scholarly journals Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis (Preprint)

2019 ◽  
Author(s):  
Jennifer Hornung Garvin ◽  
Julie Ducom ◽  
Michael Matheny ◽  
Anne Miller ◽  
Dax Westerman ◽  
...  
Keyword(s):  
Decision Making ◽  
Quantitative Methods ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
User Centered Design ◽  
Support Tool ◽  
Clinical Scenarios ◽  
The Impact

BACKGROUND There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis. OBJECTIVE Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow. METHODS Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods. RESULTS We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians’ ratings of CirrODS indicated above average usability. CONCLUSIONS We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice.

scholarly journals Clinicians’ experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Carlisle ◽  
H. A. Watson ◽  
J. Carter ◽  
K. Kuhrt ◽  
P. T. Seed ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Cultural Context ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Scale Up ◽  
Clinical Decision ◽  
Clinical Trial Registry ◽  
Support Tool ◽  
The Impact

Abstract Background As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. Methods Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. Results Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app. Conclusion This study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. Clinical trial registry and registration number ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.

scholarly journals Scar Resurfacing

2020 ◽  
pp. 311-316
Author(s):  
Fiona M. Wood
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Healing Process ◽  
Clinical Decision ◽  
Skin Surface ◽  
History Of ◽  
Secondary Healing ◽  
The Impact ◽  
Selection Of

AbstractScar resurfacing is focused on the improvement in the quality of a scar by disruption of the skin surface and reducing the bulk of the scar by control of the secondary healing process. The prerequisite is knowledge of the wound healing and scarring process such that the intervention can be designed to reduce the risk of increasing the scarring.The clinical examination and assessment of the scar will guide the selection of the technique addressing the specific aspects of the scar, such as the pigment restoration and volume reduction, with the aim of blending the scar with the surrounding uninjured skin.Understanding the natural history of the scar, the impact it has on the patient, and the techniques available for improvement provides the clinical decision-making matrix to drive an improved scar outcome. Resurfacing is one opportunity for scar modulation which needs to be taken into context relative to the range of conservative and surgical therapeutic opportunities explored within the chapters of the book.

scholarly journals Methods for the Development of Healthcare Practice Recommendations Using Systematic Reviews and Meta-Analyses

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Platz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Reviews ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Practice Recommendations ◽  
Meta Analyses

Quality of healthcare can be improved when the best external evidence available is integrated in clinical decision-making in a systematic explicit manner. With the rapid expansion of clinical evidence, the opportunities for evidence-based high-quality healthcare increase. Paradoxically, the likelihood of any one person to get a complete and balanced picture of the evidence available decreases. This is especially true for rehabilitation interventions that are complex in nature and where clinical research is rather diverse. Given the complex nature of the evidence, there is a substantial risk of misinterpreting the complex information both at the level of individual sources (e.g., reports of clinical trials) and for aggregated data syntheses (e.g., systematic reviews and meta-analyses). These risks are inherent in these sources themselves and are in addition related to the methodological expertise necessary to make valid use of the evidence for clinical decision-making. Taken together, there is a great demand for systematic structured guidance from evidence to clinical decision. This methodology paper describes a structured process for the development and report of evidence-based clinical practice recommendations that uses systematic reviews and meta-analyses as evidence source. It provides a comprehensive framework with specific requirements for the development group, the formulation of the healthcare question addressed, the systematic search for the evidence, its critical appraisal, the extraction and the outcome-centered presentation of the evidence, the rating of its quality, strengths and weaknesses, any further considerations relevant for decision-making, and an explicit recommendation statement along with its justification, implementation, and resource aspects. The suggested methodology uses international standards in evidence synthesis, critical appraisal of systematic reviews, rating the quality of evidence, characteristics of recommendations, and guideline development as developed by Cochrane, GRADE (Grading of Recommendations Assessment, Development and Evaluation), AMSTAR (A MeaSurement Tool to Assess systematic Reviews), and AGREE (Appraisal of Guidelines for REsearch & Evaluation). An added distinctive feature of the methodology is to focus on the most up-to-date, most valid evidence and hence to support the development of valid practice recommendations in an efficient way. Practice recommendations generated by such a valid methodology would be generally applicable and promote evidence-based clinical practice globally.

scholarly journals Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score

2003 ◽  
Vol 10 (6) ◽  
pp. 563-572 ◽  
Author(s):  
Padmanabhan Ramnarayan ◽  
Ritika R. Kapoor ◽  
Michael Coren ◽  
Vasantha Nanduri ◽  
Amanda L. Tomlinson ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Composite Score ◽  
Diagnostic Decision ◽  
The Impact

Nursing Information Systems

2015 ◽  
pp. 959-977
Author(s):  
Ana Paula Macedo ◽  
Fernando Petronilho ◽  
João Cainé
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Health Information Systems ◽  
Clinical Decision ◽  
Central Resource ◽  
The Impact ◽  
And Training

We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.

Evidence-Based Medicine

2005 ◽  
pp. 125-135 ◽  
Author(s):  
Nilmini Wickramasinghe ◽  
Sushil K. Sharma ◽  
Harsha P. Reddy
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
New Developments ◽  
Postgraduate Educational ◽  
New Knowledge ◽  
Based Medicine

The ongoing tension between certainty over uncertainty is the main force that is driving the evidence-based medicine movement. The central philosophy of this practice lies in the idea that one can never take for granted one’s own practice, but by using a structured, problem-based approach, practitioners can logically manoeuvre their way through the obstacle course of clinical decision-making. Attending postgraduate educational events and reading various science journals are no longer sufficient to keep healthcare practitioners aware of all the new developments in practice. To gain this knowledge they need to accept that there are questions they have to ask about their practice. Having posed a number of questions, answers should be found to the most important, practitioners should appraise the quality of the resulting evidence and, if appropriate, practitioners should implement change in response to that new knowledge.

Using On-Line Medical Knowledge to Support Evidence-Based Practice

2011 ◽  
pp. 187-203
Author(s):  
Daniel L. Moody ◽  
Graeme G. Shanks
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Medical Knowledge ◽  
Clinical Decision ◽  
Evidence Based ◽  
On Line ◽  
Management Project

This paper describes a successful knowledge management project in one of Australia’s state health departments. The objective of the project was to provide medical staff with on-line access to the latest medical knowledge at the point of care in order to improve the quality of clinical decision making. We believe this represents an important case study from both a theoretical and practical viewpoint:

Nursing Information Systems

2013 ◽  
pp. 474-491
Author(s):  
Ana Paula Macedo ◽  
Fernando Petronilho ◽  
João Cainé
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Health Information Systems ◽  
Clinical Decision ◽  
Central Resource ◽  
The Impact ◽  
And Training

We have witnessed a change in the Health Information Systems (HIS) in what concerns structure, contents, and support for optimization of the resources, the best efficiency in cost control, and a better management of the quality of services rendered to the citizens. From the standpoint of reformulating the HIS, we can see an evolution in the production of information centered almost exclusively in the need of a documental proof on the care rendered by nurses to the citizens to produce information that can constitute a central resource for their clinical decision making. The authors describe the evolution of the Nursing Information Systems (NIS), reflect upon the impact of reformulation and implementation of the NIS in Portugal in the development of the nursing practice, and reflect upon the impact of the NIS reformulation in the quality of care as well as in education and training in the nursing area.

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