Medical decision making : an international journal of the Society for Medical Decision Making
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Perioperative hypotension is associated with adverse outcomes in patients undergoing surgery. A computer-based model that integrates related factors and predicts the risk of hypotension would be helpful in clinical anesthesia. The purpose of this study was to develop artificial neural network (ANN) models to identify patients at high risk for postinduction hypotension during general anesthesia. ⋯ The ANN model developed in this study had good discrimination and calibration and would provide decision support to clinicians and increase vigilance for patients at high risk of postinduction hypotension during general anesthesia.
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Randomized Controlled Trial
The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial.
Eliciting patients' preferences within a framework of shared decision making (SDM) has been advocated as a strategy for increasing colorectal cancer (CRC) screening adherence. Our objective was to assess the effectiveness of a novel decision aid on SDM in the primary care setting. ⋯ Our interactive computer-based decision aid facilitates SDM, but overall effectiveness is determined by the extent to which providers comply with patient preferences.
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Processes of communication that guide decision making among clinicians collaboratively caring for complex patients are poorly understood and vary based on local contexts. In this paper, the authors characterize these processes and propose a wiki-style communication model to improve coordination of decision making among clinicians using an integrated electronic health record (EHR). ⋯ EHR-based wiki-style applications may have the potential to improve communication and care coordination among clinicians caring for complex patients. This could lead to improved quality and safety within multidisciplinary disease management programs.
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Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. ⋯ . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient's care, and collection of cost-effectiveness data is a key need for future research.
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Patients with hospital-acquired acute kidney injury (AKI) are at risk for increased mortality and further medical complications. Evaluating these patients with a prediction tool easily implemented within an electronic health record (EHR) would identify high-risk patients prior to the development of AKI and could prevent iatrogenically induced episodes of AKI and improve clinical management. ⋯ The authors generated risk prediction models for hospital-acquired AKI using only commonly available electronic data. The models identify patients at high risk for AKI who might benefit from early intervention or increased monitoring.