scholarly journals Results of decision support system implementation for prescribing anticoagulants to patients with atrial fibrillation in hospital

2020 ◽  
Vol 92 (8) ◽  
pp. 37-42
Author(s):  
A. A. Chernov ◽  
E. B. Kleymenova ◽  
D. A. Sychev ◽  
L. P. Yashina ◽  
M. D. Nigmatkulova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Decision Support ◽  
Support System ◽  
Dosage Regimen ◽  
Adherence Level ◽  
Specialty Hospital ◽  
Before And After ◽  
Therapeutic Doses ◽  
Drug Errors

Background. In 819% of patients with atrial fibrillation (AF) with anticoagulant therapy (ACT), hemorrhagic complications occur, including due to excess doses of AC. At the same time, ACT is necessary for patients with AF, since anticoagulants effectively reduces the risk of ischemic stroke. To make a decision on the appointment of ACT, it is necessary to correlate the risks of ischemic stroke and bleeding, this requires knowledge of current clinical using ACT recommendations and instructions. Among patients admitted to hospital, 30% receive ACT, so increasing adherence to clinical recommendations for prescribing AC to patients with AF by doctors of various profiles is an urgent task. Aim. To analyze the adherence of physicians to recommendations for prescribing ACT before and after the introduction of decision support system (DSS) in patients with AF in a multi-specialty hospital. Materials and methods. A single-center non-randomized study with historical control to assess adherence to recommendations based on the analysis of medical prescriptions and the structure of drug errors in patients with AF in a multi-specialty hospital in Moscow before and after the introduction of DSS. Compliance with the recommendations of physicians was evaluated in the sections indications /contraindications to AC and dosage regimen of AC. The presence of deviations from the clinical recommendations /instructions for medical use of AC was regarded as management of the patient with non-compliance with recommendations. Physicians adherence level to recommendations was calculated as the ratio of cases of compliance with recommendations to the total number of cases. Results. In the control and experimental groups, there was a significant increase in the proportion of POAC at discharge in comparison with admission to hospital: from 54.5 to 76.8% (p=0.0005) and from 63 to 85.7% (p=0.0002), respectively. However, only in the experimental group it was possible to significantly reduce the number of patients without a prescribed ACT (if there are indications) from 7.6 to 1% (p=0.04) in comparison with admission. During the study, it was possible to significantly increase physicians adherence level to the recommendations for the AC dosage regimen in patients with AF from 59% (44 discrepancies for 107 prescriptions) to 84.6% (16 discrepancies for 104 prescriptions); p0.005. Before the introduction of the DSS, the analysis of drug prescriptions revealed 56 drug errors (0.5 errors per patient), after the introduction of the DSS, the number of drug errors significantly decreased to 21 (0.2 errors per patient); p0.05. After the introduction of DSS, the number of sub-therapeutic doses of AC was reduced from 31 (27.7%) to 8 (7.6%); p0.05. Conclusion. The level of adherence to the recommendations for prescribing ACT to patients with AF in the hospital is high. The use of DSS increases the level of adherence to the recommendations on the AC dosage regimen in patients with AF, as well as eliminates errors in calculating the risk of ischemic stroke and systemic thromboembolic complications, and contributes to reducing the frequency of prescribing sub-therapeutic doses of AC.

Prediction Reliability of Container Terminal Simulation Models

2010 ◽  
pp. 315-335
Author(s):  
Armando Cartenì
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Optimization Problem ◽  
Container Terminal ◽  
Simulation Models ◽  
Large Set ◽  
Model Application ◽  
Before And After ◽  
Prediction Reliability

In this chapter attention is focused on the container terminal optimization problem, given that today most international cargo is transported through seaports and on containerized vessels. In this context, in order to manage a container terminal it is sometimes necessary to develop a Decision Support System (DSS). This chapter investigated the prediction reliability of container terminal simulation models (DSS), through a before and after analysis, taking advantage of some significant investment made by the Salerno Container Terminal (Italy) between 2003 and 2008. In particular, disaggregate and an aggregate simulation models implemented in 2003 were validated with a large set of data acquired in 2008 after some structural and functional terminal modifications. Through this analysis it was possible to study both the mathematical details required for model application and the field of application (prediction reliability) of the different simulation approaches implemented.

A CAD software application as a decision support system for ischemic stroke detection in the posterior fossa

2021 ◽  
pp. 203-221
Author(s):  
Anis Azwani Muhd Suberi ◽  
Wan Nurshazwani Wan Zakaria ◽  
Nik Farhan Nik Fuad ◽  
Razali Tomari ◽  
Ain Nazari ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Decision Support ◽  
Decision Support System ◽  
Posterior Fossa ◽  
Support System ◽  
Software Application

scholarly journals Pengembangan Sistem Pendukung Keputusan Untuk Mendukung Penegakkan Diagnosa TB Dots Di Rumah Sakit Aisyiyah Muntilan

2016 ◽  
Vol 4 (2) ◽  
pp. 123-128
Author(s):  
Susanti Susanti ◽  
Mateus Sakundarno Adi ◽  
Atik Mawarni
Keyword(s):  
Information System ◽  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
T Test ◽  
P Value ◽  
Research Subjects ◽  
Quality Of Information ◽  
Before And After

Tuberculosis (TB) disease intervention is a national program and being a target of MDGs. Therefore, a government determined minimum service standards of a hospital that had to be implemented in all health service units and hospitals in Indonesia. A strategy of DOTS at Aisyiyah Hospital in Muntilan had been available particularly in terms of case finding. Notwithstanding, a process of patient diagnosis had not been implemented in accordance with a standard of human resource. Number of medical officers at a TB DOTS unit was not sufficient. In addition, quality of information like completeness, accurateness in diagnosis, and timeliness in reporting TB cases had not achieved a target. The aim of this study was to develop decision support system of TB as an effort to systematically diagnose and manage data of TB based on the standard. This was qualitative-quantitative research. A qualitative method was used to identify each step of information system development. Meanwhile, a quantitative method was used to assess quality of information between before and after developing information system using pre-experimental design (the one group pre and posttest design). Qualitative data were collected by conducting indepth interview, whereas quantitative data were collected using checklist. Data were analysed using T test. Research object was decision support system before and after applying at TB unit at Aisyiyah Hospital in Muntilan. Research subjects consisted of four TB officers as main informants. Informants for triangulation purpose consisted of head of SIMRS and head of medical services. The results of T test showed that variables of completeness, accurateness, and preciseness after developing the decision support system were better than that of before developing the system (p-value = 0.000). As suggestions, head of SIMRS needs to conduct further development of decision support system of TB in another unit particularly in inpatient unit. The decision support system needs to be evaluated and adjusted with the standard.

scholarly journals Use of quick sequential organ failure assessment score-based sepsis clinical decision support system may be helpful to predict sepsis development

2021 ◽  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Compliance Rate ◽  
Clinical Decision ◽  
Suspected Infection ◽  
Before And After ◽  
Bundle Compliance ◽  
Resuscitation Bundle

Objectives: A sepsis clinical decision support system (CDSS) can facilitate quicker sepsis detection and treatment and consequently improve outcomes. We developed a qSOFA-based sepsis CDSS and evaluated its impact on compliance with a 3-hour resuscitation bundle for patients with sepsis. Methods: This before-and-after study included consecutive adult patients with suspected infection and qSOFA scores of ≥ 2 at their emergency department (ED) presentation of a tertiary care hospital. Sepsis was defined according to the Sepsis-3 criteria. We evaluated the 3-hour resuscitation bundle compliance rate for control patients from July through August 2016, for patients using the qSOFA-based sepsis CDSS from September through December 2016, and the impact of the system using multivariable logistic regression analysis. Results: Of 306 patients with suspected infection and positive qSOFA scores at presentation, 265 patients (86.6%) developed sepsis (including 71 patients with septic shock). The 3-hour resuscitation bundle compliance rate did not differ significantly between the patients before and after the routine implementation of the qSOFA-based sepsis CDSS (63.7% vs. 52.6%; P = 0.071). Multivariate analysis showed that age (AOR [adjusted odds ratio], 1.033; P = 0.002) and body temperature (AOR, 1.677; P < 0.001) were associated with bundle compliance. Conclusions: Among patients with a positive qSOFA score at presentation, sepsis developed in 86.6%, which means the qSOFA-based sepsis CDSS may be helpful; however, it was not associated with improved bundle compliance. Future quality improvement studies with multifactorial, hospital-wide approaches using sepsis CDSS tools are warranted.

scholarly journals Association between exercise habits and stroke, heart failure, and mortality in Korean patients with incident atrial fibrillation: A nationwide population-based cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003659
Author(s):  
Hyo-Jeong Ahn ◽  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Jin-Hyung Jung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Population Based ◽  
Health Examination ◽  
Regular Exercise ◽  
Exercise Habits ◽  
Before And After

Background There is a paucity of information about cardiovascular outcomes related to exercise habit change after a new diagnosis of atrial fibrillation (AF). We investigated the association between exercise habits after a new AF diagnosis and ischemic stroke, heart failure (HF), and all-cause death. Methods and findings This is a nationwide population-based cohort study using data from the Korea National Health Insurance Service. A retrospective analysis was performed for 66,692 patients with newly diagnosed AF between 2010 and 2016 who underwent 2 serial health examinations within 2 years before and after their AF diagnosis. Individuals were divided into 4 categories according to performance of regular exercise, which was investigated by a self-reported questionnaire in each health examination, before and after their AF diagnosis: persistent non-exercisers (30.5%), new exercisers (17.8%), exercise dropouts (17.4%), and exercise maintainers (34.2%). The primary outcomes were incidence of ischemic stroke, HF, and all-cause death. Differences in baseline characteristics among groups were balanced considering demographics, comorbidities, medications, lifestyle behaviors, and income status. The risks of the outcomes were computed by weighted Cox proportional hazards models with inverse probability of treatment weighting (IPTW) during a mean follow-up of 3.4 ± 2.0 years. The new exerciser and exercise maintainer groups were associated with a lower risk of HF compared to the persistent non-exerciser group: the hazard ratios (HRs) (95% CIs) were 0.95 (0.90–0.99) and 0.92 (0.88–0.96), respectively (p < 0.001). Also, performing exercise any time before or after AF diagnosis was associated with a lower risk of mortality compared to persistent non-exercising: the HR (95% CI) was 0.82 (0.73–0.91) for new exercisers, 0.83 (0.74–0.93) for exercise dropouts, and 0.61 (0.55–0.67) for exercise maintainers (p < 0.001). For ischemic stroke, the estimates of HRs were 10%–14% lower in patients of the exercise groups, yet differences were statistically insignificant (p = 0.057). Energy expenditure of 1,000–1,499 MET-min/wk (regular moderate exercise 170–240 min/wk) was consistently associated with a lower risk of each outcome based on a subgroup analysis of the new exerciser group. Study limitations include recall bias introduced due to the nature of the self-reported questionnaire and restricted external generalizability to other ethnic groups. Conclusions Initiating or continuing regular exercise after AF diagnosis was associated with lower risks of HF and mortality. The promotion of exercise might reduce the future risk of adverse outcomes in patients with AF.

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