A Systematic Review of Clinical Vestibular Symptom Triage, Tools, and Algorithms

Objective The evaluation of peripheral vestibular disorders in clinical practice is an especially difficult endeavor, particularly for the inexperienced clinician. The goal of this systematic review is thus to evaluate the design, approaches, and outcomes for clinical vestibular symptom triage and decision support tools reported in contemporary published literature. Data Sources A comprehensive search of existing literature in August 2020 was conducted using MEDLINE, CINAHL, and EMBASE using terms of desired diagnostic tools such as algorithm, protocol, and questionnaire as well as an exhaustive set of terms to encompass vestibular disorders. Review Methods Study characteristics, tool metrics, and performance were extracted using a standardized form. Quality assessment was conducted using a modified version of the Quality of Diagnostic Accuracy Studies 2 (QUADAS-2) assessment tool. Results A total of 18 articles each reporting a novel tool for the evaluation of vestibular disorders were identified. Tools were organized into 3 discrete categories, including self-administered questionnaires, health care professional administered tools, and decision support systems. Most tools could differentiate between specific vestibular pathologies, with outcome measures including sensitivity, specificity, and accuracy. Conclusion A multitude of tools have been published to aid with the evaluation of vertiginous patients. Our systematic review identified several low-evidence reports of triage and decision support tools for the evaluation of vestibular disorders.

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Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp19x706745 ◽

2019 ◽

Vol 69 (689) ◽

pp. e809-e818 ◽

Cited By ~ 3

Author(s):

Sophie Chima ◽

Jeanette C Reece ◽

Kristi Milley ◽

Shakira Milton ◽

Jennifer G McIntosh ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Decision Making ◽

Decision Support ◽

Cost Effectiveness ◽

Cancer Diagnosis ◽

Decision Support Tools ◽

Diagnostic Decision ◽

Support Tools ◽

Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

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Decision Support Tools for Regenerative Medicine: Systematic Review

Journal of Medical Internet Research ◽

10.2196/12448 ◽

2018 ◽

Vol 20 (12) ◽

pp. e12448 ◽

Cited By ~ 2

Author(s):

Ching Lam ◽

Edward Meinert ◽

Abrar Alturkistani ◽

Alison R Carter ◽

Jeffrey Karp ◽

...

Keyword(s):

Systematic Review ◽

Decision Support ◽

Regenerative Medicine ◽

Decision Support Tools ◽

Support Tools

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Clinical Decision Support Tools for Predicting Outcomes in Patients Undergoing Total Knee Arthroplasty: A Systematic Review

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.10.053 ◽

2020 ◽

Author(s):

Jodie A. Cochrane ◽

Traci Flynn ◽

Adrian Wills ◽

Frederick R. Walker ◽

Michael Nilsson ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Decision Support ◽

Clinical Decision Support ◽

Knee Arthroplasty ◽

Clinical Decision ◽

Decision Support Tools ◽

Support Tools ◽

Total Knee ◽

Clinical Decision Support Tools

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Can evidence-based decision support tools transform antibiotic management? A systematic review and meta-analyses

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz543 ◽

2020 ◽

Vol 75 (5) ◽

pp. 1099-1111 ◽

Cited By ~ 5

Author(s):

Mah Laka ◽

Adriana Milazzo ◽

Tracy Merlin

Keyword(s):

Systematic Review ◽

Decision Support ◽

Methodological Quality ◽

Length Of Hospital Stay ◽

Clinical Decision Support Systems ◽

Antibiotic Prescribing ◽

Decision Support Tools ◽

Support Tools ◽

Antibiotic Management ◽

Meta Analyses

Abstract Objectives To assess the effectiveness of clinical decision support systems (CDSSs) at reducing unnecessary and suboptimal antibiotic prescribing within different healthcare settings. Methods A systematic review of published studies was undertaken with seven databases from database inception to November 2018. A protocol was developed using the PRISMA-P checklist and study selection criteria were determined prior to performing the search. Critical appraisal of studies was undertaken using relevant tools. Meta-analyses were performed using a random-effects model to determine whether CDSS use affected optimal antibiotic management. Results Fifty-seven studies were identified that reported on CDSS effectiveness. Most were non-randomized studies with low methodological quality. However, randomized controlled trials of moderate methodological quality were available and assessed separately. The meta-analyses indicated that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (OR 2.28, 95% CI 1.82–2.86, k = 20). The use of CDSSs was also associated with a relative decrease (18%) in mortality (OR 0.82, 95% CI 0.73–0.91, k = 18). CDSS implementation also decreased the overall volume of antibiotic use, length of hospital stay, duration and cost of therapy. The magnitude of the effect did vary by study design, but the direction of the effect was consistent in favouring CDSSs. Conclusions Decision support tools can be effective to improve antibiotic prescribing, although there is limited evidence available on use in primary care. Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship.

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