Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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Comparative Study
Neural network modeling to predict the hypnotic effect of propofol bolus induction.
Dose requirements of propofol to achieve loss of consciousness depend on the interindividual variability. Until now when propofol was administered by a single bolus, how to define the optimal individual dose and to assess its hypnotic effect have not been clearly studied. The goal of this study is to develop an artificial neural network model to predict the hypnotic effect of propofol on the basis of common clinical parameters. ⋯ The bispectral index of EEG was used to record the consciousness level of patients and served as the output factor. The predictive results of neural net models were superior to that of clinician. This model could potentially help determine the optimal dose of propofol and thus reduce the anesthetic cost.
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Randomized Controlled Trial Clinical Trial
Health care provider quality improvement organization Medicare data-sharing: a diabetes quality improvement initiative.
This paper describes a collaborative Medicare claims data linkage and sharing effort between the Baylor Health Care System (BHCS) and Texas Medical Foundation (TMF, the Texas Quality Improvement Organization) designed to assess the effect of three quality improvement interventions on care delivered to elderly patients with diabetes. The randomized controlled trial is being conducted among a network of primary care physician practices owned by BHCS and focuses on measures of care process and outcome. ⋯ The use of Medicare claims data, through collaboration with a QIO, can help health care providers overcome a significant barrier associated with quality improvement initiatives. Limitations associated with the use of Medicare claims can impact implementation of intervention strategies, but do not prevent them from being a practical tool for improving care.
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Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. ⋯ We present recommendations for incorporating support for each of these areas into point-of-care clinical information systems that provide access to shared patient records. Finally, we discuss general design approaches for incorporating this type of support, including the need for workers to maintain awareness of the activities of others, and the need to integrate communication with the presentation of the health record.
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We present a prototype of a decision support system for anesthesia that applies set covering theory. The system is designed to generate dynamically configured check-lists for intra-operative problems. These lists have the potential to help anesthesiologists detect and manage problems in a timely manner. ⋯ A set covering algorithm that accommodates multiple problem sets was used to implement the prototype. A simulated case and the system behavior are presented. The ultimate goals of a system such as the one presented are to function as an intelligent alarm module for electronic monitors and to facilitate the task of correcting intra-operative problems.
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Comparative Study
Does size matter?--Evaluation of value added content of two decades of successive coding schemes in secondary care.
Over the last two decades there has been a gradual evolution from the use of simple coding schemes to controlled clinical terminologies within clinical information systems in secondary care. This evolution has required significant resources in both the development of the different coding schemes and the cost of hardware, software and human effort in implementation. During this time there has been successively larger and more complex coding schemes available for use in the UK Health Service: Read Codes 4 byte set, Read Codes 5 byte set, ICD-10 and Clinical Terms Version 3. ⋯ The schemes are quantitatively evaluated by measuring their success in providing a concept match for every notion from the CIS and their relative merits are compared. Significant added value has accrued over the years in completeness of the schemes reflected in their increased size. There appears to be justification for the continued development of clinical terminologies to support secondary care.