Keyword: clinical
2023 (2)
Cutaneous tuberculosis: an infrequent manifestation of a common pathogen in South Africa. Van Heerden, J. K, Broadhurst, A. G B, De Jager, R. S, Du Plessis, W., Ebrahim, N., Mnguni, A. T, Schietekat, D., Meintjes, G. A, & Van Heerden, J. Southern African Journal of Infectious Diseases, 38(1):a526, jun, 2023.
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Paper doi abstract bibtex
Paper doi abstract bibtex Cutaneous tuberculosis is an infrequent form of extra-pulmonary tuberculosis, even in high-prevalence settings. We present the case of a patient living with advanced HIV who developed extensive cutaneous tuberculosis. The polymorphic skin lesions were the most striking clinical manifestation of underlying disseminated tuberculosis. Contribution: This case report highlights an unusual presentation of tuberculosis. Cutaneous tuberculosis has a wide spectrum of clinical presentations and may be under-recognised by clinicians. We recommend early biopsy for microbiological diagnosis.
@article{VanHeerden2023,
abstract = {Cutaneous tuberculosis is an infrequent form of extra-pulmonary tuberculosis, even in high-prevalence settings. We present the case of a patient living with advanced HIV who developed extensive cutaneous tuberculosis. The polymorphic skin lesions were the most striking clinical manifestation of underlying disseminated tuberculosis. Contribution: This case report highlights an unusual presentation of tuberculosis. Cutaneous tuberculosis has a wide spectrum of clinical presentations and may be under-recognised by clinicians. We recommend early biopsy for microbiological diagnosis.},
author = {{Van Heerden}, Jennifer K and Broadhurst, Alistair G B and {De Jager}, Ruan S and {Du Plessis}, Wesley and Ebrahim, Nabilah and Mnguni, Ayanda T and Schietekat, Denzil and Meintjes, Graeme A and {Van Heerden}, Jennifer},
doi = {10.4102/SAJID.V38I1.526},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Van Heerden et al. - 2023 - Cutaneous tuberculosis an infrequent manifestation of a common pathogen in South Africa.pdf:pdf},
issn = {2313-1810},
journal = {Southern African Journal of Infectious Diseases},
keywords = {HIV,Infectious diseases,OA,OA{\_}PMC,South Africa,TB,bacterial,clinical,communicable,cutaneous tuberculosis,diagnosis,epidemiology,fund{\_}not{\_}ack,fungal,human immunodeficiency virus,laboratory,original,parasitic,treatment,tuberculosis,viral},
mendeley-tags = {OA,OA{\_}PMC,fund{\_}not{\_}ack,original},
month = {jun},
number = {1},
pages = {a526},
pmid = {37435117},
title = {{Cutaneous tuberculosis: an infrequent manifestation of a common pathogen in South Africa}},
url = {https://sajid.co.za/index.php/sajid/article/view/526/1222 https://sajid.co.za/index.php/sajid/article/view/526/1223 https://sajid.co.za/index.php/sajid/article/view/526/1224 https://sajid.co.za/index.php/sajid/article/view/526},
volume = {38},
year = {2023}
}Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa. Hermans, L. E, Booysen, P., Boloko, L., Adriaanse, M., de Wet, T. J, Lifson, A. R, Wadee, N., Papavarnavas, N., Marais, G., Hsiao, N., Rosslee, M., Symons, G., Calligaro, G. L, Iranzadeh, A., Wilkinson, R. J, Ntusi, N. A B, Williamson, C., Davies, M., Meintjes, G. A, & Wasserman, S. Southern African Journal of Infectious Diseases, 38(1):a550, AOSIS, dec, 2023.
Paper doi abstract bibtex
Paper doi abstract bibtex Background: The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented. Objectives: To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave. Method: We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models. Results: We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 & BA4/BA5 variants. Crude 28-day mortality was 25.8% (34/133) in the Omicron wave period versus 37.1% (138/374) in the Delta wave period (hazard ratio [HR] 0.68 [95% CI 0.47–1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95% CI 0.28–0.67] p \textless 0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter. Conclusion: There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk. Contribution: This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity.
@article{Hermans2023,
abstract = {Background: The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented. Objectives: To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave. Method: We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models. Results: We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 {\&} BA4/BA5 variants. Crude 28-day mortality was 25.8{\%} (34/133) in the Omicron wave period versus 37.1{\%} (138/374) in the Delta wave period (hazard ratio [HR] 0.68 [95{\%} CI 0.47–1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95{\%} CI 0.28–0.67] p {\textless} 0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter. Conclusion: There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk. Contribution: This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity.},
author = {Hermans, Lucas E and Booysen, Petro and Boloko, Linda and Adriaanse, Marguerite and de Wet, Timothy J and Lifson, Aimee R and Wadee, Naweed and Papavarnavas, Nectarios and Marais, Gert and Hsiao, Nei-yuan and Rosslee, Michael-Jon and Symons, Gregory and Calligaro, Gregory L and Iranzadeh, Arash and Wilkinson, Robert J and Ntusi, Ntobeko A B and Williamson, Carolyn and Davies, Mary-Ann and Meintjes, Graeme A and Wasserman, Sean},
doi = {10.4102/SAJID.V38I1.550},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hermans et al. - 2023 - Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa.pdf:pdf},
issn = {2313-1810},
journal = {Southern African Journal of Infectious Diseases},
keywords = {19,2,COVID,CoV,Delta,Infectious diseases,OA,Omicron,SARS,bacterial,clinical,clinical characteristics,communicable,diagnosis,epidemiology,fund{\_}ack,fungal,genomics{\_}fund{\_}ack,laboratory,observational study,original,parasitic,treatment,viral},
mendeley-tags = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
month = {dec},
number = {1},
pages = {a550},
pmid = {38223432},
publisher = {AOSIS},
title = {{Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa}},
url = {https://sajid.co.za/index.php/sajid/article/view/550/1329 https://sajid.co.za/index.php/sajid/article/view/550/1330 https://sajid.co.za/index.php/sajid/article/view/550/1331 https://sajid.co.za/index.php/sajid/article/view/550},
volume = {38},
year = {2023}
}2022 (1)
Best practices: Appropriate use of the new $β$-lactam/$β$-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South Africa. Brink, A. J, Coetzee, J., Richards, G. A, Feldman, C., Lowman, W., Tootla, H. D, Miller, M. G A, Niehaus, A. J, Wasserman, S., Perovic, O., Govind, C. N, Schellack, N., & Mendelson, M. Southern African Journal of Infectious Diseases, 37(1):a453, oct, 2022.
Paper doi abstract bibtex
Paper doi abstract bibtex Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant (DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of last resort. High toxicity levels and developing resistance to colistin are narrowing treatment options further. Recently, two new $β$-lactam/$β$-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa, bringing hope of new options for management of these life-threatening infections. However, with increased use in the private sector, increasing levels of resistance to ceftazidime-avibactam are already being witnessed, putting their long-term viability as treatment options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics should be stewarded within a framework that recognises the resistance mechanisms currently predominant in South Africa's multi-drug and DTR Gram-negative bacteria. Moreover, the withholding of their use for resistant infections that can be treated with currently available antibiotics is a critical part of stewardship, if these antibiotics are to be conserved in the long term.
@article{Brink2022,
abstract = {Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant (DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of last resort. High toxicity levels and developing resistance to colistin are narrowing treatment options further. Recently, two new $\beta$-lactam/$\beta$-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa, bringing hope of new options for management of these life-threatening infections. However, with increased use in the private sector, increasing levels of resistance to ceftazidime-avibactam are already being witnessed, putting their long-term viability as treatment options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics should be stewarded within a framework that recognises the resistance mechanisms currently predominant in South Africa's multi-drug and DTR Gram-negative bacteria. Moreover, the withholding of their use for resistant infections that can be treated with currently available antibiotics is a critical part of stewardship, if these antibiotics are to be conserved in the long term.},
author = {Brink, Adrian J and Coetzee, Jennifer and Richards, Guy A and Feldman, Charles and Lowman, Warren and Tootla, Hafsah D and Miller, Malcolm G A and Niehaus, Abraham J and Wasserman, Sean and Perovic, Olga and Govind, Chetna N and Schellack, Natalie and Mendelson, Marc},
doi = {10.4102/SAJID.V37I1.453},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Brink et al. - 2022 - Best practices Appropriate use of the new $\beta$-lactam$\beta$-lactamase inhibitor combinations, ceftazidime-avibactam and ce.pdf:pdf},
issn = {2313-1810},
journal = {Southern African Journal of Infectious Diseases},
keywords = {Enterobacterales,Gram,Infectious diseases,OA,Pseudomonas aeruginosa,antimicrobial stewardship,avibactam,bacterial,ceftazidime,ceftolozane,clinical,communicable,diagnosis,epidemiology,fund{\_}not{\_}ack,fungal,guideline,laboratory,lactam/$\beta$,lactamase inhibitor combinations,negatives,parasitic,tazobactam,treatment,viral,$\beta$},
mendeley-tags = {OA,fund{\_}not{\_}ack,guideline},
month = {oct},
number = {1},
pages = {a453},
title = {{Best practices: Appropriate use of the new $\beta$-lactam/$\beta$-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South Africa}},
url = {https://sajid.co.za/index.php/sajid/article/view/453/1065 https://sajid.co.za/index.php/sajid/article/view/453/1066 https://sajid.co.za/index.php/sajid/article/view/453/1067 https://sajid.co.za/index.php/sajid/article/view/453},
volume = {37},
year = {2022}
}2021 (4)
Explainable AI-based clinical decision support system for hearing disorders. Tarnowska, K. A., Dispoto, B. C., & Conragan, J. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science, 2021:595–604, 2021.
abstract bibtex
abstract bibtex
In clinical system design, human-computer interaction and explainability are important topics of research. Clinical systems need to provide users with not only results but also an account of their behaviors. In this research, we propose a knowledge-based clinical decision support system (CDSS) for the diagnosis and therapy of hearing disorders, such as tinnitus, hyperacusis, and misophonia. Our prototype eTRT system offers an explainable output that we expect to increase its trustworthiness and acceptance in the clinical setting. Within this paper, we: (1) present the problem area of tinnitus and its treatment; (2) describe our data-driven approach based on machine learning, such as association- and action rule discovery; (3) present the evaluation results from the inference on the extracted rule-based knowledge and chosen test cases of patients; (4) discuss advantages of explainable output incorporated into a graphical user interface; (5) conclude with the results achieved and directions for future work.
@article{tarnowska_explainable_2021,
title = {Explainable {AI}-based clinical decision support system for hearing disorders.},
volume = {2021},
copyright = {©2021 AMIA - All rights reserved.},
issn = {2153-4063},
abstract = {In clinical system design, human-computer interaction and explainability are important topics of research. Clinical systems need to provide users with not only results but also an account of their behaviors. In this research, we propose a knowledge-based clinical decision support system (CDSS) for the diagnosis and therapy of hearing disorders, such as tinnitus, hyperacusis, and misophonia. Our prototype eTRT system offers an explainable output that we expect to increase its trustworthiness and acceptance in the clinical setting. Within this paper, we: (1) present the problem area of tinnitus and its treatment; (2) describe our data-driven approach based on machine learning, such as association- and action rule discovery; (3) present the evaluation results from the inference on the extracted rule-based knowledge and chosen test cases of patients; (4) discuss advantages of explainable output incorporated into a graphical user interface; (5) conclude with the results achieved and directions for future work.},
language = {eng},
journal = {AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science},
author = {Tarnowska, Katarzyna A. and Dispoto, Brett C. and Conragan, Jordan},
year = {2021},
pmid = {34457175},
pmcid = {PMC8378626},
keywords = {*Decision Support Systems, Clinical, Hearing Disorders, Humans, Machine Learning},
pages = {595--604},
}Validation of Roche immunoassay for severe acute respiratory coronavirus 2 in South Africa. Grove, J. S, Mayne, E. S, Burgers, W. A, Blackburn, J., Jugwanth, S., Stevens, W., Scott, L., David, A., Gededzha, M., Sanne, I. M, Maphayi, M. R, Pillay, T., & George, J. A Southern African Journal of Infectious Diseases, 36(1):a286, jul, 2021.
Paper doi abstract bibtex
Paper doi abstract bibtex Background: Serology testing is an important ancillary diagnostic to the reverse transcriptase polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the performance of the Roche Elecsys™ chemiluminescent immunoassay (Rotkreuz, Switzerland), that detects antibodies against the SARS-CoV-2 nucleocapsid antigen, at an academic laboratory in South Africa. Methods: Serum samples were collected from 312 donors with confirmed positive SARS-CoV-2 RT-PCR tests, with approval from a large university's human research ethics committee. Negative controls included samples stored prior to December 2019 and from patients who tested negative for SARS-CoV-2 on RT-PCR and were confirmed negative using multiple serology methods ( n = 124). Samples were stored at –80 °C and analysed on a Roche cobas™ 602 autoanalyser. Results: Compared with RT-PCR, our evaluation revealed a specificity of 100% and overall sensitivity of 65.1%. The sensitivity in individuals \textgreater 14 days' post-diagnosis was 72.6%, with the highest sensitivity 31–50 days' post-diagnosis at 88.6%. Results were also compared with in-house serology tests that showed high agreement in majority of categories. Conclusions: The sensitivity at all-time points post-diagnosis was lower than reported in other studies, but sensitivity in appropriate cohorts approached 90% with a high specificity. The lower sensitivity at earlier time points or in individuals without symptomatology may indicate failure to produce antibodies, which was further supported by the comparison against in-house serology tests.
@article{Grove2021,
abstract = {Background: Serology testing is an important ancillary diagnostic to the reverse transcriptase polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the performance of the Roche Elecsys™ chemiluminescent immunoassay (Rotkreuz, Switzerland), that detects antibodies against the SARS-CoV-2 nucleocapsid antigen, at an academic laboratory in South Africa. Methods: Serum samples were collected from 312 donors with confirmed positive SARS-CoV-2 RT-PCR tests, with approval from a large university's human research ethics committee. Negative controls included samples stored prior to December 2019 and from patients who tested negative for SARS-CoV-2 on RT-PCR and were confirmed negative using multiple serology methods ( n = 124). Samples were stored at –80 °C and analysed on a Roche cobas™ 602 autoanalyser. Results: Compared with RT-PCR, our evaluation revealed a specificity of 100{\%} and overall sensitivity of 65.1{\%}. The sensitivity in individuals {\textgreater} 14 days' post-diagnosis was 72.6{\%}, with the highest sensitivity 31–50 days' post-diagnosis at 88.6{\%}. Results were also compared with in-house serology tests that showed high agreement in majority of categories. Conclusions: The sensitivity at all-time points post-diagnosis was lower than reported in other studies, but sensitivity in appropriate cohorts approached 90{\%} with a high specificity. The lower sensitivity at earlier time points or in individuals without symptomatology may indicate failure to produce antibodies, which was further supported by the comparison against in-house serology tests.},
author = {Grove, Jurette S and Mayne, Elizabeth S and Burgers, Wendy A and Blackburn, Jonathan and Jugwanth, Sarika and Stevens, Wendy and Scott, Lesley and David, Anura and Gededzha, Maemu and Sanne, Ian M and Maphayi, Mpho R and Pillay, Taryn and George, Jaya A},
doi = {10.4102/SAJID.V36I1.286},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Grove et al. - 2021 - Validation of Roche immunoassay for severe acute respiratory coronavirus 2 in South Africa.pdf:pdf},
issn = {2313-1810},
journal = {Southern African Journal of Infectious Diseases},
keywords = {19,2,COVID,CoV,Infectious diseases,OA,SARS,antibodies,bacterial,clinical,communicable,diagnosis,epidemiology,fund{\_}ack,fungal,immunoglobulin G,immunoglobulin M,laboratory,original,parasitic,serology,treatment,validation,viral},
mendeley-tags = {OA,fund{\_}ack,original},
month = {jul},
number = {1},
pages = {a286},
title = {{Validation of Roche immunoassay for severe acute respiratory coronavirus 2 in South Africa}},
url = {https://sajid.co.za/index.php/sajid/article/view/286/686 https://sajid.co.za/index.php/sajid/article/view/286/687 https://sajid.co.za/index.php/sajid/article/view/286/688 https://sajid.co.za/index.php/sajid/article/view/286},
volume = {36},
year = {2021}
}Digital Pathology Operations at an NYC Tertiary Cancer Center During the First 4 Months of COVID-19 Pandemic Response. Ardon, O., Reuter, V. E., Hameed, M., Corsale, L., Manzo, A., Sirintrapun, S. J., Ntiamoah, P., Stamelos, E., Schueffler, P. J., England, C., Klimstra, D. S., & Hanna, M. G. Academic Pathology, April, 2021. Publisher: SAGE Publications Inc
Paper doi abstract bibtex 3 downloads
Paper doi abstract bibtex 3 downloads Implementation of an infrastructure to support digital pathology began in 2006 at Memorial Sloan Kettering Cancer Center. The public health emergency and COVID-19 pandemic regulations in New York City required a novel workflow to sustain existing operations. While regulatory enforcement discretions offered faculty workspace flexibility, a substantial portion of laboratory and digital pathology workflows require on-site presence of staff. Maintaining social distancing and offering staggered work schedules. Due to a decrease in patients seeking health care at the onset of the pandemic, a temporary decrease in patient specimens was observed. Hospital and travel regulations impacted onsite vendor technical support. Digital glass slide scanning activities onsite proceeded without interruption throughout the pandemic, with challenges including staff who required quarantine due to virus exposure, unrelated illness, family support, or lack of public transportation. During the public health emergency, we validated digital pathology systems for a remote pathology operation. Since March 2020, the departmental digital pathology staff were able to maintain scanning volumes of over 100 000 slides per month. The digital scanning team reprioritized archival slide scanning and participated in a remote sign-out validation and successful submission of New York State approval for a laboratory developed test. Digital pathology offers a health care delivery model where pathologists can perform their sign out duties at remote location and prevent disruptions to critical pathology services for patients seeking care at our institution during emergencies. Development of standard operating procedures to support digital workflows will maintain turnaround times and enable clinical operations during emergency or otherwise unanticipated events.
@article{ardon_digital_2021,
title = {Digital {Pathology} {Operations} at an {NYC} {Tertiary} {Cancer} {Center} {During} the {First} 4 {Months} of {COVID}-19 {Pandemic} {Response}},
volume = {8},
issn = {2374-2895},
url = {https://doi.org/10.1177/23742895211010276},
doi = {10.1177/23742895211010276},
abstract = {Implementation of an infrastructure to support digital pathology began in 2006 at Memorial Sloan Kettering Cancer Center. The public health emergency and COVID-19 pandemic regulations in New York City required a novel workflow to sustain existing operations. While regulatory enforcement discretions offered faculty workspace flexibility, a substantial portion of laboratory and digital pathology workflows require on-site presence of staff. Maintaining social distancing and offering staggered work schedules. Due to a decrease in patients seeking health care at the onset of the pandemic, a temporary decrease in patient specimens was observed. Hospital and travel regulations impacted onsite vendor technical support. Digital glass slide scanning activities onsite proceeded without interruption throughout the pandemic, with challenges including staff who required quarantine due to virus exposure, unrelated illness, family support, or lack of public transportation. During the public health emergency, we validated digital pathology systems for a remote pathology operation. Since March 2020, the departmental digital pathology staff were able to maintain scanning volumes of over 100 000 slides per month. The digital scanning team reprioritized archival slide scanning and participated in a remote sign-out validation and successful submission of New York State approval for a laboratory developed test. Digital pathology offers a health care delivery model where pathologists can perform their sign out duties at remote location and prevent disruptions to critical pathology services for patients seeking care at our institution during emergencies. Development of standard operating procedures to support digital workflows will maintain turnaround times and enable clinical operations during emergency or otherwise unanticipated events.},
language = {en},
urldate = {2021-09-01},
journal = {Academic Pathology},
author = {Ardon, Orly and Reuter, Victor E. and Hameed, Meera and Corsale, Lorraine and Manzo, Allyne and Sirintrapun, Sahussapont J. and Ntiamoah, Peter and Stamelos, Evangelos and Schueffler, Peter J. and England, Christine and Klimstra, David S. and Hanna, Matthew G.},
month = apr,
year = {2021},
note = {Publisher: SAGE Publications Inc},
keywords = {COVID-19, clinical, digital pathology, implementation, operations, remote signout, telepathology},
}Towards The Automated, Empirical Filtering of Drug-Drug Interaction Alerts in Clinical Decision Support Systems: Historical Cohort Study of Vitamin K Antagonists. Chazard, E., Boudry, A., Beeler, P. E., Dalleur, O., Hubert, H., Tréhou, E., Beuscart, J., & Bates, D. W. JMIR medical informatics, 9(1):e20862, January, 2021.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Drug-drug interactions (DDIs) involving vitamin K antagonists (VKAs) constitute an important cause of in-hospital morbidity and mortality. However, the list of potential DDIs is long; the implementation of all these interactions in a clinical decision support system (CDSS) results in over-alerting and alert fatigue, limiting the benefits provided by the CDSS. OBJECTIVE: To estimate the probability of occurrence of international normalized ratio (INR) changes for each DDI rule, via the reuse of electronic health records. METHODS: An 8-year, exhaustive, population-based, historical cohort study including a French community hospital, a group of Danish community hospitals, and a Bulgarian hospital. The study database included 156,893 stays. After filtering against two criteria (at least one VKA administration and at least one INR laboratory result), the final analysis covered 4047 stays. Exposure to any of the 145 drugs known to interact with VKA was tracked and analyzed if at least 3 patients were concerned. The main outcomes are VKA potentiation (defined as an INR≥5) and VKA inhibition (defined as an INR≤1.5). Groups were compared using the Fisher exact test and logistic regression, and the results were expressed as an odds ratio (95% confidence limits). RESULTS: The drugs known to interact with VKAs either did not have a statistically significant association regarding the outcome (47 drug administrations and 14 discontinuations) or were associated with significant reduction in risk of its occurrence (odds ratio\textless1 for 18 administrations and 21 discontinuations). CONCLUSIONS: The probabilities of outcomes obtained were not those expected on the basis of our current body of pharmacological knowledge. The results do not cast doubt on our current pharmacological knowledge per se but do challenge the commonly accepted idea whereby this knowledge alone should be used to define when a DDI alert should be displayed. Real-life probabilities should also be considered during the filtration of DDI alerts by CDSSs, as proposed in SPC-CDSS (statistically prioritized and contextualized CDSS). However, these probabilities may differ from one hospital to another and so should probably be calculated locally.
@article{chazard_towards_2021,
title = {Towards {The} {Automated}, {Empirical} {Filtering} of {Drug}-{Drug} {Interaction} {Alerts} in {Clinical} {Decision} {Support} {Systems}: {Historical} {Cohort} {Study} of {Vitamin} {K} {Antagonists}},
volume = {9},
issn = {2291-9694},
shorttitle = {Towards {The} {Automated}, {Empirical} {Filtering} of {Drug}-{Drug} {Interaction} {Alerts} in {Clinical} {Decision} {Support} {Systems}},
doi = {10.2196/20862},
abstract = {BACKGROUND: Drug-drug interactions (DDIs) involving vitamin K antagonists (VKAs) constitute an important cause of in-hospital morbidity and mortality. However, the list of potential DDIs is long; the implementation of all these interactions in a clinical decision support system (CDSS) results in over-alerting and alert fatigue, limiting the benefits provided by the CDSS.
OBJECTIVE: To estimate the probability of occurrence of international normalized ratio (INR) changes for each DDI rule, via the reuse of electronic health records.
METHODS: An 8-year, exhaustive, population-based, historical cohort study including a French community hospital, a group of Danish community hospitals, and a Bulgarian hospital. The study database included 156,893 stays. After filtering against two criteria (at least one VKA administration and at least one INR laboratory result), the final analysis covered 4047 stays. Exposure to any of the 145 drugs known to interact with VKA was tracked and analyzed if at least 3 patients were concerned. The main outcomes are VKA potentiation (defined as an INR≥5) and VKA inhibition (defined as an INR≤1.5). Groups were compared using the Fisher exact test and logistic regression, and the results were expressed as an odds ratio (95\% confidence limits).
RESULTS: The drugs known to interact with VKAs either did not have a statistically significant association regarding the outcome (47 drug administrations and 14 discontinuations) or were associated with significant reduction in risk of its occurrence (odds ratio{\textless}1 for 18 administrations and 21 discontinuations).
CONCLUSIONS: The probabilities of outcomes obtained were not those expected on the basis of our current body of pharmacological knowledge. The results do not cast doubt on our current pharmacological knowledge per se but do challenge the commonly accepted idea whereby this knowledge alone should be used to define when a DDI alert should be displayed. Real-life probabilities should also be considered during the filtration of DDI alerts by CDSSs, as proposed in SPC-CDSS (statistically prioritized and contextualized CDSS). However, these probabilities may differ from one hospital to another and so should probably be calculated locally.},
language = {eng},
number = {1},
journal = {JMIR medical informatics},
author = {Chazard, Emmanuel and Boudry, Augustin and Beeler, Patrick Emanuel and Dalleur, Olivia and Hubert, Hervé and Tréhou, Eric and Beuscart, Jean-Baptiste and Bates, David Westfall},
month = jan,
year = {2021},
pmid = {33470938},
keywords = {alert fatigue, anticoagulants, clinical decision support system, computerized physician order entry, decision support systems, clinical, drug-drug interaction, drug-related side effects and adverse reactions, medical order entry system, over-alerting, vitamin K antagonist},
pages = {e20862},
}2020 (1)
Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. Lechien, J., R., Chiesa-Estomba, C., M., Place, S., Van Laethem, Y., Cabaraux, P., Mat, Q., Huet, K., Plzak, J., Horoi, M., Hans, S., Rosaria Barillari, M., Cammaroto, G., Fakhry, N., Martiny, D., Ayad, T., Jouffe, L., Hopkins, C., Saussez, S., Blecic, S., De Siati, D., R., Leich, P., Souchay, C., Rossi, C., Journe, F., Hsieh, J., Ris, L., El Afia, F., Harmegnies, B., Distinguin, L., Chekkoury-Idrissi, Y., Circiu, M., Lavigne, P., Lopez Delgado, I., Calvo-Henriquez, C., Falanga, C., Coppee, F., Bon, S., D., Rodriguez, A., Dequanter, D., Cornelis, J., P., Vergez, S., Koenen, L., Giuditta, M., Molteni, G., Tucciarone, M., Radulesco, T., Khalife, M., Fourneau, A., F., Cherifi, S., Manto, M., Michel, J., Radulesco, T., Molteni, G., Tucciarone, M., Mannelli, G., & Cantarella, G. Journal of Internal Medicine, 2020.
doi abstract bibtex 4 downloads
doi abstract bibtex 4 downloads
Background: The clinical presentation of European patients with mild-to-moderate COVID-19 infection is still unknown. Objective: To study the clinical presentation of COVID-19 in Europe. Methods: Patients with positive diagnosis of COVID-19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analysing the relationship between outcomes. Results: A total of 1,420 patients completed the study (962 females, 30.7% of healthcare workers). The mean age of patients was 39.17 ± 12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by 45.4%. The mean duration of COVID-19 symptoms of mild-to-moderate cured patients was 11.5 ± 5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild-to-moderate COVID-19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. Conclusion: The clinical presentation of mild-to-moderate COVID-19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild-to-moderate COVID-19 that needs to be recognized as such by the WHO.
@article{
title = {Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019},
type = {article},
year = {2020},
keywords = {COVID-19,Europe,clinical,coronavirus,epidemiological,medicine,patients,symptoms},
id = {d75ffd29-4cb8-3373-a54d-90e83a14275b},
created = {2020-10-23T21:05:17.034Z},
file_attached = {false},
profile_id = {95e10851-cdf3-31de-9f82-1ab629e601b0},
group_id = {f4f27d7f-2273-33eb-bbb9-78e3e17cc268},
last_modified = {2020-10-23T21:05:17.034Z},
read = {false},
starred = {false},
authored = {false},
confirmed = {true},
hidden = {false},
private_publication = {false},
abstract = {Background: The clinical presentation of European patients with mild-to-moderate COVID-19 infection is still unknown. Objective: To study the clinical presentation of COVID-19 in Europe. Methods: Patients with positive diagnosis of COVID-19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analysing the relationship between outcomes. Results: A total of 1,420 patients completed the study (962 females, 30.7% of healthcare workers). The mean age of patients was 39.17 ± 12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by 45.4%. The mean duration of COVID-19 symptoms of mild-to-moderate cured patients was 11.5 ± 5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild-to-moderate COVID-19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. Conclusion: The clinical presentation of mild-to-moderate COVID-19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild-to-moderate COVID-19 that needs to be recognized as such by the WHO.},
bibtype = {article},
author = {Lechien, Jerome R. and Chiesa-Estomba, Carlos M. and Place, Sammy and Van Laethem, Yves and Cabaraux, Pierre and Mat, Quentin and Huet, Kathy and Plzak, Jan and Horoi, Mihaela and Hans, Stéphane and Rosaria Barillari, Maria and Cammaroto, Giovanni and Fakhry, Nicolas and Martiny, Delphine and Ayad, Tareck and Jouffe, Lionel and Hopkins, Claire and Saussez, Sven and Blecic, Serge and De Siati, Daniele R. and Leich, Pierre and Souchay, Christel and Rossi, Camelia and Journe, Fabrice and Hsieh, Julien and Ris, Laurence and El Afia, Fahd and Harmegnies, Bernard and Distinguin, Lea and Chekkoury-Idrissi, Younes and Circiu, Marta and Lavigne, Philippe and Lopez Delgado, Irene and Calvo-Henriquez, Christian and Falanga, Chiara and Coppee, Frederique and Bon, Serge D. and Rodriguez, Alexandra and Dequanter, Didier and Cornelis, Jean Philippe and Vergez, Sebastien and Koenen, Lukas and Giuditta, Mannelli and Molteni, Gabriele and Tucciarone, Manuel and Radulesco, Thomas and Khalife, Mohamad and Fourneau, Anne Francoise and Cherifi, Soraya and Manto, Mario and Michel, Justin and Radulesco, Thomas and Molteni, Gabriele and Tucciarone, Manuel and Mannelli, Giuditta and Cantarella, Giovanna},
doi = {10.1111/joim.13089},
journal = {Journal of Internal Medicine}
}2018 (1)
Drug-related problems identified during medication review before and after the introduction of a clinical decision support system. Verdoorn, S., Kwint, H. F., Hoogland, P., Gussekloo, J., & Bouvy, M. L. Journal of Clinical Pharmacy and Therapeutics, 43(2):224–231, April, 2018.
doi abstract bibtex
doi abstract bibtex
WHAT IS KNOWN AND OBJECTIVE: To facilitate the identification of drug-related problems (DRPs) during medication review, several tools have been developed. Explicit criteria, like Beers criteria or STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria, can easily be integrated into a clinical decision support system (CDSS). The aim of this study was to investigate the effect of adding a CDSS to medication review software on identifying and solving DRPs in daily pharmacy practice. METHODS: Pre- to post-analysis of clinical medication reviews (CMRs) performed by 121 pharmacies in 2012 and 2013, before and after the introduction of CDSS into medication review software. Mean number of DRPs per patient, type of DRPs and their resolution rates were compared in the pharmacies pre- and post-CDSS using paired t tests. RESULTS AND DISCUSSION: In total, 9151 DRPs were identified in 3100 patients pre-CDSS and 15 268 DRPs were identified in 4303 patients post-CDSS. The mean number of identified DRPs per patient (aggregated per pharmacy) was higher after the introduction of CDSS (3.2 vs 3.6 P \textless .01). The resolution rate was lower post-CDSS (50% vs 44%; P \textless .01), which overall resulted in 1.6 resolved DRPs per patient in both groups (P = .93). After the introduction of CDSS, 41% of DRPs were detected by the CDSS. The resolution rate of DRPs generated by CDSS was lower than of DRPs identified without the help of CDSS (29% vs 55%; P \textless .01). The two most prevalent DRP types were "Overtreatment" and "Suboptimal therapy" in both groups. The prevalence of "Overtreatment" was equal in both groups (mean DRPs per patient: 0.84 vs 0.77; P = .22), and "Suboptimal therapy" was more frequently identified post-CDSS (mean DRPs per patient: 0.54 vs 1.1; P \textless .01). WHAT IS NEW AND CONCLUSION: The introduction of CDSS to medication review software generated additional DRPs with a lower resolution rate. Structural assessment including a patient interview elicited the most relevant DRPs. Further development of CDSS with more specific alerts is needed to be clinical relevant.
@article{verdoorn_drug-related_2018,
title = {Drug-related problems identified during medication review before and after the introduction of a clinical decision support system},
volume = {43},
issn = {1365-2710},
doi = {10.1111/jcpt.12637},
abstract = {WHAT IS KNOWN AND OBJECTIVE: To facilitate the identification of drug-related problems (DRPs) during medication review, several tools have been developed. Explicit criteria, like Beers criteria or STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria, can easily be integrated into a clinical decision support system (CDSS). The aim of this study was to investigate the effect of adding a CDSS to medication review software on identifying and solving DRPs in daily pharmacy practice.
METHODS: Pre- to post-analysis of clinical medication reviews (CMRs) performed by 121 pharmacies in 2012 and 2013, before and after the introduction of CDSS into medication review software. Mean number of DRPs per patient, type of DRPs and their resolution rates were compared in the pharmacies pre- and post-CDSS using paired t tests.
RESULTS AND DISCUSSION: In total, 9151 DRPs were identified in 3100 patients pre-CDSS and 15 268 DRPs were identified in 4303 patients post-CDSS. The mean number of identified DRPs per patient (aggregated per pharmacy) was higher after the introduction of CDSS (3.2 vs 3.6 P {\textless} .01). The resolution rate was lower post-CDSS (50\% vs 44\%; P {\textless} .01), which overall resulted in 1.6 resolved DRPs per patient in both groups (P = .93). After the introduction of CDSS, 41\% of DRPs were detected by the CDSS. The resolution rate of DRPs generated by CDSS was lower than of DRPs identified without the help of CDSS (29\% vs 55\%; P {\textless} .01). The two most prevalent DRP types were "Overtreatment" and "Suboptimal therapy" in both groups. The prevalence of "Overtreatment" was equal in both groups (mean DRPs per patient: 0.84 vs 0.77; P = .22), and "Suboptimal therapy" was more frequently identified post-CDSS (mean DRPs per patient: 0.54 vs 1.1; P {\textless} .01).
WHAT IS NEW AND CONCLUSION: The introduction of CDSS to medication review software generated additional DRPs with a lower resolution rate. Structural assessment including a patient interview elicited the most relevant DRPs. Further development of CDSS with more specific alerts is needed to be clinical relevant.},
language = {eng},
number = {2},
journal = {Journal of Clinical Pharmacy and Therapeutics},
author = {Verdoorn, S. and Kwint, H. F. and Hoogland, P. and Gussekloo, J. and Bouvy, M. L.},
month = apr,
year = {2018},
pmid = {28971492},
keywords = {Aged, Aged, 80 and over, Community Pharmacy Services, Decision Support Systems, Clinical, Drug Prescriptions, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Male, Medication Errors, Pharmacies, Pharmacists, Polypharmacy, Prevalence, Retrospective Studies, computerised decision support, elderly, medication, pharmacist consultation, pharmacy practice},
pages = {224--231}
}2017 (1)
The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey. Erdal, E. P., Mitra, D., Khangulov, V. S., Church, S., & Plokhoy, E. Annals of Clinical Biochemistry, 54(2):230--239, March, 2017.
doi abstract bibtex
doi abstract bibtex
Background Despite advances in clinical chemistry testing, poor blood sample quality continues to impact laboratory operations and the quality of results. While previous studies have identified the preanalytical causes of lower sample quality, few studies have examined the economic impact of poor sample quality on the laboratory. Specifically, the costs associated with workarounds related to fibrin and gel contaminants remain largely unexplored. Methods A quantitative survey of clinical chemistry laboratory stakeholders across 10 international regions, including countries in North America, Europe and Oceania, was conducted to examine current blood sample testing practices, sample quality issues and practices to remediate poor sample quality. Survey data were used to estimate costs incurred by laboratories to mitigate sample quality issues. Results Responses from 164 participants were included in the analysis, which was focused on three specific issues: fibrin strands, fibrin masses and gel globules. Fibrin strands were the most commonly reported issue, with an overall incidence rate of ∼3%. Further, 65% of respondents indicated that these issues contribute to analyzer probe clogging, and the majority of laboratories had visual inspection and manual remediation practices in place to address fibrin- and gel-related quality problems (55% and 70%, respectively). Probe maintenance/replacement, visual inspection and manual remediation were estimated to carry significant costs for the laboratories surveyed. Annual cost associated with lower sample quality and remediation related to fibrin and/or gel globules for an average US laboratory was estimated to be \$100,247. Conclusions Measures to improve blood sample quality present an important step towards improved laboratory operations.
@article{erdal_economic_2017,
title = {The economic impact of poor sample quality in clinical chemistry laboratories: results from a global survey},
volume = {54},
issn = {1758-1001},
shorttitle = {The economic impact of poor sample quality in clinical chemistry laboratories},
doi = {10.1177/0004563216651647},
abstract = {Background Despite advances in clinical chemistry testing, poor blood sample quality continues to impact laboratory operations and the quality of results. While previous studies have identified the preanalytical causes of lower sample quality, few studies have examined the economic impact of poor sample quality on the laboratory. Specifically, the costs associated with workarounds related to fibrin and gel contaminants remain largely unexplored. Methods A quantitative survey of clinical chemistry laboratory stakeholders across 10 international regions, including countries in North America, Europe and Oceania, was conducted to examine current blood sample testing practices, sample quality issues and practices to remediate poor sample quality. Survey data were used to estimate costs incurred by laboratories to mitigate sample quality issues. Results Responses from 164 participants were included in the analysis, which was focused on three specific issues: fibrin strands, fibrin masses and gel globules. Fibrin strands were the most commonly reported issue, with an overall incidence rate of ∼3\%. Further, 65\% of respondents indicated that these issues contribute to analyzer probe clogging, and the majority of laboratories had visual inspection and manual remediation practices in place to address fibrin- and gel-related quality problems (55\% and 70\%, respectively). Probe maintenance/replacement, visual inspection and manual remediation were estimated to carry significant costs for the laboratories surveyed. Annual cost associated with lower sample quality and remediation related to fibrin and/or gel globules for an average US laboratory was estimated to be \$100,247. Conclusions Measures to improve blood sample quality present an important step towards improved laboratory operations.},
language = {eng},
number = {2},
journal = {Annals of Clinical Biochemistry},
author = {Erdal, Erik P. and Mitra, Debanjali and Khangulov, Victor S. and Church, Stephen and Plokhoy, Elizabeth},
month = mar,
year = {2017},
pmid = {27166314},
keywords = {Blood Specimen Collection, Chemistry, Clinical, Clinical Laboratory Services, Europe, Fibrin, Gels, Humans, Laboratories, Laboratory management, North America, Oceania, Quality Control, Surveys and Questionnaires, laboratory methods},
pages = {230--239}
}2016 (1)
Innovative approaches to bipolar disorder and its treatment. Harrison, P. J., Cipriani, A., Harmer, C. J., Nobre, A. C., Saunders, K., Goodwin, G. M., & Geddes, J. R. Annals of the New York Academy of Sciences, 1366(1):76–89, 2016. _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/nyas.13048
Paper doi abstract bibtex
Paper doi abstract bibtex All psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions. In bipolar disorder, lithium remains a mainstay of treatment, six decades since its effects were serendipitously discovered. The lack of progress reflects several factors, including ignorance of the disorder's pathophysiology and the complexities of the clinical phenotype. After reviewing the current status, we discuss some ways forward. First, we highlight the need for a richer characterization of the clinical profile, facilitated by novel devices and new forms of data capture and analysis; such data are already promoting a reevaluation of the phenotype, with an emphasis on mood instability rather than on discrete clinical episodes. Second, experimental medicine can provide early indications of target engagement and therapeutic response, reducing the time, cost, and risk involved in evaluating potential mood stabilizers. Third, genomic data can inform target identification and validation, such as the increasing evidence for involvement of calcium channel genes in bipolar disorder. Finally, new methods and models relevant to bipolar disorder, including stem cells and genetically modified mice, are being used to study key pathways and drug effects. A combination of these approaches has real potential to break the impasse and deliver genuinely new treatments.
@article{harrison_innovative_2016,
title = {Innovative approaches to bipolar disorder and its treatment},
volume = {1366},
copyright = {© 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.},
issn = {1749-6632},
url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/nyas.13048},
doi = {10.1111/nyas.13048},
abstract = {All psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions. In bipolar disorder, lithium remains a mainstay of treatment, six decades since its effects were serendipitously discovered. The lack of progress reflects several factors, including ignorance of the disorder's pathophysiology and the complexities of the clinical phenotype. After reviewing the current status, we discuss some ways forward. First, we highlight the need for a richer characterization of the clinical profile, facilitated by novel devices and new forms of data capture and analysis; such data are already promoting a reevaluation of the phenotype, with an emphasis on mood instability rather than on discrete clinical episodes. Second, experimental medicine can provide early indications of target engagement and therapeutic response, reducing the time, cost, and risk involved in evaluating potential mood stabilizers. Third, genomic data can inform target identification and validation, such as the increasing evidence for involvement of calcium channel genes in bipolar disorder. Finally, new methods and models relevant to bipolar disorder, including stem cells and genetically modified mice, are being used to study key pathways and drug effects. A combination of these approaches has real potential to break the impasse and deliver genuinely new treatments.},
language = {en},
number = {1},
urldate = {2023-06-07},
journal = {Annals of the New York Academy of Sciences},
author = {Harrison, Paul J. and Cipriani, Andrea and Harmer, Catherine J. and Nobre, Anna C. and Saunders, Kate and Goodwin, Guy M. and Geddes, John R.},
year = {2016},
note = {\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/nyas.13048},
keywords = {bipolar disorder, clinical, genetics, mood, therapy},
pages = {76--89},
}2015 (2)
Translational Medicine and Patient Safety in Europe: TRANSFoRm Architecture for the Learning Health System in Europe. Delaney, B. C., Curcin, V., Andreasson, A., Arvanitis, T. N., Bastiaens, H., Ethier, J., Corrigan, D., Kostopoulou, O., Kuchinke, W., McGilchrist, M. M., Royen, P. v., & Wagner, P. BioMed Research International, 2015:e961526, October, 2015.
Paper doi abstract bibtex
Paper doi abstract bibtex The Learning Health System (LHS) describes linking routine healthcare systems directly with both research translation and knowledge translation as an extension of the evidence-based medicine paradigm, taking advantage of the ubiquitous use of electronic health record (EHR) systems. TRANSFoRm is an EU FP7 project that seeks to develop an infrastructure for the LHS in European primary care. Methods. The project is based on three clinical use cases, a genotype-phenotype study in diabetes, a randomised controlled trial with gastroesophageal reflux disease, and a diagnostic decision support system for chest pain, abdominal pain, and shortness of breath. Results. Four models were developed (clinical research, clinical data, provenance, and diagnosis) that form the basis of the projects approach to interoperability. These models are maintained as ontologies with binding of terms to define precise data elements. CDISC ODM and SDM standards are extended using an archetype approach to enable a two-level model of individual data elements, representing both research content and clinical content. Separate configurations of the TRANSFoRm tools serve each use case. Conclusions. The project has been successful in using ontologies and archetypes to develop a highly flexible solution to the problem of heterogeneity of data sources presented by the LHS.
@article{delaney_translational_2015,
title = {Translational {Medicine} and {Patient} {Safety} in {Europe}: {TRANSFoRm} {Architecture} for the {Learning} {Health} {System} in {Europe}},
volume = {2015},
issn = {2314-6133},
shorttitle = {Translational {Medicine} and {Patient} {Safety} in {Europe}},
url = {https://www.hindawi.com/journals/bmri/2015/961526/},
doi = {10.1155/2015/961526},
abstract = {The Learning Health System (LHS) describes linking routine healthcare systems directly with both research translation and knowledge translation as an extension of the evidence-based medicine paradigm, taking advantage of the ubiquitous use of electronic health record (EHR) systems. TRANSFoRm is an EU FP7 project that seeks to develop an infrastructure for the LHS in European primary care. Methods. The project is based on three clinical use cases, a genotype-phenotype study in diabetes, a randomised controlled trial with gastroesophageal reflux disease, and a diagnostic decision support system for chest pain, abdominal pain, and shortness of breath. Results. Four models were developed (clinical research, clinical data, provenance, and diagnosis) that form the basis of the projects approach to interoperability. These models are maintained as ontologies with binding of terms to define precise data elements. CDISC ODM and SDM standards are extended using an archetype approach to enable a two-level model of individual data elements, representing both research content and clinical content. Separate configurations of the TRANSFoRm tools serve each use case. Conclusions. The project has been successful in using ontologies and archetypes to develop a highly flexible solution to the problem of heterogeneity of data sources presented by the LHS.},
language = {en},
journal = {BioMed Research International},
author = {Delaney, Brendan C. and Curcin, Vasa and Andreasson, Anna and Arvanitis, Theodoros N. and Bastiaens, Hilde and Ethier, Jean-François and Corrigan, Derek and Kostopoulou, Olga and Kuchinke, Wolfgang and McGilchrist, Mark M. and Royen, Paul van and Wagner, Peter},
month = oct,
year = {2015},
keywords = {Decision Support Systems, Clinical, Europe, Humans, Models, Theoretical, Patient Safety, Translational Medical Research, electronic health records},
pages = {e961526}
}Normal non-fluency in adult males: An intra- and inter-speaker study. Duckworth, M. & McDougall, K. Procedia - Social and Behavioral Sciences. 10th Oxford Dysfluency Conference, 17–20 July, 2014, Oxford, United Kingdom, 193:302–303, 2015.
doi abstract bibtex
doi abstract bibtex
Our study is a detailed exploration of non-fluency in adults who do not stutter and a discussion of possible clinical implications of our findings. There have been explorations of aspects of non-fluency as part of the study of the effect of cognitive load upon speech planning (e.g. Goldman-Eisler, 1968) or the role of fluency disruptions in conversation management (e.g. Eklund, 2004). There have been few descriptive studies exploring the type and frequency of all non-fluencies in an environment in which aspects of both cognitive load and the conversation structure are controlled. The University of Cambridge Dynamic Variability in Speech (DyViS) corpus (Nolan et al., 2009) contains long samples of speech elicited in two consistent contexts. One hundred 18-25 year old males with the same accent of British English participated in the study. None of the speakers had a speech or hearing disorder. They completed a mock police interview and a more informal telephone conversation which covered the same topics. The corpus aims to provide a set of baseline measures for research into aspects of speech of interest to researchers and practitioners working in the field of forensic speech analysis. In forensic speech casework the presence of non-fluencies is sometimes discussed, but quantitative analysis of its range, frequency and consistency among speakers has not previously been available. In order to address this gap the DyViS corpus was used to investigate individual variation in the two speaking contexts. The study examined the speech of 20 of the speakers in both contexts. Disfluencies were defined as phenomena which interrupt the flow of speech and were counted as the number of occurrences per 100 syllables. In addition to filled and silent pauses all speakers used repetitions, prolongations and self-interruptions in varying amounts. Statistical analysis demonstrated that the profile of types of non-fluency used by speakers tends to be distinctive. Fluency disruptions therefore contribute to the overall characteristics of a person's speech. These characteristics were relatively consistent within a speaker and across the contexts examined. The range of phenomena found will be demonstrated and comparisons with phenomena found in stuttered speech will be explored.
@article{duckworth_normal_2015,
Author = {Duckworth, Martin and McDougall, Kirsty},
Date = {2015},
Date-Modified = {2018-05-30 18:50:02 +0000},
Doi = {10.1016/j.sbspro.2015.03.282},
Journal = {Procedia - Social and Behavioral Sciences. 10th Oxford Dysfluency Conference, 17--20 July, 2014, Oxford, United Kingdom},
Keywords = {conversation, disfluencies, English, filled pauses, forensic, forensic phonetics, pauses, phonetics, prosody, repetitions, segmental lengthening, silent pauses, temporal factors, clinical, clinical phonetics, phonetics},
Pages = {302--303},
Title = {Normal non-fluency in adult males: An intra- and inter-speaker study},
Volume = {193},
Year = {2015},
Abstract = {Our study is a detailed exploration of non-fluency in adults who do not stutter and a discussion of possible clinical implications of our findings. There have been explorations of aspects of non-fluency as part of the study of the effect of cognitive load upon speech planning (e.g. Goldman-Eisler, 1968) or the role of fluency disruptions in conversation management (e.g. Eklund, 2004). There have been few descriptive studies exploring the type and frequency of all non-fluencies in an environment in which aspects of both cognitive load and the conversation structure are controlled. The University of Cambridge Dynamic Variability in Speech (DyViS) corpus (Nolan et al., 2009) contains long samples of speech elicited in two consistent contexts. One hundred 18-25 year old males with the same accent of British English participated in the study. None of the speakers had a speech or hearing disorder. They completed a mock police interview and a more informal telephone conversation which covered the same topics. The corpus aims to provide a set of baseline measures for research into aspects of speech of interest to researchers and practitioners working in the field of forensic speech analysis. In forensic speech casework the presence of non-fluencies is sometimes discussed, but quantitative analysis of its range, frequency and consistency among speakers has not previously been available. In order to address this gap the DyViS corpus was used to investigate individual variation in the two speaking contexts. The study examined the speech of 20 of the speakers in both contexts. Disfluencies were defined as phenomena which interrupt the flow of speech and were counted as the number of occurrences per 100 syllables. In addition to filled and silent pauses all speakers used repetitions, prolongations and self-interruptions in varying amounts. Statistical analysis demonstrated that the profile of types of non-fluency used by speakers tends to be distinctive. Fluency disruptions therefore contribute to the overall characteristics of a person's speech. These characteristics were relatively consistent within a speaker and across the contexts examined. The range of phenomena found will be demonstrated and comparisons with phenomena found in stuttered speech will be explored.},
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Employing computers for the recruitment into clinical trials: a comprehensive systematic review. Köpcke, F. & Prokosch, H. Journal of Medical Internet Research, 16(7):e161, July, 2014.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Medical progress depends on the evaluation of new diagnostic and therapeutic interventions within clinical trials. Clinical trial recruitment support systems (CTRSS) aim to improve the recruitment process in terms of effectiveness and efficiency. OBJECTIVE: The goals were to (1) create an overview of all CTRSS reported until the end of 2013, (2) find and describe similarities in design, (3) theorize on the reasons for different approaches, and (4) examine whether projects were able to illustrate the impact of CTRSS. METHODS: We searched PubMed titles, abstracts, and keywords for terms related to CTRSS research. Query results were classified according to clinical context, workflow integration, knowledge and data sources, reasoning algorithm, and outcome. RESULTS: A total of 101 papers on 79 different systems were found. Most lacked details in one or more categories. There were 3 different CTRSS that dominated: (1) systems for the retrospective identification of trial participants based on existing clinical data, typically through Structured Query Language (SQL) queries on relational databases, (2) systems that monitored the appearance of a key event of an existing health information technology component in which the occurrence of the event caused a comprehensive eligibility test for a patient or was directly communicated to the researcher, and (3) independent systems that required a user to enter patient data into an interface to trigger an eligibility assessment. Although the treating physician was required to act for the patient in older systems, it is now becoming increasingly popular to offer this possibility directly to the patient. CONCLUSIONS: Many CTRSS are designed to fit the existing infrastructure of a clinical care provider or the particularities of a trial. We conclude that the success of a CTRSS depends more on its successful workflow integration than on sophisticated reasoning and data processing algorithms. Furthermore, some of the most recent literature suggest that an increase in recruited patients and improvements in recruitment efficiency can be expected, although the former will depend on the error rate of the recruitment process being replaced. Finally, to increase the quality of future CTRSS reports, we propose a checklist of items that should be included.
@article{kopcke_employing_2014,
title = {Employing computers for the recruitment into clinical trials: a comprehensive systematic review},
volume = {16},
issn = {1438-8871},
shorttitle = {Employing computers for the recruitment into clinical trials},
doi = {10.2196/jmir.3446},
abstract = {BACKGROUND: Medical progress depends on the evaluation of new diagnostic and therapeutic interventions within clinical trials. Clinical trial recruitment support systems (CTRSS) aim to improve the recruitment process in terms of effectiveness and efficiency.
OBJECTIVE: The goals were to (1) create an overview of all CTRSS reported until the end of 2013, (2) find and describe similarities in design, (3) theorize on the reasons for different approaches, and (4) examine whether projects were able to illustrate the impact of CTRSS.
METHODS: We searched PubMed titles, abstracts, and keywords for terms related to CTRSS research. Query results were classified according to clinical context, workflow integration, knowledge and data sources, reasoning algorithm, and outcome.
RESULTS: A total of 101 papers on 79 different systems were found. Most lacked details in one or more categories. There were 3 different CTRSS that dominated: (1) systems for the retrospective identification of trial participants based on existing clinical data, typically through Structured Query Language (SQL) queries on relational databases, (2) systems that monitored the appearance of a key event of an existing health information technology component in which the occurrence of the event caused a comprehensive eligibility test for a patient or was directly communicated to the researcher, and (3) independent systems that required a user to enter patient data into an interface to trigger an eligibility assessment. Although the treating physician was required to act for the patient in older systems, it is now becoming increasingly popular to offer this possibility directly to the patient.
CONCLUSIONS: Many CTRSS are designed to fit the existing infrastructure of a clinical care provider or the particularities of a trial. We conclude that the success of a CTRSS depends more on its successful workflow integration than on sophisticated reasoning and data processing algorithms. Furthermore, some of the most recent literature suggest that an increase in recruited patients and improvements in recruitment efficiency can be expected, although the former will depend on the error rate of the recruitment process being replaced. Finally, to increase the quality of future CTRSS reports, we propose a checklist of items that should be included.},
language = {eng},
number = {7},
journal = {Journal of Medical Internet Research},
author = {Köpcke, Felix and Prokosch, Hans-Ulrich},
month = jul,
year = {2014},
pmid = {24985568},
pmcid = {PMC4128959},
keywords = {Algorithms, Automation, Clinical Trials as Topic, Computers, Decision Support Systems, Clinical, Humans, Information Systems, Patient Selection, research subject recruitment},
pages = {e161}
}Dynamic Bayesian Networks to predict sequences of organ failures in patients admitted to ICU. Sandri, M., Berchialla, P., Baldi, I., Gregori, D., & De Blasi, R., A. Journal of biomedical informatics, 48:106-13, 4, 2014.
Website doi abstract bibtex
Website doi abstract bibtex Multi Organ Dysfunction Syndrome (MODS) represents a continuum of physiologic derangements and is the major cause of death in the Intensive Care Unit (ICU). Scoring systems for organ failure have become an integral part of critical care practice and play an important role in ICU-based research by tracking disease progression and facilitating patient stratification based on evaluation of illness severity during ICU stay. In this study a Dynamic Bayesian Network (DBN) was applied to model SOFA severity score changes in 79 adult critically ill patients consecutively admitted to the general ICU of the Sant'Andrea University hospital (Rome, Italy) from September 2010 to March 2011, with the aim to identify the most probable sequences of organs failures in the first week after the ICU admission. Approximately 56% of patients were admitted into the ICU with lung failure and about 27% of patients with heart failure. Results suggest that, given the first organ failure at the ICU admission, a sequence of organ failures can be predicted with a certain degree of probability. Sequences involving heart, lung, hematologic system and liver turned out to be the more likely to occur, with slightly different probabilities depending on the day of the week they occur. DBNs could be successfully applied for modeling temporal systems in critical care domain. Capability to predict sequences of likely organ failures makes DBNs a promising prognostic tool, intended to help physicians in undertaking therapeutic decisions in a patient-tailored approach.
@article{
title = {Dynamic Bayesian Networks to predict sequences of organ failures in patients admitted to ICU.},
type = {article},
year = {2014},
keywords = {Aged,Algorithms,Bayes Theorem,Critical Illness,Decision Support Systems, Clinical,Female,Hospital Mortality,Humans,Intensive Care,Intensive Care Units,Intensive Care: methods,Length of Stay,Male,Middle Aged,Multiple Organ Failure,Multiple Organ Failure: physiopathology,Multiple Organ Failure: therapy,Probability,Prognosis,Software,Time Factors},
pages = {106-13},
volume = {48},
websites = {http://www.sciencedirect.com/science/article/pii/S1532046413001998},
month = {4},
id = {004dc8f2-b421-3999-9672-f9aef53e9373},
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abstract = {Multi Organ Dysfunction Syndrome (MODS) represents a continuum of physiologic derangements and is the major cause of death in the Intensive Care Unit (ICU). Scoring systems for organ failure have become an integral part of critical care practice and play an important role in ICU-based research by tracking disease progression and facilitating patient stratification based on evaluation of illness severity during ICU stay. In this study a Dynamic Bayesian Network (DBN) was applied to model SOFA severity score changes in 79 adult critically ill patients consecutively admitted to the general ICU of the Sant'Andrea University hospital (Rome, Italy) from September 2010 to March 2011, with the aim to identify the most probable sequences of organs failures in the first week after the ICU admission. Approximately 56% of patients were admitted into the ICU with lung failure and about 27% of patients with heart failure. Results suggest that, given the first organ failure at the ICU admission, a sequence of organ failures can be predicted with a certain degree of probability. Sequences involving heart, lung, hematologic system and liver turned out to be the more likely to occur, with slightly different probabilities depending on the day of the week they occur. DBNs could be successfully applied for modeling temporal systems in critical care domain. Capability to predict sequences of likely organ failures makes DBNs a promising prognostic tool, intended to help physicians in undertaking therapeutic decisions in a patient-tailored approach.},
bibtype = {article},
author = {Sandri, Micol and Berchialla, Paola and Baldi, Ileana and Gregori, Dario and De Blasi, Roberto Alberto},
doi = {10.1016/j.jbi.2013.12.008},
journal = {Journal of biomedical informatics}
}Interventions to reduce pediatric medication errors: a systematic review. Rinke, M. L., Bundy, D. G., Velasquez, C. A., Rao, S., Zerhouni, Y., Lobner, K., Blanck, J. F., & Miller, M. R. Pediatrics, 134(2):338--360, August, 2014. 00022
doi abstract bibtex
doi abstract bibtex
BACKGROUND AND OBJECTIVE: Medication errors cause appreciable morbidity and mortality in children. The objective was to determine the effectiveness of interventions to reduce pediatric medication errors, identify gaps in the literature, and perform meta-analyses on comparable studies. METHODS: Relevant studies were identified from searches of PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing Allied Health Literature and previous systematic reviews. Inclusion criteria were peer-reviewed original data in any language testing an intervention to reduce medication errors in children. Abstract and full-text article review were conducted by 2 independent authors with sequential data extraction. RESULTS: A total of 274 full-text articles were reviewed and 63 were included. Only 1% of studies were conducted at community hospitals, 11% were conducted in ambulatory populations, 10% reported preventable adverse drug events, 10% examined administering errors, 3% examined dispensing errors, and none reported cost-effectiveness data, suggesting persistent research gaps. Variation existed in the methods, definitions, outcomes, and rate denominators for all studies; and many showed an appreciable risk of bias. Although 26 studies (41%) involved computerized provider order entry, a meta-analysis was not performed because of methodologic heterogeneity. Studies of computerized provider order entry with clinical decision support compared with studies without clinical decision support reported a 36% to 87% reduction in prescribing errors; studies of preprinted order sheets revealed a 27% to 82% reduction in prescribing errors. CONCLUSIONS: Pediatric medication errors can be reduced, although our understanding of optimal interventions remains hampered. Research should focus on understudied areas, use standardized definitions and outcomes, and evaluate cost-effectiveness.
@article{rinke_interventions_2014,
title = {Interventions to reduce pediatric medication errors: a systematic review},
volume = {134},
issn = {1098-4275},
shorttitle = {Interventions to reduce pediatric medication errors},
doi = {10.1542/peds.2013-3531},
abstract = {BACKGROUND AND OBJECTIVE: Medication errors cause appreciable morbidity and mortality in children. The objective was to determine the effectiveness of interventions to reduce pediatric medication errors, identify gaps in the literature, and perform meta-analyses on comparable studies.
METHODS: Relevant studies were identified from searches of PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing Allied Health Literature and previous systematic reviews. Inclusion criteria were peer-reviewed original data in any language testing an intervention to reduce medication errors in children. Abstract and full-text article review were conducted by 2 independent authors with sequential data extraction.
RESULTS: A total of 274 full-text articles were reviewed and 63 were included. Only 1\% of studies were conducted at community hospitals, 11\% were conducted in ambulatory populations, 10\% reported preventable adverse drug events, 10\% examined administering errors, 3\% examined dispensing errors, and none reported cost-effectiveness data, suggesting persistent research gaps. Variation existed in the methods, definitions, outcomes, and rate denominators for all studies; and many showed an appreciable risk of bias. Although 26 studies (41\%) involved computerized provider order entry, a meta-analysis was not performed because of methodologic heterogeneity. Studies of computerized provider order entry with clinical decision support compared with studies without clinical decision support reported a 36\% to 87\% reduction in prescribing errors; studies of preprinted order sheets revealed a 27\% to 82\% reduction in prescribing errors.
CONCLUSIONS: Pediatric medication errors can be reduced, although our understanding of optimal interventions remains hampered. Research should focus on understudied areas, use standardized definitions and outcomes, and evaluate cost-effectiveness.},
language = {eng},
number = {2},
journal = {Pediatrics},
author = {Rinke, Michael L. and Bundy, David G. and Velasquez, Christina A. and Rao, Sandesh and Zerhouni, Yasmin and Lobner, Katie and Blanck, Jaime F. and Miller, Marlene R.},
month = aug,
year = {2014},
pmid = {25022737},
note = {00022 },
keywords = {Child, Decision Support Systems, Clinical, Humans, Medical Order Entry Systems, Medication Errors},
pages = {338--360}
}An integrated organisation-wide data quality management and information governance framework: Theoretical underpinnings. Liaw, S., -., Pearce, C., Liyanage, H., Liaw, G., S., S., & De Lusignan, S. Informatics in Primary Care, 21(4):199-206, 2014.
Website abstract bibtex
Website abstract bibtex Introduction Increasing investment in eHealth aims to improve cost effectiveness and safety of care. Data extraction and aggregation can create new data products to improve professional practice and provide feedback to improve the quality of source data. A previous systematic review concluded that locally relevant clinical indicators and use of clinical record systems could support clinical governance. We aimed to extend and update the review with a theoretical framework. Methods We searched PubMed, Medline, Web of Science, ABI Inform (Proquest) and Business Source Premier (EBSCO) using the terms curation, information ecosystem, data quality management (DQM), data governance, information governance (IG) and data stewardship. We focused on and analysed the scope of DQM and IG processes, theoretical frameworks, and determinants of the processing, quality assurance, presentation and sharing of data across the enterprise. Findings There are good theoretical reasons for integrated governance, but there is variable alignment of DQM, IG and health system objectives across the health enterprise. Ethical constraints exist that require health information ecosystems to process data in ways that are aligned with improving health and system efficiencyand ensuring patient safety. Despite an increasingly 'big-data' environment, DQM and IG in health services are still fragmented across the data production cycle. We extend current work on DQM and IG with a theoretical framework for integrated IG across the data cycle. Conclusions The dimensions of this theory-based framework would require testing with qualitative and quantitative studies to examine the applicability and utility, along with an evaluation of its impact on data quality across the health enterprise. Copyright © 2014 The Author(s).
@article{
title = {An integrated organisation-wide data quality management and information governance framework: Theoretical underpinnings},
type = {article},
year = {2014},
keywords = {Big data,Clinical,Data quality,Electronic health records,Governance,Information,Integration,Organisation},
pages = {199-206},
volume = {21},
websites = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84910152395&partnerID=40&md5=05c65403eff1c151f4ee3c35f0934385},
city = {Affiliation: School of Public Health and Community Medicine, UNSW Medicine and General Practice Unit, South Western Sydney Local Health District, Australia; Affiliation: Inner Eastern Medicare Local, Melbourne, Australia; Affiliation: Department of Primar},
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source_type = {JOUR},
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abstract = {Introduction Increasing investment in eHealth aims to improve cost effectiveness and safety of care. Data extraction and aggregation can create new data products to improve professional practice and provide feedback to improve the quality of source data. A previous systematic review concluded that locally relevant clinical indicators and use of clinical record systems could support clinical governance. We aimed to extend and update the review with a theoretical framework. Methods We searched PubMed, Medline, Web of Science, ABI Inform (Proquest) and Business Source Premier (EBSCO) using the terms curation, information ecosystem, data quality management (DQM), data governance, information governance (IG) and data stewardship. We focused on and analysed the scope of DQM and IG processes, theoretical frameworks, and determinants of the processing, quality assurance, presentation and sharing of data across the enterprise. Findings There are good theoretical reasons for integrated governance, but there is variable alignment of DQM, IG and health system objectives across the health enterprise. Ethical constraints exist that require health information ecosystems to process data in ways that are aligned with improving health and system efficiencyand ensuring patient safety. Despite an increasingly 'big-data' environment, DQM and IG in health services are still fragmented across the data production cycle. We extend current work on DQM and IG with a theoretical framework for integrated IG across the data cycle. Conclusions The dimensions of this theory-based framework would require testing with qualitative and quantitative studies to examine the applicability and utility, along with an evaluation of its impact on data quality across the health enterprise. Copyright © 2014 The Author(s).},
bibtype = {article},
author = {Liaw, S -T and Pearce, C and Liyanage, H and Liaw, G S S and De Lusignan, S},
journal = {Informatics in Primary Care},
number = {4}
}User needs and requirements analysis for big data healthcare applications. Zillner, S., Lasierra, N., Faix, W., & Neururer, S. B. In MIE, pages 657–661, 2014.
![User needs and requirements analysis for big data healthcare applications. [pdf]](https://bibbase.org/img/filetypes/pdf.svg "pdf")
Paper bibtex
Paper bibtex @inproceedings{zillner_user_2014,
title = {User needs and requirements analysis for big data healthcare applications.},
url = {https://pdfs.semanticscholar.org/f09c/9fd53639367d9090db470db295daf5e60190.pdf},
urldate = {2017-08-14TZ},
booktitle = {{MIE}},
author = {Zillner, Sonja and Lasierra, Nelia and Faix, Werner and Neururer, Sabrina Barbara},
year = {2014},
pages = {657--661}
}DysList: An annotated resource of dyslexic errors. Rello, L., Baeza-Yates, R., & Llisterri, J. In LREC 2014. Proceedings of the 9th International Conference on Language Resources and Evaluation, pages 1289-1296, Reykjavik, Iceland. 26-31 May, 2014, 2014.
Paper abstract bibtex
Paper abstract bibtex We introduce a language resource for Spanish, DysList, composed of a list of unique errors extracted from a collection of texts written by people with dyslexia. Each of the errors was annotated with a set of characteristics as well as visual and phonetic features. To the best of our knowledge this is the largest resource of this kind, especially given the difficulty of finding texts written by people with dyslexia.
@inproceedings{rello_dyslist:_2014,
Address = {Reykjavik, Iceland. 26-31 May, 2014},
Author = {Rello, Luz and Baeza-Yates, Ricardo and Llisterri, Joaquim},
Booktitle = {LREC 2014. Proceedings of the 9th International Conference on Language Resources and Evaluation},
Date = {2014},
Date-Modified = {2018-07-20 11:37:20 +0000},
Isbn = {978-2-9517408-8-4},
Keywords = {clinical, clinical phonetics, language resources, dyslexia, written corpus, phonetics},
Pages = {1289-1296},
Title = {DysList: An annotated resource of dyslexic errors},
Url = {http://liceu.uab.cat/~joaquim/publicacions/Rello_Baeza_Llisterri_DysList_14.pdf},
Year = {2014},
Abstract = {We introduce a language resource for Spanish, DysList, composed of a list of unique errors extracted from a collection of texts written by people with dyslexia. Each of the errors was annotated with a set of characteristics as well as visual and phonetic features. To the best of our knowledge this is the largest resource of this kind, especially given the difficulty of finding texts written by people with dyslexia.},
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Racial and ethnic differences in subspecialty service use by children with autism. Broder-Fingert, S., Shui, A. M, Pulcini, C. D, Kurowski, D., & Perrin, J. M Pediatrics, 132:94-100, 2013 Jul, 2013.
doi abstract bibtex
doi abstract bibtex
OBJECTIVE: To describe racial differences in use of specialty care among children with autism spectrum disorder.
METHODS: We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type.
RESULTS: We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]).
CONCLUSIONS: We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through.
@article{1418,
abstract = {<p><b>OBJECTIVE: </b>To describe racial differences in use of specialty care among children with autism spectrum disorder.</p><p><b>METHODS: </b>We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type.</p><p><b>RESULTS: </b>We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]).</p><p><b>CONCLUSIONS: </b>We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through.</p>},
added-at = {2021-02-17T03:07:48.000+0100},
author = {Broder-Fingert, Sarabeth and Shui, Amy M and Pulcini, Christian D and Kurowski, Daniel and Perrin, James M},
biburl = {https://www.bibsonomy.org/bibtex/2c6c60af6dad6b60e01caa77e56bd2226/acn},
doi = {10.1542/peds.2012-3886},
interhash = {7b64142115516ec66ed48e93c97d335a},
intrahash = {c6c60af6dad6b60e01caa77e56bd2226},
issn = {1098-4275},
journal = {Pediatrics},
keywords = {Health Consultation, Odds Psychiatry, African Americans, Young European States, Humans, Utilization Services, Male, Referral Continental Review, Medicine, Nutritional Female, United Gastroenterology, Group, Child, Sciences, Adolescent, Autistic and Ancestry Psychology, Clinical, Preschool, Adult Ratio, Neurology, Hispanic Disorder,},
month = {2013 Jul},
pages = {94-100},
timestamp = {2021-02-17T03:08:36.000+0100},
title = {Racial and ethnic differences in subspecialty service use by children with autism.},
volume = 132,
year = 2013
}Use of an on-demand drug-drug interaction checker by prescribers and consultants: a retrospective analysis in a Swiss teaching hospital. Beeler, P. E., Eschmann, E., Rosen, C., & Blaser, J. Drug safety: an international journal of medical toxicology and drug experience, 36(6):427–434, June, 2013.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Offering a drug-drug interaction (DDI) checker on-demand instead of computer-triggered alerts is a strategy to avoid alert fatigue. OBJECTIVE: The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients. METHODS: The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital. The hospital-wide use of the on-demand DDI checker was measured for prescribers and consulting pharmacologists. The number of DDIs identified on-demand was compared to the number that would have resulted by computer-triggering and this was compared to patient-specific recommendations by a consulting pharmacist. RESULTS: The on-demand use was analyzed during treatment of 64,259 inpatients with 1,316,884 prescriptions. The DDI checker was popular with nine consulting pharmacologists (648 checks/consultant). A total of 644 prescribing physicians used it infrequently (eight checks/prescriber). Among prescribers, internists used the tool most frequently and obtained higher numbers of DDIs per check (1.7) compared to surgeons (0.4). A total of 16,553 DDIs were identified on-demand, i.e., \textless10 % of the number the computer would have triggered (169,192). A pharmacist visiting 922 patients on a medical ward recommended 128 adjustments to prevent DDIs (0.14 recommendations/patient), and 76 % of them were applied by prescribers. In contrast, computer-triggering the DDI checker would have resulted in 45 times more alerts on this ward (6.3 alerts/patient). CONCLUSIONS: The on-demand DDI checker was popular with the consultants only. However, prescribers accepted 76 % of patient-specific recommendations by a pharmacist. The prescribers' limited on-demand use indicates the necessity for developing improved safety concepts, tailored to suit these consumers. Thus, different approaches have to satisfy different target groups.
@article{beeler_use_2013,
title = {Use of an on-demand drug-drug interaction checker by prescribers and consultants: a retrospective analysis in a {Swiss} teaching hospital},
volume = {36},
issn = {0114-5916},
shorttitle = {Use of an on-demand drug-drug interaction checker by prescribers and consultants},
doi = {10.1007/s40264-013-0022-1},
abstract = {BACKGROUND: Offering a drug-drug interaction (DDI) checker on-demand instead of computer-triggered alerts is a strategy to avoid alert fatigue.
OBJECTIVE: The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients.
METHODS: The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital. The hospital-wide use of the on-demand DDI checker was measured for prescribers and consulting pharmacologists. The number of DDIs identified on-demand was compared to the number that would have resulted by computer-triggering and this was compared to patient-specific recommendations by a consulting pharmacist.
RESULTS: The on-demand use was analyzed during treatment of 64,259 inpatients with 1,316,884 prescriptions. The DDI checker was popular with nine consulting pharmacologists (648 checks/consultant). A total of 644 prescribing physicians used it infrequently (eight checks/prescriber). Among prescribers, internists used the tool most frequently and obtained higher numbers of DDIs per check (1.7) compared to surgeons (0.4). A total of 16,553 DDIs were identified on-demand, i.e., {\textless}10 \% of the number the computer would have triggered (169,192). A pharmacist visiting 922 patients on a medical ward recommended 128 adjustments to prevent DDIs (0.14 recommendations/patient), and 76 \% of them were applied by prescribers. In contrast, computer-triggering the DDI checker would have resulted in 45 times more alerts on this ward (6.3 alerts/patient).
CONCLUSIONS: The on-demand DDI checker was popular with the consultants only. However, prescribers accepted 76 \% of patient-specific recommendations by a pharmacist. The prescribers' limited on-demand use indicates the necessity for developing improved safety concepts, tailored to suit these consumers. Thus, different approaches have to satisfy different target groups.},
language = {eng},
number = {6},
journal = {Drug safety: an international journal of medical toxicology and drug experience},
author = {Beeler, Patrick Emanuel and Eschmann, Emmanuel and Rosen, Christoph and Blaser, Jürg},
month = jun,
year = {2013},
pmid = {23516005},
keywords = {Attitude of Health Personnel, Databases, Pharmaceutical, Decision Support Systems, Clinical, Drug Interactions, Drug-Related Side Effects and Adverse Reactions, Hospitals, Teaching, Humans, Information Seeking Behavior, Internal Medicine, Medical Errors, Mental Fatigue, Pharmacology, Clinical, Physicians, Retrospective Studies, Software, Specialties, Surgical, Switzerland},
pages = {427--434}
}Individualised surgical outcomes: please look the other way. Moonesinghe, S. R. Postgraduate medical journal, 89(1058):677–678, December, 2013.
doi bibtex
doi bibtex
@article{moonesinghe_individualised_2013,
title = {Individualised surgical outcomes: please look the other way.},
volume = {89},
issn = {1469-0756 0032-5473},
doi = {10.1136/postgradmedj-2013-132442},
language = {eng},
number = {1058},
journal = {Postgraduate medical journal},
author = {Moonesinghe, S. R.},
month = dec,
year = {2013},
pmid = {24243981},
keywords = {*Hospital Mortality, *Physicians/standards/statistics \& numerical data, *Postoperative Complications, *State Medicine, *Thoracic Surgical Procedures/standards, Clinical Audit, Decision Making, Decision Support Systems, Clinical, Epidemiology, Ethics (see Medical Ethics), Humans, Patient Outcome Assessment, Patient Participation, Quality Assurance, Health Care, Risk Adjustment, Societies, Medical, Surgery, United Kingdom},
pages = {677--678},
}Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. Phansalkar, S., van der Sijs, H., Tucker, A. D, Desai, A. A, Bell, D. S, Teich, J. M, Middleton, B., & Bates, D. W Journal of the American Medical Informatics Association: JAMIA, 20(3):489–493, May, 2013.
doi abstract bibtex
doi abstract bibtex
OBJECTIVE: Alert fatigue represents a common problem associated with the use of clinical decision support systems in electronic health records (EHR). This problem is particularly profound with drug-drug interaction (DDI) alerts for which studies have reported override rates of approximately 90%. The objective of this study is to report consensus-based recommendations of an expert panel on DDI that can be safely made non-interruptive to the provider's workflow, in EHR, in an attempt to reduce alert fatigue. METHODS: We utilized an expert panel process to rate the interactions. Panelists had expertise in medicine, pharmacy, pharmacology and clinical informatics, and represented both academic institutions and vendors of medication knowledge bases and EHR. In addition, representatives from the US Food and Drug Administration and the American Society of Health-System Pharmacy contributed to the discussions. RESULTS: Recommendations and considerations of the panel resulted in the creation of a list of 33 class-based low-priority DDI that do not warrant being interruptive alerts in EHR. In one institution, these accounted for 36% of the interactions displayed. DISCUSSION: Development and customization of the content of medication knowledge bases that drive DDI alerting represents a resource-intensive task. Creation of a standardized list of low-priority DDI may help reduce alert fatigue across EHR. CONCLUSIONS: Future efforts might include the development of a consortium to maintain this list over time. Such a list could also be used in conjunction with financial incentives tied to its adoption in EHR.
@article{phansalkar_drug-drug_2013,
title = {Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records},
volume = {20},
issn = {1527-974X},
doi = {10.1136/amiajnl-2012-001089},
abstract = {OBJECTIVE: Alert fatigue represents a common problem associated with the use of clinical decision support systems in electronic health records (EHR). This problem is particularly profound with drug-drug interaction (DDI) alerts for which studies have reported override rates of approximately 90\%. The objective of this study is to report consensus-based recommendations of an expert panel on DDI that can be safely made non-interruptive to the provider's workflow, in EHR, in an attempt to reduce alert fatigue.
METHODS: We utilized an expert panel process to rate the interactions. Panelists had expertise in medicine, pharmacy, pharmacology and clinical informatics, and represented both academic institutions and vendors of medication knowledge bases and EHR. In addition, representatives from the US Food and Drug Administration and the American Society of Health-System Pharmacy contributed to the discussions.
RESULTS: Recommendations and considerations of the panel resulted in the creation of a list of 33 class-based low-priority DDI that do not warrant being interruptive alerts in EHR. In one institution, these accounted for 36\% of the interactions displayed.
DISCUSSION: Development and customization of the content of medication knowledge bases that drive DDI alerting represents a resource-intensive task. Creation of a standardized list of low-priority DDI may help reduce alert fatigue across EHR.
CONCLUSIONS: Future efforts might include the development of a consortium to maintain this list over time. Such a list could also be used in conjunction with financial incentives tied to its adoption in EHR.},
language = {eng},
number = {3},
journal = {Journal of the American Medical Informatics Association: JAMIA},
author = {Phansalkar, Shobha and van der Sijs, Heleen and Tucker, Alisha D and Desai, Amrita A and Bell, Douglas S and Teich, Jonathan M and Middleton, Blackford and Bates, David W},
month = may,
year = {2013},
pmid = {23011124},
pmcid = {PMC3628052},
keywords = {DDI alerts, Decision Support Systems, Clinical, Drug Interactions, Drug Therapy, Computer-Assisted, Electronic Health Records, Humans, Medical Order Entry Systems, Workflow, alert fatigue, clinical decision support, computerized decision support systems, drug-drug interactions, medication alerts},
pages = {489--493}
}A clinical case of electronic health record drug alert fatigue: consequences for patient outcome. Carspecken, C W., Sharek, P. J, Longhurst, C., & Pageler, N. M Pediatrics, 131(6):e1970–1973, June, 2013.
doi abstract bibtex
doi abstract bibtex
Despite advances in electronic medication order entry systems, it has been well established that clinicians override many drug allergy alerts generated by the electronic health record. The direct clinical consequences of overalerting clinicians in a pediatric setting have not been well demonstrated in the literature. We observed a patient in the PICU who experienced complications as a result of an extended series of non-evidence-based alerts in the electronic health record. Subsequently, evidence-based allergy alerting changes were made to the hospital's system. Incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.
@article{carspecken_clinical_2013,
title = {A clinical case of electronic health record drug alert fatigue: consequences for patient outcome},
volume = {131},
issn = {1098-4275},
shorttitle = {A clinical case of electronic health record drug alert fatigue},
doi = {10.1542/peds.2012-3252},
abstract = {Despite advances in electronic medication order entry systems, it has been well established that clinicians override many drug allergy alerts generated by the electronic health record. The direct clinical consequences of overalerting clinicians in a pediatric setting have not been well demonstrated in the literature. We observed a patient in the PICU who experienced complications as a result of an extended series of non-evidence-based alerts in the electronic health record. Subsequently, evidence-based allergy alerting changes were made to the hospital's system. Incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.},
language = {eng},
number = {6},
journal = {Pediatrics},
author = {Carspecken, C William and Sharek, Paul J and Longhurst, Christopher and Pageler, Natalie M},
month = jun,
year = {2013},
pmid = {23713099},
keywords = {Child, Preschool, Decision Support Systems, Clinical, Diagnosis, Differential, Drug Hypersensitivity, Electronic Health Records, Evidence-Based Medicine, Fatigue, Humans, Male, Medical Order Entry Systems, Medication Errors, Physician's Practice Patterns},
pages = {e1970--1973}
}Comparative performance of two drug interaction screening programmes analysing a cross-sectional prescription dataset of 84,625 psychiatric inpatients. Zorina, O. I, Haueis, P., Greil, W., Grohmann, R., Kullak-Ublick, G. A, & Russmann, S. Drug safety: an international journal of medical toxicology and drug experience, 36(4):247–258, April, 2013.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Clinical decision support software (CDSS) solutions can automatically identify drug interactions and thereby aim to improve drug safety. However, data on the comparative performance of different CDSS to detect and appropriately classify interactions in real-life prescription datasets is limited. OBJECTIVE: The aim of this study was to compare the results from two different CDSS analysing the pharmacotherapy of a large population of psychiatric inpatients for drug interactions. METHODS: We performed mass analyses of cross-sectional patient-level prescriptions from 84,625 psychiatric inpatients using two CDSS - MediQ and ID PHARMA CHECK(®). Interactions with the highest risk ratings and the most frequent ratings were reclassified according to the Zurich Interaction System (ZHIAS), a multidimensional classification that incorporates the OpeRational ClassificAtion of Drug Interactions (ORCA) and served as a reference standard. RESULTS: MediQ reported 6,133 unique interacting combinations responsible for 270,617 alerts affecting 63,454 patients. ID PHARMA CHECK(®) issued 5,400 interactions and 157,489 alerts in 48,302 patients. Only 2,154 unique interactions were identified by both programmes, but overlap increased with higher risk rating. MediQ reported high-risk interactions in 2.5 % of all patients, compared with 5 % according to ID PHARMA CHECK(®). The positive predictive value for unique major alerts to be (provisionally) contraindicated according to ORCA was higher for MediQ (0.63) than for either of the two ID PHARMA CHECK(®) components (0.42 for hospINDEX and 0.30 for ID MACS). MediQ reported more interactions, and ID PHARMA CHECK(®) tended to classify interactions into a higher risk class, but overall both programmes identified a similar number of (provisionally) contraindicated interactions according to ORCA criteria. Both programmes identified arrhythmia as the most frequent specific risk associated with interactions in psychiatric patients. CONCLUSIONS: CDSS can be used for mass-analysis of prescription data and thereby support quality management. However, in clinical practice CDSS impose an overwhelming alert burden on the prescriber, and prediction of clinical relevance remains a major challenge. Only a small subset of yet to be determined alerts appears suitable for automated display in clinical routine.
@article{zorina_comparative_2013,
title = {Comparative performance of two drug interaction screening programmes analysing a cross-sectional prescription dataset of 84,625 psychiatric inpatients},
volume = {36},
issn = {0114-5916},
doi = {10.1007/s40264-013-0027-9},
abstract = {BACKGROUND: Clinical decision support software (CDSS) solutions can automatically identify drug interactions and thereby aim to improve drug safety. However, data on the comparative performance of different CDSS to detect and appropriately classify interactions in real-life prescription datasets is limited.
OBJECTIVE: The aim of this study was to compare the results from two different CDSS analysing the pharmacotherapy of a large population of psychiatric inpatients for drug interactions.
METHODS: We performed mass analyses of cross-sectional patient-level prescriptions from 84,625 psychiatric inpatients using two CDSS - MediQ and ID PHARMA CHECK(®). Interactions with the highest risk ratings and the most frequent ratings were reclassified according to the Zurich Interaction System (ZHIAS), a multidimensional classification that incorporates the OpeRational ClassificAtion of Drug Interactions (ORCA) and served as a reference standard.
RESULTS: MediQ reported 6,133 unique interacting combinations responsible for 270,617 alerts affecting 63,454 patients. ID PHARMA CHECK(®) issued 5,400 interactions and 157,489 alerts in 48,302 patients. Only 2,154 unique interactions were identified by both programmes, but overlap increased with higher risk rating. MediQ reported high-risk interactions in 2.5 \% of all patients, compared with 5 \% according to ID PHARMA CHECK(®). The positive predictive value for unique major alerts to be (provisionally) contraindicated according to ORCA was higher for MediQ (0.63) than for either of the two ID PHARMA CHECK(®) components (0.42 for hospINDEX and 0.30 for ID MACS). MediQ reported more interactions, and ID PHARMA CHECK(®) tended to classify interactions into a higher risk class, but overall both programmes identified a similar number of (provisionally) contraindicated interactions according to ORCA criteria. Both programmes identified arrhythmia as the most frequent specific risk associated with interactions in psychiatric patients.
CONCLUSIONS: CDSS can be used for mass-analysis of prescription data and thereby support quality management. However, in clinical practice CDSS impose an overwhelming alert burden on the prescriber, and prediction of clinical relevance remains a major challenge. Only a small subset of yet to be determined alerts appears suitable for automated display in clinical routine.},
language = {eng},
number = {4},
journal = {Drug safety: an international journal of medical toxicology and drug experience},
author = {Zorina, Olesya I and Haueis, Patrick and Greil, Waldemar and Grohmann, Renate and Kullak-Ublick, Gerd A and Russmann, Stefan},
month = apr,
year = {2013},
pmid = {23494998},
keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Child, Cross-Sectional Studies, Decision Support Systems, Clinical, Drug Interactions, Female, Hospitals, Psychiatric, Humans, Inpatients, Male, Mental Disorders, Middle Aged, Psychiatric Status Rating Scales, Young Adult},
pages = {247--258}
}Criteria for assessing high-priority drug-drug interactions for clinical decision support in electronic health records. Phansalkar, S., Desai, A., Choksi, A., Yoshida, E., Doole, J., Czochanski, M., Tucker, A. D, Middleton, B., Bell, D., & Bates, D. W BMC medical informatics and decision making, 13(1):65, 2013.
doi abstract bibtex
doi abstract bibtex
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.
@article{phansalkar_criteria_2013,
title = {Criteria for assessing high-priority drug-drug interactions for clinical decision support in electronic health records},
volume = {13},
issn = {1472-6947},
doi = {10.1186/1472-6947-13-65},
abstract = {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.},
language = {eng},
number = {1},
journal = {BMC medical informatics and decision making},
author = {Phansalkar, Shobha and Desai, Amrita and Choksi, Anish and Yoshida, Eileen and Doole, John and Czochanski, Melissa and Tucker, Alisha D and Middleton, Blackford and Bell, Douglas and Bates, David W},
year = {2013},
pmid = {23763856},
pmcid = {PMC3706355},
keywords = {Adverse Drug Reaction Reporting Systems, Decision Support Systems, Clinical, Drug Interactions, Electronic Health Records, Humans, Knowledge Bases, Medical Order Entry Systems, Reference Standards, Reproducibility of Results},
pages = {65}
}Safe practice: using high-fidelity simulation to teach blood transfusion reactions. Prentice, D. & O'rourke, T. Journal of infusion nursing : the official publication of the Infusion Nurses Society, 36(3):207–10, 2013.
abstract bibtex
abstract bibtex
High-fidelity simulation can play an important role in educating novice nurses for a challenging health care environment by fostering their confidence levels in recognizing high-risk, low-incident events. This paper reports on a quality improvement project to increase student nurses' knowledge and skills in caring for clients receiving blood transfusions.
@article{prentice_safe_2013,
title = {Safe practice: using high-fidelity simulation to teach blood transfusion reactions.},
volume = {36},
issn = {1539-0667},
abstract = {High-fidelity simulation can play an important role in educating novice nurses for a challenging health care environment by fostering their confidence levels in recognizing high-risk, low-incident events. This paper reports on a quality improvement project to increase student nurses' knowledge and skills in caring for clients receiving blood transfusions.},
number = {3},
journal = {Journal of infusion nursing : the official publication of the Infusion Nurses Society},
author = {Prentice, Dawn and O'rourke, Tammy},
year = {2013},
keywords = {*Blood Transfusion/ae [Adverse Effects], *Education, Nursing, *Patient Safety, Chemistry, Clinical, Quality Improvement, Students, Nursing, humans},
pages = {207--10},
}Limitations of Medical Research and Evidence at the Patient-Clinician Encounter Scale. Morris, A. H. & Ioannidis, J. P. A. Chest, 143(4):1127-1135, 2013.
doi bibtex
doi bibtex
@article{mor13lim,
title = {Limitations of Medical Research and Evidence at the Patient-Clinician Encounter Scale},
volume = {143},
number = {4},
journal = {Chest},
doi = {10.1378/chest.12-1908},
author = {Morris, Alan H. and Ioannidis, John P. A.},
year = {2013},
keywords = {personalized-medicine,bad-science,practice-guidelines,problems-with-non-randomized-studies},
pages = {1127-1135},
citeulike-article-id = {13265971},
citeulike-linkout-0 = {http://dx.doi.org/10.1378/chest.12-1908},
posted-at = {2014-07-14 14:10:08},
priority = {0}
}2012 (8)
Coupling K-nearest neighbors with logistic regression in case-based reasoning. Campillo-Gimenez, B., Bayat, S., & Cuggia, M. Studies in Health Technology and Informatics, 180:275–279, 2012.
abstract bibtex
abstract bibtex
Case-based reasoning (CBR) systems use similarity functions to solve new problems with past situations. K-nearest neighbors algorithm (K-NN) have been used in CBR systems to define new cases status according to characteristics of past nearest cases. We proposed a new hybrid approach combining logistic regression (LR) with K-NN to optimize CBR classification. First, we analyzed the knowledge database by LR procedures and the Pearson residuals of the LR model were used to define cases' utility of the knowledge database into K-NN. Secondly, we compared the classification performances of LR model and K-NNs coupled or not with LR. Our results showed that the information provided by the residuals could be used to optimize the settings of K-NN and to improve CBR classification.
@article{campillo-gimenez_coupling_2012,
title = {Coupling {K}-nearest neighbors with logistic regression in case-based reasoning},
volume = {180},
issn = {0926-9630},
abstract = {Case-based reasoning (CBR) systems use similarity functions to solve new problems with past situations. K-nearest neighbors algorithm (K-NN) have been used in CBR systems to define new cases status according to characteristics of past nearest cases. We proposed a new hybrid approach combining logistic regression (LR) with K-NN to optimize CBR classification. First, we analyzed the knowledge database by LR procedures and the Pearson residuals of the LR model were used to define cases' utility of the knowledge database into K-NN. Secondly, we compared the classification performances of LR model and K-NNs coupled or not with LR. Our results showed that the information provided by the residuals could be used to optimize the settings of K-NN and to improve CBR classification.},
language = {eng},
journal = {Studies in Health Technology and Informatics},
author = {Campillo-Gimenez, Boris and Bayat, Sahar and Cuggia, Marc},
year = {2012},
pmid = {22874195},
keywords = {Algorithms, Artificial Intelligence, Case-Control Studies, Computer Simulation, Databases, Factual, Decision Support Systems, Clinical, Decision Support Techniques, Logistic Models, Pattern Recognition, Automated, Regression Analysis},
pages = {275--279}
}Effect of clinical decision-support systems: a systematic review. Bright, T. J., Wong, A., Dhurjati, R., Bristow, E., Bastian, L., Coeytaux, R. R., Samsa, G., Hasselblad, V., Williams, J. W., Musty, M. D., Wing, L., Kendrick, A. S., Sanders, G. D., & Lobach, D. Annals of Internal Medicine, 157(1):29–43, July, 2012.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking. PURPOSE: To evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, and Web of Science through January 2011. STUDY SELECTION: Investigators independently screened reports to identify randomized trials published in English of electronic CDSSs that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, health care process, workload, relationship-centered, economic, or provider use outcomes. DATA EXTRACTION: Investigators extracted data about study design, participant characteristics, interventions, outcomes, and quality. DATA SYNTHESIS: 148 randomized, controlled trials were included. A total of 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n= 25; odds ratio [OR], 1.42 [95% CI, 1.27 to 1.58]), ordering clinical studies (n= 20; OR, 1.72 [CI, 1.47 to 2.00]), and prescribing therapies (n= 46; OR, 1.57 [CI, 1.35 to 1.82]). Few studies measured potential unintended consequences or adverse effects. LIMITATIONS: Studies were heterogeneous in interventions, populations, settings, and outcomes. Publication bias and selective reporting cannot be excluded. CONCLUSION: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse. This review expands knowledge in the field by demonstrating the benefits of CDSSs outside of experienced academic centers. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
@article{bright_effect_2012,
title = {Effect of clinical decision-support systems: a systematic review},
volume = {157},
issn = {1539-3704},
shorttitle = {Effect of clinical decision-support systems},
doi = {10.7326/0003-4819-157-1-201207030-00450},
abstract = {BACKGROUND: Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking.
PURPOSE: To evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation.
DATA SOURCES: MEDLINE, CINAHL, PsycINFO, and Web of Science through January 2011.
STUDY SELECTION: Investigators independently screened reports to identify randomized trials published in English of electronic CDSSs that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, health care process, workload, relationship-centered, economic, or provider use outcomes.
DATA EXTRACTION: Investigators extracted data about study design, participant characteristics, interventions, outcomes, and quality.
DATA SYNTHESIS: 148 randomized, controlled trials were included. A total of 128 (86\%) assessed health care process measures, 29 (20\%) assessed clinical outcomes, and 22 (15\%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n= 25; odds ratio [OR], 1.42 [95\% CI, 1.27 to 1.58]), ordering clinical studies (n= 20; OR, 1.72 [CI, 1.47 to 2.00]), and prescribing therapies (n= 46; OR, 1.57 [CI, 1.35 to 1.82]). Few studies measured potential unintended consequences or adverse effects.
LIMITATIONS: Studies were heterogeneous in interventions, populations, settings, and outcomes. Publication bias and selective reporting cannot be excluded.
CONCLUSION: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse. This review expands knowledge in the field by demonstrating the benefits of CDSSs outside of experienced academic centers.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.},
language = {eng},
number = {1},
journal = {Annals of Internal Medicine},
author = {Bright, Tiffani J. and Wong, Anthony and Dhurjati, Ravi and Bristow, Erin and Bastian, Lori and Coeytaux, Remy R. and Samsa, Gregory and Hasselblad, Vic and Williams, John W. and Musty, Michael D. and Wing, Liz and Kendrick, Amy S. and Sanders, Gillian D. and Lobach, David},
month = jul,
year = {2012},
pmid = {22751758},
keywords = {Cost-Benefit Analysis, Decision Support Systems, Clinical, Humans, Randomized Controlled Trials as Topic, Treatment Outcome},
pages = {29--43}
}Comparative evaluation of three clinical decision support systems: prospective screening for medication errors in 100 medical inpatients. Fritz, D., Ceschi, A., Curkovic, I., Huber, M., Egbring, M., Kullak-Ublick, G. A, & Russmann, S. European journal of clinical pharmacology, 68(8):1209–1219, August, 2012.
doi abstract bibtex
doi abstract bibtex
PURPOSE: Clinical decision support systems (CDSS) are promoted as powerful screening tools to improve pharmacotherapy. The aim of our study was to evaluate the potential contribution of CDSS to patient management in clinical practice. METHODS: We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of three CDSS, namely, Pharmavista, DrugReax, and TheraOpt. After expert discussion that also considered all patient-specific clinical information, we selected apparently relevant alerts, issued suitable recommendations to physicians, and recorded subsequent prescription changes. RESULTS: For 100 patients with a median of eight concomitant drugs, Pharmavista, DrugReax, and TheraOpt generated a total of 53, 362, and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts to the attending physician, resulting in 19 prescription changes. Four adverse drug events were associated with interactions. The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0, and 7.6%, and the sensitivity to detect all 33 relevant alerts was 9.1, 87.9, and 75.8% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 to be relevant; three of these were followed by dose reductions. CONCLUSIONS: CDSS are valuable screening tools for medication errors, but only a small fraction of their alerts appear relevant in individual patients. In order to avoid overalerting CDSS should use patient-specific information and management-oriented classifications. Comprehensive information should be displayed on-demand, whereas a limited number of computer-triggered alerts that have management implications in the majority of affected patients should be based on locally customized and supported algorithms.
@article{fritz_comparative_2012,
title = {Comparative evaluation of three clinical decision support systems: prospective screening for medication errors in 100 medical inpatients},
volume = {68},
issn = {1432-1041},
shorttitle = {Comparative evaluation of three clinical decision support systems},
doi = {10.1007/s00228-012-1241-6},
abstract = {PURPOSE: Clinical decision support systems (CDSS) are promoted as powerful screening tools to improve pharmacotherapy. The aim of our study was to evaluate the potential contribution of CDSS to patient management in clinical practice.
METHODS: We prospectively analyzed the pharmacotherapy of 100 medical inpatients through the parallel use of three CDSS, namely, Pharmavista, DrugReax, and TheraOpt. After expert discussion that also considered all patient-specific clinical information, we selected apparently relevant alerts, issued suitable recommendations to physicians, and recorded subsequent prescription changes.
RESULTS: For 100 patients with a median of eight concomitant drugs, Pharmavista, DrugReax, and TheraOpt generated a total of 53, 362, and 328 interaction alerts, respectively. Among those we identified and forwarded 33 clinically relevant alerts to the attending physician, resulting in 19 prescription changes. Four adverse drug events were associated with interactions. The proportion of clinically relevant alerts among all alerts (positive predictive value) was 5.7, 8.0, and 7.6\%, and the sensitivity to detect all 33 relevant alerts was 9.1, 87.9, and 75.8\% for Pharmavista, DrugReax and TheraOpt, respectively. TheraOpt recommended 31 dose adjustments, of which we considered 11 to be relevant; three of these were followed by dose reductions.
CONCLUSIONS: CDSS are valuable screening tools for medication errors, but only a small fraction of their alerts appear relevant in individual patients. In order to avoid overalerting CDSS should use patient-specific information and management-oriented classifications. Comprehensive information should be displayed on-demand, whereas a limited number of computer-triggered alerts that have management implications in the majority of affected patients should be based on locally customized and supported algorithms.},
language = {eng},
number = {8},
journal = {European journal of clinical pharmacology},
author = {Fritz, Daniela and Ceschi, Alessandro and Curkovic, Ivanka and Huber, Martin and Egbring, Marco and Kullak-Ublick, Gerd A and Russmann, Stefan},
month = aug,
year = {2012},
pmid = {22374346},
keywords = {Academic Medical Centers, Adult, Adverse Drug Event -- Prevention and Control, Aged, Aged, 80 and over, Clinical Pharmacy Information Systems, Cross Sectional Studies, Data Analysis Software, Decision Making, Clinical -- Evaluation, Decision Making, Computer Assisted -- Evaluation, Decision Making, Computer Assisted -- Methods, Decision Support Systems, Clinical, Descriptive Statistics, Drug Interactions, Drug Prescriptions, Drug-Related Side Effects and Adverse Reactions, Female, Human, Humans, Inpatients, Male, Medication Errors, Medication Errors -- Prevention and Control, Middle Age, Middle Aged, Polypharmacy, Prescription Drugs, Prospective Studies, Sensitivity and Specificity, Treatment Outcomes},
pages = {1209--1219}
}Access Control Realities As Observed in a Clinical Medical Setting. Sinclair, S. & Smith, S., W. Technical Report Dartmouth College, Computer Science, 1, 2012.
Website abstract bibtex
Website abstract bibtex Effective computer security requires looking not just at technology, but also at how it meshes with users in the real-world enterprises depending on it. As part of a longer-term series of projects, we have been looking at these issues---- particularly access control---- in a variety of real-world enterprises. In previous work, we looked at companies in the finance and software industries; this paper reports on a study of a hospital's access control systems. Both studies employ ethnographic methods to elicit observations on the failures of current access control technologies in large, dynamic organizations; participants in the corporate study were largely drawn from IT staff members, whereas this clinical study involved a larger number of end users.
@techreport{
title = {Access Control Realities As Observed in a Clinical Medical Setting},
type = {techreport},
year = {2012},
keywords = {access-control,clinical,study},
issue = {TR2012-714},
websites = {http://www.cs.dartmouth.edu/cms_file/SYS_techReport/582/TR2012-714.pdf},
month = {1},
city = {Hanover, NH},
institution = {Dartmouth College, Computer Science},
id = {4d39a85b-de43-324c-95c2-e67faaf26ef7},
created = {2018-07-12T21:30:52.947Z},
file_attached = {false},
profile_id = {f954d000-ce94-3da6-bd26-b983145a920f},
group_id = {b0b145a3-980e-3ad7-a16f-c93918c606ed},
last_modified = {2018-07-12T21:30:52.947Z},
read = {false},
starred = {false},
authored = {false},
confirmed = {true},
hidden = {false},
citation_key = {sinclair:realities12},
source_type = {techreport},
notes = {Has some interesting real life anecdotes about problems with security in real world. Scout talks about some of her experiences when observing staff at a hospital, mainly dealing with the difficulties users face with their access-control system. Many interesting scenarios addressing important security questions. For example, how users circumvent the system, why they (usually) do it, what factors govern their choice of laptop for a task (when presented with x number of laptops to choose from), how the proximity authentication system failed because users do not necessarily follow the modeled usage (i.e., user comes near the system, uses it, and leave when done; in real life users use the computer, do non-computer task and then come back to finish the task on the computer), scenarios in which proximity won't work (e.g., when doctors are on a round), delegation of permissions should be easily and convenient.},
private_publication = {false},
abstract = {Effective computer security requires looking not just at technology, but also at how it meshes with users in the real-world enterprises depending on it. As part of a longer-term series of projects, we have been looking at these issues---- particularly access control---- in a variety of real-world enterprises. In previous work, we looked at companies in the finance and software industries; this paper reports on a study of a hospital's access control systems. Both studies employ ethnographic methods to elicit observations on the failures of current access control technologies in large, dynamic organizations; participants in the corporate study were largely drawn from IT staff members, whereas this clinical study involved a larger number of end users.},
bibtype = {techreport},
author = {Sinclair, Sara and Smith, Sean W}
}Clinical Trials in Oncology, Third Edition. Green, S., Benedetti, J., Smith, A., & Crowley, J. CRC Press, May, 2012. Google-Books-ID: OEr3str3Np8C
abstract bibtex
abstract bibtex
The third edition of the bestselling Clinical Trials in Oncology provides a concise, nontechnical, and thoroughly up-to-date review of methods and issues related to cancer clinical trials. The authors emphasize the importance of proper study design, analysis, and data management and identify the pitfalls inherent in these processes. In addition, the book has been restructured to have separate chapters and expanded discussions on general clinical trials issues, and issues specific to Phases I, II, and III. New sections cover innovations in Phase I designs, randomized Phase II designs, and overcoming the challenges of array data. Although this book focuses on cancer trials, the same issues and concepts are important in any clinical setting. As always, the authors use clear, lucid prose and a multitude of real-world examples to convey the principles of successful trials without the need for a strong statistics or mathematics background. Armed with Clinical Trials in Oncology, Third Edition, clinicians and statisticians can avoid the many hazards that can jeopardize the success of a trial.
@book{green_clinical_2012,
title = {Clinical {Trials} in {Oncology}, {Third} {Edition}},
isbn = {978-1-4398-1448-2},
abstract = {The third edition of the bestselling Clinical Trials in Oncology provides a concise, nontechnical, and thoroughly up-to-date review of methods and issues related to cancer clinical trials. The authors emphasize the importance of proper study design, analysis, and data management and identify the pitfalls inherent in these processes. In addition, the book has been restructured to have separate chapters and expanded discussions on general clinical trials issues, and issues specific to Phases I, II, and III. New sections cover innovations in Phase I designs, randomized Phase II designs, and overcoming the challenges of array data. Although this book focuses on cancer trials, the same issues and concepts are important in any clinical setting. As always, the authors use clear, lucid prose and a multitude of real-world examples to convey the principles of successful trials without the need for a strong statistics or mathematics background. Armed with Clinical Trials in Oncology, Third Edition, clinicians and statisticians can avoid the many hazards that can jeopardize the success of a trial.},
language = {en},
publisher = {CRC Press},
author = {Green, Stephanie and Benedetti, Jacqueline and Smith, Angela and Crowley, John},
month = may,
year = {2012},
note = {Google-Books-ID: OEr3str3Np8C},
keywords = {2do, Mathematics / Probability \& Statistics / General, Medical / Biostatistics, Medical / Epidemiology, Medical / Oncology, Science / Life Sciences / Biology, clinical, design}
}Immunotherapeutic applications of IL-15. Croce, M., Orengo, A. M., Azzarone, B., & Ferrini, S. Immunotherapy, 4(9):957–69, September, 2012.
Paper abstract bibtex
Paper abstract bibtex IL-15 is a member of the IL-2 family of cytokines, which play a fundamental role in innate and adaptive immune responses. IL-15 has pleiotropic immune-enhancing activities, as it stimulates NK, T and NKT cell proliferation, survival and effector functions. In view of these properties, IL-15 is regarded as a good candidate for cancer immunotherapy. This possibility is reinforced by its low toxicity and efficacy in preclinical tumor models. The use of IL-15 to boost the immune response in HIV infection has also been proposed, although further studies are required to establish potential risks and benefits. Clinical trials of IL-15 have been initiated in cancer patients and in HIV vaccination and will elucidate the potential of IL-15-based immunotherapy. The purpose of this review is to provide an update on the potential applications of IL-15 in cancer immunotherapy and HIV infection.
@article{croce_immunotherapeutic_2012,
title = {Immunotherapeutic applications of {IL}-15},
volume = {4},
issn = {1750-7448 (ELECTRONIC) 1750-743X (LINKING)},
shorttitle = {Immunotherapeutic applications of {IL}-15},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23046239},
abstract = {IL-15 is a member of the IL-2 family of cytokines, which play a fundamental role in innate and adaptive immune responses. IL-15 has pleiotropic immune-enhancing activities, as it stimulates NK, T and NKT cell proliferation, survival and effector functions. In view of these properties, IL-15 is regarded as a good candidate for cancer immunotherapy. This possibility is reinforced by its low toxicity and efficacy in preclinical tumor models. The use of IL-15 to boost the immune response in HIV infection has also been proposed, although further studies are required to establish potential risks and benefits. Clinical trials of IL-15 have been initiated in cancer patients and in HIV vaccination and will elucidate the potential of IL-15-based immunotherapy. The purpose of this review is to provide an update on the potential applications of IL-15 in cancer immunotherapy and HIV infection.},
number = {9},
journal = {Immunotherapy},
author = {Croce, M. and Orengo, A. M. and Azzarone, B. and Ferrini, S.},
month = sep,
year = {2012},
keywords = {Animals, Clinical, HIV, Humans, Immunotherapy, Infections/*drug, Interleukin-15/physiology/*therapeutic, Neoplasms/*drug, Therapy, Topic, Trials, as, use/toxicity},
pages = {957--69},
}Clinical usefulness of electronic drug-drug interaction checking in the care of cardiovascular surgery inpatients. Taegtmeyer, A B, Kullak-Ublick, G A, Widmer, N, Falk, V, & Jetter, A Cardiology, 123(4):219–222, 2012.
doi abstract bibtex
doi abstract bibtex
OBJECTIVES: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. This study tested the applicability of clinical decision support software in identifying and managing DRPs among cardiovascular surgery inpatients. METHODS: Two clinical pharmacologists attended ward rounds on a low-dependency cardiovascular surgery ward every 2 weeks over a 7-month period. Three hundred and three patients were assessed. On average, patients received 17 scheduled and 'as required' medicines. DRPs were identified 'manually' via assessment of electronic prescription charts and patient records and 'electronically' using clinical decision support software (Pharmavista). The numbers of alerts for optimizing medication safety generated by the two methods were compared. RESULTS: Manual checking identified 346 DRPs leading to 346 alerts in 201 patients (overall 1.1 alerts/patient). Relevant interactions accounted for 44% of DRPs detected by clinical pharmacologists. Clinical decision support software, which could only report interactions, however, generated 1,370 alerts (average 4.5 alerts/patient). Only 147 (11%) drug-drug interaction alerts were identical to those identified by manual checking; the remaining 89% were considered not clinically relevant. CONCLUSIONS: Compared to identification of DRPs by clinical pharmacologists, the clinical decision support software performed poorly due to over-alerting and inability to assess for problems not caused by drug-drug interactions.
@article{taegtmeyer_clinical_2012,
title = {Clinical usefulness of electronic drug-drug interaction checking in the care of cardiovascular surgery inpatients},
volume = {123},
issn = {1421-9751},
doi = {10.1159/000343272},
abstract = {OBJECTIVES: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. This study tested the applicability of clinical decision support software in identifying and managing DRPs among cardiovascular surgery inpatients.
METHODS: Two clinical pharmacologists attended ward rounds on a low-dependency cardiovascular surgery ward every 2 weeks over a 7-month period. Three hundred and three patients were assessed. On average, patients received 17 scheduled and 'as required' medicines. DRPs were identified 'manually' via assessment of electronic prescription charts and patient records and 'electronically' using clinical decision support software (Pharmavista). The numbers of alerts for optimizing medication safety generated by the two methods were compared.
RESULTS: Manual checking identified 346 DRPs leading to 346 alerts in 201 patients (overall 1.1 alerts/patient). Relevant interactions accounted for 44\% of DRPs detected by clinical pharmacologists. Clinical decision support software, which could only report interactions, however, generated 1,370 alerts (average 4.5 alerts/patient). Only 147 (11\%) drug-drug interaction alerts were identical to those identified by manual checking; the remaining 89\% were considered not clinically relevant.
CONCLUSIONS: Compared to identification of DRPs by clinical pharmacologists, the clinical decision support software performed poorly due to over-alerting and inability to assess for problems not caused by drug-drug interactions.},
language = {eng},
number = {4},
journal = {Cardiology},
author = {Taegtmeyer, A B and Kullak-Ublick, G A and Widmer, N and Falk, V and Jetter, A},
year = {2012},
pmid = {23208189},
keywords = {Cardiovascular Surgical Procedures, Decision Support Systems, Clinical, Drug Interactions, Humans, Inpatients, Pharmacology, Clinical, Software},
pages = {219--222}
}Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations: need for specific alerts. Eschmann, E., Beeler, P. E, Kaplan, V., Schneemann, M., Zünd, G., & Blaser, J. Studies in health technology and informatics, 180:1200–1202, 2012.
abstract bibtex
abstract bibtex
Computer-triggered reminders alerting physicians on every potentially harmful drug-drug-interaction (DDI) induce alert fatigue due to frequent messages of limited clinical relevance. On demand DDI-checks, however, are not commonly used by physicians. Optimal strategies for sustained quality assurance have to consider patients' risk factors and focus on the most significant DDIs only. An approach is proposed based on the analysis of concurrent prescription of potassium-sparing diuretics and potassium supplements (CPPP), which are the most frequent DDIs classified as contraindicated. Although the frequency of monitoring potassium serum levels declined during prolonged periods of CPPP, the likelihood of observing a hyperkalaemia increased. The median treatment period of CPPP was 3.3 days, whereas hyperkalaemia occurred after a median observation time of 4.5 days of CPPP. Thus, computer-triggered reminders for ordering potassium serum levels may be indicated if monitoring has been discontinued after 48h of CPPP.
@article{eschmann_clinical_2012,
title = {Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations: need for specific alerts},
volume = {180},
issn = {0926-9630},
shorttitle = {Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations},
abstract = {Computer-triggered reminders alerting physicians on every potentially harmful drug-drug-interaction (DDI) induce alert fatigue due to frequent messages of limited clinical relevance. On demand DDI-checks, however, are not commonly used by physicians. Optimal strategies for sustained quality assurance have to consider patients' risk factors and focus on the most significant DDIs only. An approach is proposed based on the analysis of concurrent prescription of potassium-sparing diuretics and potassium supplements (CPPP), which are the most frequent DDIs classified as contraindicated. Although the frequency of monitoring potassium serum levels declined during prolonged periods of CPPP, the likelihood of observing a hyperkalaemia increased. The median treatment period of CPPP was 3.3 days, whereas hyperkalaemia occurred after a median observation time of 4.5 days of CPPP. Thus, computer-triggered reminders for ordering potassium serum levels may be indicated if monitoring has been discontinued after 48h of CPPP.},
language = {eng},
journal = {Studies in health technology and informatics},
author = {Eschmann, Emmanuel and Beeler, Patrick E and Kaplan, Vladimir and Schneemann, Markus and Zünd, Gregor and Blaser, Jürg},
year = {2012},
pmid = {22874400},
keywords = {Decision Support Systems, Clinical, Drug Interactions, Drug Therapy, Computer-Assisted, Drug-Related Side Effects and Adverse Reactions, Humans, Hyperkalemia, Potassium, Reminder Systems, Switzerland},
pages = {1200--1202}
}2011 (14)
Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system. Persell, S. D., Kaiser, D., Dolan, N. C., Andrews, B., Levi, S., Khandekar, J., Gavagan, T., Thompson, J. A., Friesema, E. M., & Baker, D. W. Medical Care, 49(2):117–125, February, 2011.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Electronic health record (EHR) systems have the potential to revolutionize quality improvement (QI) methods by enhancing quality measurement and integrating multiple proven QI strategies. OBJECTIVES: To implement and evaluate a multifaceted QI intervention using EHR tools to improve quality measurement (including capture of contraindications and patient refusals), make point-of-care reminders more accurate, and provide more valid and responsive clinician feedback (including lists of patients not receiving essential medications) for 16 chronic disease and preventive service measures. DESIGN: Time series analysis at a large internal medicine practice using a commercial EHR. SUBJECTS: All adult patients eligible for each measure (range approximately 100-7500). MEASURES: The proportion of eligible patients who satisfied each measure after removing those with exceptions from the denominator. RESULTS: During the year before the intervention, performance improved significantly for 8 measures. During the year after the intervention, performance improved significantly for 14 measures. For 9 measures, the primary outcome improved more rapidly during the intervention year than during the previous year (P \textless 0.001 for 8 measures, P = 0.02 for 1). Four other measures improved at rates that were not significantly different from the previous year. Improvements resulted from increases in patients receiving the service, documentation of exceptions, or a combination of both. For 5 drug-prescribing measures, more than half of physicians achieved 100% performance. CONCLUSIONS: Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously.
@article{persell_changes_2011,
title = {Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system},
volume = {49},
issn = {1537-1948},
doi = {10.1097/MLR.0b013e318202913d},
abstract = {BACKGROUND: Electronic health record (EHR) systems have the potential to revolutionize quality improvement (QI) methods by enhancing quality measurement and integrating multiple proven QI strategies.
OBJECTIVES: To implement and evaluate a multifaceted QI intervention using EHR tools to improve quality measurement (including capture of contraindications and patient refusals), make point-of-care reminders more accurate, and provide more valid and responsive clinician feedback (including lists of patients not receiving essential medications) for 16 chronic disease and preventive service measures.
DESIGN: Time series analysis at a large internal medicine practice using a commercial EHR.
SUBJECTS: All adult patients eligible for each measure (range approximately 100-7500).
MEASURES: The proportion of eligible patients who satisfied each measure after removing those with exceptions from the denominator.
RESULTS: During the year before the intervention, performance improved significantly for 8 measures. During the year after the intervention, performance improved significantly for 14 measures. For 9 measures, the primary outcome improved more rapidly during the intervention year than during the previous year (P {\textless} 0.001 for 8 measures, P = 0.02 for 1). Four other measures improved at rates that were not significantly different from the previous year. Improvements resulted from increases in patients receiving the service, documentation of exceptions, or a combination of both. For 5 drug-prescribing measures, more than half of physicians achieved 100\% performance.
CONCLUSIONS: Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously.},
language = {eng},
number = {2},
journal = {Medical Care},
author = {Persell, Stephen D. and Kaiser, Darren and Dolan, Nancy C. and Andrews, Beth and Levi, Sue and Khandekar, Janardan and Gavagan, Thomas and Thompson, Jason A. and Friesema, Elisha M. and Baker, David W.},
month = feb,
year = {2011},
pmid = {21178789},
keywords = {Aged, Chicago, Coronary Disease, Decision Support Systems, Clinical, Diabetes Mellitus, Documentation, Drug Prescriptions, Electronic Health Records, Female, Heart Failure, Humans, Internal Medicine, Linear Models, Longitudinal Studies, Male, Middle Aged, Outcome Assessment (Health Care), Physician's Practice Patterns, Point-of-Care Systems, Program Evaluation, Quality Indicators, Health Care, Reminder Systems, Total Quality Management},
pages = {117--125}
}Multiparameter Intelligent Monitoring in Intensive Care II: a public-access intensive care unit database. Saeed, M., Villarroel, M., Reisner, A., T., Clifford, G., D., Lehman, L., H., Moody, G., B., Heldt, T., Kyaw, T., H., Moody, B., & Mark, R., G. Critical care medicine, 39(5):952-60, 5, 2011.
abstract bibtex
abstract bibtex
OBJECTIVE: We sought to develop an intensive care unit research database applying automated techniques to aggregate high-resolution diagnostic and therapeutic data from a large, diverse population of adult intensive care unit patients. This freely available database is intended to support epidemiologic research in critical care medicine and serve as a resource to evaluate new clinical decision support and monitoring algorithms. DESIGN: Data collection and retrospective analysis. SETTING: All adult intensive care units (medical intensive care unit, surgical intensive care unit, cardiac care unit, cardiac surgery recovery unit) at a tertiary care hospital. PATIENTS: Adult patients admitted to intensive care units between 2001 and 2007. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database consists of 25,328 intensive care unit stays. The investigators collected detailed information about intensive care unit patient stays, including laboratory data, therapeutic intervention profiles such as vasoactive medication drip rates and ventilator settings, nursing progress notes, discharge summaries, radiology reports, provider order entry data, International Classification of Diseases, 9th Revision codes, and, for a subset of patients, high-resolution vital sign trends and waveforms. Data were automatically deidentified to comply with Health Insurance Portability and Accountability Act standards and integrated with relational database software to create electronic intensive care unit records for each patient stay. The data were made freely available in February 2010 through the Internet along with a detailed user's guide and an assortment of data processing tools. The overall hospital mortality rate was 11.7%, which varied by critical care unit. The median intensive care unit length of stay was 2.2 days (interquartile range, 1.1-4.4 days). According to the primary International Classification of Diseases, 9th Revision codes, the following disease categories each comprised at least 5% of the case records: diseases of the circulatory system (39.1%); trauma (10.2%); diseases of the digestive system (9.7%); pulmonary diseases (9.0%); infectious diseases (7.0%); and neoplasms (6.8%). CONCLUSIONS: MIMIC-II documents a diverse and very large population of intensive care unit patient stays and contains comprehensive and detailed clinical data, including physiological waveforms and minute-by-minute trends for a subset of records. It establishes a new public-access resource for critical care research, supporting a diverse range of analytic studies spanning epidemiology, clinical decision-rule development, and electronic tool development.
@article{
title = {Multiparameter Intelligent Monitoring in Intensive Care II: a public-access intensive care unit database.},
type = {article},
year = {2011},
identifiers = {[object Object]},
keywords = {Adult,Artificial Intelligence,Clinical,Computerized,Critical Care,Critical Care: statistics & numerical data,Databases,Decision Support Systems,Expert Systems,Factual,Female,Humans,Intensive Care,Intensive Care Units,Intensive Care Units: statistics & numerical data,Intensive Care: statistics & numerical data,Medical Informatics Applications,Medical Records Systems,Monitoring,Physiologic,Physiologic: instrumentation,Quality Control,Retrospective Studies,United States},
pages = {952-60},
volume = {39},
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abstract = {OBJECTIVE: We sought to develop an intensive care unit research database applying automated techniques to aggregate high-resolution diagnostic and therapeutic data from a large, diverse population of adult intensive care unit patients. This freely available database is intended to support epidemiologic research in critical care medicine and serve as a resource to evaluate new clinical decision support and monitoring algorithms. DESIGN: Data collection and retrospective analysis. SETTING: All adult intensive care units (medical intensive care unit, surgical intensive care unit, cardiac care unit, cardiac surgery recovery unit) at a tertiary care hospital. PATIENTS: Adult patients admitted to intensive care units between 2001 and 2007. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database consists of 25,328 intensive care unit stays. The investigators collected detailed information about intensive care unit patient stays, including laboratory data, therapeutic intervention profiles such as vasoactive medication drip rates and ventilator settings, nursing progress notes, discharge summaries, radiology reports, provider order entry data, International Classification of Diseases, 9th Revision codes, and, for a subset of patients, high-resolution vital sign trends and waveforms. Data were automatically deidentified to comply with Health Insurance Portability and Accountability Act standards and integrated with relational database software to create electronic intensive care unit records for each patient stay. The data were made freely available in February 2010 through the Internet along with a detailed user's guide and an assortment of data processing tools. The overall hospital mortality rate was 11.7%, which varied by critical care unit. The median intensive care unit length of stay was 2.2 days (interquartile range, 1.1-4.4 days). According to the primary International Classification of Diseases, 9th Revision codes, the following disease categories each comprised at least 5% of the case records: diseases of the circulatory system (39.1%); trauma (10.2%); diseases of the digestive system (9.7%); pulmonary diseases (9.0%); infectious diseases (7.0%); and neoplasms (6.8%). CONCLUSIONS: MIMIC-II documents a diverse and very large population of intensive care unit patient stays and contains comprehensive and detailed clinical data, including physiological waveforms and minute-by-minute trends for a subset of records. It establishes a new public-access resource for critical care research, supporting a diverse range of analytic studies spanning epidemiology, clinical decision-rule development, and electronic tool development.},
bibtype = {article},
author = {Saeed, Mohammed and Villarroel, Mauricio and Reisner, Andrew T and Clifford, Gari D and Lehman, Li-wei H and Moody, George B and Heldt, Thomas and Kyaw, Tin H and Moody, Benjamin and Mark, Roger G},
journal = {Critical care medicine},
number = {5}
}Syntactic and lexical context of pauses and hesitations in the discourse of Alzheimer patients and healthy elderly subjects. Gayraud, F., Lee, H., & Barkat-Defradas, M. Clinical Linguistics & Phonetics, 25(3):198–209, 2011.
doi abstract bibtex
doi abstract bibtex
Psycholinguistic studies dealing with Alzheimer's disease (AD) commonly consider verbal aspects of language. In this article, we investigated both verbal and non-verbal aspects of speech production in AD. We used pauses and hesitations as markers of planning difficulties and hypothesized that AD patients show different patterns in the process of discourse production. We compared the distribution, the duration and the frequency of speech dysfluencies in the spontaneous discourse of 20 AD patients with 20 age, gender and socio-economically matched healthy peers. We found that patients and controls differ along several lines: patients' discourse displays more frequent silent pauses, which occur more often outside syntactic boundaries and are followed by more frequent words. Overall patients show more lexical retrieval and planning difficulties, but where controls signal their planning difficulties using filled pauses, AD patients do not.
@article{gayraud_syntactic_2011,
Author = {Gayraud, Frédérique and Lee, Hyeran and Barkat-Defradas, Melissa},
Date = {2011},
Date-Modified = {2018-05-30 18:50:03 +0000},
Doi = {10.3109/02699206.2010.521612},
Journal = {Clinical Linguistics \& Phonetics},
Keywords = {age, Alzheimer, clinical, clinical phonetics, disfluencies, filled pauses, French, interspeaker variation, pause location, pauses, phonetics, prosody, silent pauses, temporal factors, phonetics},
Number = {3},
Pages = {198--209},
Title = {Syntactic and lexical context of pauses and hesitations in the discourse of Alzheimer patients and healthy elderly subjects},
Volume = {25},
Year = {2011},
Abstract = {Psycholinguistic studies dealing with Alzheimer's disease (AD) commonly consider verbal aspects of language. In this article, we investigated both verbal and non-verbal aspects of speech production in AD. We used pauses and hesitations as markers of planning difficulties and hypothesized that AD patients show different patterns in the process of discourse production. We compared the distribution, the duration and the frequency of speech dysfluencies in the spontaneous discourse of 20 AD patients with 20 age, gender and socio-economically matched healthy peers. We found that patients and controls differ along several lines: patients' discourse displays more frequent silent pauses, which occur more often outside syntactic boundaries and are followed by more frequent words. Overall patients show more lexical retrieval and planning difficulties, but where controls signal their planning difficulties using filled pauses, AD patients do not.},
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Bdsk-Url-1 = {http://dx.doi.org/10.3109/02699206.2010.521612}}A critical evaluation of clinical decision support for the detection of drug-drug interactions. Smithburger, P. L, Buckley, M. S, Bejian, S., Burenheide, K., & Kane-Gill, S. L Expert opinion on drug safety, 10(6):871–882, November, 2011.
doi abstract bibtex
doi abstract bibtex
INTRODUCTION: Incorporation of clinical decision support systems (CDSSs) into computerized physician order entry assists prescribers with medication dosing, identification of duplicate therapies, drug-allergy alerts and drug-drug interactions (DDIs). The generation of DDI alerts is one aspect of CDSS that may improve patient safety and reduce adverse drug events. AREAS COVERED: Currents issues with the generation of DDI alerts, such as alert fatigue, unclear clinical significance and database inconsistencies are a few of the problems that have been identified with DDI alerting. Research has shown that DDI alerting may be improved through the tiering of alerts, generation of patient-specific alert and directing some alerts to clinicians other than physicians. More research in this area, such as how to decrease the variability of database rating systems, improve the identification of clinically significant alerts and increase the patient specificity of the generated DDI alerts, should be conducted. EXPERT OPINION: DDI knowledgebases need to take into account more patient-specific information. Strategies to avoid alert fatigue, such as DDI tiering and reducing signal:noise ratios, are important areas for future study. End-user participation and clinician feedback should be incorporated in the development of DDI knowledgebases to increase alert compliance.
@article{smithburger_critical_2011,
title = {A critical evaluation of clinical decision support for the detection of drug-drug interactions},
volume = {10},
issn = {1744-764X},
doi = {10.1517/14740338.2011.583916},
abstract = {INTRODUCTION: Incorporation of clinical decision support systems (CDSSs) into computerized physician order entry assists prescribers with medication dosing, identification of duplicate therapies, drug-allergy alerts and drug-drug interactions (DDIs). The generation of DDI alerts is one aspect of CDSS that may improve patient safety and reduce adverse drug events.
AREAS COVERED: Currents issues with the generation of DDI alerts, such as alert fatigue, unclear clinical significance and database inconsistencies are a few of the problems that have been identified with DDI alerting. Research has shown that DDI alerting may be improved through the tiering of alerts, generation of patient-specific alert and directing some alerts to clinicians other than physicians. More research in this area, such as how to decrease the variability of database rating systems, improve the identification of clinically significant alerts and increase the patient specificity of the generated DDI alerts, should be conducted.
EXPERT OPINION: DDI knowledgebases need to take into account more patient-specific information. Strategies to avoid alert fatigue, such as DDI tiering and reducing signal:noise ratios, are important areas for future study. End-user participation and clinician feedback should be incorporated in the development of DDI knowledgebases to increase alert compliance.},
language = {eng},
number = {6},
journal = {Expert opinion on drug safety},
author = {Smithburger, Pamela L and Buckley, Mitchell S and Bejian, Sharon and Burenheide, Katie and Kane-Gill, Sandra L},
month = nov,
year = {2011},
pmid = {21542665},
keywords = {Decision Support Systems, Clinical, Drug Interactions, Humans, Medical Order Entry Systems, Medication Errors, Reminder Systems, Safety},
pages = {871--882}
}Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children: a cross-sectional and longitudinal study (Ballabeina). Burgi, F., Meyer, U., Granacher, U., Schindler, C., Marques-Vidal, P., Kriemler, S., & Puder, J J International Journal of Obesity, 35(7):937–944, 2011.
Paper doi abstract bibtex
Paper doi abstract bibtex Background: Objective: Design: Subjects: Measurements: Results: Conclusion:
@article{burgi_relationship_2011,
title = {Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children: a cross-sectional and longitudinal study ({Ballabeina})},
volume = {35},
copyright = {© 2011 Nature Publishing Group},
issn = {0307-0565},
shorttitle = {Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children},
url = {http://www.nature.com/ijo/journal/v35/n7/full/ijo201154a.html},
doi = {10.1038/ijo.2011.54},
abstract = {Background:
Objective:
Design:
Subjects:
Measurements:
Results:
Conclusion:},
language = {en},
number = {7},
urldate = {2012-06-25},
journal = {International Journal of Obesity},
author = {Burgi, F. and Meyer, U. and Granacher, U. and Schindler, C. and Marques-Vidal, P. and Kriemler, S. and Puder, J J},
year = {2011},
keywords = {Body Mass Index, Diet, IJO, WEIGHT gain, clinical, fat, metabolic disorders, metabolism, nutrition, obese, obesity, pediatric},
pages = {937--944},
}Cluster randomised trial in the General Practice Research Database: 1. Electronic decision support to reduce antibiotic prescribing in primary care (eCRT study). Gulliford, M. C., van Staa, T., McDermott, L., Dregan, A., McCann, G., Ashworth, M., Charlton, J., Grieve, A. P., Little, P., Moore, M. V., Yardley, L., & electronic Cluster Randomised Trial Research Team eCRT Research Team Trials, 12:115, 2011.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: The purpose of this research is to develop and evaluate methods for conducting cluster randomised trials in a primary care database that contains electronic patient records for large numbers of family practices. Cluster randomised trials are trials in which the units allocated represent groups of individuals, in this case family practices and their registered patients. Cluster randomised trials often suffer from the limitation that they include too few clusters, leading to problems of insufficient power and only imprecise estimation of the intraclass correlation coefficient, a key design parameter. This difficulty might be overcome by utilising databases that already hold electronic patient records for large numbers of practices. The protocol describes one application: a study of antibiotic prescribing for acute respiratory infection; a second protocol outlines an intervention in a less frequent chronic condition of public health importance, stroke. METHODS/DESIGN: The objective of the study is to implement a cluster randomised trial to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls. Family practices will be recruited from the practices that presently contribute data to the UK General Practice Research Database (GPRD). Following randomisation, electronic prompts will be installed remotely at intervention practices to promote adherence with evidence-based standards of medical practice. The intervention was developed through qualitative research at non-intervention practices. Data for outcome assessment will be obtained from anonymised electronic patient records that are routinely collected into GPRD. This protocol outlines the proposed study designs, data sources, sample size requirements, analysis methods and dissemination plans. Ethical issues are also discussed. DISCUSSION: Results from this study will provide methodological evidence concerning the use of electronic patient records and databases for implementing cluster randomised trials in primary care. The study will also provide substantive findings in respect of electronic record-based interventions to reduce antibiotic prescribing in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 47558792.
@article{gulliford_cluster_2011,
title = {Cluster randomised trial in the {General} {Practice} {Research} {Database}: 1. {Electronic} decision support to reduce antibiotic prescribing in primary care ({eCRT} study)},
volume = {12},
issn = {1745-6215},
shorttitle = {Cluster randomised trial in the {General} {Practice} {Research} {Database}},
doi = {10.1186/1745-6215-12-115},
abstract = {BACKGROUND: The purpose of this research is to develop and evaluate methods for conducting cluster randomised trials in a primary care database that contains electronic patient records for large numbers of family practices. Cluster randomised trials are trials in which the units allocated represent groups of individuals, in this case family practices and their registered patients. Cluster randomised trials often suffer from the limitation that they include too few clusters, leading to problems of insufficient power and only imprecise estimation of the intraclass correlation coefficient, a key design parameter. This difficulty might be overcome by utilising databases that already hold electronic patient records for large numbers of practices. The protocol describes one application: a study of antibiotic prescribing for acute respiratory infection; a second protocol outlines an intervention in a less frequent chronic condition of public health importance, stroke.
METHODS/DESIGN: The objective of the study is to implement a cluster randomised trial to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls. Family practices will be recruited from the practices that presently contribute data to the UK General Practice Research Database (GPRD). Following randomisation, electronic prompts will be installed remotely at intervention practices to promote adherence with evidence-based standards of medical practice. The intervention was developed through qualitative research at non-intervention practices. Data for outcome assessment will be obtained from anonymised electronic patient records that are routinely collected into GPRD. This protocol outlines the proposed study designs, data sources, sample size requirements, analysis methods and dissemination plans. Ethical issues are also discussed.
DISCUSSION: Results from this study will provide methodological evidence concerning the use of electronic patient records and databases for implementing cluster randomised trials in primary care. The study will also provide substantive findings in respect of electronic record-based interventions to reduce antibiotic prescribing in primary care.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN 47558792.},
language = {eng},
journal = {Trials},
author = {Gulliford, Martin C. and van Staa, Tjeerd and McDermott, Lisa and Dregan, Alex and McCann, Gerard and Ashworth, Mark and Charlton, Judith and Grieve, Andrew P. and Little, Paul and Moore, Michael V. and Yardley, Lucy and {electronic Cluster Randomised Trial Research Team eCRT Research Team}},
year = {2011},
pmid = {21569237},
pmcid = {PMC3101122},
keywords = {Acute Disease, Adolescent, Adult, Anti-Bacterial Agents, Cluster Analysis, Decision Support Systems, Clinical, Evidence-Based Medicine, General Practice, Great Britain, Guideline Adherence, Health Records, Personal, Humans, Middle Aged, Physician's Practice Patterns, Practice Guidelines as Topic, Primary Health Care, Referral and Consultation, Reminder Systems, Research Design, Respiration Disorders, Young Adult, databases as topic},
pages = {115}
}Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment. Rasinski, A, K., Yoon, D, J., Kalad, G, Y., Curlin, & A, F. Journal of medical ethics, 37(12):711--714, December, 2011.
doi abstract bibtex
doi abstract bibtex
BACKGROUND AND OBJECTIVES: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. DESIGN: A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee--whether the doctor referred and whether the doctor disclosed their objection to the abortion. PARTICIPANTS AND SETTING: 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. MEASUREMENT: Physicians indicated their approval for the vignette doctor's decision. MAIN RESULTS: Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. CONCLUSION: OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.
@article{ rasinski_obstetrician-gynaecologists_2011,
title = {Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment},
volume = {37},
issn = {1473-4257},
shorttitle = {Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion},
doi = {10.1136/jme.2010.040782},
abstract = {{BACKGROUND} {AND} {OBJECTIVES}: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists ({ACOG}) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' ({OB}/{GYN}) support for the recommendations.
{DESIGN}: A national survey of {OB}/{GYN} physicians contained a vignette experiment in which an {OB}/{GYN} doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the {ACOG} ethics committee--whether the doctor referred and whether the doctor disclosed their objection to the abortion.
{PARTICIPANTS} {AND} {SETTING}: 1800 {OB}/{GYN} randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.
{MEASUREMENT}: Physicians indicated their approval for the vignette doctor's decision.
{MAIN} {RESULTS}: Overall, 43% of {OB}/{GYN} physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.
{CONCLUSION}: {OB}/{GYN} physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with {ACOG} recommendations and with some models of the doctor-patient relationship.},
language = {eng},
number = {12},
journal = {Journal of medical ethics},
author = {Rasinski, Kenneth A and Yoon, John D and Kalad, Youssef G and Curlin, Farr A},
month = {December},
year = {2011},
pmid = {21670319},
keywords = {Abortion Applicants, Adult, Aged, Attitude of Health Personnel, Ethics, Clinical, Ethics, Medical, Female, Gynecology, Humans, Male, Middle Aged, Obstetrics, Physicians, Pregnancy, Questionnaires, Referral and Consultation, Refusal to Treat, Research Design},
pages = {711--714}
}Computerized detection of adverse drug reactions in the medical intensive care unit. Kane-Gill, S. L., Visweswaran, S., Saul, M. I., Wong, A. I., Penrod, L. E., & Handler, S. M. International Journal of Medical Informatics, 80(8):570–578, August, 2011.
Paper doi abstract bibtex
Paper doi abstract bibtex Objective Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit. Method This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration. Alerts were assessed using 3 objective published adverse drug reaction determination instruments. An event was considered an adverse drug reaction when 2 out of 3 instruments had agreement of possible, probable or definite. Positive predictive values were calculated as the proportion of alerts that occurred, divided by the number of times that alerts occurred and adverse drug reactions were confirmed. Results 145 patients were eligible for evaluation. For the 48 patients (50% male) having an alert, the mean±SD age was 62±19 years. A total of 253 alerts were generated. Positive predictive values were 1.0, 0.55, 0.38 and 0.33 for vancomycin, glucose, sodium, and blood urea nitrogen, respectively. A quinidine alert was not generated during the evaluation. Conclusions Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information.
@article{kane-gill_computerized_2011,
series = {Special {Issue}: {Supporting} {Collaboration} in {Healthcare} {Settings}: {The} {Role} of {Informatics}},
title = {Computerized detection of adverse drug reactions in the medical intensive care unit},
volume = {80},
issn = {1386-5056},
url = {http://www.sciencedirect.com/science/article/pii/S1386505611001079},
doi = {10.1016/j.ijmedinf.2011.04.005},
abstract = {Objective
Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit.
Method
This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration. Alerts were assessed using 3 objective published adverse drug reaction determination instruments. An event was considered an adverse drug reaction when 2 out of 3 instruments had agreement of possible, probable or definite. Positive predictive values were calculated as the proportion of alerts that occurred, divided by the number of times that alerts occurred and adverse drug reactions were confirmed.
Results
145 patients were eligible for evaluation. For the 48 patients (50\% male) having an alert, the mean±SD age was 62±19 years. A total of 253 alerts were generated. Positive predictive values were 1.0, 0.55, 0.38 and 0.33 for vancomycin, glucose, sodium, and blood urea nitrogen, respectively. A quinidine alert was not generated during the evaluation.
Conclusions
Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information.},
number = {8},
urldate = {2018-03-19TZ},
journal = {International Journal of Medical Informatics},
author = {Kane-Gill, Sandra L. and Visweswaran, Shyam and Saul, Melissa I. and Wong, An-Kwok Ian and Penrod, Louis E. and Handler, Steven M.},
month = aug,
year = {2011},
keywords = {Adverse drug event, Adverse drug reaction reporting systems, Clinical, Critical care, Decision support systems, Drug toxicity, Information systems, Intensive care units, Safety},
pages = {570--578}
}Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. Berry, D. L., Blumenstein, B. A., Halpenny, B., Wolpin, S., Fann, J. R., Austin-Seymour, M., Bush, N., Karras, B. T., Lober, W. B., & McCorkle, R. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 29(8):1029–1035, March, 2011.
doi abstract bibtex
doi abstract bibtex
PURPOSE: Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. PATIENTS AND METHODS: This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. RESULTS: The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. CONCLUSION: The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.
@article{berry_enhancing_2011,
title = {Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial},
volume = {29},
issn = {1527-7755},
shorttitle = {Enhancing patient-provider communication with the electronic self-report assessment for cancer},
doi = {10.1200/JCO.2010.30.3909},
abstract = {PURPOSE: Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.
PATIENTS AND METHODS: This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.
RESULTS: The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.
CONCLUSION: The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.},
language = {eng},
number = {8},
journal = {Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology},
author = {Berry, Donna L. and Blumenstein, Brent A. and Halpenny, Barbara and Wolpin, Seth and Fann, Jesse R. and Austin-Seymour, Mary and Bush, Nigel and Karras, Bryant T. and Lober, William B. and McCorkle, Ruth},
month = mar,
year = {2011},
pmid = {21282548},
pmcid = {PMC3068053},
keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Computer Graphics, Decision Support Systems, Clinical, Electronic Mail, Female, Humans, Logistic Models, Male, Middle Aged, Neoplasms, Odds Ratio, Physician-Patient Relations, Prospective Studies, Quality of Life, Self Report, United States, Young Adult},
pages = {1029--1035},
}Evaluation of drug interactions and dosing in 484 neurological inpatients using clinical decision support software and an extended operational interaction classification system (Zurich Interaction System). Guzek, M., Zorina, O. I, Semmler, A., Gonzenbach, R. R, Huber, M., Kullak-Ublick, G. A, Weller, M., & Russmann, S. Pharmacoepidemiology and drug safety, 20(9):930–938, September, 2011.
doi abstract bibtex
doi abstract bibtex
PURPOSE: The current study aimed at identifying and quantifying critical drug interactions in neurological inpatients using clinical decision support software (CDSS). Reclassification of interactions with a focus on clinical management aimed to support the development of CDSS with higher efficacy to reduce overalerting and improve medication safety in clinical practice. METHODS: We conducted a cross-sectional study in consecutive patients admitted to the neurology ward of a tertiary care hospital. We developed a customized interface for mass analysis with the CDSS MediQ, which we used for automated retrospective identification of drug interactions during the first day of hospitalization. Interactions were reclassified according to the Zurich Interaction System (ZHIAS), which incorporates the Operational Classification of Drug Interactions (ORCA). Dose adjustments for renal impairment were also evaluated. RESULTS: In 484 patients with 2812 prescriptions, MediQ generated 8 "high danger," 518 "average danger," and 1233 "low danger" interaction alerts. According to ZHIAS, 6 alerts involved contraindicated and 33 alerts involved provisionally contraindicated combinations, and 327 alerts involved a conditional and 1393 alerts involved a minimal risk of adverse outcomes. Thirty-five patients (6.2%) had at least one combination that was at least provisionally contraindicated. ZHIAS also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 13 prescriptions without recommended dose adjustment for impaired renal function. CONCLUSIONS: MediQ detected a large number of drug interactions with variable clinical relevance in neurological inpatients. ZHIAS supports the selection of those interactions that require active management, and the effects of its implementation into CDSS on medication safety should be evaluated in future prospective studies.
@article{guzek_evaluation_2011,
title = {Evaluation of drug interactions and dosing in 484 neurological inpatients using clinical decision support software and an extended operational interaction classification system ({Zurich} {Interaction} {System})},
volume = {20},
issn = {1099-1557},
doi = {10.1002/pds.2197},
abstract = {PURPOSE: The current study aimed at identifying and quantifying critical drug interactions in neurological inpatients using clinical decision support software (CDSS). Reclassification of interactions with a focus on clinical management aimed to support the development of CDSS with higher efficacy to reduce overalerting and improve medication safety in clinical practice.
METHODS: We conducted a cross-sectional study in consecutive patients admitted to the neurology ward of a tertiary care hospital. We developed a customized interface for mass analysis with the CDSS MediQ, which we used for automated retrospective identification of drug interactions during the first day of hospitalization. Interactions were reclassified according to the Zurich Interaction System (ZHIAS), which incorporates the Operational Classification of Drug Interactions (ORCA). Dose adjustments for renal impairment were also evaluated.
RESULTS: In 484 patients with 2812 prescriptions, MediQ generated 8 "high danger," 518 "average danger," and 1233 "low danger" interaction alerts. According to ZHIAS, 6 alerts involved contraindicated and 33 alerts involved provisionally contraindicated combinations, and 327 alerts involved a conditional and 1393 alerts involved a minimal risk of adverse outcomes. Thirty-five patients (6.2\%) had at least one combination that was at least provisionally contraindicated. ZHIAS also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 13 prescriptions without recommended dose adjustment for impaired renal function.
CONCLUSIONS: MediQ detected a large number of drug interactions with variable clinical relevance in neurological inpatients. ZHIAS supports the selection of those interactions that require active management, and the effects of its implementation into CDSS on medication safety should be evaluated in future prospective studies.},
language = {eng},
number = {9},
journal = {Pharmacoepidemiology and drug safety},
author = {Guzek, Markus and Zorina, Olesya I and Semmler, Alexander and Gonzenbach, Roman R and Huber, Martin and Kullak-Ublick, Gerd A and Weller, Michael and Russmann, Stefan},
month = sep,
year = {2011},
pmid = {21774031},
keywords = {Central Nervous System Diseases, Cross-Sectional Studies, Decision Support Systems, Clinical, Drug Interactions, Humans, Inpatients, Retrospective Studies, Risk Factors, Software},
pages = {930--938}
}Development of a context model to prioritize drug safety alerts in CPOE systems. Riedmann, D., Jung, M., Hackl, W. O, Stühlinger, W., van der Sijs, H., & Ammenwerth, E. BMC medical informatics and decision making, 11:35, 2011.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Computerized physician order entry systems (CPOE) can reduce the number of medication errors and adverse drug events (ADEs) in healthcare institutions. Unfortunately, they tend to produce a large number of partly irrelevant alerts, in turn leading to alert overload and causing alert fatigue. The objective of this work is to identify factors that can be used to prioritize and present alerts depending on the 'context' of a clinical situation. METHODS: We used a combination of literature searches and expert interviews to identify and validate the possible context factors. The internal validation of the context factors was performed by calculating the inter-rater agreement of two researcher's classification of 33 relevant articles. RESULTS: We developed a context model containing 20 factors. We grouped these context factors into three categories: characteristics of the patient or case (e.g. clinical status of the patient); characteristics of the organizational unit or user (e.g. professional experience of the user); and alert characteristics (e.g. severity of the effect). The internal validation resulted in nearly perfect agreement (Cohen's Kappa value of 0.97). CONCLUSION: To our knowledge, this is the first structured attempt to develop a comprehensive context model for prioritizing drug safety alerts in CPOE systems. The outcome of this work can be used to develop future tailored drug safety alerting in CPOE systems.
@article{riedmann_development_2011,
title = {Development of a context model to prioritize drug safety alerts in {CPOE} systems},
volume = {11},
issn = {1472-6947},
doi = {10.1186/1472-6947-11-35},
abstract = {BACKGROUND: Computerized physician order entry systems (CPOE) can reduce the number of medication errors and adverse drug events (ADEs) in healthcare institutions. Unfortunately, they tend to produce a large number of partly irrelevant alerts, in turn leading to alert overload and causing alert fatigue. The objective of this work is to identify factors that can be used to prioritize and present alerts depending on the 'context' of a clinical situation.
METHODS: We used a combination of literature searches and expert interviews to identify and validate the possible context factors. The internal validation of the context factors was performed by calculating the inter-rater agreement of two researcher's classification of 33 relevant articles.
RESULTS: We developed a context model containing 20 factors. We grouped these context factors into three categories: characteristics of the patient or case (e.g. clinical status of the patient); characteristics of the organizational unit or user (e.g. professional experience of the user); and alert characteristics (e.g. severity of the effect). The internal validation resulted in nearly perfect agreement (Cohen's Kappa value of 0.97).
CONCLUSION: To our knowledge, this is the first structured attempt to develop a comprehensive context model for prioritizing drug safety alerts in CPOE systems. The outcome of this work can be used to develop future tailored drug safety alerting in CPOE systems.},
language = {eng},
journal = {BMC medical informatics and decision making},
author = {Riedmann, Daniel and Jung, Martin and Hackl, Werner O and Stühlinger, Wolf and van der Sijs, Heleen and Ammenwerth, Elske},
year = {2011},
pmid = {21612623},
pmcid = {PMC3127742},
keywords = {Decision Support Systems, Clinical, Drug Therapy, Computer-Assisted, Humans, Medical Order Entry Systems, Medication Errors, Reminder Systems},
pages = {35}
}Data mining to generate adverse drug events detection rules. Chazard, E., Ficheur, G., Bernonville, S., Luyckx, M., & Beuscart, R. IEEE transactions on information technology in biomedicine: a publication of the IEEE Engineering in Medicine and Biology Society, 15(6):823–830, November, 2011.
Paper doi abstract bibtex
Paper doi abstract bibtex Adverse drug events (ADEs) are a public health issue. Their detection usually relies on voluntary reporting or medical chart reviews. The objective of this paper is to automatically detect cases of ADEs by data mining. 115,447 complete past hospital stays are extracted from six French, Danish, and Bulgarian hospitals using a common data model including diagnoses, drug administrations, laboratory results, and free-text records. Different kinds of outcomes are traced, and supervised rule induction methods (decision trees and association rules) are used to discover ADE detection rules, with respect to time constraints. The rules are then filtered, validated, and reorganized by a committee of experts. The rules are described in a rule repository, and several statistics are automatically computed in every medical department, such as the confidence, relative risk, and median delay of outcome appearance. 236 validated ADE-detection rules are discovered; they enable to detect 27 different kinds of outcomes. The rules use a various number of conditions related to laboratory results, diseases, drug administration, and demographics. Some rules involve innovative conditions, such as drug discontinuations.
@article{chazard_data_2011,
title = {Data mining to generate adverse drug events detection rules},
volume = {15},
copyright = {All rights reserved},
issn = {1558-0032},
url = {http://www.chazard.org/emmanuel/pdf_articles/paper_2011_ieeetitb_dataminingadedetectionrules.pdf},
doi = {10.1109/TITB.2011.2165727},
abstract = {Adverse drug events (ADEs) are a public health issue. Their detection usually relies on voluntary reporting or medical chart reviews. The objective of this paper is to automatically detect cases of ADEs by data mining. 115,447 complete past hospital stays are extracted from six French, Danish, and Bulgarian hospitals using a common data model including diagnoses, drug administrations, laboratory results, and free-text records. Different kinds of outcomes are traced, and supervised rule induction methods (decision trees and association rules) are used to discover ADE detection rules, with respect to time constraints. The rules are then filtered, validated, and reorganized by a committee of experts. The rules are described in a rule repository, and several statistics are automatically computed in every medical department, such as the confidence, relative risk, and median delay of outcome appearance. 236 validated ADE-detection rules are discovered; they enable to detect 27 different kinds of outcomes. The rules use a various number of conditions related to laboratory results, diseases, drug administration, and demographics. Some rules involve innovative conditions, such as drug discontinuations.},
language = {eng},
number = {6},
journal = {IEEE transactions on information technology in biomedicine: a publication of the IEEE Engineering in Medicine and Biology Society},
author = {Chazard, Emmanuel and Ficheur, Grégoire and Bernonville, Stéphanie and Luyckx, Michel and Beuscart, Régis},
month = nov,
year = {2011},
pmid = {21859604},
keywords = {Adverse Drug Reaction Reporting Systems, Adverse drug events (ADEs), Data Mining, Decision Support Systems, Clinical, Decision Trees, Drug Toxicity, Electronic Health Records, Humans, Medical diagnostic imaging, Medical information systems, Medical services, Patient Safety, Patient monitoring, Pharmaceutical Preparations, Software, adverse drug events detection rules, automatically detect cases, data model, data models, demographics, drug administrations, drug discontinuations, drugs, free-text recording, median delay, medical computing, patient diagnosis, public health, relative risk, rule repository, statistical analysis, supervised rule methods},
pages = {823--830},
}Real-time automated paging and decision support for critical laboratory abnormalities. Etchells, E., Adhikari, N. K J, Wu, R., Cheung, M., Quan, S., Mraz, R., Wong, B., Pinto, R., Mehta, R., Morra, D., Fowler, R., Sibbald, W., Abrams, H., & Rossos, P. G BMJ quality & safety, 20(11):924–930, November, 2011.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: For patients with critical laboratory abnormalities, timely clinical alerts with decision support could improve management and reduce adverse events. METHODS: The authors developed a real-time clinical alerting system for critical laboratory abnormalities. The system sent alerts to physicians as text messages to a smartphone or alphanumeric pager. Decision support was available via smartphone or hospital intranet. The authors evaluated the system in a prospective controlled stepped-wedge study with blinded outcome assessment in general internal medicine units at two academic hospitals. The outcomes were the proportion of potential clinical actions that were actually completed in response to the alert, and adverse events (worsening of condition or complications related to treatment of the condition). RESULTS: The authors evaluated 498 laboratory conditions on 271 patients. Overall, only 50% of potential clinical actions were carried out, and there were adverse clinical events within 48 h for 36% of the laboratory conditions. The median (IQR) proportion of potential clinical actions that were actually completed was 50% (33-75%) with alerting system on and 50% (33-100%) with alerting system off (p=0.94, Wilcoxon rank sum test). When the alerting system was on (n=164 alerts) there were 67 adverse events within 48 h of the alerts (42%). When the alerting system was off (n=334 alerts), there were 112 adverse events within 48 h (33%; difference: 9% higher with alerting system on, p=0.06). CONCLUSIONS: The provision of real-time clinical alerts and decision support for critical laboratory abnormalities did not improve clinical management or decrease adverse events.
@article{etchells_real-time_2011,
title = {Real-time automated paging and decision support for critical laboratory abnormalities},
volume = {20},
issn = {2044-5423},
doi = {10.1136/bmjqs.2010.051110},
abstract = {BACKGROUND: For patients with critical laboratory abnormalities, timely clinical alerts with decision support could improve management and reduce adverse events.
METHODS: The authors developed a real-time clinical alerting system for critical laboratory abnormalities. The system sent alerts to physicians as text messages to a smartphone or alphanumeric pager. Decision support was available via smartphone or hospital intranet. The authors evaluated the system in a prospective controlled stepped-wedge study with blinded outcome assessment in general internal medicine units at two academic hospitals. The outcomes were the proportion of potential clinical actions that were actually completed in response to the alert, and adverse events (worsening of condition or complications related to treatment of the condition).
RESULTS: The authors evaluated 498 laboratory conditions on 271 patients. Overall, only 50\% of potential clinical actions were carried out, and there were adverse clinical events within 48 h for 36\% of the laboratory conditions. The median (IQR) proportion of potential clinical actions that were actually completed was 50\% (33-75\%) with alerting system on and 50\% (33-100\%) with alerting system off (p=0.94, Wilcoxon rank sum test). When the alerting system was on (n=164 alerts) there were 67 adverse events within 48 h of the alerts (42\%). When the alerting system was off (n=334 alerts), there were 112 adverse events within 48 h (33\%; difference: 9\% higher with alerting system on, p=0.06).
CONCLUSIONS: The provision of real-time clinical alerts and decision support for critical laboratory abnormalities did not improve clinical management or decrease adverse events.},
language = {eng},
number = {11},
journal = {BMJ quality \& safety},
author = {Etchells, Edward and Adhikari, Neill K J and Wu, Robert and Cheung, Mark and Quan, Sherman and Mraz, Richard and Wong, Brian and Pinto, Ruxandra and Mehta, Rajin and Morra, Dante and Fowler, Robert and Sibbald, William and Abrams, Howard and Rossos, Peter G},
month = nov,
year = {2011},
pmid = {21725046},
keywords = {Aged, Aged, 80 and over, Automation, Clinical Laboratory Information Systems, Communication, Decision Support Systems, Clinical, Diagnosis, Computer-Assisted, Female, Humans, Male, Middle Aged, Prospective Studies},
pages = {924--930}
}Human Voice Recognition Depends on Language Ability. Perrachione, T., K., Del Tufo, S., N., & Gabrieli, J., D., E. Science, 333(6042):595-595, 7, 2011.
Website abstract bibtex
Website abstract bibtex The ability to recognize people by their voice is an important social behavior. Individuals differ in how they pronounce words, and listeners may take advantage of language-specific knowledge of speech phonology to facilitate recognizing voices. Impaired phonological processing is characteristic of dyslexia and thought to be a basis for difficulty in learning to read. We tested voice-recognition abilities of dyslexic and control listeners for voices speaking listeners’ native language or an unfamiliar language. Individuals with dyslexia exhibited impaired voice-recognition abilities compared with controls only for voices speaking their native language. These results demonstrate the importance of linguistic representations for voice recognition. Humans appear to identify voices by making comparisons between talkers’ pronunciations of words and listeners’ stored abstract representations of the sounds in those words.
@article{
title = {Human Voice Recognition Depends on Language Ability},
type = {article},
year = {2011},
identifiers = {[object Object]},
pages = {595-595},
volume = {333},
websites = {http://www.sciencemag.org/content/333/6042/595.abstract},
month = {7},
day = {28},
id = {c34da379-541e-3931-9160-19f51b1bd965},
created = {2011-08-01T08:41:11.000Z},
accessed = {2011-07-29},
file_attached = {false},
profile_id = {50edede7-0a24-356e-8f8a-d03397fa3277},
group_id = {a84e3e74-b76a-3098-bae1-c8a78c436569},
last_modified = {2017-03-14T14:02:54.442Z},
read = {false},
starred = {false},
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confirmed = {true},
hidden = {false},
citation_key = {Perrachione2011},
private_publication = {false},
abstract = {The ability to recognize people by their voice is an important social behavior. Individuals differ in how they pronounce words, and listeners may take advantage of language-specific knowledge of speech phonology to facilitate recognizing voices. Impaired phonological processing is characteristic of dyslexia and thought to be a basis for difficulty in learning to read. We tested voice-recognition abilities of dyslexic and control listeners for voices speaking listeners’ native language or an unfamiliar language. Individuals with dyslexia exhibited impaired voice-recognition abilities compared with controls only for voices speaking their native language. These results demonstrate the importance of linguistic representations for voice recognition. Humans appear to identify voices by making comparisons between talkers’ pronunciations of words and listeners’ stored abstract representations of the sounds in those words.},
bibtype = {article},
author = {Perrachione, T. K. and Del Tufo, S. N. and Gabrieli, J. D. E.},
journal = {Science},
number = {6042}
}2010 (8)
Correlates of changes in BMI of children from the Azores islands. Martins, D., Maia, J., Seabra, A., Garganta, R., Lopes, V., Katzmarzyk, P., & Beunen, G. International Journal of Obesity, 34(10):1487–1493, 2010.
Paper doi abstract bibtex
Paper doi abstract bibtex Objective: To model changes in body mass index (BMI), including its stability, and to investigate the association between physical activity, 1-mile run/walk and levels of gross motor coordination and BMI during 5 consecutive years. Design: A longitudinal study of children 6 years of age at baseline followed at annual intervals over 5 years. Subjects: A total of 285 children (143 boys and 142 girls) were enrolled in grade 1 (age 6 years) and followed through grade 5 (age 10 years). Measurements: BMI was recorded and physical activity was assessed by questionnaire, aerobic fitness was evaluated with the 1-mile run/walk and gross motor coordination was measured with the KTK test battery (Körperkoordination test für Kinder). Multilevel modelling techniques were for the primary analysis. Results: Changes in BMI showed similar curvilinear trends in boys and girls, with ample inter-individual crossing trajectories that is, low tracking. Longitudinal changes in physical activity (PA) and aerobic fitness were not significantly associated with BMI-changes during the 5 years. Children who were more proficient in their motor coordination showed lower values of BMI during the 5 years. Conclusions: BMI trajectories of both boys and girls show low tracking of BMI-values. Considerable inter-individual variation exists both in baseline BMI-values and changes (velocity and acceleration) over time. PA and fitness were not associated with BMI-changes, but gross motor function was negatively associated with BMI-changes. No gender-specific associations were found. If confirmed in other populations these observations could be translated in the promotion of physical activities that improve gross motor function in children aged 6–10 years. This seems to be of major importance for the physical education curriculum of primary school children.
@article{martins_correlates_2010,
title = {Correlates of changes in {BMI} of children from the {Azores} islands},
volume = {34},
copyright = {© 2010 Nature Publishing Group},
issn = {0307-0565},
url = {http://www.nature.com/ijo/journal/v34/n10/abs/ijo201056a.html},
doi = {10.1038/ijo.2010.56},
abstract = {Objective: To model changes in body mass index (BMI), including its stability, and to investigate the association between physical activity, 1-mile run/walk and levels of gross motor coordination and BMI during 5 consecutive years.
Design: A longitudinal study of children 6 years of age at baseline followed at annual intervals over 5 years.
Subjects: A total of 285 children (143 boys and 142 girls) were enrolled in grade 1 (age 6 years) and followed through grade 5 (age 10 years).
Measurements: BMI was recorded and physical activity was assessed by questionnaire, aerobic fitness was evaluated with the 1-mile run/walk and gross motor coordination was measured with the KTK test battery (Körperkoordination test für Kinder). Multilevel modelling techniques were for the primary analysis.
Results: Changes in BMI showed similar curvilinear trends in boys and girls, with ample inter-individual crossing trajectories that is, low tracking. Longitudinal changes in physical activity (PA) and aerobic fitness were not significantly associated with BMI-changes during the 5 years. Children who were more proficient in their motor coordination showed lower values of BMI during the 5 years.
Conclusions: BMI trajectories of both boys and girls show low tracking of BMI-values. Considerable inter-individual variation exists both in baseline BMI-values and changes (velocity and acceleration) over time. PA and fitness were not associated with BMI-changes, but gross motor function was negatively associated with BMI-changes. No gender-specific associations were found. If confirmed in other populations these observations could be translated in the promotion of physical activities that improve gross motor function in children aged 6–10 years. This seems to be of major importance for the physical education curriculum of primary school children.},
language = {en},
number = {10},
urldate = {2012-06-26},
journal = {International Journal of Obesity},
author = {Martins, D. and Maia, J. and Seabra, A. and Garganta, R. and Lopes, V. and Katzmarzyk, P. and Beunen, G.},
year = {2010},
keywords = {Body Mass Index, Diet, IJO, WEIGHT gain, clinical, fat, metabolic disorders, metabolism, nutrition, obese, obesity, pediatric},
pages = {1487--1493},
}General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study. Hor, C. P., O'Donnell, J. M, Murphy, A. W, O'Brien, T., & Kropmans, T. J B BMC medical informatics and decision making, 10:2, 2010.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Electronic clinical decision support (CDS) is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland. METHODS: This cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected. RESULTS: The overall response rate was 37%. Nearly 92% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71%) and reducing prescribing errors (84%). Despite a high degree of unfamiliarity (73%), the practitioners were open to the use of CDS-eP (94%) and willing to invest greater resources for its implementation (62%). Lack of a strategic implementation plan (78%) is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i) lack of financial incentives (70%), ii) lack of standardized product software (61%), iii) high sensitivity of drug-drug interaction or medication allergy markers (46%), iv) concern about overriding physicians' prescribing decisions(44%) and v) lack of convincing evidence on the systems' effectiveness (22%). CONCLUSIONS: Despite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine clinical use in the West of Ireland.
@article{hor_general_2010,
title = {General practitioners' attitudes and preparedness towards {Clinical} {Decision} {Support} in e-{Prescribing} ({CDS}-{eP}) adoption in the {West} of {Ireland}: a cross sectional study},
volume = {10},
issn = {1472-6947},
shorttitle = {General practitioners' attitudes and preparedness towards {Clinical} {Decision} {Support} in e-{Prescribing} ({CDS}-{eP}) adoption in the {West} of {Ireland}},
doi = {10.1186/1472-6947-10-2},
abstract = {BACKGROUND: Electronic clinical decision support (CDS) is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland.
METHODS: This cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected.
RESULTS: The overall response rate was 37\%. Nearly 92\% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71\%) and reducing prescribing errors (84\%). Despite a high degree of unfamiliarity (73\%), the practitioners were open to the use of CDS-eP (94\%) and willing to invest greater resources for its implementation (62\%). Lack of a strategic implementation plan (78\%) is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i) lack of financial incentives (70\%), ii) lack of standardized product software (61\%), iii) high sensitivity of drug-drug interaction or medication allergy markers (46\%), iv) concern about overriding physicians' prescribing decisions(44\%) and v) lack of convincing evidence on the systems' effectiveness (22\%).
CONCLUSIONS: Despite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine clinical use in the West of Ireland.},
language = {eng},
journal = {BMC medical informatics and decision making},
author = {Hor, Chee Peng and O'Donnell, James M and Murphy, Andrew W and O'Brien, Timothy and Kropmans, Thomas J B},
year = {2010},
pmid = {20067624},
pmcid = {PMC2824732},
keywords = {Attitude of Health Personnel, Cross-Sectional Studies, Decision Support Systems, Clinical, Diffusion of Innovation, Electronic Health Records, Electronic prescribing, Health Plan Implementation, Humans, Ireland, Physicians, Family, Quality Assurance, Health Care, Questionnaires},
pages = {2}
}A review on systematic reviews of health information system studies. Lau, F., Kuziemsky, C., Price, M., & Gardner, J. Journal of the American Medical Informatics Association: JAMIA, 17(6):637–645, December, 2010.
doi abstract bibtex
doi abstract bibtex
The purpose of this review is to consolidate existing evidence from published systematic reviews on health information system (HIS) evaluation studies to inform HIS practice and research. Fifty reviews published during 1994-2008 were selected for meta-level synthesis. These reviews covered five areas: medication management, preventive care, health conditions, data quality, and care process/outcome. After reconciliation for duplicates, 1276 HIS studies were arrived at as the non-overlapping corpus. On the basis of a subset of 287 controlled HIS studies, there is some evidence for improved quality of care, but in varying degrees across topic areas. For instance, 31/43 (72%) controlled HIS studies had positive results using preventive care reminders, mostly through guideline adherence such as immunization and health screening. Key factors that influence HIS success included having in-house systems, developers as users, integrated decision support and benchmark practices, and addressing such contextual issues as provider knowledge and perception, incentives, and legislation/policy.
@article{lau_review_2010,
title = {A review on systematic reviews of health information system studies},
volume = {17},
issn = {1527-974X},
doi = {10.1136/jamia.2010.004838},
abstract = {The purpose of this review is to consolidate existing evidence from published systematic reviews on health information system (HIS) evaluation studies to inform HIS practice and research. Fifty reviews published during 1994-2008 were selected for meta-level synthesis. These reviews covered five areas: medication management, preventive care, health conditions, data quality, and care process/outcome. After reconciliation for duplicates, 1276 HIS studies were arrived at as the non-overlapping corpus. On the basis of a subset of 287 controlled HIS studies, there is some evidence for improved quality of care, but in varying degrees across topic areas. For instance, 31/43 (72\%) controlled HIS studies had positive results using preventive care reminders, mostly through guideline adherence such as immunization and health screening. Key factors that influence HIS success included having in-house systems, developers as users, integrated decision support and benchmark practices, and addressing such contextual issues as provider knowledge and perception, incentives, and legislation/policy.},
language = {eng},
number = {6},
journal = {Journal of the American Medical Informatics Association: JAMIA},
author = {Lau, Francis and Kuziemsky, Craig and Price, Morgan and Gardner, Jesse},
month = dec,
year = {2010},
pmid = {20962125},
pmcid = {PMC3000756},
keywords = {Decision Support Systems, Clinical, Electronic Health Records, Hospital Information Systems, Humans, Information Systems, Review Literature as Topic},
pages = {637--645}
}Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial. Strom, B. L, Schinnar, R., Aberra, F., Bilker, W., Hennessy, S., Leonard, C. E, & Pifer, E. Archives of internal medicine, 170(17):1578–1583, September, 2010.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. METHODS: To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007. RESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients. CONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00870298.
@article{strom_unintended_2010,
title = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial},
volume = {170},
issn = {1538-3679},
shorttitle = {Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction},
doi = {10.1001/archinternmed.2010.324},
abstract = {BACKGROUND: The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts.
METHODS: To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007.
RESULTS: The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2\% (111 of 194 hard stop alerts) in the intervention group and 13.5\% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95\% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients.
CONCLUSIONS: An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00870298.},
language = {eng},
number = {17},
journal = {Archives of internal medicine},
author = {Strom, Brian L and Schinnar, Rita and Aberra, Faten and Bilker, Warren and Hennessy, Sean and Leonard, Charles E and Pifer, Eric},
month = sep,
year = {2010},
pmid = {20876410},
keywords = {Anti-Infective Agents, Anticoagulants, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Drug Interactions, Drug Prescriptions, Drug Therapy, Computer-Assisted, Electronic prescribing, Hemorrhage, Humans, Medical Order Entry Systems, Medication Errors, Medication Systems, Hospital, Odds Ratio, Philadelphia, Reminder Systems, Time Factors, Trimethoprim-Sulfamethoxazole Combination, Warfarin},
pages = {1578--1583}
}Grading the severity of drug-drug interactions in the intensive care unit: a comparison between clinician assessment and proprietary database severity rankings. Smithburger, P. L, Kane-Gill, S. L, Benedict, N. J, Falcione, B. A, & Seybert, A. L The Annals of pharmacotherapy, 44(11):1718–1724, November, 2010.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: Computerized provider order entry with decision support software offers an opportunity to identify and prevent medication-related errors, including drug-drug interactions (DDIs), through alerting mechanisms. However, the number of alerts generated can overwhelm and lead to "alert fatigue." A DDI alert system based on severity rankings has been shown to reduce alert fatigue; however, the best method to populate this type of database is unclear. OBJECTIVE: To compare the severity ranking of proprietary databases to clinician assessment for DDIs occurring in critically ill patients. METHODS: This observational, prospective study was conducted over 8 weeks in the cardiac and cardiothoracic intensive care unit. Medication profiles of patients were screened for the presence of DDIs and a severity evaluation was conducted using rankings of proprietary databases and clinician opinion using a DDI severity assessment tool. The primary outcome measure was the number of DDIs considered severe by both evaluation methods. RESULTS: A total of 1150 DDIs were identified after 400 patient medication profiles were evaluated. Of these, 458 were unique drug pairs. Overall, 7.4% (34/458) were considered a severe interaction based upon proprietary database ratings. The assessment by clinicians ranked 6.6% (30/458) of the unique DDIs as severe. Only 3 interactions, atazanavir-simvastatin, atazanavir-tenofovir, and aspirin-warfarin, were considered severe by both evaluation methods. CONCLUSIONS: Since proprietary databases and clinician assessment of severe DDIs do not agree, developing a knowledge base for a DDI alert system likely requires proprietary database information in conjunction with clinical opinion.
@article{smithburger_grading_2010,
title = {Grading the severity of drug-drug interactions in the intensive care unit: a comparison between clinician assessment and proprietary database severity rankings},
volume = {44},
issn = {1542-6270},
shorttitle = {Grading the severity of drug-drug interactions in the intensive care unit},
doi = {10.1345/aph.1P377},
abstract = {BACKGROUND: Computerized provider order entry with decision support software offers an opportunity to identify and prevent medication-related errors, including drug-drug interactions (DDIs), through alerting mechanisms. However, the number of alerts generated can overwhelm and lead to "alert fatigue." A DDI alert system based on severity rankings has been shown to reduce alert fatigue; however, the best method to populate this type of database is unclear.
OBJECTIVE: To compare the severity ranking of proprietary databases to clinician assessment for DDIs occurring in critically ill patients.
METHODS: This observational, prospective study was conducted over 8 weeks in the cardiac and cardiothoracic intensive care unit. Medication profiles of patients were screened for the presence of DDIs and a severity evaluation was conducted using rankings of proprietary databases and clinician opinion using a DDI severity assessment tool. The primary outcome measure was the number of DDIs considered severe by both evaluation methods.
RESULTS: A total of 1150 DDIs were identified after 400 patient medication profiles were evaluated. Of these, 458 were unique drug pairs. Overall, 7.4\% (34/458) were considered a severe interaction based upon proprietary database ratings. The assessment by clinicians ranked 6.6\% (30/458) of the unique DDIs as severe. Only 3 interactions, atazanavir-simvastatin, atazanavir-tenofovir, and aspirin-warfarin, were considered severe by both evaluation methods.
CONCLUSIONS: Since proprietary databases and clinician assessment of severe DDIs do not agree, developing a knowledge base for a DDI alert system likely requires proprietary database information in conjunction with clinical opinion.},
language = {eng},
number = {11},
journal = {The Annals of pharmacotherapy},
author = {Smithburger, Pamela L and Kane-Gill, Sandra L and Benedict, Neal J and Falcione, Bonnie A and Seybert, Amy L},
month = nov,
year = {2010},
pmid = {20959499},
keywords = {Coronary Care Units, Critical Illness, Databases, Factual, Decision Support Systems, Clinical, Drug Interactions, Drug Therapy, Computer-Assisted, Humans, Medical Order Entry Systems, Medication Errors, Prospective Studies, Reminder Systems, Severity of Illness Index},
pages = {1718--1724}
}Understanding handling of drug safety alerts: a simulation study. van der Sijs, H., van Gelder, T., Vulto, A., Berg, M., & Aarts, J. International journal of medical informatics, 79(5):361–369, May, 2010.
doi abstract bibtex
doi abstract bibtex
PURPOSE: To study correctness of drug safety alert handling and error type in a computerized physician order entry (CPOE) system in a simulated work environment. METHODS: Disguised observation study of 18 physicians (12 from internal medicine and 6 from surgery) entering 35 orders of predefined patient cases with 13 different drug safety alerts in a CPOE. Structured interviews about how the generated drug safety alerts were handled in the simulation test and resemblance of the test to the normal work environment. Handling and reasons for this were scored for correctness and error type. RESULTS: Thirty percent of alerts were handled incorrectly, because the action itself and/or the reason for the handling were incorrect. Sixty-three percent of the errors were categorized as rule based and residents in surgery used incorrect justifications twice as often as residents in internal medicine. They often referred to monitoring of incorrect substances or parameters. One alert presented as a second alert in one screen was unconsciously overridden several times. One quarter of residents showed signs of alert fatigue. CONCLUSION: Although alerts were mainly handled correctly, underlying rules and reasoning were often incorrect, thereby threatening patient safety. This study gave an insight into the factors playing a role in incorrect drug safety alert handling that should be studied in more detail. The results suggest that better training, improved concise alert texts, and increased specificity might help. Furthermore, the safety of the predefined override reason 'will monitor' and double alert presentation in one screen is questioned.
@article{van_der_sijs_understanding_2010,
title = {Understanding handling of drug safety alerts: a simulation study},
volume = {79},
issn = {1872-8243},
shorttitle = {Understanding handling of drug safety alerts},
doi = {10.1016/j.ijmedinf.2010.01.008},
abstract = {PURPOSE: To study correctness of drug safety alert handling and error type in a computerized physician order entry (CPOE) system in a simulated work environment.
METHODS: Disguised observation study of 18 physicians (12 from internal medicine and 6 from surgery) entering 35 orders of predefined patient cases with 13 different drug safety alerts in a CPOE. Structured interviews about how the generated drug safety alerts were handled in the simulation test and resemblance of the test to the normal work environment. Handling and reasons for this were scored for correctness and error type.
RESULTS: Thirty percent of alerts were handled incorrectly, because the action itself and/or the reason for the handling were incorrect. Sixty-three percent of the errors were categorized as rule based and residents in surgery used incorrect justifications twice as often as residents in internal medicine. They often referred to monitoring of incorrect substances or parameters. One alert presented as a second alert in one screen was unconsciously overridden several times. One quarter of residents showed signs of alert fatigue.
CONCLUSION: Although alerts were mainly handled correctly, underlying rules and reasoning were often incorrect, thereby threatening patient safety. This study gave an insight into the factors playing a role in incorrect drug safety alert handling that should be studied in more detail. The results suggest that better training, improved concise alert texts, and increased specificity might help. Furthermore, the safety of the predefined override reason 'will monitor' and double alert presentation in one screen is questioned.},
language = {eng},
number = {5},
journal = {International journal of medical informatics},
author = {van der Sijs, Heleen and van Gelder, Teun and Vulto, Arnold and Berg, Marc and Aarts, Jos},
month = may,
year = {2010},
pmid = {20171929},
keywords = {Attitude of Health Personnel, Computer Simulation, Computer-assisted drug therapy, Computerized physician order entry, Decision Support Systems, Clinical, Drug Interactions, Drug Overdose, Drug Prescriptions, Drug Therapy, Computer-Assisted, Drug safety alert, Drug-Related Side Effects and Adverse Reactions, Electronic prescribing, Humans, Medical Order Entry Systems, Medication Errors, Reminder Systems, Safety},
pages = {361--369}
}Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital Unit. Chipara, O., Lu, C., Bailey, T., C., & Roman, G. In Proceedings of the 8th ACM Conference on Embedded Networked Sensor Systems (SenSys), 11, 2010.
Website abstract bibtex
Website abstract bibtex This paper presents the design, deployment, and empirical study of a wireless clinical monitoring system that collects pulse and oxygen saturation readings from patients. The primary contribution of this paper is an in-depth clinical trial that assesses the feasibility of wireless sensor networks for patient monitoring in general hospital units. We present a detailed analysis of the system reliability from a long term hospital deployment over seven months involving 41 patients in a step-down cardiology unit. The network achieved high reliability (median 99.68%, range 95.21% -- 100%). The overall reliability of the system was dominated by sensing reliability of the pulse oximeters (median 80.85%, range 0.46% -- 97.69%). Sensing failures usually occurred in short bursts, although longer periods were also present due to sensor disconnections. We show that the sensing reliability could be significantly improved through oversampling and by implementing a disconnection alarm system that incurs minimal intervention cost. A retrospective data analysis indicated that the system provided sufficient temporal resolution to support the detection of clinical deterioration in three patients who suffered from significant clinical events including transfer to Intensive Care Units. These results indicate the feasibility and promise of using wireless sensor networks for continuous patient monitoring and clinical deterioration detection in general hospital units.
@inProceedings{
title = {Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital Unit},
type = {inProceedings},
year = {2010},
identifiers = {[object Object]},
keywords = {clinical,experiences,implementation,monitor,monitoring,reading-group,sensor-network,summarized,trg,wireless,wsn},
websites = {http://www.cse.wustl.edu/~lu/papers/sensys10.pdf},
month = {11},
id = {44474064-3ebd-3be8-a779-0ff2ee76fd16},
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notes = {They set up a mesh network of 802.15.4 nodes in a hospital in-patient setting. Then they attached motes (also using 802.15.14) via a serial cable to a pulse-ox sensor attached to the patients on the ward. The pulse-ox data was thus collected, across the network to a base station, where it was then available to nurses. They developed algorithms for detecting adverse events, and compared with hospital records(?). The paper discusses (a) the reliability of the network itself and (b) the reliability of the sensor readings they're getting, over a 7-month deployment with 41 patients. Reasonably interesting, though we were unconvinced about some of their arguments about why a custom 802.15.4 mesh was better than using the existing 802.11 network for data collection.},
private_publication = {false},
abstract = {This paper presents the design, deployment, and empirical study of a wireless clinical monitoring system that collects pulse and oxygen saturation readings from patients. The primary contribution of this paper is an in-depth clinical trial that assesses the feasibility of wireless sensor networks for patient monitoring in general hospital units. We present a detailed analysis of the system reliability from a long term hospital deployment over seven months involving 41 patients in a step-down cardiology unit. The network achieved high reliability (median 99.68%, range 95.21% -- 100%). The overall reliability of the system was dominated by sensing reliability of the pulse oximeters (median 80.85%, range 0.46% -- 97.69%). Sensing failures usually occurred in short bursts, although longer periods were also present due to sensor disconnections. We show that the sensing reliability could be significantly improved through oversampling and by implementing a disconnection alarm system that incurs minimal intervention cost. A retrospective data analysis indicated that the system provided sufficient temporal resolution to support the detection of clinical deterioration in three patients who suffered from significant clinical events including transfer to Intensive Care Units. These results indicate the feasibility and promise of using wireless sensor networks for continuous patient monitoring and clinical deterioration detection in general hospital units.},
bibtype = {inProceedings},
author = {Chipara, Octav and Lu, Chenyang and Bailey, Thomas C and Roman, Gruia-Catalin},
booktitle = {Proceedings of the 8th ACM Conference on Embedded Networked Sensor Systems (SenSys)}
}Systems biology: an approach. Kohl, P., Crampin, E., J., Quinn, T., a., & Noble, D. Clinical pharmacology and therapeutics, 88(1):25-33, Nature Publishing Group, 7, 2010.
Paper Website abstract bibtex
Paper Website abstract bibtex In just over a decade, Systems Biology has moved from being an idea, or rather a disparate set of ideas, to a mainstream feature of research and funding priorities. Institutes, departments, and centers of various flavors of Systems Biology have sprung up all over the world. An Internet search now produces more than 2 million hits. Of the 2,800 entries in PubMed with "Systems Biology" in either the title or the abstract, only two papers were published before 2000, and >90% were published in the past five years. In this article, we interpret Systems Biology as an approach rather than as a field or a destination of research. We illustrate that this approach is productive for the exploration of systems behavior, or "phenotypes," at all levels of structural and functional complexity, explicitly including the supracellular domain, and suggest how this may be related conceptually to genomes and biochemical networks. We discuss the role of models in Systems Biology and conclude with a consideration of their utility in biomedical research and development.
@article{
title = {Systems biology: an approach.},
type = {article},
year = {2010},
identifiers = {[object Object]},
keywords = {Animals,Genetics,Genome,Humans,Models, Biological,Pharmacology, Clinical,Pharmacology, Clinical: trends,Phenotype,Systems Biology,Systems Biology: trends},
pages = {25-33},
volume = {88},
websites = {http://www.ncbi.nlm.nih.gov/pubmed/20531468},
month = {7},
publisher = {Nature Publishing Group},
id = {6bff9e8b-fde0-35b6-900d-30c7945eb627},
created = {2012-08-19T23:12:15.000Z},
accessed = {2012-07-29},
file_attached = {true},
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last_modified = {2014-07-14T11:07:28.000Z},
read = {true},
starred = {false},
authored = {false},
confirmed = {true},
hidden = {false},
citation_key = {Kohl2010a},
abstract = {In just over a decade, Systems Biology has moved from being an idea, or rather a disparate set of ideas, to a mainstream feature of research and funding priorities. Institutes, departments, and centers of various flavors of Systems Biology have sprung up all over the world. An Internet search now produces more than 2 million hits. Of the 2,800 entries in PubMed with "Systems Biology" in either the title or the abstract, only two papers were published before 2000, and >90% were published in the past five years. In this article, we interpret Systems Biology as an approach rather than as a field or a destination of research. We illustrate that this approach is productive for the exploration of systems behavior, or "phenotypes," at all levels of structural and functional complexity, explicitly including the supracellular domain, and suggest how this may be related conceptually to genomes and biochemical networks. We discuss the role of models in Systems Biology and conclude with a consideration of their utility in biomedical research and development.},
bibtype = {article},
author = {Kohl, P and Crampin, E J and Quinn, T a and Noble, D},
journal = {Clinical pharmacology and therapeutics},
number = {1}
}2009 (5)
Patient safety: detection and prevention of adverse drug events. Beuscart, R., McNair, P., Darmoni, S. J., Koutkia, V., Maglaveras, N., Beuscart-Zephir, M., Nohr, C., & PSIP Project Consortium Studies in Health Technology and Informatics, 150:968–971, 2009.
abstract bibtex
abstract bibtex
Adverse Drug Events (ADE) represent a key problem in Public Health. The detection and prevention of ADE is a real challenge for hospitals and healthcare professionals. Healthcare Information and Communication Technologies can contribute to reduce the incidence of preventable ADE. During this workshop, we will discuss the various aspects of detection of ADE through methods like data and semantic mining in medical databases; the possibility of preventing ADE by using clinical decision support systems; the importance of Human Factors Engineering and the contextualization of knowledge. Examples and demonstrations will come from the European Project PSIP, devoted to the detection and prevention of ADE in Hospitals.
@article{beuscart_patient_2009,
title = {Patient safety: detection and prevention of adverse drug events},
volume = {150},
issn = {0926-9630},
shorttitle = {Patient safety},
abstract = {Adverse Drug Events (ADE) represent a key problem in Public Health. The detection and prevention of ADE is a real challenge for hospitals and healthcare professionals. Healthcare Information and Communication Technologies can contribute to reduce the incidence of preventable ADE. During this workshop, we will discuss the various aspects of detection of ADE through methods like data and semantic mining in medical databases; the possibility of preventing ADE by using clinical decision support systems; the importance of Human Factors Engineering and the contextualization of knowledge. Examples and demonstrations will come from the European Project PSIP, devoted to the detection and prevention of ADE in Hospitals.},
language = {eng},
journal = {Studies in Health Technology and Informatics},
author = {Beuscart, Régis and McNair, Peter and Darmoni, Stéfan J. and Koutkia, Vassilis and Maglaveras, Nicos and Beuscart-Zephir, Marie-Catherine and Nohr, Christian and {PSIP Project Consortium}},
year = {2009},
pmid = {19745457},
keywords = {Decision Support Systems, Clinical, Education, Humans, Medication Errors, Quality of Health Care, Safety Management, public health},
pages = {968--971}
}Adverse drug events prevention rules: multi-site evaluation of rules from various sources. Chazard, E., Ficheur, G., Merlin, B., Serrot, E., PSIP Consortium, & Beuscart, R. Studies in health technology and informatics, 148:102–111, 2009.
Paper abstract bibtex 1 download
Paper abstract bibtex 1 download Adverse drug events are a public health issue (98,000 deaths in the USA every year). Some computerized physician order entry (CPOEs) coupled with clinical decision support systems (CDSS) allow to prevent ADEs thanks to decision rules. Those rules can come from many sources: academic knowledge, record reviews, and data mining. Whatever their origin, the rules may induce too numerous alerts of poor accuracy when identically applied in different places. In this work we formalized rules from various sources in XML and enforced their execution on several medical departments to evaluate their local confidence. The article details the process and shows examples of evaluated rules from various sources. Several needs are enlightened to improve confidences: segmentation, contextualization, and evaluation of the rules over time.
@article{chazard_adverse_2009,
title = {Adverse drug events prevention rules: multi-site evaluation of rules from various sources},
volume = {148},
copyright = {All rights reserved},
issn = {0926-9630},
shorttitle = {Adverse drug events prevention rules},
url = {http://www.chazard.org/emmanuel/pdf_articles/paper_2009_psip_rulesrepository.pdf},
abstract = {Adverse drug events are a public health issue (98,000 deaths in the USA every year). Some computerized physician order entry (CPOEs) coupled with clinical decision support systems (CDSS) allow to prevent ADEs thanks to decision rules. Those rules can come from many sources: academic knowledge, record reviews, and data mining. Whatever their origin, the rules may induce too numerous alerts of poor accuracy when identically applied in different places. In this work we formalized rules from various sources in XML and enforced their execution on several medical departments to evaluate their local confidence. The article details the process and shows examples of evaluated rules from various sources. Several needs are enlightened to improve confidences: segmentation, contextualization, and evaluation of the rules over time.},
language = {eng},
journal = {Studies in health technology and informatics},
author = {Chazard, Emmanuel and Ficheur, Grégoire and Merlin, Béatrice and Serrot, Elisabeth and {PSIP Consortium} and Beuscart, Régis},
year = {2009},
pmid = {19745240},
keywords = {Data Mining, Decision Making, Decision Support Systems, Clinical, Drug Toxicity, Guidelines as Topic, Humans, Medical Order Entry Systems, Safety Management, Systems Integration},
pages = {102--111},
}Toward automatic detection and prevention of adverse drug events. Leroy, N., Chazard, E., Beuscart, R., Beuscart-Zephir, M. C., & Psip Consortium Studies in health technology and informatics, 143:30–35, 2009.
Paper abstract bibtex
Paper abstract bibtex Adverse Drug Events (ADE) due to medication errors and human factors are a major public health issue. They endanger patient safety and cause considerable extra healthcare costs. The European project PSIP (Patient Safety through Intelligent Procedures in medication) aims to identify and prevent ADE. Data mining of the structured hospital data bases will give a list of observed ADE with frequencies and probabilities, thereby giving a better understanding of potential risks. The main objective of the project is to develop innovative knowledge based on the mining results and to deliver to professionals and patients, in the form of alerts and decision support functions, a contextualized knowledge fitting the local risk parameters.
@article{leroy_toward_2009,
title = {Toward automatic detection and prevention of adverse drug events},
volume = {143},
copyright = {All rights reserved},
issn = {0926-9630},
url = {http://www.chazard.org/emmanuel/pdf_articles/paper_2009_itch_towardautomaticdetection.pdf},
abstract = {Adverse Drug Events (ADE) due to medication errors and human factors are a major public health issue. They endanger patient safety and cause considerable extra healthcare costs. The European project PSIP (Patient Safety through Intelligent Procedures in medication) aims to identify and prevent ADE. Data mining of the structured hospital data bases will give a list of observed ADE with frequencies and probabilities, thereby giving a better understanding of potential risks. The main objective of the project is to develop innovative knowledge based on the mining results and to deliver to professionals and patients, in the form of alerts and decision support functions, a contextualized knowledge fitting the local risk parameters.},
language = {eng},
journal = {Studies in health technology and informatics},
author = {Leroy, Nicolas and Chazard, Emmanuel and Beuscart, Régis and Beuscart-Zephir, Marie Catherine and {Psip Consortium}},
year = {2009},
pmid = {19380911},
keywords = {Decision Support Systems, Clinical, Denmark, Drug Toxicity, France, Hospital Information Systems, Humans, Medical Audit},
pages = {30--35},
}Syntactic Frames in Fast Mapping Verbs: Effect of Age, Dialect, and Clinical Status. Johnson, V. E. & de Villiers, J. G. Journal of Speech, Language, and Hearing Research, 52(3):610–622, June, 2009.
Paper doi bibtex 1 download
Paper doi bibtex 1 download @article{johnson_syntactic_2009,
title = {Syntactic {Frames} in {Fast} {Mapping} {Verbs}: {Effect} of {Age}, {Dialect}, and {Clinical} {Status}},
volume = {52},
issn = {1092-4388, 1558-9102},
shorttitle = {Syntactic {Frames} in {Fast} {Mapping} {Verbs}},
url = {http://pubs.asha.org/doi/10.1044/1092-4388%282008/07-0135%29},
doi = {10.1044/1092-4388(2008/07-0135)},
language = {en},
number = {3},
urldate = {2020-05-05},
journal = {Journal of Speech, Language, and Hearing Research},
author = {Johnson, Valerie E. and de Villiers, Jill G.},
month = jun,
year = {2009},
keywords = {Clinical, Speech Pathology},
pages = {610--622},
}Drug safety alert generation and overriding in a large Dutch university medical centre. van der Sijs, H., Mulder, A., van Gelder, T., Aarts, J., Berg, M., & Vulto, A. Pharmacoepidemiology and drug safety, 18(10):941–947, October, 2009.
doi abstract bibtex
doi abstract bibtex
PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre. METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months. RESULTS: In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides. CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.
@article{van_der_sijs_drug_2009,
title = {Drug safety alert generation and overriding in a large {Dutch} university medical centre},
volume = {18},
issn = {1099-1557},
doi = {10.1002/pds.1800},
abstract = {PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre.
METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months.
RESULTS: In the disguised observation study 34\% of the orders generated a drug safety alert of which 91\% were overridden. The majority of alerts generated (56\%) concerned drug-drug interactions (DDIs) and these were overridden more often (98\%) than overdoses (89\%) or duplicate orders (80\%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59\%, overdoses 24\% and duplicate orders 17\%. DDI alerts of medium-level seriousness were overridden more often (55\%) than low-level (22\%) or high-level DDIs (19\%). In 36\% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76\% of all DDI overrides.
CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20\%) than did alerts for overdose (11\%) or DDIs (2\%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.},
language = {eng},
number = {10},
journal = {Pharmacoepidemiology and drug safety},
author = {van der Sijs, Heleen and Mulder, Alexandra and van Gelder, Teun and Aarts, Jos and Berg, Marc and Vulto, Arnold},
month = oct,
year = {2009},
pmid = {19579216},
keywords = {Academic Medical Centers, Decision Support Systems, Clinical, Drug Interactions, Drug Overdose, Drug Prescriptions, Drug Therapy, Computer-Assisted, Hospital Units, Humans, Internal Medicine, Medical Order Entry Systems, Medication Errors, Netherlands, Pharmacy Service, Hospital, Reminder Systems, Retrospective Studies, Time Factors},
pages = {941--947}
}2008 (8)
Is conscientious objection incompatible with a physician's professional obligations?. Wicclair & R, M. Theoretical medicine and bioethics, 29(3):171--185, 2008.
Paper doi abstract bibtex
Paper doi abstract bibtex In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician's professional obligations (the "incompatibility thesis"). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician's professional obligations unequivocally supports the incompatibility thesis.
@article{ wicclair_is_2008,
title = {Is conscientious objection incompatible with a physician's professional obligations?},
volume = {29},
issn = {1386-7415},
url = {http://www.aafcp.org/cplm/files/15.pdf},
doi = {10.1007/s11017-008-9075-z},
abstract = {In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician's professional obligations (the "incompatibility thesis"). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician's professional obligations unequivocally supports the incompatibility thesis.},
language = {eng},
number = {3},
journal = {Theoretical medicine and bioethics},
author = {Wicclair, Mark R},
year = {2008},
pmid = {18752039},
keywords = {Codes of Ethics, Conscience, Ethics, Clinical, Ethics, Medical, Humans, Moral Obligations, Physician-Patient Relations, Physicians, Physician's Practice Patterns, Professional Autonomy, Refusal to Treat},
pages = {171--185}
}Dynamic Bayesian networks as prognostic models for clinical patient management. van Gerven, M., A., J., Taal, B., G., & Lucas, P., J., F. Journal of biomedical informatics, 41(4):515-29, 8, 2008.
Website doi abstract bibtex
Website doi abstract bibtex Prognostic models in medicine are usually been built using simple decision rules, proportional hazards models, or Markov models. Dynamic Bayesian networks (DBNs) offer an approach that allows for the incorporation of the causal and temporal nature of medical domain knowledge as elicited from domain experts, thereby allowing for detailed prognostic predictions. The aim of this paper is to describe the considerations that must be taken into account when constructing a DBN for complex medical domains and to demonstrate their usefulness in practice. To this end, we focus on the construction of a DBN for prognosis of carcinoid patients, compare performance with that of a proportional hazards model, and describe predictions for three individual patients. We show that the DBN can make detailed predictions, about not only patient survival, but also other variables of interest, such as disease progression, the effect of treatment, and the development of complications. Strengths and limitations of our approach are discussed and compared with those offered by traditional methods.
@article{
title = {Dynamic Bayesian networks as prognostic models for clinical patient management.},
type = {article},
year = {2008},
keywords = {Algorithms,Bayes Theorem,Carcinoid Tumor,Carcinoid Tumor: diagnosis,Carcinoid Tumor: mortality,Decision Support Systems, Clinical,Diagnosis, Computer-Assisted,Diagnosis, Computer-Assisted: methods,Humans,Neural Networks (Computer),Prognosis,Risk Assessment,Risk Assessment: methods,Risk Factors,Survival Analysis,Survival Rate},
pages = {515-29},
volume = {41},
websites = {http://www.sciencedirect.com/science/article/pii/S1532046408000154},
month = {8},
id = {812f1eae-d7e5-3eff-85a4-ec3d22a0c90a},
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abstract = {Prognostic models in medicine are usually been built using simple decision rules, proportional hazards models, or Markov models. Dynamic Bayesian networks (DBNs) offer an approach that allows for the incorporation of the causal and temporal nature of medical domain knowledge as elicited from domain experts, thereby allowing for detailed prognostic predictions. The aim of this paper is to describe the considerations that must be taken into account when constructing a DBN for complex medical domains and to demonstrate their usefulness in practice. To this end, we focus on the construction of a DBN for prognosis of carcinoid patients, compare performance with that of a proportional hazards model, and describe predictions for three individual patients. We show that the DBN can make detailed predictions, about not only patient survival, but also other variables of interest, such as disease progression, the effect of treatment, and the development of complications. Strengths and limitations of our approach are discussed and compared with those offered by traditional methods.},
bibtype = {article},
author = {van Gerven, Marcel A J and Taal, Babs G and Lucas, Peter J F},
doi = {10.1016/j.jbi.2008.01.006},
journal = {Journal of biomedical informatics},
number = {4}
}Three years experience with the implementation of a networked electronic medical record in Haiti. Lober, W. B., Quiles, C., Wagner, S., Cassagnol, R., Lamothes, R., Alexis, D. R. P., Joseph, P., Sutton, P., Puttkammer, N., & Kitahata, M. M. AMIA ... Annual Symposium proceedings. AMIA Symposium, November, 2008.
abstract bibtex
abstract bibtex
Since 2005 we have been developing and implementing an electronic medical record (EMR) that supports both individual and population health care of HIV-infected patients in Haiti. Unreliable electrical power and network infrastructure, cultural differences, variable levels of experience and computer literacy, and the geographic dispersion of the team remain challenges, but the system is now implemented in about 40 sites nationwide providing antiretroviral therapy, and includes records for about 18,600 patients. The need to support country-wide monitoring and evaluation drove early architectural decisions to support linking systems under conditions of network uncertainty. We have found surprising end user acceptance of the system, with the adoption of interactive EMR usage exceeding our expectations and timeline.
@article{lober_three_2008,
title = {Three years experience with the implementation of a networked electronic medical record in {Haiti}},
issn = {1942-597X},
abstract = {Since 2005 we have been developing and implementing an electronic medical record (EMR) that supports both individual and population health care of HIV-infected patients in Haiti. Unreliable electrical power and network infrastructure, cultural differences, variable levels of experience and computer literacy, and the geographic dispersion of the team remain challenges, but the system is now implemented in about 40 sites nationwide providing antiretroviral therapy, and includes records for about 18,600 patients. The need to support country-wide monitoring and evaluation drove early architectural decisions to support linking systems under conditions of network uncertainty. We have found surprising end user acceptance of the system, with the adoption of interactive EMR usage exceeding our expectations and timeline.},
language = {eng},
journal = {AMIA ... Annual Symposium proceedings. AMIA Symposium},
author = {Lober, William B. and Quiles, Christina and Wagner, Steve and Cassagnol, Rachelle and Lamothes, Roges and Alexis, Don Rock Pierre and Joseph, Patrice and Sutton, Perri and Puttkammer, Nancy and Kitahata, Mari M.},
month = nov,
year = {2008},
pmid = {18999283},
pmcid = {PMC2655963},
keywords = {CIRG\_Selected, Decision Support Systems, Clinical, Electronic Health Records, HIV Infections, Hawaii, Internet, Medical Record Linkage, Technology Assessment, Biomedical, Telemedicine},
pages = {434--438},
}Turning off frequently overridden drug alerts: limited opportunities for doing it safely. van der Sijs, H., Aarts, J., van Gelder, T., Berg, M., & Vulto, A. Journal of the American Medical Informatics Association: JAMIA, 15(4):439–448, August, 2008.
doi abstract bibtex
doi abstract bibtex
OBJECTIVES: This study sought to identify opportunities to safely turn off frequently overridden drug-drug interaction alerts (DDIs) in computerized physician order entry (CPOE). DESIGN: Quantitative retrospective analysis of drug safety alerts overridden during 1 month and qualitative interviews with 24 respondents (18 physicians and 6 pharmacists) about turning off frequently overridden DDI alerts, based on the Dutch drug database, in a hospital setting. Screen shots and complete texts of frequently overridden DDIs were presented to physicians of internal medicine, cardiology, and surgery and to hospital pharmacists who were asked whether these could be turned off hospital-wide without impairing patient safety, and the reasons for their recommendations. RESULTS: Data on the frequency of alerts overridden in 1 month identified 3,089 overrides, of which 1,963 were DDIs. The category DDIs showed 86 different alerts, of which 24 frequently overridden alerts, accounting for 72% of all DDI overrides, were selected for further evaluation. The 24 respondents together made 576 assessments. Upon investigation, differences in the reasons for turning off alerts were found across medical specialties and among respondents within a specialty. Frequently mentioned reasons for turning off were "alert well known," "alert not serious," or "alert not needing (additional) action," or that the effects of the combination were monitored or intended. For none of the alerts did all respondents agree that it could be safely turned off hospital-wide. The highest agreement was 13 of 24 respondents (54%). A positive correlation was found between the number of alerts overridden and the number of clinicians recommending to turn them off. CONCLUSION: Although the Dutch drug database is already a selected reduction from all DDIs mentioned in literature, the majority of respondents wanted to turn off DDI alerts to reduce alert overload. Turning off DDI alerts hospital-wide appeared to be problematic because of differences among physicians regarding drug-related knowledge and of differences across the hospital in routine drug monitoring practices. Furthermore, several reasons for suppression of alerts could be questioned from a safety perspective. Further research should investigate when each of the following might help: changes in alert texts; new differential alert triggers based on clinician knowledge or specialty; and nonintrusive alert presentation so long as serum levels and patient parameters are measured and stay within limits.
@article{van_der_sijs_turning_2008,
title = {Turning off frequently overridden drug alerts: limited opportunities for doing it safely},
volume = {15},
issn = {1067-5027},
shorttitle = {Turning off frequently overridden drug alerts},
doi = {10.1197/jamia.M2311},
abstract = {OBJECTIVES: This study sought to identify opportunities to safely turn off frequently overridden drug-drug interaction alerts (DDIs) in computerized physician order entry (CPOE).
DESIGN: Quantitative retrospective analysis of drug safety alerts overridden during 1 month and qualitative interviews with 24 respondents (18 physicians and 6 pharmacists) about turning off frequently overridden DDI alerts, based on the Dutch drug database, in a hospital setting. Screen shots and complete texts of frequently overridden DDIs were presented to physicians of internal medicine, cardiology, and surgery and to hospital pharmacists who were asked whether these could be turned off hospital-wide without impairing patient safety, and the reasons for their recommendations.
RESULTS: Data on the frequency of alerts overridden in 1 month identified 3,089 overrides, of which 1,963 were DDIs. The category DDIs showed 86 different alerts, of which 24 frequently overridden alerts, accounting for 72\% of all DDI overrides, were selected for further evaluation. The 24 respondents together made 576 assessments. Upon investigation, differences in the reasons for turning off alerts were found across medical specialties and among respondents within a specialty. Frequently mentioned reasons for turning off were "alert well known," "alert not serious," or "alert not needing (additional) action," or that the effects of the combination were monitored or intended. For none of the alerts did all respondents agree that it could be safely turned off hospital-wide. The highest agreement was 13 of 24 respondents (54\%). A positive correlation was found between the number of alerts overridden and the number of clinicians recommending to turn them off.
CONCLUSION: Although the Dutch drug database is already a selected reduction from all DDIs mentioned in literature, the majority of respondents wanted to turn off DDI alerts to reduce alert overload. Turning off DDI alerts hospital-wide appeared to be problematic because of differences among physicians regarding drug-related knowledge and of differences across the hospital in routine drug monitoring practices. Furthermore, several reasons for suppression of alerts could be questioned from a safety perspective. Further research should investigate when each of the following might help: changes in alert texts; new differential alert triggers based on clinician knowledge or specialty; and nonintrusive alert presentation so long as serum levels and patient parameters are measured and stay within limits.},
language = {eng},
number = {4},
journal = {Journal of the American Medical Informatics Association: JAMIA},
author = {van der Sijs, Heleen and Aarts, Jos and van Gelder, Teun and Berg, Marc and Vulto, Arnold},
month = aug,
year = {2008},
pmid = {18436915},
pmcid = {PMC2442265},
keywords = {Attitude of Health Personnel, Attitude to Computers, Decision Support Systems, Clinical, Drug Therapy, Computer-Assisted, Humans, Internship and Residency, Medical Order Entry Systems, Medication Errors, Medicine, Netherlands, Reminder Systems, Retrospective Studies, Specialization, User-Computer Interface},
pages = {439--448}
}BOLD-MRI cerebrovascular reactivity findings in cocaine-induced cerebral vasculitis. Han, J. S, Mandell, D. M, Poublanc, J., Mardimae, A., Slessarev, M., Jaigobin, C., Fisher, J. A, & Mikulis, D. J Nature Clinical Practice. Neurology, 4(11):628--632, November, 2008.
Paper doi abstract bibtex
Paper doi abstract bibtex BACKGROUND: An 18-year-old woman presented to a regional stroke center with dysphasia and right hemiparesis 2 days after consuming alcohol and inhaling cannabis and -- for the first time -- cocaine. INVESTIGATIONS: Physical examination, blood tests for inflammatory markers, vasculitis and toxicology screen, echocardiography, electrocardiography, CT scanning, brain MRI, magnetic resonance angiography, magnetic resonance vessel wall imaging, catheter angiography, and correlation of blood oxygen level-dependent (BOLD)-MRI signal intensity with changes in end-tidal partial pressure of carbon dioxide. DIAGNOSIS: Cocaine-induced cerebral vasculitis. MANAGEMENT: No specific therapy was initiated. The patient's vital signs and neurological status were monitored during her admission. Follow-up medical imaging was performed after the patient's discharge from hospital.
@article{han_bold-mri_2008,
title = {{BOLD}-{MRI} cerebrovascular reactivity findings in cocaine-induced cerebral vasculitis},
volume = {4},
issn = {1745-8358},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18839005},
doi = {10.1038/ncpneuro0918},
abstract = {BACKGROUND: An 18-year-old woman presented to a regional stroke center with dysphasia and right hemiparesis 2 days after consuming alcohol and inhaling cannabis and -- for the first time -- cocaine. INVESTIGATIONS: Physical examination, blood tests for inflammatory markers, vasculitis and toxicology screen, echocardiography, electrocardiography, CT scanning, brain MRI, magnetic resonance angiography, magnetic resonance vessel wall imaging, catheter angiography, and correlation of blood oxygen level-dependent (BOLD)-MRI signal intensity with changes in end-tidal partial pressure of carbon dioxide. DIAGNOSIS: Cocaine-induced cerebral vasculitis. MANAGEMENT: No specific therapy was initiated. The patient's vital signs and neurological status were monitored during her admission. Follow-up medical imaging was performed after the patient's discharge from hospital.},
number = {11},
urldate = {2009-01-20},
journal = {Nature Clinical Practice. Neurology},
author = {Han, Jay S and Mandell, Daniel M and Poublanc, Julien and Mardimae, Alexandra and Slessarev, Marat and Jaigobin, Cheryl and Fisher, Joseph A and Mikulis, David J},
month = nov,
year = {2008},
pmid = {18839005},
keywords = {CVR, hardcopy, ILL, clinical},
pages = {628--632},
file = {PubMed Snapshot:/Users/nickb/Zotero/storage/HBGAH7TU/18839005.html:text/html}
}Verbal abuse experienced by nursing students. Ferns, T & Meerabeau, L Journal of Advanced Nursing, 61(4):436–444, February, 2008.
Paper abstract bibtex
Paper abstract bibtex Aim. This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. Background. Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73·0%. Findings. Experience of verbal abuse was reported by 45·1% of respondents, 34·5% had witnessed other students experiencing this and 65·5% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64·7% of cases, 15·7% involved visitors or relatives and 19·6% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. Conclusion. Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students.
@article{ferns_verbal_2008,
title = {Verbal abuse experienced by nursing students.},
volume = {61},
issn = {0309-2402},
url = {http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009771222&site=ehost-live},
abstract = {Aim. This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. Background. Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73·0\%. Findings. Experience of verbal abuse was reported by 45·1\% of respondents, 34·5\% had witnessed other students experiencing this and 65·5\% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64·7\% of cases, 15·7\% involved visitors or relatives and 19·6\% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. Conclusion. Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students.},
number = {4},
journal = {Journal of Advanced Nursing},
author = {Ferns, T and Meerabeau, L},
month = feb,
year = {2008},
keywords = {Adult, Convenience Sample, Descriptive Research, Descriptive Statistics, Empirical Research, England, Face Validity, Female, Human, Learning Environment, Clinical, Male, Middle Age, Questionnaires, Racism, Sexual Harassment, Student-Patient Relations, Students, Nursing, Diploma Programs, Summated Rating Scaling, Survey Research, Verbal Abuse, Verbal Abuse -- Classification, Verbal Abuse -- Epidemiology, Visitors to Patients},
pages = {436--444},
}Patient-specific learning in real time for adaptive monitoring in critical care. Zhang, Y. & Szolovits, P. Journal of Biomedical Informatics, 41(3):452--460, June, 2008.
doi abstract bibtex
doi abstract bibtex
Intensive care monitoring systems are typically developed from population data, but do not take into account the variability among individual patients' characteristics. This study develops patient-specific alarm algorithms in real time. Classification tree and neural network learning were carried out in batch mode on individual patients' vital sign numerics in successive intervals of incremental duration to generate binary classifiers of patient state and thus to determine when to issue an alarm. Results suggest that the performance of these classifiers follows the course of a learning curve. After 8h of patient-specific training during each of 10 monitoring sessions, our neural networks reached average sensitivity, specificity, positive predictive value, and accuracy of 0.96, 0.99, 0.79, and 0.99, respectively. The classification trees achieved 0.84, 0.98, 0.72, and 0.98, respectively. Thus, patient-specific modeling in real time is not only feasible but also effective in generating alerts at the bedside.
@article{zhang_patient-specific_2008,
title = {Patient-specific learning in real time for adaptive monitoring in critical care},
volume = {41},
issn = {1532-0480},
doi = {10.1016/j.jbi.2008.03.011},
abstract = {Intensive care monitoring systems are typically developed from population data, but do not take into account the variability among individual patients' characteristics. This study develops patient-specific alarm algorithms in real time. Classification tree and neural network learning were carried out in batch mode on individual patients' vital sign numerics in successive intervals of incremental duration to generate binary classifiers of patient state and thus to determine when to issue an alarm. Results suggest that the performance of these classifiers follows the course of a learning curve. After 8h of patient-specific training during each of 10 monitoring sessions, our neural networks reached average sensitivity, specificity, positive predictive value, and accuracy of 0.96, 0.99, 0.79, and 0.99, respectively. The classification trees achieved 0.84, 0.98, 0.72, and 0.98, respectively. Thus, patient-specific modeling in real time is not only feasible but also effective in generating alerts at the bedside.},
language = {eng},
number = {3},
journal = {Journal of Biomedical Informatics},
author = {Zhang, Ying and Szolovits, Peter},
month = jun,
year = {2008},
pmid = {18463000},
pmcid = {PMC4450160},
keywords = {Artificial Intelligence, Computer Systems, Critical Care, Decision Support Systems, Clinical, Diagnosis, Computer-Assisted, Monitoring, Physiologic, Reproducibility of Results, Sensitivity and Specificity},
pages = {452--460}
}Sticks and stones. Ferns, T & Meerabeau, L Nursing Standard, 22(36):61–61, May, 2008.
Paper abstract bibtex
Paper abstract bibtex Terry Ferns and Liz Meerabeau find that nursing students experience racial and sexual verbal abuse.
@article{ferns_sticks_2008,
title = {Sticks and stones.},
volume = {22},
issn = {0029-6570},
url = {http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009932154&site=ehost-live},
abstract = {Terry Ferns and Liz Meerabeau find that nursing students experience racial and sexual verbal abuse.},
number = {36},
journal = {Nursing Standard},
author = {Ferns, T and Meerabeau, L},
month = may,
year = {2008},
keywords = {Learning Environment, Clinical, Student-Patient Relations, Students, Nursing, Diploma Programs, Verbal Abuse},
pages = {61--61},
}2007 (2)
Clash of definitions: controversies about conscience in medicine. Lawrence, E, R., Curlin, & A, F. The American journal of bioethics: AJOB, 7(12):10--14, December, 2007.
doi abstract bibtex
doi abstract bibtex
What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine.
@article{ lawrence_clash_2007,
title = {Clash of definitions: controversies about conscience in medicine},
volume = {7},
issn = {1536-0075},
shorttitle = {Clash of definitions},
doi = {10.1080/15265160701709859},
abstract = {What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine.},
language = {eng},
number = {12},
journal = {The American journal of bioethics: {AJOB}},
author = {Lawrence, Ryan E and Curlin, Farr A},
month = {December},
year = {2007},
pmid = {18098008},
keywords = {Christianity, Conscience, Dissent and Disputes, Ethics, Clinical, Ethics, Medical, Humans, Islam, Judaism, Moral Obligations, Negotiating, Personal Autonomy, Physicians, Refusal to Treat, Religion and Medicine, Social Responsibility, United States},
pages = {10--14}
}Some Theoretical Underpinnings of Knowledge Translation. Graham, I., D. & Tetroe, J. Academic Emergency Medicine, 14(11):936-941, 2007.
Website abstract bibtex
Website abstract bibtex A careful analysis of the definition of knowledge translation highlights the importance of the judicious translation of research into practice and policy. There is, however, a considerable gap between research and practice. Closing the research-to-practice gap involves changing clinical practice, a complex and challenging endeavor. There is increasing recognition that efforts to change practice should be guided by conceptual models or frameworks to better understand the process of change. The authors conducted a focused literature search, developed inclusion criteria to identify planned action theories, and then extracted data from each theory to determine the origins, examine the meaning, judge the logical consistency, and define the degree of generalizability, parsimony, and testability. An analysis was conducted of the concepts found in each theory, and a set of action categories was developed that form the phases of planned action. Thirty-one planned action theories were identified that formed the basis of the analyses. An Access database was created, as well as a KT Theories User's Guide that synthesizes all the planned change models and theories, identifies common elements of each, and provides information on their use. There are many planned change models and frameworks with many common elements and action categories. Whenever any planned change model is used, change agents should consider documenting their experiences with the model so as to advance understanding of how useful the model is and to provide information to others who are attempting a similar project. © 2007 Society for Academic Emergency Medicine.
@article{
title = {Some Theoretical Underpinnings of Knowledge Translation},
type = {article},
year = {2007},
identifiers = {[object Object]},
keywords = {Biomedical Research,Decision Support Systems, Clinical,Diffusion of Innovation,Humans,Models, Theoretical,article,implementation research,information science,knowledge,knowledge translation,language,medical literature,medical research,priority journal,theoretical study,theory analysis},
pages = {936-941},
volume = {14},
websites = {http://www.scopus.com/inward/record.url?eid=2-s2.0-35348990719&partnerID=40&md5=5996c879510f9b3bc00bffc5882ca1c9},
city = {Affiliation: Canadian Institutes of Health Research (IDG, JT), Ottawa, Ont., Canada; Correspondence Address: Graham, I.D.; Canadian Institutes of Health Research (IDG, JT), Ottawa, Ont., Canada; email: igraham@cihr.gc.ca},
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notes = {Cited By (since 1996): 49},
folder_uuids = {028056a6-dab5-46a4-b9bf-02542e7cfa2b},
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abstract = {A careful analysis of the definition of knowledge translation highlights the importance of the judicious translation of research into practice and policy. There is, however, a considerable gap between research and practice. Closing the research-to-practice gap involves changing clinical practice, a complex and challenging endeavor. There is increasing recognition that efforts to change practice should be guided by conceptual models or frameworks to better understand the process of change. The authors conducted a focused literature search, developed inclusion criteria to identify planned action theories, and then extracted data from each theory to determine the origins, examine the meaning, judge the logical consistency, and define the degree of generalizability, parsimony, and testability. An analysis was conducted of the concepts found in each theory, and a set of action categories was developed that form the phases of planned action. Thirty-one planned action theories were identified that formed the basis of the analyses. An Access database was created, as well as a KT Theories User's Guide that synthesizes all the planned change models and theories, identifies common elements of each, and provides information on their use. There are many planned change models and frameworks with many common elements and action categories. Whenever any planned change model is used, change agents should consider documenting their experiences with the model so as to advance understanding of how useful the model is and to provide information to others who are attempting a similar project. © 2007 Society for Academic Emergency Medicine.},
bibtype = {article},
author = {Graham, I D and Tetroe, J},
journal = {Academic Emergency Medicine},
number = {11}
}2006 (5)
May doctors refuse infertility treatments to gay patients?. Appel & M, J. The Hastings Center report, 36(4):20--21, August, 2006.
bibtex
bibtex
@article{ appel_may_2006,
title = {May doctors refuse infertility treatments to gay patients?},
volume = {36},
issn = {0093-0334},
language = {eng},
number = {4},
journal = {The Hastings Center report},
author = {Appel, Jacob M},
month = {August},
year = {2006},
pmid = {16898357},
keywords = {California, Conscience, Ethics, Clinical, Ethics, Medical, Female, Fertilization in Vitro, Freedom, Homosexuality, Female, Humans, Infertility, Physician-Patient Relations, Prejudice, Refusal to Treat, Religion and Medicine, United States},
pages = {20--21}
}Microbubble contrast agents: Targeted ultrasound imaging and ultrasound-assisted drug-delivery applications. Klibanov, A. Investigative Radiology, 41(3):354-362, 2006.
bibtex
bibtex
@Article{Klibanov_2006_876,
author = {Klibanov, A.L.},
journal = {Investigative Radiology},
number = {3},
pages = {354-362},
title = {Microbubble contrast agents: {T}argeted ultrasound imaging and ultrasound-assisted drug-delivery applications},
volume = {41},
year = {2006},
keywords = {Animals, Clinical, Trials, Contrast, Media/*administration, &, dosage/pharmacokinetics, *Drug, Delivery, Systems, Humans, *Microbubbles, Plasmids, *Ultrasonography, Vascular, Diseases/*drug, therapy/ultrasonography},
title_with_no_special_chars = {Microbubble contrast agents Targeted ultrasound imaging and ultrasoundassisted drugdelivery applications}
}Clinical experiences of students with dyslexia. Morris, D. A. & Turnbull, P. A. Journal of advanced nursing, 54(2):238–247, 2006.
bibtex
bibtex
@article{morris_clinical_2006,
title = {Clinical experiences of students with dyslexia},
volume = {54},
number = {2},
journal = {Journal of advanced nursing},
author = {Morris, David A. and Turnbull, Patricia A.},
year = {2006},
keywords = {Clinical, Dyslexia;, Education;, Interviews;, descriptive, experiences, nurse, nursing, personal, practice;, students;, study;},
pages = {238--247},
}Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer. Berry, D. L., Wolpin, S. E., Lober, W. B., Ellis, W. J., Russell, K. J., & Davison, B. J. Studies in Health Technology and Informatics, 122:781–782, 2006.
abstract bibtex
abstract bibtex
The purpose of this pilot study was to develop and test the Personal Patient Profile-Prostate (P4), a customized, Internet-based decision support system for men with localized prostate cancer. In a sample of 30 men, the P4 program was successfully implemented in a clinical setting. Men reported the program useful and web-logs documented a high use rate of menu-driven components of the intervention.
@article{berry_actual_2006,
title = {Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer},
volume = {122},
issn = {0926-9630},
abstract = {The purpose of this pilot study was to develop and test the Personal Patient Profile-Prostate (P4), a customized, Internet-based decision support system for men with localized prostate cancer. In a sample of 30 men, the P4 program was successfully implemented in a clinical setting. Men reported the program useful and web-logs documented a high use rate of menu-driven components of the intervention.},
language = {eng},
journal = {Studies in Health Technology and Informatics},
author = {Berry, Donna L. and Wolpin, Seth E. and Lober, William B. and Ellis, William J. and Russell, Kenneth J. and Davison, B. Joyce},
year = {2006},
pmid = {17102377},
keywords = {Decision Support Systems, Clinical, Humans, Internet, Male, Patient Satisfaction, Prostatic Neoplasms, Surveys and Questionnaires},
pages = {781--782},
}Using commercial knowledge bases for clinical decision support: opportunities, hurdles, and recommendations. Kuperman, G. J, Reichley, R. M, & Bailey, T. C Journal of the American Medical Informatics Association: JAMIA, 13(4):369–371, August, 2006.
doi bibtex
doi bibtex
@article{kuperman_using_2006,
title = {Using commercial knowledge bases for clinical decision support: opportunities, hurdles, and recommendations},
volume = {13},
issn = {1067-5027},
shorttitle = {Using commercial knowledge bases for clinical decision support},
doi = {10.1197/jamia.M2055},
language = {eng},
number = {4},
journal = {Journal of the American Medical Informatics Association: JAMIA},
author = {Kuperman, Gilad J and Reichley, Richard M and Bailey, Thomas C},
month = aug,
year = {2006},
pmid = {16622160},
pmcid = {PMC1513681},
keywords = {Commerce, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Health Facilities, Knowledge Bases},
pages = {369--371}
}2005 (4)
Feature mining for prediction of degree of liver fibrosis. Mayer, B. W, Rangwala, H. S, Gupta, R., Srivastava, J., Karypis, G., Kumar, V., & de Groen, P. C AMIA Annu Symp Proc, University of Minnesota, Minneapolis, MN, USA., 2005.
bibtex
bibtex
@article {Mayer:2005qf,
title = {Feature mining for prediction of degree of liver fibrosis.},
journal = {AMIA Annu Symp Proc},
year = {2005},
pages = {1048},
address = {University of Minnesota, Minneapolis, MN, USA.},
keywords = {*Diagnosis, Clinical, Computer-Assisted, Decision Support Systems, Humans, Liver Cirrhosis/*diagnosis},
issn = {1942-597X (Electronic); 1559-4076 (Linking)},
author = {Mayer, Benjamin W and Rangwala, Huzefa S and Gupta, Rohit and Srivastava, Jaideep and George Karypis and Kumar, Vipin and de Groen, Piet C}
}Conflicting notions of research ethics: The mutually challenging traditions of social scientists and medical researchers. Hoeyer, K., Dahlager, L., & Lynöe, N. Social science & medicine, 61(8):1741–1749, 2005.
bibtex
bibtex
@article{hoeyer_conflicting_2005,
title = {Conflicting notions of research ethics: {The} mutually challenging traditions of social scientists and medical researchers},
volume = {61},
number = {8},
journal = {Social science \& medicine},
author = {Hoeyer, Klaus and Dahlager, Lisa and Lynöe, Niels},
year = {2005},
keywords = {Anthropology;, Clinical, Informed, Politics, Research, consent;, ethics;, medicine;, of},
pages = {1741--1749},
}Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study. Kroese, W. L. G., Avery, A. J., Savelyich, B. S. P., Brown, N. S., Schers, H., Howard, R., Hippisley-Cox, J., & Horsfield, P. Journal of Clinical Pharmacy and Therapeutics, 30(3):279--283, June, 2005.
doi abstract bibtex
doi abstract bibtex
BACKGROUND: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index. OBJECTIVES: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program. METHODS: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin. RESULTS: Forty-five patients were recruited. There was a correlation of 0.65 between measured and predicted digoxin concentrations (P \textless 0.001). The mean difference was 0.12 microg/L (SD 0.26; 95% CI 0.04, 0.19, P = 0.005). Forty-seven per cent of the patients were prescribed the same dose as recommended by the software, 44% were prescribed a higher dose and 9% a lower dose than recommended. CONCLUSION: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.
@article{kroese_assessing_2005,
title = {Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study},
volume = {30},
issn = {0269-4727},
shorttitle = {Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care},
doi = {10.1111/j.1365-2710.2005.00650.x},
abstract = {BACKGROUND: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index.
OBJECTIVES: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program.
METHODS: We needed 45 patients to have 95\% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10\% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin.
RESULTS: Forty-five patients were recruited. There was a correlation of 0.65 between measured and predicted digoxin concentrations (P {\textless} 0.001). The mean difference was 0.12 microg/L (SD 0.26; 95\% CI 0.04, 0.19, P = 0.005). Forty-seven per cent of the patients were prescribed the same dose as recommended by the software, 44\% were prescribed a higher dose and 9\% a lower dose than recommended.
CONCLUSION: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.},
language = {eng},
number = {3},
journal = {Journal of Clinical Pharmacy and Therapeutics},
author = {Kroese, W. L. G. and Avery, A. J. and Savelyich, B. S. P. and Brown, N. S. and Schers, H. and Howard, R. and Hippisley-Cox, J. and Horsfield, P.},
month = jun,
year = {2005},
pmid = {15896246},
keywords = {Aged, Aged, 80 and over, Cardiotonic Agents, Decision Support Systems, Clinical, Digoxin, Female, Humans, Male, Middle Aged, Primary Health Care, Software Validation},
pages = {279--283}
}A comparison of disfluency patterns in normal and stuttered speech. Arbisi-Kelm, T. & Jun, S. In Véronis, J. & Campione, E., editors, DISS 2005. Proceedings of the ISCA Tutorial and Research Workshop Disfluency in Spontaneous Speech, pages 13–16, 2005.
Paper abstract bibtex
Paper abstract bibtex While speech disfluencies are commonly found in every speaker's speech, stuttering is a language disorder characterized by an abnormally high rate of speech aberrations, including prolongation, cessation, and repetition of speech segments. However, despite the obvious differences between stuttered and normal speech, identifying the crucial qualities that identify stuttered speech remains a significant challenge. A story-telling task was presented to four stutterers and four non-stutterers in order to analyze the prosodic patterns that surfaced from their spontaneous narrations. Preliminary results revealed that the major difference between stutterers' and non-stutterers' disfluencies -aside from the total number- is the type of disfluency and the context affected by the disfluency. Disfluencies in both groups included prolongation, pause and cut, but stutterers' disfluencies also include repetition and combinations of the three (e.g., cut followed by pause). In addition, stutterers' disfluencies were accompanied by more prosodic irregularities (e.g. pitch accent on function words, creating a prosodic break with degraded phonetic cues) prior to the actual disfluency than non-stutterers' disfluencies, indirectly supporting the overvigilant self-monitoring hypothesis.
@inproceedings{arbisi-kelm_comparison_2005,
Author = {Arbisi-Kelm, Timothy and Jun, Sun-Ah},
Booktitle = {DISS 2005. Proceedings of the ISCA Tutorial and Research Workshop Disfluency in Spontaneous Speech},
Date = {2005},
Date-Modified = {2018-05-30 18:49:56 +0000},
Editor = {Véronis, Jean and Campione, Estelle},
Eventdate = {2005-09-10/2005-09-12},
Keywords = {clinical, clinical phonetics, disfluencies, duration, dysphemia, English, pauses, phonetics, prosody, repetitions, segmental lengthening, temporal factors, phonetics},
Location = {Aix-en-Provence, France},
Pages = {13--16},
Title = {A comparison of disfluency patterns in normal and stuttered speech},
Url = {http://www.isca-speech.org/archive_open/diss_05/dis5_013.html},
Year = {2005},
Abstract = {While speech disfluencies are commonly found in every speaker's speech, stuttering is a language disorder characterized by an abnormally high rate of speech aberrations, including prolongation, cessation, and repetition of speech segments. However, despite the obvious differences between stuttered and normal speech, identifying the crucial qualities that identify stuttered speech remains a significant challenge. A story-telling task was presented to four stutterers and four non-stutterers in order to analyze the prosodic patterns that surfaced from their spontaneous narrations. Preliminary results revealed that the major difference between stutterers' and non-stutterers' disfluencies -aside from the total number- is the type of disfluency and the context affected by the disfluency. Disfluencies in both groups included prolongation, pause and cut, but stutterers' disfluencies also include repetition and combinations of the three (e.g., cut followed by pause). In addition, stutterers' disfluencies were accompanied by more prosodic irregularities (e.g. pitch accent on function words, creating a prosodic break with degraded phonetic cues) prior to the actual disfluency than non-stutterers' disfluencies, indirectly supporting the overvigilant self-monitoring hypothesis.},
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Back schools for non-specific low-back pain. Heymans, M., W., van Tulder, M., W., Esmail, R., Bombardier, C., & Koes, B., W. Cochrane database of systematic reviews (Online), 30(4):CD000261, 2004.
abstract bibtex
abstract bibtex
BACKGROUND: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. OBJECTIVES: To assess the effectiveness of back schools for patients with non-specific LBP. SEARCH STRATEGY: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) that reported on any type of back school for non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Four reviewers, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies. MAIN RESULTS: Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. REVIEWERS' CONCLUSIONS: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools.
@article{
title = {Back schools for non-specific low-back pain.},
type = {article},
year = {2004},
identifiers = {[object Object]},
keywords = {2153,2163,30,back scoliosis,clinical,coch-,department of public and,effectiveness,emgo-,from the,low back pain,occupational health,rane collaboration,relevance,spine 2005,systematic review},
pages = {CD000261},
volume = {30},
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created = {2015-12-02T02:16:28.000Z},
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last_modified = {2015-12-02T02:16:28.000Z},
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abstract = {BACKGROUND: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. OBJECTIVES: To assess the effectiveness of back schools for patients with non-specific LBP. SEARCH STRATEGY: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) that reported on any type of back school for non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Four reviewers, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies. MAIN RESULTS: Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. REVIEWERS' CONCLUSIONS: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools.},
bibtype = {article},
author = {Heymans, M W and van Tulder, M W and Esmail, R and Bombardier, C and Koes, B W},
journal = {Cochrane database of systematic reviews (Online)},
number = {4}
}A pausa na produção da fala com comprometimento neurológico. Vieira, J. M., Barbosa, P. A., & Pegoraro-Krook, M. I. Revista de Estudos da Linguagem, 12(2):181–191, 2004.
doi abstract bibtex
doi abstract bibtex
Dysarthria is associated with a deficit in phonemic planning orparalysis of specific speech articulators, besides a frequentvelopharyngeal impairment and expected prosodic alterations. Themain goal of this work is to describe the speech rhythm of a userof a palatal lift protheses by analyzing the way she signals somelinguistic boundaries when reading a short story. Pause durationswere measured and pauses were classified into six syntacticcategories. The correlation coefficient between categories anddurations is 62%, signaling that not all variance can be solelyexplained by syntax, but also by considering prosody as the interplaybetween linguistic knowledge and constraints of a biomechanicalsystem. Despite her neuromotor impairment, the subject is able touse pauses to signal a prosodic hierarchy.
@article{vieira_pausa_2004,
Author = {Vieira, Jussara Melo and Barbosa, Plínio Almeida and Pegoraro-Krook, Maria Inês},
Date = {2004},
Date-Modified = {2018-05-30 18:50:16 +0000},
Doi = {10.17851/2237-2083.12.2.181-191},
Journal = {Revista de Estudos da Linguagem},
Keywords = {clinical, clinical phonetics, disfluencies, dysarthria, pauses, phonetics, Portuguese, prosody, speech production, temporal factors, phonetics},
Number = {2},
Pages = {181--191},
Title = {A pausa na produção da fala com comprometimento neurológico},
Volume = {12},
Year = {2004},
Abstract = {Dysarthria is associated with a deficit in phonemic planning orparalysis of specific speech articulators, besides a frequentvelopharyngeal impairment and expected prosodic alterations. Themain goal of this work is to describe the speech rhythm of a userof a palatal lift protheses by analyzing the way she signals somelinguistic boundaries when reading a short story. Pause durationswere measured and pauses were classified into six syntacticcategories. The correlation coefficient between categories anddurations is 62\%, signaling that not all variance can be solelyexplained by syntax, but also by considering prosody as the interplaybetween linguistic knowledge and constraints of a biomechanicalsystem. Despite her neuromotor impairment, the subject is able touse pauses to signal a prosodic hierarchy.},
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Bdsk-Url-1 = {http://dx.doi.org/10.17851/2237-2083.12.2.181-191}}2003 (7)
Producción de unidades lingüísticas y no lingüísticas en el habla de pacientes con enfermedad de Alzheimer. Tapia, M., Quiroga, P., & Valdivieso, H. Anales de Psiquiatría, 19(8):323–328, 2003.
Paper abstract bibtex
Paper abstract bibtex Estudios en sujetos con enfermedad de Alzheimer (EA) revelan diferencias en su producción del habla comparada con la de personas mayores normales. El hallazgo más frecuente ha sido un menor número de unidades lingüísticas y una mayor duración de las pausas en el habla. En este artículo, se presentan los resultados de las unidades lingüísticas y no lingüísticas durante entrevistas grabadas a 16 pacientes con EA y 21 senescentes normales. Los diagnósticos fueron efectuados por psiquiatras, (Proyecto "Demencias asociadas a edad" Facultad de Medicina, Universidad de Concepción, Chile) mediante procedimiento multifásico: tamizaje validado para deterioro cognitivo, criterios clínicos estandarizados para demencia y escalas de estadio, igualmente validadas. Los pacientes, mostraron una producción de secuencias de habla más pequeñas y más turnos en la conversación. Esto concuerda con hallazgos anteriores que identifican la variable duración de las pausas como la más discriminante entre los grupos, lo que sugiere que la búsqueda de palabras y la planificación del discurso estarían alteradas en ellos, debido a los procesos degenerativos propios de la EA.
@article{tapia_produccion_2003,
Author = {Tapia, Mónica and Quiroga, Pilar and Valdivieso, Humberto},
Date = {2003},
Date-Modified = {2018-05-30 18:50:16 +0000},
Journal = {Anales de Psiquiatría},
Keywords = {Alzheimer, América, Chile, clinical, clinical phonetics, disfluencies, geographical variation, pauses, phonetics, prosody, Spanish, speech production, temporal factors, phonetics},
Number = {8},
Pages = {323--328},
Title = {Producción de unidades lingüísticas y no lingüísticas en el habla de pacientes con enfermedad de Alzheimer},
Url = {https://www.academia.edu/12817044/Producci?n_de_unidades_ling??sticas_y_no_ling??sticas_en_el_habla_de_pacientes_con_enfermedad_de_Alzheimer},
Volume = {19},
Year = {2003},
Abstract = {Estudios en sujetos con enfermedad de Alzheimer (EA) revelan diferencias en su producción del habla comparada con la de personas mayores normales. El hallazgo más frecuente ha sido un menor número de unidades lingüísticas y una mayor duración de las pausas en el habla. En este artículo, se presentan los resultados de las unidades lingüísticas y no lingüísticas durante entrevistas grabadas a 16 pacientes con EA y 21 senescentes normales. Los diagnósticos fueron efectuados por psiquiatras, (Proyecto "Demencias asociadas a edad" Facultad de Medicina, Universidad de Concepción, Chile) mediante procedimiento multifásico: tamizaje validado para deterioro cognitivo, criterios clínicos estandarizados para demencia y escalas de estadio, igualmente validadas. Los pacientes, mostraron una producción de secuencias de habla más pequeñas y más turnos en la conversación. Esto concuerda con hallazgos anteriores que identifican la variable duración de las pausas como la más discriminante entre los grupos, lo que sugiere que la búsqueda de palabras y la planificación del discurso estarían alteradas en ellos, debido a los procesos degenerativos propios de la EA.},
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Bdsk-Url-1 = {https://www.academia.edu/12817044/Producci?n_de_unidades_ling??sticas_y_no_ling??sticas_en_el_habla_de_pacientes_con_enfermedad_de_Alzheimer}}Análisis de los enunciados producidos despues de una pausa en la conversación de enfermos de Alzheimer y de senescentes normales. Tapia, M. Revista de Lingüística Teórica y Aplicada, 41:103–118, 2003.
abstract bibtex
abstract bibtex
Studies about speech characteristics of Alzheimer patients reveal their difficulties to search for words and their problems to produce utterances according to the communicative situation. This article examines the utterances produced by mild and moderate Alzheimer patients and normal elderly subjects after pausing during a conversation. The sample was constituted by 21 normal elderly subjects and 16 Alzheimer patients. Both groups were assessed within The Age Associated Dementia Project at the School of Medicine in the University of Concepción through a multiphasic procedure in which the MMSEm and PFAQm criteria for cognitive impairment and the DSM-III and CIE-10 criteria for dementia were used. The speech samples were gathered through recorded conversations with the subjects. The speech material was transcribed into simple notation. The utterance content after a pause that expressed a difficulty in discourse planning was besides analysed. The findings reveal that Alzheimer patients show difficulties to complete coherently utterances interrupted by a pause.
@article{tapia_alisis_2003,
Author = {Tapia, Mónica},
Date = {2003},
Date-Modified = {2018-05-30 18:50:16 +0000},
Journal = {Revista de Lingüística Teórica y Aplicada},
Keywords = {age, Alzheimer, América, Chile, clinical, clinical phonetics, disfluencies, geographical variation, interspeaker variation, pauses, phonetics, prosody, Spanish, temporal factors, phonetics},
Pages = {103--118},
Title = {Análisis de los enunciados producidos despues de una pausa en la conversación de enfermos de Alzheimer y de senescentes normales},
Volume = {41},
Year = {2003},
Abstract = {Studies about speech characteristics of Alzheimer patients reveal their difficulties to search for words and their problems to produce utterances according to the communicative situation. This article examines the utterances produced by mild and moderate Alzheimer patients and normal elderly subjects after pausing during a conversation. The sample was constituted by 21 normal elderly subjects and 16 Alzheimer patients. Both groups were assessed within The Age Associated Dementia Project at the School of Medicine in the University of Concepción through a multiphasic procedure in which the MMSEm and PFAQm criteria for cognitive impairment and the DSM-III and CIE-10 criteria for dementia were used. The speech samples were gathered through recorded conversations with the subjects. The speech material was transcribed into simple notation. The utterance content after a pause that expressed a difficulty in discourse planning was besides analysed. The findings reveal that Alzheimer patients show difficulties to complete coherently utterances interrupted by a pause.}}Cyclin A and ki-67 expression as predictors for locoregional recurrence and outcome in laryngeal cancer patients treated with surgery and postoperative radiotherapy. Saarilahti, K., Kajanti, M., Kouri, M., Aaltonen, L. M., Franssila, K., & Joensuu, H. International Journal of Radiation Oncology Biology Physics, 57(4):986-995, 2003. 738NB Times Cited:3 Cited References Count:59
bibtex
bibtex
@Article{Saarilahti_2003_1283,
author = {Saarilahti, K. and Kajanti, M. and Kouri, M. and Aaltonen, L. M. and Franssila, K. and Joensuu, H.},
journal = {International Journal of Radiation Oncology Biology Physics},
note = {738NB Times Cited:3 Cited References Count:59},
number = {4},
pages = {986-995},
title = {Cyclin A and ki-67 expression as predictors for locoregional recurrence and outcome in laryngeal cancer patients treated with surgery and postoperative radiotherapy},
volume = {57},
year = {2003},
keywords = {cyclin, a, ki-67, laryngeal, cancer, radiotherapy, outcome, squamous-cell, carcinoma, neck-cancer, clinical, relevance, lung, carcinomas, poor-prognosis, cdk, inhibitors, treatment, time, messenger-rna, head, d1},
title_with_no_special_chars = {Cyclin A and Ki67 expression as predictors for locoregional recurrence and outcome in laryngeal cancer patients treated with surgery and postoperative radiotherapy}
}Serum protein expression profiling for cancer detection: Validation of a seldi-based approach for prostate cancer. Grizzle, W. E., Adam, B. L., Bigbee, W. L., Conrads, T. P., Carroll, C., Feng, Z., Izbicka, E., Jendoubi, M., Johnsey, D., Kagan, J., Leach, R. J., McCarthy, D. B., Semmes, O. J., Srivastava, S., Srivastava, S., Thompson, I. M., Thornquist, M. D., Verma, M., Zhang, Z., & Zou, Z. Dis Markers, 19(4-5):185-95, 2003. P30 ca54174/ca/nci Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Netherlands
bibtex
bibtex
@Article{Grizzle_2003_1213,
author = {Grizzle, W. E. and Adam, B. L. and Bigbee, W. L. and Conrads, T. P. and Carroll, C. and Feng, Z. and Izbicka, E. and Jendoubi, M. and Johnsey, D. and Kagan, J. and Leach, R. J. and McCarthy, D. B. and Semmes, O. J. and Srivastava, S. and Srivastava, S. and Thompson, I. M. and Thornquist, M. D. and Verma, M. and Zhang, Z. and Zou, Z.},
journal = {Dis Markers},
note = {P30 ca54174/ca/nci Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Netherlands},
number = {4-5},
pages = {185-95},
title = {Serum protein expression profiling for cancer detection: {V}alidation of a seldi-based approach for prostate cancer},
volume = {19},
year = {2003},
keywords = {Adenocarcinoma/blood/*diagnosis, Algorithms, Blood, Proteins/*analysis, Clinical, Trials, Humans, Male, Prostatic, Neoplasms/blood/*diagnosis, Research, Design, Spectrometry, Mass, Matrix-Assisted, Laser, Desorption-Ionization},
title_with_no_special_chars = {Serum protein expression profiling for cancer detection Validation of a SELDIbased approach for prostate cancer}
}Clinical decision support in critical care nursing. Lyons, A. & Richardson, S. AACN clinical issues, 14(3):295–301, August, 2003.
abstract bibtex
abstract bibtex
A clinical decision support system (CDSS) is a computerized application that helps clinicians detect and prevent untoward clinical events such as drug interactions, errors of omission, and trends in symptomatology. A CDSS in healthcare usually is built around an alerting system based on rules of logic. The alerting system of a CDSS can notify clinicians immediately on clinical data entry, or it can generate alerts over time after relating data from multiple sources. A CDSS for nurses and patients offers immediate benefits for nurses and patients by detecting potential drug-laboratory and drug-drug combinations and impending pharmacologic complications, monitoring microbiology results, and helping nurses relate symptoms to pharmacology and medication side effects. Other benefits include savings in time and money and reductions in morbidity and mortality. A CDSS presents an opportunity for nursing informatics and critical care nursing to collaborate for the benefit of the patient and the profession.
@article{lyons_clinical_2003,
title = {Clinical decision support in critical care nursing},
volume = {14},
issn = {1079-0713},
abstract = {A clinical decision support system (CDSS) is a computerized application that helps clinicians detect and prevent untoward clinical events such as drug interactions, errors of omission, and trends in symptomatology. A CDSS in healthcare usually is built around an alerting system based on rules of logic. The alerting system of a CDSS can notify clinicians immediately on clinical data entry, or it can generate alerts over time after relating data from multiple sources. A CDSS for nurses and patients offers immediate benefits for nurses and patients by detecting potential drug-laboratory and drug-drug combinations and impending pharmacologic complications, monitoring microbiology results, and helping nurses relate symptoms to pharmacology and medication side effects. Other benefits include savings in time and money and reductions in morbidity and mortality. A CDSS presents an opportunity for nursing informatics and critical care nursing to collaborate for the benefit of the patient and the profession.},
language = {eng},
number = {3},
journal = {AACN clinical issues},
author = {Lyons, Ann and Richardson, Stephanie},
month = aug,
year = {2003},
pmid = {12909797},
keywords = {Adverse Drug Reaction Reporting Systems, Critical Care, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Humans, Nursing Process, Software},
pages = {295--301}
}Investigation of antibiotic and antibacterial agent cross-resistance in target bacteria from homes of antibacterial product users and nonusers. Cole, E. C., Addison, R. M., Rubino, J. R., Leese, K. E., Dulaney, P. D., Newell, M. S., Wilkins, J., Gaber, D. J., Wineinger, T., & Criger, D. A. Journal of Applied Microbiology, 95(4):664–676, 2003.
doi abstract bibtex
doi abstract bibtex
AIM: To describe the relationship between antibiotic and antibacterial resistance in environmental and clinical bacteria from home environments across geographical locations, relative to the use or nonuse of antibacterial products, with a focus on target organisms recognized as potential human pathogens. METHODS AND RESULTS: In a randomized study, environmental and clinical samples were collected from the homes of antibacterial product users (n=30) and nonusers (n=30) for the isolation of target bacteria for antibiotic and antibacterial testing in three geographical areas (in USA and UK). Isolates were tested for antibiotic susceptibility, with selected antibiotic-resistant and antibiotic-susceptible isolates tested against four common antibacterial agents (triclosan, para-chloro-meta-xylenol, pine oil and quaternary ammonium compound). Prequalified users and nonusers at each location were randomly selected after meeting exclusionary criteria. Of 1238 isolates, more target bacteria were recovered from nonuser than user homes. Of Staphylococcus aureus isolates (n=33), none showed resistance to oxacillin or vancomycin; for Enterococcus sp. (n=149), none were resistant to ampicillin or vancomycin; and for Klebsiella pneumoniae (n=54)and Escherichia coli (n=24), none were resistant to third generation cephalosporins. Antibiotic resistance to one or more of the standard test panel drugs for Gram-positive and Gram-negative target bacteria was comparable between nonuser and user homes for both environmental and clinical isolates [e.g. resistance of environmental coagulase-negative (CN) Staphylococcus sp. was 73.8% (124/168) from nonuser homes and 73.0% (111/152) from user homes, and Enterobacteriaceae other than E. coli, 75.9% (186/245) from nonuser homes compared with 78.0% from user homes]. Of 524 Gram-negatives tested against preferred/alternative drugs, 97.1% (509/524) were susceptible to all antibiotics, across both groups. Isolates of S. aureus, Enterococcus sp. and CN Staphylococcus sp. susceptible to all preferred treatment drugs showed comparable antibacterial minimum inhibitory concentration (MIC) results between nonuser and user home isolates. For Gram-positives resistant to one or more preferred drugs, greatest resistance to antibacterial active ingredients was found in the nonuser group. For Gram-negatives, the antibacterial MIC data were comparable for isolates that were fully susceptible and resistant to one or more preferred/alternative treatment antibiotics. CONCLUSIONS: The results showed a lack of antibiotic and antibacterial agent cross-resistance in target bacteria from the homes of antibacterial product users and nonusers, as well as increased prevalence of potential pathogens in nonuser homes. SIGNIFICANCE AND IMPACT OF THE STUDY: It refutes widely publicized, yet unsupported, hypotheses that use of antibacterial products facilitates the development of antibiotic resistance in bacteria from the home environment.
@article{cole_investigation_2003,
title = {Investigation of antibiotic and antibacterial agent cross-resistance in target bacteria from homes of antibacterial product users and nonusers},
volume = {95},
issn = {13645072},
doi = {10.1046/j.1365-2672.2003.02022.x},
abstract = {AIM: To describe the relationship between antibiotic and antibacterial resistance in environmental and clinical bacteria from home environments across geographical locations, relative to the use or nonuse of antibacterial products, with a focus on target organisms recognized as potential human pathogens. METHODS AND RESULTS: In a randomized study, environmental and clinical samples were collected from the homes of antibacterial product users (n=30) and nonusers (n=30) for the isolation of target bacteria for antibiotic and antibacterial testing in three geographical areas (in USA and UK). Isolates were tested for antibiotic susceptibility, with selected antibiotic-resistant and antibiotic-susceptible isolates tested against four common antibacterial agents (triclosan, para-chloro-meta-xylenol, pine oil and quaternary ammonium compound). Prequalified users and nonusers at each location were randomly selected after meeting exclusionary criteria. Of 1238 isolates, more target bacteria were recovered from nonuser than user homes. Of Staphylococcus aureus isolates (n=33), none showed resistance to oxacillin or vancomycin; for Enterococcus sp. (n=149), none were resistant to ampicillin or vancomycin; and for Klebsiella pneumoniae (n=54)and Escherichia coli (n=24), none were resistant to third generation cephalosporins. Antibiotic resistance to one or more of the standard test panel drugs for Gram-positive and Gram-negative target bacteria was comparable between nonuser and user homes for both environmental and clinical isolates [e.g. resistance of environmental coagulase-negative (CN) Staphylococcus sp. was 73.8\% (124/168) from nonuser homes and 73.0\% (111/152) from user homes, and Enterobacteriaceae other than E. coli, 75.9\% (186/245) from nonuser homes compared with 78.0\% from user homes]. Of 524 Gram-negatives tested against preferred/alternative drugs, 97.1\% (509/524) were susceptible to all antibiotics, across both groups. Isolates of S. aureus, Enterococcus sp. and CN Staphylococcus sp. susceptible to all preferred treatment drugs showed comparable antibacterial minimum inhibitory concentration (MIC) results between nonuser and user home isolates. For Gram-positives resistant to one or more preferred drugs, greatest resistance to antibacterial active ingredients was found in the nonuser group. For Gram-negatives, the antibacterial MIC data were comparable for isolates that were fully susceptible and resistant to one or more preferred/alternative treatment antibiotics. CONCLUSIONS: The results showed a lack of antibiotic and antibacterial agent cross-resistance in target bacteria from the homes of antibacterial product users and nonusers, as well as increased prevalence of potential pathogens in nonuser homes. SIGNIFICANCE AND IMPACT OF THE STUDY: It refutes widely publicized, yet unsupported, hypotheses that use of antibacterial products facilitates the development of antibiotic resistance in bacteria from the home environment.},
number = {4},
journal = {Journal of Applied Microbiology},
author = {Cole, E. C. and Addison, R. M. and Rubino, J. R. and Leese, K. E. and Dulaney, P. D. and Newell, M. S. and Wilkins, J. and Gaber, D. J. and Wineinger, T. and Criger, D. A.},
year = {2003},
pmid = {12969278},
keywords = {Antibacterial, Antibiotic, Antimicrobial, Bacteria, Clinical, Environmental, Home, Resistance},
pages = {664--676},
}Drug eluting stents: Are human and animal studies comparable?. Virmani, R., Kolodgie, F. D., Farb, A., & Lafont, A. Heart, 89(2):133-138, 2003. DA - 20030115 NOT IN FILE
bibtex
bibtex
@Article{Virmani_2003_1305,
author = {Virmani, R. and Kolodgie, F. D. and Farb, A. and Lafont, A.},
journal = {Heart},
note = {DA - 20030115 NOT IN FILE},
number = {2},
pages = {133-138},
title = {Drug eluting stents: {A}re human and animal studies comparable?},
volume = {89},
year = {2003},
keywords = {Animals, Arteries, Balloon, Dilatation, Brachytherapy, Clinical, Trials, Coronary, Restenosis, drug, effects, Drug, Implants, Humans, methods, Models, Animal, pathology, physiology, prevention, &, control, Stents, Wound, Healing},
title_with_no_special_chars = {Drug eluting stents Are human and animal studies comparable}
}2001 (2)
Assessing risk and harm: the convergence of ethical and empirical considerations. Macciocchi, S. N. & Stringer, A. Y. Archives of Physical Medicine and Rehabilitation, 82(12 Suppl 2):S15–19, December, 2001. Number: 12 Suppl 2
abstract bibtex
abstract bibtex
Neurorehabilitation clinicians are frequently asked to make clinical predictions of risk and harm in cases where persons with brain injury are believed to be unable or unsafe to conduct normal activities of daily living. Because predictions of risk and harm may ultimately limit a brain-injured person's autonomy, clinical decision makers should be aware of the ethical and empirical issues involved in such determinations. Constraining autonomy can be an ethical problem even when clinicians are apparently acting in patients' best interests. Clinicians must consider their ability to make accurate risk and harm predictions based on clinical data. Clinicians who are aware of contemporary ethical principles will be most prepared to integrate ethical and empirical considerations when determining risk and harm.
@article{macciocchi_assessing_2001,
title = {Assessing risk and harm: the convergence of ethical and empirical considerations},
volume = {82},
issn = {0003-9993},
shorttitle = {Assessing risk and harm},
abstract = {Neurorehabilitation clinicians are frequently asked to make clinical predictions of risk and harm in cases where persons with brain injury are believed to be unable or unsafe to conduct normal activities of daily living. Because predictions of risk and harm may ultimately limit a brain-injured person's autonomy, clinical decision makers should be aware of the ethical and empirical issues involved in such determinations. Constraining autonomy can be an ethical problem even when clinicians are apparently acting in patients' best interests. Clinicians must consider their ability to make accurate risk and harm predictions based on clinical data. Clinicians who are aware of contemporary ethical principles will be most prepared to integrate ethical and empirical considerations when determining risk and harm.},
language = {eng},
number = {12 Suppl 2},
journal = {Archives of Physical Medicine and Rehabilitation},
author = {Macciocchi, S. N. and Stringer, A. Y.},
month = dec,
year = {2001},
pmid = {11805915},
note = {Number: 12 Suppl 2},
keywords = {Activities of Daily Living, Bioethics and Professional Ethics, Brain Injuries, Decision Making, Ethics, Clinical, Female, Health Care and Public Health, Humans, Injury Severity Score, Male, Personal Autonomy, Physical and Rehabilitation Medicine, Predictive Value of Tests, Prognosis, Quality of Life, Risk Assessment},
pages = {S15--19},
}Too many vessels? not enough? the wrong kind? the VEGF debate continues. Ware, J. A. Nat.Med., 7(4):403-404, 2001. DA - 20010403 NOT IN FILE
bibtex
bibtex
@Article{Ware_2001_1497,
author = {Ware, J. A.},
journal = {Nat.Med.},
note = {DA - 20010403 NOT IN FILE},
number = {4},
pages = {403-404},
title = {Too many vessels? not enough? the wrong kind? the VEGF debate continues},
volume = {7},
year = {2001},
keywords = {adverse, effects, Animals, Arteriosclerosis, Clinical, Trials, drug, effects, drug, therapy, Endothelial, Growth, Factors, etiology, Humans, Lymphokines, Myocardial, Ischemia, Neovascularization, Pathologic, Neovascularization, Physiologic, pharmacology, physiology, Safety, Vascular, Endothelial, Growth, Factor, A, Vascular, Endothelial, Growth, Factors},
title_with_no_special_chars = {Too many vessels Not enough The wrong kind The VEGF debate continues}
}2000 (1)
A multiscale dynamic programming procedure for boundary detection in ultrasonic artery images. Quan, L., Wendelhag, I., Wikstrand, J., & Gustavsson, T. Medical Imaging, IEEE Transactions on, 19(2):127-142, 2000. 0278-0062
bibtex
bibtex
@Article{Quan_2000_5468,
author = {Quan, Liang and Wendelhag, I. and Wikstrand, J. and Gustavsson, T.},
journal = {Medical Imaging, IEEE Transactions on},
note = {0278-0062},
number = {2},
pages = {127-142},
title = {A multiscale dynamic programming procedure for boundary detection in ultrasonic artery images},
volume = {19},
year = {2000},
keywords = {biomedical, ultrasonics, blood, vessels, dynamic, programming, edge, detection, medical, image, processing, clinical, environment, coarse-scale, image, cost, function, fine-scale, image, fuzzy, expression, forms, geometrical, characteristics, global, optimality, human, expert, tracings, manual, procedure, medical, diagnostic, imaging, operator, intervention, overall, analysis, time, subjectiveness, vessel, interfaces},
title_with_no_special_chars = {A multiscale dynamic programming procedure for boundary detection in ultrasonic artery images}
}1994 (1)
Do clinical clerks suffer ethical erosion? Students' perceptions of their ethical environment and personal development. Feudtner, C., Christakis, A, D., Christakis, & A, N. Academic medicine: journal of the Association of American Medical Colleges, 69(8):670--679, August, 1994.
Paper abstract bibtex
Paper abstract bibtex BACKGROUND: Little is known about the ethical dilemmas that medical students believe they encounter while working in hospitals or how students feel these dilemmas affect them. The authors examine how clinical students perceive their ethical environment, their feelings about their dilemmas, and whether these dilemmas erode students' ethical principles. METHOD: An anonymous mail survey was sent in 1992-93 to the 1,853 third- and fourth-year medical students enrolled at six Pennsylvania medical schools. The survey addressed whether students had encountered situations they felt were ethically problematic, their attitudes toward these situations, and their perceptions of their personal ethical development. Data were analyzed with logistic regression; respondents' comments were analyzed qualitatively. RESULTS: Of the 665 students (36%) who responded, 58% reported having done something they believed was unethical, and 52% reported having misled a patient; 80% reported at least one of these two behaviors. In addition, 98% had heard physicians refer derogatorily to patients; 61% had witnessed what they believed to be unethical behavior by other medical team members, and of these students, 54% felt like accomplices. Many students reported dissatisfaction with their actions and ethical development: 67% had felt bad or guilty about something they had done as clinical clerks; 62% believed that at least some of their ethical principles had been eroded or lost. Controlling for other factors, students who had witnessed an episode of unethical behavior were more likely to have acted improperly themselves for fear of poor evaluation [odds ratio, OR, 1.37 (95% CI, 1.18-1.60)] or to fit in with the team [OR 1.45 (1.25-1.69)]. Moreover, students were twice as likely to report erosion of their ethical principles if they had behaved unethically for fear of poor evaluation [OR 2.25 (1.47-3.45)] or to fit in with the team [OR 1.78 (1.18-2.71)]. CONCLUSION: The ethical dilemmas that medical students perceive as affecting them while serving as clinical clerks are apparently common and often detrimental, and warrant the attention of physicians, educators, and ethicists.
@article{ feudtner_clinical_1994,
title = {Do clinical clerks suffer ethical erosion? Students' perceptions of their ethical environment and personal development},
volume = {69},
issn = {1040-2446},
shorttitle = {Do clinical clerks suffer ethical erosion?},
url = {http://www.nicholaschristakis.net/pdf/publications/articles/018.pdf},
abstract = {{BACKGROUND}: Little is known about the ethical dilemmas that medical students believe they encounter while working in hospitals or how students feel these dilemmas affect them. The authors examine how clinical students perceive their ethical environment, their feelings about their dilemmas, and whether these dilemmas erode students' ethical principles.
{METHOD}: An anonymous mail survey was sent in 1992-93 to the 1,853 third- and fourth-year medical students enrolled at six Pennsylvania medical schools. The survey addressed whether students had encountered situations they felt were ethically problematic, their attitudes toward these situations, and their perceptions of their personal ethical development. Data were analyzed with logistic regression; respondents' comments were analyzed qualitatively.
{RESULTS}: Of the 665 students (36%) who responded, 58% reported having done something they believed was unethical, and 52% reported having misled a patient; 80% reported at least one of these two behaviors. In addition, 98% had heard physicians refer derogatorily to patients; 61% had witnessed what they believed to be unethical behavior by other medical team members, and of these students, 54% felt like accomplices. Many students reported dissatisfaction with their actions and ethical development: 67% had felt bad or guilty about something they had done as clinical clerks; 62% believed that at least some of their ethical principles had been eroded or lost. Controlling for other factors, students who had witnessed an episode of unethical behavior were more likely to have acted improperly themselves for fear of poor evaluation [odds ratio, {OR}, 1.37 (95% {CI}, 1.18-1.60)] or to fit in with the team [{OR} 1.45 (1.25-1.69)]. Moreover, students were twice as likely to report erosion of their ethical principles if they had behaved unethically for fear of poor evaluation [{OR} 2.25 (1.47-3.45)] or to fit in with the team [{OR} 1.78 (1.18-2.71)].
{CONCLUSION}: The ethical dilemmas that medical students perceive as affecting them while serving as clinical clerks are apparently common and often detrimental, and warrant the attention of physicians, educators, and ethicists.},
language = {eng},
number = {8},
journal = {Academic medicine: journal of the Association of American Medical Colleges},
author = {Feudtner, C and Christakis, D A and Christakis, N A},
month = {August},
year = {1994},
pmid = {8054117},
keywords = {Adult, Attitude of Health Personnel, Behavior, Clinical Clerkship, Complicity, Conflict (Psychology), Disclosure, Ethics, Clinical, Ethics, Medical, Humans, Interpersonal Relations, Male, Moral Development, Pennsylvania, Professional Misconduct, Social Perception, Students, Medical, Whistleblowing},
pages = {670--679}
}1993 (1)
Audiometría vocal. Prueba de intelibigilidad. Discriminación acústica. Confusión consonántica. Widex Audífonos SA Widex Audífonos SA, Barcelona, 1993. Listas elaboradas por el Departamento de Filología Española de la UAB - J. M. Garrido y J. Llisterri. Medida del poder separador temporal Test Leman-Renard. Elaborado por el Dr. Leman y X. Renard. Locutor: J. Royo
bibtex
bibtex
@book{widex_audifonos_sa_audiometrivocal._1993,
Address = {Barcelona},
Author = {{Widex Audífonos SA}},
Date = {1993},
Date-Modified = {2018-05-30 18:50:17 +0000},
Keywords = {assessment, audiology, audiometry, clinical, clinical phonetics, hearing impairment, materials, Spanish, speech perception, phonetics},
Note = {Listas elaboradas por el Departamento de Filología Española de la UAB - J. M. Garrido y J. Llisterri. Medida del poder separador temporal Test Leman-Renard. Elaborado por el Dr. Leman y X. Renard. Locutor: J. Royo},
Publisher = {Widex Audífonos SA},
Title = {Audiometría vocal. Prueba de intelibigilidad. Discriminación acústica. Confusión consonántica.},
Titleaddon = {{CD Digital Audio}},
Year = {1993}}1992 (2)
Lingüística y patología del lenguaje y del habla. Jackson, C A In Panorama de la lingüística moderna de la Universidad de Cambridge. Volumen III El lenguaje: aspectos psicológicos y biológicos, pages 297-316. Visor, Madrid, 1992.
bibtex
bibtex
@incollection{jackson_linguistica_1992,
Address = {Madrid},
Author = {Jackson, C A},
Booktitle = {Panorama de la lingüística moderna de la Universidad de Cambridge. Volumen III El lenguaje: aspectos psicológicos y biológicos},
Date = {1992},
Date-Modified = {2018-05-30 18:51:33 +0000},
Editor = {Newmeyer, F J},
Keywords = {clinical, clinical linguistics, linguistics},
Language = {es},
Pages = {297-316},
Publisher = {Visor},
Title = {Lingüística y patología del lenguaje y del habla},
Translator = {Llisterri, Joaquim},
Year = {1992}}Diseño de un corpus en español para pruebas audiométricas. Garrido, J. M. & Llisterri, J. Technical Report Departament de Filologia Espanyola, Universitat Autònoma de Barcelona, Bellaterra, 1992.
Paper bibtex
Paper bibtex @techreport{garrido_diseno_1992,
Address = {Bellaterra},
Author = {Garrido, Juan María and Llisterri, Joaquim},
Date = {1992},
Date-Modified = {2018-05-30 18:50:03 +0000},
Institution = {Departament de Filologia Espanyola, Universitat Autònoma de Barcelona},
Keywords = {assessment, audiology, audiometry, clinical, clinical phonetics, hearing impairment, speech perception, phonetics},
Title = {Diseño de un corpus en español para pruebas audiométricas},
Type = {Informe técnico para Widex Audífonos SA, Barcelona},
Url = {http://liceu.uab.cat/~joaquim/publicacions/Garrido_Llisterri_92_Audiometria.pdf},
Year = {1992},
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Bdsk-Url-1 = {http://liceu.uab.cat/~joaquim/publicacions/Garrido_Llisterri_92_Audiometria.pdf}}1987 (1)
Pausing in the speech of deaf young adults. Bochner, J. H, Barefoot, S. M, & Johnson, B. A. Journal of Phonetics, 15(4):323–333, 1987.
Paper bibtex
Paper bibtex @article{bochner_pausing_1987,
Author = {Bochner, Joseph H and Barefoot, Sidney M and Johnson, Barbara Ann},
Date = {1987},
Date-Modified = {2018-05-30 18:49:59 +0000},
Journal = {Journal of Phonetics},
Keywords = {audiology, clinical, clinical phonetics, disfluencies, English, hearing impairment, intelligibility, pause duration, pause location, pauses, phonetics, prosody, read speech, speaking styles, speech perception, speech rate, temporal factors, phonetics},
Number = {4},
Pages = {323--333},
Title = {Pausing in the speech of deaf young adults},
Url = {https://www.researchgate.net/publication/258265868_Pausing_in_the_speech_of_deaf_young_adults},
Volume = {15},
Year = {1987},
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Clinical Comparison of Two Photosensitizers for Oral Cavity Decontamination. Adad, H., R., Donato, R., Pratavieira, S., O., Grecco, C., Brugnera-Jú, A., Bagnato, V., S., & Kurachi, C.
Paper abstract bibtex
Paper abstract bibtex Objective: In this study, we aim to compare the photodynamic inactivation (PDI) effects of two different photosensitizers (PS), Photogem Ò and Natural Curcumin, irradiated with light-emitted diodes (LED) at 630 and 450 nm, respectively. Background: The current antimicrobial mouthwash for oral hygiene has several draw-backs. In this context, PDI is an alternative technique to inactivate pathogenic microbes in mucosa and in periodontal tissue. Furthermore, there are numerous infectious diseases that may affect the oral cavity, moti-vating the use of PDI in dentistry. Methods: The volunteers (n = 50) were randomize separated into five experimental groups (n = 5) for each PS: water control, PS control, light control, and two PS concentrations (25 and 100 mg/L). Each patient underwent mouthwash solution containing the PS before illumination procedure that was performed with an LED device. For microbial decontamination evaluation, the saliva was collected three times: before (T0), immediately after (T1), and 24 h after the illumination procedure (T2). After that, the difference between the colony forming units (CFU) for each volunteer was compared. Results: The results show that regardless of PS and treatment applied, there was microbial reduction immediately after PDI, however, after 24 h only Natural Curcumin still presents a reduction. For Photogem after 24 h, the microorganism returns to the original CFU. Conclusions: Immediately after PDI, both PS have the same efficiency, nevertheless the Natural Curcumin still has an efficacy after 24 h and also is a more viable photosensitizer. In addition, the results indicate that PDI can be a promised technique used for microbial reducing for the oral cavity.
@article{
title = {Clinical Comparison of Two Photosensitizers for Oral Cavity Decontamination},
type = {article},
identifiers = {[object Object]},
keywords = {clinical,curcuminoids,hematoporphyrin,in vivo,photodynamic inactivation},
id = {b37e068d-29bf-3863-b933-89ba2923ec31},
created = {2017-01-14T15:53:44.000Z},
file_attached = {true},
profile_id = {9a94bc2c-179e-361a-8ebd-41a00966522f},
last_modified = {2019-01-04T17:27:45.518Z},
read = {false},
starred = {false},
authored = {true},
confirmed = {true},
hidden = {false},
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abstract = {Objective: In this study, we aim to compare the photodynamic inactivation (PDI) effects of two different photosensitizers (PS), Photogem Ò and Natural Curcumin, irradiated with light-emitted diodes (LED) at 630 and 450 nm, respectively. Background: The current antimicrobial mouthwash for oral hygiene has several draw-backs. In this context, PDI is an alternative technique to inactivate pathogenic microbes in mucosa and in periodontal tissue. Furthermore, there are numerous infectious diseases that may affect the oral cavity, moti-vating the use of PDI in dentistry. Methods: The volunteers (n = 50) were randomize separated into five experimental groups (n = 5) for each PS: water control, PS control, light control, and two PS concentrations (25 and 100 mg/L). Each patient underwent mouthwash solution containing the PS before illumination procedure that was performed with an LED device. For microbial decontamination evaluation, the saliva was collected three times: before (T0), immediately after (T1), and 24 h after the illumination procedure (T2). After that, the difference between the colony forming units (CFU) for each volunteer was compared. Results: The results show that regardless of PS and treatment applied, there was microbial reduction immediately after PDI, however, after 24 h only Natural Curcumin still presents a reduction. For Photogem after 24 h, the microorganism returns to the original CFU. Conclusions: Immediately after PDI, both PS have the same efficiency, nevertheless the Natural Curcumin still has an efficacy after 24 h and also is a more viable photosensitizer. In addition, the results indicate that PDI can be a promised technique used for microbial reducing for the oral cavity.},
bibtype = {article},
author = {Adad, Hé Rica and Donato, Ricci and Pratavieira, Sebastiã O and Grecco, Clovis and Brugnera-Jú, Aldo and Bagnato, Vanderlei Salvador and Kurachi, Cristina}
}