Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.
200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). ⋯ Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.
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A critical mass of Internet users is leading to a wide diffusion of electronic communications within medical practice. Unless implemented with substantial forethought, these new technological linkages could disturb delicate balances in the doctor-patient relationship, threaten the privacy of medical information, widen social disparity in health outcomes, and even function as barriers to access. ⋯ This paper describes the motivations for and the design of HealthConnect, a web-based patient-doctor communications tool currently in use at Children's Hospital, Boston. Structural and process-oriented features of HealthConnect, as they relate to promotion of adherence with the Guidelines, are discussed.
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Continuity of care necessitates communication between the primary providers of inpatient and outpatient care. Communication requires identification of providers in addition to clinical information. We have constructed a web-based SignOut System to improve provider identification. ⋯ When analyzed by attending type (i.e., service and private,) the SignOut System correctly identified 86% of service providers in contrast to the hospital bed census that correctly identified 57% of service providers. Both the SignOut System (100%) and the hospital bed census (95%) had superior results in identifying private attendings. The web-based technology provides a familiar user interface and ubiquitous workstation access.
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A limiting factor in realizing the full potential of electronic medical records (EMR) is physician reluctance to use these applications. There have been very few formal usability studies of experienced physician users of EMRs in routine clinical use. ⋯ Overall user satisfaction was most highly correlated with screen design and layout, and surprisingly not with system response time. Human-computer interaction studies can help focus our design efforts as we strive to increase clinician usage of information technology.
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Artifacts in clinical intensive care monitoring lead to false alarms and complicate data analysis. They must be identified and processed to obtain true information. In this paper, we present a method for detecting artifacts in heart-rate (HR) and mean blood-pressure (BP) data from a physiological monitoring system used in preterm infants. ⋯ In a huge space of CVDetector instances, we have successfully discovered an optimal CVDetector instance, denoted by CVDetector. The sensitivity and specificity of CVDetector for HR artifacts is 94.8% (SD = 7.6%) and 90.6% (SD = 6.9%), respectively. The sensitivity and specificity of CVDetector for BP artifacts is 94.2% (SD = 5.3%) and 80.0% (SD = 12.4%), respectively.