressive malignancy with an alarmingly rising incidence. TNM staging is widely used by oncologists to stratify prognosis as well as direct therapeutic strategies. However, inadequate lymphadenectomy is frequently encountered for GEJA and largely confounds prognosis resulting from TNM staging. Thus, a molecular biomarker, which can accurately forecast the risk of nodal metastasis in patients with inadequate lymphadenectomy, is required to guide precisely clinical decision. In this study, bioinformatics and pathological analysis identified that p21 protein-activated kinase 1 (PAK1) is associated with lymph nodal metastasis of GEJA. The PAK1 H-score was lower in the patients with negative lymph nodes than that in patients with positive (metastatic) lymph nodes (6.865?±?3.376, 9.370?±?2.530, respectively; p??7 and high PAK1 expression in PTs were associated with significantly increased risk of recurrence and cancer-related death. In conclusion, high PAK1 expression in PTs is predictive of node metastasis and can be easily integrated in the clinical decision process for personalized therapeutics of GEJA. PMID:25159681

Li, Zongtai; Zou, Xiaofang; Xie, Liangxi; Chen, Hongcai; Chen, Yuping; Yeung, Sai-Ching Jim; Zhang, Hao

2015-04-01

400

A Study of The Effects of Computerized Multimedia Technology on Anatomical and Physiological Concept Retention  

Microsoft Academic Search

Computerized multimedia educational software has been developed for many disciplines but not for teaching clinical dietetics. The effectiveness of incorporating multimedia technology into lectures on anatomical and physiological concepts was studied using a pre-test\\/post-test format and cross-over design. Two groups of students (N=44) enrolled in a clinical nutrition class were given a pre-test that included normal and pathological lower gastrointestinal

W. V. Strauss; S. S. Dahlheimer

1998-01-01

401

Neural network modeling for surgical decisions on traumatic brain injury patients  

Microsoft Academic Search

Computerized medical decision support systems have been a major research topic in recent years. Intelligent computer programs were implemented to aid physicians and other medical professionals in making difficult medical decisions. This report compares three different mathematical models for building a traumatic brain injury (TBI) medical decision support system (MDSS). These models were developed based on a large TBI patient

Yu-Chuan Li; Li Liu; Wen-Ta Chiu; Wen-Shan Jian

2000-01-01

402

Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial  

Microsoft Academic Search

BACKGROUND: To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients

Michel Labrecque; Gaston Godin; Annie LeBlanc; Claudine Laurier; Jeremy Grimshaw; Josette Castel; Isabelle Tremblay; Pierre Frémont; Michel Cauchon; Kathleen Lemieux; Caroline Rhéaume

2011-01-01

403

Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study  

PubMed Central

Background Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician’s perceived professional autonomy, (2) involvement in the decision to implement CDSS and (3) the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested. Methods A questionnaire-based survey conducted between July 2010 and December 2010. The study was conducted in seven public and five private hospitals in Kuala Lumpur, Malaysia. Before contacting the hospitals, necessary permission was obtained from the Ministry of Health, Malaysia and the questionnaire was vetted by the ethics committee of the ministry. Physicians working in 12 hospitals from 10 different specialties participated in the study. The sampling method used was stratified random sampling and the physicians were stratified based on the specialty. A total of 450 physicians were selected using a random number generator. Each of these physicians was given a questionnaire and out of 450 questionnaires, 335 (response rate – 74%) were returned and 309 (69%) were deemed usable. Results The hypotheses were tested using Structural Equation Modeling (SEM). Salient results are: (1) Physicians’ perceived threat to professional autonomy lowers the intention to use CDSS (p < 0.01); (2) Physicians involvement in the planning, design and implementation increases their intention to use CDSS (p < 0.01); (3) Physicians belief that the new CDSS will improve his/her job performance increases their intention to use CDSS (p < 0.01). Conclusion The proposed model with the three main constructs (physician’s professional characteristic, involvement and belief) explains 47% of the variance in the intention to use CDSS. This is significantly higher than the models addressed so far. The results will have a major impact in implementing CDSS in developing countries. PMID:23216866

2012-01-01

404

The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)  

PubMed Central

Background The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) – with versions for patients (CDIS-P) and staff (CDIS-S) – for use in mental health services. Methods An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. Results After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. Conclusions CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. Trial registration ISRCTN75841675. PMID:25066212

2014-01-01

405

Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience  

PubMed Central

Background Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way. Method In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor. Results From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it. Conclusions Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health. PMID:21962009

2011-01-01

406

Feasibility and Validity of Computerized Ecological Momentary Assessment in Schizophrenia  

PubMed Central

Background: Computerized Ecological Momentary Assessment (EMAc) techniques permit the assessment of daily life behaviors and experiences. The present investigation examined the feasibility and validity of this assessment methodology in outpatients with schizophrenia. Methods: Outpatients with schizophrenia or schizoaffective disorder (n = 54) received a battery of standard laboratory clinical and functional outcome measures and then completed electronic questionnaires on a personal digital assistant (PDA) microcomputer 4 times per day for 1 week. Results: Generally good compliance (87%) with EMAc was found, and participants rated their experience with the study positively. The data collected in daily life demonstrated expected patterns across the assessment week and were significantly associated with scores from standard laboratory instruments measuring similar constructs. Conclusions: EMAc is a feasible and valid approach to data collection in community-dwelling people with schizophrenia, and it may provide important information that is inaccessible via standard clinical and functional outcome measures administered in the laboratory. PMID:17932087

Granholm, Eric; Loh, Catherine; Swendsen, Joel

2008-01-01

407

Searching for a way to live to the end: decision-making process in patients considering participation in cancer phase I clinical trials. | accrualnet.cancer.gov  

Cancer.gov

Participation in Phase I trials is an important decision that influences quality of life for patients with end-stage cancer. The authors identified four phases of the decision-making process and four factors that influence decisions. The core category that explained the decision-making process was searching for a way to live to the end of life. The findings of this study may help nurses and physicians support patients in their decision making.

408

Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke.  

PubMed

This article reports redesign strategies identified to create a Web-based user-interface for the Self-management TO Prevent (STOP) Stroke Tool. Members of a Stroke Quality Improvement Network (N = 12) viewed a visualization video of a proposed prototype and provided feedback on implementation barriers/facilitators. Stroke-care providers (N = 10) tested the Web-based prototype in think-aloud sessions of simulated clinic visits. Participants' dialogues were coded into themes. Access to comprehensive information and the automated features/systematized processes were the primary accessibility and usability facilitator themes. The need for training, time to complete the tool, and computer-centric care were identified as possible usability barriers. Patient accountability, reminders for best practice, goal-focused care, and communication/counseling themes indicate that the STOP Stroke Tool supports the paradigm of patient-centered care. The STOP Stroke Tool was found to prompt clinicians on secondary stroke-prevention clinical-practice guidelines, facilitate comprehensive documentation of evidence-based care, and support clinicians in providing patient-centered care through the shared decision-making process that occurred while using the action-planning/goal-setting feature of the tool. PMID:24352597

Anderson, Jane A; Godwin, Kyler M; Saleem, Jason J; Russell, Scott; Robinson, Joshua J; Kimmel, Barbara

2014-12-01

409

Mental Health Computing in the 1980s: II. Clinical Applications.  

ERIC Educational Resources Information Center

Presents the second of a two-part state-of-the-art review concerning current trends in mental health computing, with special clinical applications in automated psychological testing, computer interviews, computerized diagnosis, clinical consultation, computer-aided instruction, computerized treatment intervention, and user acceptance. (Author/ABB)

Hedlund, James L.; And Others

1985-01-01

410

Bone Health Monitoring in Astronauts: Recommended Use of Quantitative Computed Tomography [QCT] for Clinical and Operational Decisions  

NASA Technical Reports Server (NTRS)

This slide presentation reviews the concerns that astronauts in long duration flights might have a greater risk of bone fracture as they age than the general population. A panel of experts was convened to review the information and recommend mechanisms to monitor the health of bones in astronauts. The use of Quantitative Computed Tomography (QCT) scans for risk surveillance to detect the clinical trigger and to inform countermeasure evaluation is reviewed. An added benefit of QCT is that it facilitates an individualized estimation of bone strength by Finite Element Modeling (FEM), that can inform approaches for bone rehabilitation. The use of FEM is reviewed as a process that arrives at a composite number to estimate bone strength, because it integrates multiple factors.

Sibonga, J. D.; Truskowski, P.

2010-01-01

411

Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings.  

PubMed

Achieving hemostasis is a crucial focus of clinicians working in surgical and trauma settings. Topical hemostatic agents-including mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants-are frequently used in efforts to control bleeding, and new options such as hemostatic dressings, initially used in combat situations, are increasingly being used in civilian settings. To achieve successful hemostasis, a number of vital factors must be considered by surgeons and perioperative nurses, such as the size of the wound; bleeding severity; and the efficacy, possible adverse effects, and method of application of potential hemostatic agents. Understanding how and when to use each of the available hemostatic agents can greatly affect clinical outcomes and help to limit the overall cost of treatment. PMID:22035823

Schreiber, Martin A; Neveleff, Deborah J

2011-11-01

412

Validation of a clinical decision rule: chest X-ray in patients with chest pain and possible acute coronary syndrome.  

PubMed

Current literature suggests that a large proportion of chest X-rays (CXRs) performed in emergency department (ED) patients with chest pain and suspected acute coronary syndrome (ACS) are unnecessary. The Canadian ACS Guidelines aim to guide clinicians in the appropriate use of CXR within this patient population. This study determined the prevalence of clinically significant CXR abnormalities and assessed the utility of the guidelines in a population of ED patients with chest pain and suspected ACS. Included in the study were participants over the age of 18 who presented to an Australian metropolitan ED, over a 1-year period, with a primary complaint of chest pain and who had a CXR and troponin level ordered in the ED (N = 760). We retrospectively compared their radiographic findings with their recommendations for CXR according to the ACS Guidelines. We found that 12 % of the participants had a clinically significant chest X-ray. The guidelines had a sensitivity of 80 % (95 % CI 0.70-0.87) and specificity of 50 % (95 % CI 0.47-0.54). The positive predictive value was 18 % (95 % CI 0.15-0.22) with a 95 % negative predictive value (95 % CI 0.92-0.97). Had the ACS guidelines been applied to our patient population, the number of CXR performed would have been reduced by 47 %. This study suggests that the ACS Guidelines has the potential to reduce the numbers of unnecessary CXR performed in ED patients. However, this would come at the expense of missing a minority of significant CXR abnormalities. PMID:24595499

Goldschlager, Romi; Roth, Hedley; Solomon, Jarryd; Robson, Scott; Green, Jessica; Green, Sarah; Spanger, Manfred; Gunn, Robyn; Cameron, Peter

2014-08-01

413

11 CFR 9033.12 - Production of computerized information.  

Code of Federal Regulations, 2013 CFR

...paragraphs (a)(1) through (a)(9) of this section, the committee shall provide computerized magnetic media, such as magnetic tapes or magnetic diskettes, containing the computerized information at the times specified in 11 CFR...

2013-01-01

414

11 CFR 9033.12 - Production of computerized information.  

Code of Federal Regulations, 2011 CFR

...paragraphs (a)(1) through (a)(9) of this section, the committee shall provide computerized magnetic media, such as magnetic tapes or magnetic diskettes, containing the computerized information at the times specified in 11 CFR...

2011-01-01

415

11 CFR 9033.12 - Production of computerized information.  

Code of Federal Regulations, 2012 CFR

...paragraphs (a)(1) through (a)(9) of this section, the committee shall provide computerized magnetic media, such as magnetic tapes or magnetic diskettes, containing the computerized information at the times specified in 11 CFR...

2012-01-01

416

Identification of individuals using palatal rugae: Computerized method  

PubMed Central

Identification of individuals is a challenging task in forensic odontology. In circumstances where identification of an individual by fingerprint or dental record comparison is difficult, the palatal rugae may be considered as an alternative source. Palatal rugae have been shown to be highly individualistic and it maintains consistency in shape throughout life. Aims and Objectives: The present study is conducted to test the efficiency of computerized software in the identification of individuals after obtaining digital photographic images of the rugae. Materials and Methods: The intra oral photographs of 100 individuals were taken using a SLR digital camera. The custom made external attachment was attached to the camera to standardize all the photographs. A special software was designed called the Palatal Rugae Comparison Software (PRCS Version 2.0) to match the clinical photographs. Five evaluators including 3 dentists, 1 computer professional, and 1 general surgeon were asked to match the rugae pattern using the software. The results were recorded along with time taken by each operator to match all the photos using software. Results: The software recorded an accuracy of 99% in identification of individuals. Conclusion: The present study supports the fact of individuality of the rugae. Computerized method has given very good results to support the individualization of rugae. Through our study, we feel that palatal rugae patterns will be of great use in the future of forensic odontology. PMID:21731346

Hemanth, M; Vidya, M; Shetty, Nandaprasad; Karkera, Bhavana V

2010-01-01

417

Computerized quantification of ultrasonic heterogeneity in thyroid nodules.  

PubMed

To test whether computerized quantification of ultrasonic heterogeneity can be of help in the diagnosis of thyroid malignancy, we evaluated ultrasonic heterogeneity with an objective and quantitative computerized method in a prospective setting. A total of 400 nodules including 271 benign thyroid nodules and 129 malignant thyroid nodules were evaluated. Patient clinical data were collected, and the grading of heterogeneity on conventional gray-scale ultrasound images was retrospectively reviewed by a thyroid specialist. Quantification of ultrasonic heterogeneity (heterogeneity index, HI) was performed by a proprietary program implemented with methods proposed in this article. HI values differed significantly between benign and malignant nodules, diagnosed by a combination of fine-needle aspiration and surgical pathology results (p < 0.001, area under the curve = 0.714). The ultrasonic heterogeneity of these samples, as assessed by an experienced clinician, could not significantly differentiate between benign and malignant thyroid nodules. However, nodules with marked ultrasonic heterogeneity had higher HI values than nodules with homogeneous nodules. These results indicate that the new computer-aided diagnosis method for evaluation of the ultrasonic heterogeneity of thyroid nodules is an objective and quantitative method that is correlated with conventional ultrasonic heterogeneity assessment, but can better aid in the diagnosis of thyroid malignancy. PMID:25218450

Chen, Kuen-Yuan; Chen, Chiung-Nien; Wu, Ming-Hsun; Ho, Ming-Chih; Tai, Hao-Chih; Kuo, Wen-Hong; Huang, Wen-Chang; Wang, Yu-Hsin; Chen, Argon; Chang, King-Jen

2014-11-01

418

Predicting severity of pathological scarring due to burn injuries: a clinical decision making tool using Bayesian networks.  

PubMed

It is important for clinicians to understand which are the clinical signs, the patient characteristics and the procedures that are related with the occurrence of hypertrophic burn scars in order to carry out a possible prognostic assessment. Providing clinicians with an easy-to- use tool for predicting the risk of pathological scars. A total of 703 patients with 2440 anatomical burn sites who were admitted to the Department of Plastic and Reconstructive Surgery, Burn Center of the Traumatological Hospital in Torino between January 1994 and May 2006 were included in the analysis. A Bayesian network (BN) model was implemented. The probability of developing a hypertrophic scar was evaluated on a number of scenarios. The error rate of the BN model was assessed internally and it was equal to 24·83%. While classical statistical method as logistic models can infer only which variables are related to the final outcome, the BN approach displays a set of relationships between the final outcome (scar type) and the explanatory covariates (patient's age and gender, burn surface area, full-thickness burn surface area, burn anatomical area and wound-healing time; burn treatment options such as advanced dressings, type of surgical approach, number of surgical procedures, type of skin graft, excision and coverage timing). A web-based interface to handle the BN model was developed on the website www.pubchild.org (burns header). Clinicians who registered at the website could submit their data in order to get from the BN model the predicted probability of observing a pathological scar type. PMID:22958613

Berchialla, Paola; Gangemi, Ezio Nicola; Foltran, Francesca; Haxhiaj, Arber; Buja, Alessandra; Lazzarato, Fulvio; Stella, Maurizio; Gregori, Dario

2014-06-01

419

Fertility and contraceptive decision-making and support for HIV infected individuals: client and provider experiences and perceptions at two HIV clinics in Uganda  

PubMed Central

Background Some people living with HIV/AIDS (PLHIV) want to have children while others want to prevent pregnancies; this calls for comprehensive services to address both needs. This study explored decisions to have or not to have children and contraceptive preferences among PLHIV at two clinics in Uganda. Methods This was a qualitative cross-sectional study. We conducted seventeen focus group discussions and 14 in-depth interviews with sexually active adult men and women and adolescent girls and boys, and eight key informant interviews with providers. Overall, 106 individuals participated in the interviews; including 84 clients through focus group discussions. Qualitative latent content analysis technique was used, guided by key study questions and objectives. A coding system was developed before the transcripts were examined. Codes were grouped into categories and then themes and subthemes further identified. Results In terms of contraceptive preferences, clients had a wide range of preferences; whereas some did not like condoms, pills and injectables, others preferred these methods. Fears of complications were raised mainly about pills and injectables while cost of the methods was a major issue for the injectables, implants and intrauterine devices. Other than HIV sero-discordance and ill health (which was cited as transient), the decision to have children or not was largely influenced by socio-cultural factors. All adult men, women and adolescents noted the need to have children, preferably more than one. The major reasons for wanting more children for those who already had some were; the sex of the children (wanting to have both girls and boys and especially boys), desire for large families, pressure from family, and getting new partners. Providers were supportive of the decision to have children, especially for those who did not have any child at all, but some clients cited negative experiences with providers and information gaps for those who wanted to have children. Conclusions These findings show the need to expand family planning services for PLHIV to provide more contraceptive options and information as well as expand support for those who want to have children. PMID:23374175

2013-01-01

420

A Pilot Study to Evaluate the Role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in Clinical Decisions for Pressure Ulcer Treatment.  

PubMed

The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (?2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (?2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally positive but reservations remain. Additional research is being conducted to determine the barriers and facilitators to SCI-PUMT implementation. The SCI-PUMT was the first tool found to be valid, reliable, and sensitive to assess PrU healing in persons with SCI, and studies to examine the prospective validity of using this instrument on ulcer treatment decisions and outcomes are warranted. PMID:25485550

Thomason, Susan S; Graves, Barbara Ann; Madaris, Linda

2014-12-01

421

A clinical decision tool for predicting patient care characteristics: patients returning within 72 hours in the emergency department.  

PubMed

The primary purpose of this study was to develop a clinical tool capable of identifying discriminatory characteristics that can predict patients who will return within 72 hours to the Pediatric emergency department (PED). We studied 66,861 patients who were discharged from the EDs during the period from May 1 2009 to December 31 2009. We used a classification model to predict return visits based on factors extracted from patient demographic information, chief complaint, diagnosis, treatment, and hospital real-time ED statistics census. We began with a large pool of potentially important factors, and used particle swarm optimization techniques for feature selection coupled with an optimization-based discriminant analysis model (DAMIP) to identify a classification rule with relatively small subsets of discriminatory factors that can be used to predict - with 80% accuracy or greater - return within 72 hours. The analysis involves using a subset of the patient cohort for training and establishment of the predictive rule, and blind predicting the return of the remaining patients. Good candidate factors for revisit prediction are obtained where the accuracy of cross validation and blind prediction are over 80%. Among the predictive rules, the most frequent discriminatory factors identified include diagnosis (> 97%), patient complaint (>97%), and provider type (> 57%). There are significant differences in the readmission characteristics among different acuity levels. For Level 1 patients, critical readmission factors include patient complaint (>57%), time when the patient arrived until he/she got an ED bed (> 64%), and type/number of providers (>50%). For Level 4/5 patients, physician diagnosis (100%), patient complaint (99%), disposition type when patient arrives and leaves the ED (>30%), and if patient has lab test (>33%) appear to be significant. The model was demonstrated to be consistent and predictive across multiple PED sites.The resulting tool could enable ED staff and administrators to use patient specific values for each of a small number of discriminatory factors, and in return receive a prediction as to whether the patient will return to the ED within 72 hours. Our prediction accuracy can be as high as over 85%. This provides an opportunity for improving care and offering additional care or guidance to reduce ED readmission. PMID:23304321

Lee, Eva K; Yuan, Fan; Hirsh, Daniel A; Mallory, Michael D; Simon, Harold K

2012-01-01

422

Implementation of a Computerized Maintenance Management System  

NASA Technical Reports Server (NTRS)

A primer Computerized Maintenance Management System (CMMS) has been established for NASA Ames pressure component certification program. The CMMS takes full advantage of the latest computer technology and SQL relational database to perform periodic services for vital pressure components. The Ames certification program is briefly described and the aspects of the CMMS implementation are discussed as they are related to the certification objectives.

Shen, Yong-Hong; Askari, Bruce

1994-01-01

423

Dichotomous Search Strategies for Computerized Adaptive Testing.  

ERIC Educational Resources Information Center

Dichotomous search strategies (DSSs) for computerized adaptive testing are similar to golden section search strategies (GSSSs). Each middle point of successive search regions is a testing point. After each item is administered, the subject's obtained score is compared with the expected score at successive testing points. If the subject's obtained…

Xiao, Beiling

424

Strategies for Computerized Adaptive Grading Testing.  

ERIC Educational Resources Information Center

Evaluated three strategies for assigning examinees to grading categories in computerized adaptive testing. The expected a posteriori-based method had more correct classifications in the middle range of grade levels and more errors for the extremes than the golden section search grading test and the Z-score grading test. (SLD)

Xiao, Beiling

1999-01-01

425

NATIONAL ARCHIVE OF COMPUTERIZED DATA ON AGING  

EPA Science Inventory

The National Archive of Computerized Data on Aging (NACDA), located within ICPSR, is funded by the National Institute on Aging. NACDA's mission is to advance research on aging by helping researchers to profit from the under-exploited potential of a broad range of datasets. NACDA ...