Cluster randomised trial of a computer based decision support system (CDSS) and decision aid for patients with high blood pressure in the community

2013 ◽  
Author(s):  
Tom Fahey
Keyword(s):  
Blood Pressure ◽  
Decision Support ◽  
Decision Support System ◽  
High Blood Pressure ◽  
Support System ◽  
Decision Aid ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
Computer Based

scholarly journals Hospital-wide ELectronic medical record evaluated computerised decision support system to improve outcomes of Patients with staphylococcal bloodstream infection (HELP): study protocol for a multicentre stepped-wedge cluster randomised trial

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033391
Author(s):  
Stefan Hagel ◽  
Julia Gantner ◽  
Cord Spreckelsen ◽  
Claudia Fischer ◽  
Danny Ammon ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Hospital Mortality ◽  
Support System ◽  
Control Period ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Free Survival ◽  
Cluster Randomised

IntroductionStaphylococci are the most commonly identified pathogens in bloodstream infections. Identification of Staphylococcus aureus in blood culture (SAB) requires a prompt and adequate clinical management. The detection of coagulase-negative staphylococci (CoNS), however, corresponds to contamination in about 75% of the cases. Nevertheless, antibiotic therapy is often initiated, which contributes to the risk of drug-related side effects. We developed a computerised clinical decision support system (HELP-CDSS) that assists physicians with an appropriate management of patients with Staphylococcus bacteraemia. The CDSS is evaluated using data of the Data Integration Centers (DIC) established at each clinic. DICs transform heterogeneous primary clinical data into an interoperable format, and the HELP-CDSS displays information according to current best evidence in bacteraemia treatment. The overall aim of the HELP-CDSS is a safe but more efficient allocation of infectious diseases specialists and an improved adherence to established guidelines in the treatment of SAB.Methods and analysisThe study is conducted at five German university hospitals and is designed as a stepped-wedge cluster randomised trial. Over the duration of 18 months, 135 wards will change from a control period to the intervention period in a randomised stepwise sequence. The coprimary outcomes are hospital mortality for all patients to establish safety, the 90-day disease reoccurrence-free survival for patients with SAB and the cumulative vancomycin use for patients with CoNS bacteraemia. We will use a closed, hierarchical testing procedure and generalised linear mixed modelling to test for non-inferiority of the CDSS regarding hospital mortality and 90-day disease reoccurrence-free survival and for superiority of the HELP-CDSS regarding cumulative vancomycin use.Ethics and disseminationThe study is approved by the ethics committee of Jena University Hospital and will start at each centre after local approval. Results will be published in a peer-reviewed journal and presented at scientific conferences.Trial registration numberDRKS00014320.

scholarly journals Process evaluation of the Bridging the Age Gap in Breast Cancer decision support intervention cluster randomised trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maria Burton ◽  
Kate J. Lifford ◽  
Lynda Wyld ◽  
Fiona Armitage ◽  
Alistair Ring ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Process Evaluation ◽  
Decision Aid ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Online Tool ◽  
Cluster Randomised ◽  
Age Gap

Abstract Background The Bridging the Age Gap in Breast Cancer research programme sought to improve treatment decision-making for older women with breast cancer by developing and testing, in a cluster randomised trial (n = 1339 patients), two decision support interventions (DESIs). Both DESIs were used in the intervention arm and each comprised an online risk prediction model, brief decision aid and information booklet. One DESI supported the decision to have either primary endocrine therapy (PET) or surgery with adjuvant therapies and the second supported the decision to have adjuvant chemotherapy after surgery or not. Methods Sixteen sites were randomly selected to take part in the process evaluation. Multiple methods of data collection were used. Medical Research Council (MRC) guidelines for the evaluation of complex interventions were used. Results Eighty-two patients, mean age 75.5 (range 70–93), provided data for the process evaluation. Seventy-three interviews were completed with patients. Ten clinicians from six intervention sites took part in telephone interviews. Dose: Ninety-one members of staff in the intervention arm received intervention training. Reach: The online tool was accessed on 324 occasions by 27 clinicians. Reasons for non-use of the online tool were commonly that the patient had already made a decision or that there was no online access in the clinic. Of the 32 women for whom there were data available, fifteen from the intervention arm and six from the usual care arm were offered a choice of treatment. Fidelity: Clinicians used the online tool in different ways, with some using it during the consultation and others checking the online survival estimates before the consultation. Adaptation: There was evidence of adaptation when using the DESIs. A lack of infrastructure, e.g. internet access, was a barrier to the use of the online tool. The brief decision aid was rarely used. Mediators: Shared decision-making: Most patients felt able to contribute to decision-making and expressed high levels of satisfaction with the process. Participants’ responses to intervention: Six patients reported the DESIs to be very useful, one somewhat useful and two moderately useful. Conclusions Clinicians who participated were mainly supportive of the interventions and had attempted some adaptations to make the interventions applicable, but there were practical and engagement barriers that led to sub-optimal adoption in routine practice. Trial registration ISRCTN46099296. Registered on 11 August 2016—retrospectively registered

scholarly journals Supporting care for suboptimally controlled type 2 diabetes mellitus in general practice with a clinical decision support system: a mixed methods pilot cluster randomised trial

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032594
Author(s):  
Mark E Murphy ◽  
Jenny McSharry ◽  
Molly Byrne ◽  
Fiona Boland ◽  
Derek Corrigan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Practice ◽  
Decision Support ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Randomised Trial ◽  
Clinical Decision

ObjectivesWe developed a complex intervention called DECIDE (ComputeriseD dECisIonal support for suboptimally controlleD typE 2 Diabetes mellitus in Irish General Practice) which used a clinical decision support system to address clinical inertia and support general practitioner (GP) intensification of treatment for adults with suboptimally controlled type2 diabetes mellitus (T2DM). The current study explored the feasibility and potential impact of DECIDE.DesignA pilot cluster randomised controlled trial.SettingConducted in 14 practices in Irish General Practice.ParticipantsThe DECIDE intervention was targeted at GPs. They applied DECIDE to patients with suboptimally controlled T2DM, defined as a glycated haemoglobin (HbA1c) ≥70 mmol/mol and/or blood pressure ≥150/95 mmHg.InterventionThe intervention incorporated training and a web-based clinical decision support system which supported; (i) medication intensification actions; and (ii) non-pharmacological actions to support care. Control practices delivered usual care.Primary and secondary outcome measuresFeasibility and acceptability was determined using thematic analysis of semi-structured interviews with GPs, combined with data from the DECIDE website. Clinical outcomes included HbA1c, medication intensification, blood pressure and lipids.ResultsWe recruited 14 practices and 134 patients. At 4-month follow-up, all practices and 114 patients were followed up. GPs reported finding decision support helpful navigating increasingly complex medication algorithms. However, the majority of GPs believed that the target patient group had poor engagement with GP and hospital services for a range of reasons. At follow-up, there was no difference in glycaemic control (−3.6 mmol/mol (95% CI −11.2 to 4.0)) between intervention and control groups or in secondary outcomes including, blood pressure, total cholesterol, medication intensification or utilisation of services. Continuation criteria supported proceeding to a definitive randomised trial with some modifications.ConclusionThe DECIDE study was feasible and acceptable to GPs but wider impacts on glycaemic and blood pressure control need to be considered for this patient population going forward.Trial registration numberISRCTN69498919

IMPLEMENTASI METODE VIKOR DALAM PENERIMAAN JURNALIS PADA KORAN WASPADA MEDAN

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Soraya Rahma Hayati ◽  
Mesran Mesran ◽  
Taronisokhi Zebua ◽  
Heri Nurdiyanto ◽  
Khasanah Khasanah
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Decision Support System ◽  
Decision Support Systems ◽  
Support System ◽  
Support Systems ◽  
Knowledge Based ◽  
Computer Based ◽  
Support Decision Making ◽  
Made In

The reception of journalists at the Waspada Daily Medan always went through several rigorous selections before being determined to be accepted as journalists at the Waspada Medan Daily. There are several criteria that must be possessed by each participant as a condition for becoming a journalist in the Daily Alert Medan. To get the best participants, the Waspada Medan Daily needed a decision support system. Decision Support Systems (SPK) are part of computer-based information systems (including knowledge-based systems (knowledge management)) that are used to support decision making within an organization or company. Decision support systems provide a semitructured decision, where no one knows exactly how the decision should be made. In this study the authors applied the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) as the method to be applied in the decision support system application. The VIKOR method is part of the Multi-Attibut Decision Making (MADM) Concept, which requires normalization in its calculations. The expected results in this study can obtain maximum decisions.Keywords: Journalist Acceptance, Decision Support System, VIKOR

A new computer-based decision-support system for the interpretation of bone scans

2006 ◽  
Vol 27 (5) ◽  
pp. 417-423 ◽  
Author(s):  
May Sadik ◽  
David Jakobsson ◽  
Fredrik Olofsson ◽  
Mattias Ohlsson ◽  
Madis Suurkula ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Computer Based ◽  
Bone Scans

scholarly journals Decision Supporting System For Malang City Baseball and Softball Athletes Selection Using The Vikor Method

2020 ◽  
Vol 5 (1) ◽  
pp. 218-221
Author(s):  
Eka Larasati Amalia ◽  
Deasy Sandhya Elya Ikawati ◽  
Muhammad Arya Puja Laksana
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
User Testing ◽  
Vikor Method ◽  
Decision Supporting ◽  
Decision Supporting System ◽  
Computer Based ◽  
Run Test

Decision support system is a computer-based system that is used to solve problems by semi-structured and unstructured conditions. In this case, the best solution can be found from certain criteria and provided alternatives and is easy to use by users. In this study, researchers designed and built a website-based decision support system to select athletes in PERBASASI Malang with the provided test criteria, namely the hit test, catch test, throw test, and run test. The purpose of this study was to provide recommendations for participants who passed the selection based on test scores that have been processed using the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method. From the results of calculations, the use of the VIKOR method for this case study produced an accuracy value of 90.90%, a precision value of 93.33%, and a recall value of 93.33%. In addition, the VIKOR sensitivity test showed a consistent ranking of the calculation of the value with veto (value of v less than 0.5), by consensus (value of v is 0.5), and voting by majority rule (value of v more than 0.5). User testing that was applied by using each level of the existing account, i.e. administrator account level, selection account level, and members account level conducted on this information system concluded that the system that was built was running smoothly and was easy to use.

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