scholarly journals Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Odhran O'Donoghue ◽  
Anuraag A Vazirani ◽  
David Brindley ◽  
Edward Meinert
Keyword(s):  
Systematic Review ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Research Question ◽  
Design Development ◽  
Trade Offs ◽  
Business Application ◽  
Assessment Skills ◽  
Meta Analyses ◽  
Quality Assessments

BACKGROUND A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” OBJECTIVE This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” METHODS Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. RESULTS A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. CONCLUSIONS The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. INTERNATIONAL REGISTERED REPOR RR2-10.2196/10994

scholarly journals How Effective Is Auditory–Verbal Therapy (AVT) for Building Language Development of Children with Cochlear Implants? A Systematic Review

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 239
Author(s):  
Paris Binos ◽  
Elina Nirgianaki ◽  
George Psillas
Keyword(s):  
Systematic Review ◽  
Young Children ◽  
Cochlear Implants ◽  
Research Question ◽  
Voice Quality ◽  
Receptive Vocabulary ◽  
Pubmed Database ◽  
Mainstream Society ◽  
Meta Analyses ◽  
Auditory Verbal Therapy

This systematic review sheds light on the effectiveness of auditory–verbal therapy (AVT) outcomes in children with cochlear implants (CIs). The presented outcome is based on research findings from the last 10 years. The systematic review was designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Critical Appraisal of Treatment Evidence (CATE) checklist. Specific keywords were chosen based on the research question and searched on the PubMed database. All searched papers were analysed based on specific exclusion criteria and classified into four evidence levels. The results revealed that children who participated in AV therapy can achieve linguistic skills at the same level as their hearing peers. Voice quality seemed positively affected, placing young children with CIs in the normal range for receptive vocabulary development. In contrast, reading skills seemed less benefited. AV therapy seems to contribute to integration into mainstream society. Despite the recorded speech and language improvements of young children with CIs, the aim of AV therapy is still not fulfilled. AV therapy can be seen as the best clinical practice for young children with CIs till now, but the lack of well-controlled studies is undermining.

Do Electronic Medical Records Improve Advance Directive Documentation? A Systematic Review

2018 ◽  
Vol 36 (3) ◽  
pp. 255-263 ◽  
Author(s):  
Christopher Lemon ◽  
Michael De Ridder ◽  
Mohamed Khadra
Keyword(s):  
Systematic Review ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Planning Process ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Decision Aids ◽  
Automatic Identification ◽  
Cross Sectional ◽  
Identification Software

Background: Documentation rates of advance directives (ADs) remain low. Using electronic medical records (EMRs) could help, but a synthesis of evidence is currently lacking. Objectives: To evaluate the evidence for using EMRs in documenting ADs and its implications for overcoming challenges associated with their use. Design: Systematic review of articles in English, published from inception of databases to December 2017. Data Sources: PubMed, PsycINFO, EMBASE, and CINAHL. Methods/Measurements: Four databases were searched from inception to December 2017. Randomized and nonrandomized quantitative studies examining the effects of EMRs on creation, storage, or use of ADs were included. All featured an advance care planning process. Evidence was evaluated using the Cochrane Collaboration’s risk assessment tool. Results: Fifteen studies were included: 1 randomized controlled trial, 1 randomized pilot, 4 pre–post studies, 4 cross-sectional studies, 1 retrospective cohort study, 1 historical control study, 1 retrospective observational study, 1 retrospective review, and 1 evaluation of an EMR feature. Seven studies showed that EMR-based reminders, AD templates, and decision aids can improve AD documentation rates. Three demonstrated that EMR search functions, decision aids, and automatic identification software can help identify patients who have or need ADs according to certain criteria. Five showed EMRs can create documentation challenges, including locating ADs, and making some patients more likely than others to have an AD. Most studies had an unclear or high risk of bias. Conclusions: Limited evidence suggests EMRs could be used to help address AD documentation challenges but may also create additional problems. Stronger evidence is needed to more conclusively determine how EMR may assist in population approaches to improving AD documentation.

How to Write a Systematic Review of the Literature

2017 ◽  
Vol 11 (1) ◽  
pp. 15-30 ◽  
Author(s):  
Debajyoti Pati ◽  
Lesa N. Lorusso
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Research Question ◽  
Cochrane Collaboration ◽  
Quality Level ◽  
Methodological Rigor ◽  
Prisma Statement ◽  
Level Of Understanding ◽  
Meta Analyses ◽  
The Cochrane Collaboration

This article provides a step-by-step approach to conducting and reporting systematic literature reviews (SLRs) in the domain of healthcare design and discusses some of the key quality issues associated with SLRs. SLR, as the name implies, is a systematic way of collecting, critically evaluating, integrating, and presenting findings from across multiple research studies on a research question or topic of interest. SLR provides a way to assess the quality level and magnitude of existing evidence on a question or topic of interest. It offers a broader and more accurate level of understanding than a traditional literature review. A systematic review adheres to standardized methodologies/guidelines in systematic searching, filtering, reviewing, critiquing, interpreting, synthesizing, and reporting of findings from multiple publications on a topic/domain of interest. The Cochrane Collaboration is the most well-known and widely respected global organization producing SLRs within the healthcare field and a standard to follow for any researcher seeking to write a transparent and methodologically sound SLR. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), like the Cochrane Collaboration, was created by an international network of health-based collaborators and provides the framework for SLR to ensure methodological rigor and quality. The PRISMA statement is an evidence-based guide consisting of a checklist and flowchart intended to be used as tools for authors seeking to write SLR and meta-analyses.

scholarly journals Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ronald Dendere ◽  
Christine Slade ◽  
Andrew Burton-Jones ◽  
Clair Sullivan ◽  
Andrew Staib ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Outcomes ◽  
Electronic Medical Records ◽  
Patient Engagement ◽  
Medical Records ◽  
Provider Communication ◽  
Patient Portals ◽  
High Quality ◽  
Patient Provider Communication

BACKGROUND Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. OBJECTIVE The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. METHODS A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). RESULTS The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. CONCLUSIONS While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

scholarly journals Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review

10.2196/12779 ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. e12779 ◽  
Author(s):  
Ronald Dendere ◽  
Christine Slade ◽  
Andrew Burton-Jones ◽  
Clair Sullivan ◽  
Andrew Staib ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Patient Portals

Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review

2020 ◽  
Vol 134 ◽  
pp. 104036
Author(s):  
Elizabeth Manias ◽  
Tracey Bucknall ◽  
Nilmini Wickramasinghe ◽  
Kathleen Gray ◽  
Jonathan Schaffer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Family Engagement

THE PREVALENCE OF PROBABLE FAMILIAL CHYLOMICRONEMIA SYNDROME IN A SOUTHERN CALIFORNIA POPULATION

2020 ◽  
Author(s):  
Mrinali Tripathi ◽  
April Wong ◽  
Victoria Solomon ◽  
Hussein N. Yassine
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Southern California ◽  
Genetic Disorder ◽  
Lipid Lowering ◽  
Inadequate Response ◽  
Academic Center ◽  
Secondary Causes

Background: Familial Chylomicronemia Syndrome (FCS) is a rare genetic disorder characterized by severe hypertriglyceridemia with inadequate response to lipid lowering agents or low-fat diet. The diagnosis of FCS is often missed due to the heterogeneity of its clinical features. Due to lack of awareness, most FCS cases are misdiagnosed or detected too late resulting in complications. Objective: Our goal is to estimate the prevalence of probable FCS in a major Southern California Academic Center, as well as to provide a systematic review of past FCS studies and management recommendations. Methods: Electronic medical records were queried based on a single fasting plasma triglyceride (TG) values of ≥ 880 mg/dL and at least one episode of acute pancreatitis. After exclusion of secondary causes (diabetes, alcohol use, gall bladder disease, chronic kidney disease, uncontrolled hypothyroidism, estrogen, drug use) and response to lipid lowering treatment, probable FCS patients were identified. A systematic review of all published literature on the prevalence and management guidelines for FCS was then presented and discussed. Results: Out of 7,699,288 charts queried, 138 patients with TG levels of ≥880 mg/dL and documented evidence of at least one episode of acute pancreatitis were identified. Nine patients did not have any documented secondary causes of chylomicronemia. Four of the 9 patients had a greater than 20% decrease in TG levels after lipid lowering treatment, 2 patients were not responsive to lipid lowering medication, and data on lipid lowering medications was missing in 3 patients. Conclusions: Our study estimates the prevalence of probable FCS at a range of 0.26 to 0.66 per million. Using the recommended above criteria, probable FCS cases can be identified to allow early diagnosis and management. Abbreviations: FCS = Familial Chylomicronemia Syndrome; MCS = Multifactorial Chylomicronemia Syndrome; CS = Chylomicronemia Syndrome; HTG = Hypertriglyceridemia; TG = Triglyceride; LPL = Lipoprotein Lipase; EMR = Electronic Medical Records.

Methods Employed to Assess Weight Loss in Older Adults by Means of Electronic Medical Records: A Systematic Review

2017 ◽  
Vol 36 (1) ◽  
pp. 18-30 ◽  
Author(s):  
Sunny Chen ◽  
William A. Banks ◽  
Julie Silverman ◽  
Meera Sheffrin ◽  
Stephen M. Thielke
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Weight Loss ◽  
Electronic Medical Records ◽  
Medical Records
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