scholarly journals The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review

2021 ◽  
Vol 27 (2) ◽  
pp. 146045822110075
Author(s):  
Olufisayo Olusegun Olakotan ◽  
Maryati Mohd Yusof
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Inclusion Criteria ◽  
Clinical Practices ◽  
Clinical Workflow ◽  
Ovid Medline ◽  
Human Organization ◽  
Technical Framework

A CDSS generates a high number of inappropriate alerts that interrupt the clinical workflow. As a result, clinicians silence, disable, or ignore alerts, thereby undermining patient safety. Therefore, the effectiveness and appropriateness of CDSS alerts need to be evaluated. A systematic review was carried out to identify the factors that affect CDSS alert appropriateness in supporting clinical workflow. Seven electronic databases (PubMed, Scopus, ACM, Science Direct, IEEE, Ovid Medline, and Ebscohost) were searched for English language articles published between 1997 and 2018. Seventy six papers met the inclusion criteria, of which 26, 24, 15, and 11 papers are retrospective cohort, qualitative, quantitative, and mixed-method studies, respectively. The review highlights various factors influencing the appropriateness and efficiencies of CDSS alerts. These factors are categorized into technology, human, organization, and process aspects using a combination of approaches, including socio-technical framework, five rights of CDSS, and Lean. Most CDSS alerts were not properly designed based on human factor methods and principles, explaining high alert overrides in clinical practices. The identified factors and recommendations from the review may offer valuable insights into how CDSS alerts can be designed appropriately to support clinical workflow.

The Use of Imaging to Detect Intracranial Tumors in Idiopathic Olfactory Dysfunction: A Systematic Review

2019 ◽  
Vol 34 (2) ◽  
pp. 297-305
Author(s):  
Jack L. Birkenbeuel ◽  
Dillon C. Cheung ◽  
Ronald Sahyouni ◽  
Khodayar Goshtasbi ◽  
Janice T. Chua ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Imaging ◽  
English Language ◽  
Screening Tool ◽  
Early Stage ◽  
Inclusion Criteria ◽  
Resonance Imaging ◽  
Detection Rates ◽  
Olfactory Loss ◽  
Ovid Medline

Objectives To review the literature regarding the use of intracranial imaging as a screening tool for idiopathic olfactory loss (IOL) and to review the incidence of identifying a sinonasal or intracranial neoplasm as a result of intracranial imaging. Methods A systematic review of published English-language literature was performed using PubMed, Ovid MEDLINE, Scopus, and Cochrane databases. Results Of the 694 available abstracts, 5 met inclusion criteria for this review. Out of 470 eligible patients, intracranial imaging identified tumors causing IOL in 8 patients (1.7%). Tumor detection rates ranged from 0% to 4.9%. Of the 470 eligible patients, intracranial imaging detected intracranial or sinonasal pathology, excluding tumors, causing IOL in 53 patients (11%). The findings ranged from 0.77% to 23%. Of the 604 eligible IOL patients, 470 (81%) underwent intracranial imaging, ranging from 53% to 100%. Conclusions In most cases, diagnostic imaging in IOL patients is frequently ordered. This study finds computed tomography or magnetic resonance imaging to be an important recommendation given to all patients with IOL. Although the overall rate of detecting tumor from diagnostic imaging is low, it is important to offer diagnostic imaging to this subset of patients to avoid missing tumors at an early stage.

scholarly journals Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys

2012 ◽  
Vol 4 (4) ◽  
pp. 425-433 ◽  
Author(s):  
Mohammad U. Malik ◽  
David A. Diaz Voss Varela ◽  
Charles M. Stewart ◽  
Kulsoom Laeeq ◽  
Gayane Yenokyan ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Medical Knowledge ◽  
Program Directors ◽  
Faculty Support ◽  
Inclusion Criteria ◽  
Competency Based Education ◽  
Inadequate Knowledge ◽  
Competency Based

Abstract Introduction The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcome Project in July 2001 to improve the quality of resident education through competency-based learning. The purpose of this systematic review is to determine and explore the perceptions of program directors regarding challenges to implementing the ACGME Outcome Project. Methods We used the PubMed and Web of Science databases and bibliographies for English-language articles published between January 1, 2001, and February 17, 2012. Studies were included if they described program directors' opinions on (1) barriers encountered when attempting to implement ACGME competency-based education, and (2) assessment methods that each residency program was using to implement competency-based education. Articles meeting the inclusion criteria were screened by 2 researchers. The grading criterion was created by the authors and used to assess the quality of each study. Results The survey-based data reported the opinions of 1076 program directors. Barriers that were encountered include: (1) lack of time; (2) lack of faculty support; (3) resistance of residents to the Outcome Project; (4) insufficient funding; (5) perceived low priority for the Outcome Project; (6) inadequate salary incentive; and (7) inadequate knowledge of the competencies. Of the 6 competencies, those pertaining to patient care and medical knowledge received the most responses from program directors and were given highest priority. Conclusions The reviewed literature revealed that time and financial constraints were the most important barriers encountered when implementing the ACGME Outcome Project.

scholarly journals XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study

10.2196/17512 ◽  
2020 ◽  
Vol 4 (10) ◽  
pp. e17512
Author(s):  
Ever Augusto Torres Silva ◽  
Sebastian Uribe ◽  
Jack Smith ◽  
Ivan Felipe Luna Gomez ◽  
Jose Fernando Florez-Arango
Keyword(s):  
Decision Support ◽  
Antenatal Care ◽  
Clinical Decision Support ◽  
Web Application ◽  
Clinical Care ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Structure Design ◽  
Mobile App ◽  
Clinical Workflow

Background Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability. Objective This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician’s perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow. Methods We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings. Results In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable. Conclusions Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.

Randomized Controlled Trials of Headache Treatments in Pregnancy: A Systematic Review

2020 ◽  
Author(s):  
Elisa T. Bushman ◽  
Gabriella Cozzi ◽  
Rachel G. Sinkey ◽  
Catherine H. Smith ◽  
Michael W. Varner ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
English Language ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Control Group ◽  
Inclusion Criteria ◽  
Headache Diagnosis ◽  
Registration Number ◽  
In Pregnancy

Abstract Objective Headaches affect 88% of reproductive-aged women. Yet data are limited addressing treatment of headache in pregnancy. While many women experience improvement in pregnancy, primary and secondary headaches can develop. Consequently, pregnancy is a time when headache diagnosis can influence maternal and fetal interventions. This study was aimed to summarize existing randomized control trials (RCTs) addressing headache treatment in pregnancy. Study Design We searched PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS from January 1, 1970 through June 31, 2019. Studies were eligible if they were English-language RCTs addressing treatment of headache in pregnancy. Conference abstracts and studies investigating postpartum headache were excluded. Three authors reviewed English-language RCTs addressing treatment of antepartum headache. To be included, all authors agreed each article to meet the following criteria: predefined control group, participants underwent randomization, and treatment of headache occurred in the antepartum period. If inclusion criteria were met no exclusions were made. Our systematic review registration number was CRD42019135874. Results A total of 193 studies were reviewed. Of the three that met inclusion criteria all were small, with follow-up designed to measure pain reduction and showed statistical significance. Conclusion Our systematic review of RCTs evaluating treatment of headache in pregnancy revealed only three studies. This paucity of data limits treatment, puts women at risk for worsening headache disorders, and delays diagnosis placing both the mother and fetus at risk for complications.

Computerized Clinical Decision Support Systems and Antibiotic Prescribing: A Systematic Review and Meta-analysis

2019 ◽  
Vol 41 (3) ◽  
pp. 552-581 ◽  
Author(s):  
Eduardo Carracedo-Martinez ◽  
Christian Gonzalez-Gonzalez ◽  
Antonio Teixeira-Rodrigues ◽  
Jesus Prego-Dominguez ◽  
Bahi Takkouche ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Meta Analysis ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Antibiotic Prescribing

scholarly journals Yoga as an Alternative and Complementary Treatment for Patients With Low Back Pain

2012 ◽  
Vol 18 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Manoj Sharma ◽  
Taj Haider
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
English Language ◽  
Holistic Approach ◽  
The United States ◽  
Low Back ◽  
Inclusion Criteria ◽  
Complementary Treatment ◽  
Study Inclusion

Low back pain is not only a leading cause of disability in the United States but also one of the most expensive to treat. Exercise proves to be inconsistent, and surgery often leads to disease reappearance. Yoga offers a holistic approach to overcome the psychological and physical aspects of low back pain. A systematic review was performed to determine the efficacy of yoga for low back pain. Study inclusion criteria were studies ( a) published in the English language, ( b) published between January 2000 and June 2012, ( c) included any form of yoga as an intervention, ( d) used any quantitative study design, and (5) measured low back pain as an outcome. Of the 13 studies included, 9 demonstrated a reduction in low back pain using yoga as part of the intervention. Limitations include lack of theory-based approaches, unclear definitions of low back pain, and multiple instruments used to measure the outcome.

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