| 1. |
- Baig, M. M., et al.
(författare)
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Early Detection of Prediabetes and T2DM Using Wearable Sensors and Internet-of-Things-Based Monitoring Applications
- 2021
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Ingår i: Applied Clinical Informatics. - : Georg Thieme Verlag. - 1869-0327. ; 12:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background Prediabetes and type 2 diabetes mellitus (T2DM) are one of the major long-term health conditions affecting global healthcare delivery. One of the few effective approaches is to actively manage diabetes via a healthy and active lifestyle. Objectives This research is focused on early detection of prediabetes and T2DM using wearable technology and Internet-of-Things-based monitoring applications. Methods We developed an artificial intelligence model based on adaptive neuro-fuzzy inference to detect prediabetes and T2DM via individualized monitoring. The key contributing factors to the proposed model include heart rate, heart rate variability, breathing rate, breathing volume, and activity data (steps, cadence, and calories). The data was collected using an advanced wearable body vest and combined with manual recordings of blood glucose, height, weight, age, and sex. The model analyzed the data alongside a clinical knowledgebase. Fuzzy rules were used to establish baseline values via existing interventions, clinical guidelines, and protocols. Results The proposed model was tested and validated using Kappa analysis and achieved an overall agreement of 91%. Conclusion We also present a 2-year follow-up observation from the prediction results of the original model. Moreover, the diabetic profile of a participant using M-health applications and a wearable vest (smart shirt) improved when compared to the traditional/routine practice.
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| 2. |
- Baysari, Melissa T, et al.
(författare)
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Redesign of computerized decision support to improve antimicrobial prescribing. A controlled before-and-after study.
- 2017
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Ingår i: Applied clinical informatics. - 1869-0327. ; 8:3, s. 949-963
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the impact of the introduction of new pre-written orders for antimicrobials in a computerized provider order entry (CPOE) system on 1) accuracy of documented indications for antimicrobials in the CPOE system, 2) appropriateness of antimicrobial prescribing, and 3) compliance with the hospital's antimicrobial policy. Prescriber opinions of the new decision support were also explored to determine why the redesign was effective or ineffective in altering prescribing practices.METHODS: The study comprised two parts: a controlled pre-post study and qualitative interviews. The intervention involved the redesign of pre-written orders for half the antimicrobials so that approved indications were incorporated into pre-written orders. 555 antimicrobials prescribed before (September - October, 2013) and 534 antimicrobials prescribed after (March - April, 2015) the intervention on all general wards of a hospital were audited by study pharmacists. Eleven prescribers participated in semi-structured interviews.RESULTS: Redesign of computerized decision support did not result in more appropriate or compliant antimicrobial prescribing, nor did it improve accuracy of indication documentation in the CPOE system (Intervention antimicrobials: appropriateness 49% vs. 50%; compliance 44% vs. 42%; accuracy 58% vs. 38%; all p>0.05). Via our interviews with prescribers we identified five main reasons for this, primarily that indications entered into the CPOE system were not monitored or followed-up, and that the antimicrobial approval process did not align well with prescriber workflow.CONCLUSION: Redesign of pre-written orders to incorporate appropriate indications did not improve antimicrobial prescribing. Workarounds are likely when compliance with hospital policy creates additional work for prescribers or when system usability is poor. Implementation of IT, in the absence of support or follow-up, is unlikely to achieve all anticipated benefits.
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| 3. |
- Carlsson, Sigrid, 1982, et al.
(författare)
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A Provider-Facing Decision Support Tool for Prostate Cancer Screening in Primary Care: A Pilot Study
- 2024
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Ingår i: APPLIED CLINICAL INFORMATICS. - 1869-0327. ; 15:02, s. 274-281
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Our objective was to pilot test an electronic health record-embedded decision support tool to facilitate prostate-specific antigen (PSA) screening discussions in the primary care setting. Methods We pilot-tested a novel decision support tool that was used by 10 primary care physicians (PCPs) for 6 months, followed by a survey. The tool comprised (1) a risk-stratified algorithm, (2) a tool for facilitating shared decision-making (Simple Schema), (3) three best practice advisories (BPAs: <45, 45-75, and >75 years), and (4) a health maintenance module for scheduling automated reminders about PSA rescreening. Results All PCPs found the tool feasible, acceptable, and clear to use. Eight out of ten PCPs reported that the tool made PSA screening conversations somewhat or much easier. Before using the tool, 70% of PCPs felt confident in their ability to discuss PSA screening with their patient, and this improved to 100% after the tool was used by PCPs for 6 months. PCPs found the BPAs for eligible (45-75 years) and older men (>75 years) more useful than the BPA for younger men (<45 years). Among the 10 PCPs, 60% found the Simple Schema to be very useful, and 50% found the health maintenance module to be extremely or very useful. Most PCPs reported the components of the tool to be at least somewhat useful, with 10% finding them to be very burdensome. Conclusion We demonstrated the feasibility and acceptability of the tool, which is notable given the marked low acceptance of existing tools. All PCPs reported that they would consider continuing to use the tool in their clinic and were likely or very likely to recommend the tool to a colleague.
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| 4. |
- Carlsson, Sigrid, 1982, et al.
(författare)
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Provider Perceptions of an Electronic Health Record Prostate Cancer Screening Tool
- 2024
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Ingår i: APPLIED CLINICAL INFORMATICS. - 1869-0327. ; 15:02, s. 282-294
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Tidskriftsartikel (refereegranskat)abstract
- Objectives We conducted a focus group to assess the attitudes of primary care physicians (PCPs) toward prostate-specific antigen (PSA)-screening algorithms, perceptions of using decision support tools, and features that would make such tools feasible to implement. Methods A multidisciplinary team (primary care, urology, behavioral sciences, bioinformatics) developed the decision support tool that was presented to a focus group of 10 PCPs who also filled out a survey. Notes and audio-recorded transcripts were analyzed using Thematic Content Analysis. Results The survey showed that PCPs followed different guidelines. In total, 7/10 PCPs agreed that engaging in shared decision-making about PSA screening was burdensome. The majority (9/10) had never used a decision aid for PSA screening. Although 70% of PCPs felt confident about their ability to discuss PSA screening, 90% still felt a need for a provider-facing platform to assist in these discussions. Three major themes emerged: (1) confirmatory reactions regarding the importance, innovation, and unmet need for a decision support tool embedded in the electronic health record; (2) issues around implementation and application of the tool in clinic workflow and PCPs' own clinical bias; and (3) attitudes/reflections regarding discrepant recommendations from various guideline groups that cause confusion. Conclusion There was overwhelmingly positive support for the need for a provider-facing decision support tool to assist with PSA-screening decisions in the primary care setting. PCPs appreciated that the tool would allow flexibility for clinical judgment and documentation of shared decision-making. Incorporation of suggestions from this focus group into a second version of the tool will be used in subsequent pilot testing.
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| 5. |
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| 6. |
- Fossum, Mariann, et al.
(författare)
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An evaluation of the usability of a computerized decision support system for nursing homes
- 2011
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Ingår i: Applied Clinical Informatics. - Stuttgart : Schattauer Gmbh. - 1869-0327. ; 2:4, s. 420-436
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Tidskriftsartikel (refereegranskat)abstract
- Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.
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| 7. |
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| 8. |
- Hojen, A.R., et al.
(författare)
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Methods and applications for visualization of SNOMED CT concept sets
- 2014
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Ingår i: Applied Clinical Informatics. - : Schattauer. - 1869-0327. ; 5:1, s. 127-152
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Tidskriftsartikel (refereegranskat)abstract
- Inconsistent use of SNOMED CT concepts may reduce comparability of information in health information systems. Terminology implementation should be approached by common strategies for navigating and selecting proper concepts. This study aims to explore ways of illustrating common pathways and ancestors of particular sets of concepts, to support consistent use of SNOMED CT and also assess potential applications for such visualizations. The open source prototype presented is an interactive web-based re-implementation of the terminology visualization tool TermViz that provides an overview of concepts and their hierarchical relations. It provides terminological features such as interactively rearranging graphs, fetching more concept nodes, highlighting least common parents and shared pathways in merged graphs etc. Four teams of three to four people used the prototype to complete a terminology mapping task and then, in focus group interviews, discussed the user experience and potential future tool usage. Potential purposes discussed included SNOMED CT search and training, consistent selection of concepts and content management. The evaluation indicated that the tool may be useful in many contexts especially if integrated with existing systems, and that the graph layout needs further tuning and development.
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| 9. |
- Joukes, Erik, et al.
(författare)
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Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record
- 2018
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Ingår i: Applied Clinical Informatics. - : GEORG THIEME VERLAG KG. - 1869-0327. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations. Objective This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations. Methods We measured physicians time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation. We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression. Results We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (-8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (-4.6%). The effect on dedicated documentation time significantly differed between centers. Conclusion Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.
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| 10. |
- Koch, S, et al.
(författare)
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On Bridges and Stacks
- 2016
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Ingår i: Applied clinical informatics. - 1869-0327. ; 7:3, s. 707-710
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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