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1.
Adv Exp Med Biol ; 1213: 73-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030664

RESUMO

Lung cancer is the most common cancer among men and the third most common among women in the world. Many diagnostic techniques have been introduced to diagnose lung cancer. Positron emission tomography (PET)/computed tomography (CT) examination is an image diagnostic method that performs automatic detection and distinction of lung lesions. In addition, pathological examination by biopsy is performed for lesions that are suspected of being malignant, and appropriate treatment methods are applied according to the diagnosis results. Currently, lung cancer diagnosis is performed through coordination between respiratory, radiation, and pathological diagnosis experts, but there are some tasks, such as image diagnosis, that require a large amount of time and effort to complete. Therefore, we developed a decision support system using PET/CT and microscopic images at the time of image diagnosis, which leads to appropriate treatment. In this chapter, we introduce the proposed system using deep learning and radiomic techniques.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Aprendizado Profundo , Humanos
2.
Gastroenterology ; 158(1): 76-94.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31593701

RESUMO

Since 2010, substantial progress has been made in artificial intelligence (AI) and its application to medicine. AI is explored in gastroenterology for endoscopic analysis of lesions, in detection of cancer, and to facilitate the analysis of inflammatory lesions or gastrointestinal bleeding during wireless capsule endoscopy. AI is also tested to assess liver fibrosis and to differentiate patients with pancreatic cancer from those with pancreatitis. AI might also be used to establish prognoses of patients or predict their response to treatments, based on multiple factors. We review the ways in which AI may help physicians make a diagnosis or establish a prognosis and discuss its limitations, knowing that further randomized controlled studies will be required before the approval of AI techniques by the health authorities.


Assuntos
Inteligência Artificial , Diagnóstico por Computador/métodos , Gastroenterologia/métodos , Gastroenteropatias/diagnóstico , Hepatopatias/diagnóstico , Tomada de Decisão Clínica/métodos , Sistemas de Apoio a Decisões Clínicas , Árvores de Decisões , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Humanos , Hepatopatias/mortalidade , Hepatopatias/terapia , Prognóstico , Resultado do Tratamento
3.
J Surg Res ; 245: 649-655, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31542695

RESUMO

BACKGROUND: Limiting variability is an essential element to improving quality of care. Frequent resident turnover represents a significant barrier to clinical standardization. Trainees joining new surgical services must familiarize themselves with the guidelines and protocols that direct patient care as well as their learning objectives and expectations. A clinical decision support system (CDSS) is a dynamic, searchable electronic resource intended for use at the point of care. The CDSS can provide convenient and timely access to relevant information for residents, allowing them to incorporate the most up-to-date protocols and guidelines in their daily care of patients. The objective of this quality improvement intervention was to determine the objective rate of CDSS utilization and its subjective value to residents. MATERIALS AND METHODS: An internally developed, web-based CDSS including essential, clinically useful documents was created for use by trainees on a busy pediatric surgery service. A standardized orientation was provided to each resident and fellow on joining the service, complemented by a summary card to be attached to the trainee's ID badge. CDSS usage was monitored using web analytics. Trainees who rotated before and after the CDSS launch were surveyed regarding attitudes toward clinical resources and confidence in patient management. RESULTS: Documents published to the CDSS included 33 clinical guideline documents and 207 additional educational and support files including reference materials from service orientation were made available to trainees and staff. Goals for resident usage were established by evaluation and adaptation of early traffic patterns. Analysis of web traffic collected over 14 consecutive months revealed utilization above target levels, with 4.0 average weekly page views per trainee (IQR: 1.6-5.6). A total of 60 survey responses were received (54% of trainees invited); majorities of rotating trainees and survey respondents were trainees in general surgery and most were interns. Mean composite scores reflected a trend toward improved satisfaction when seeking CDSM (before intervention 3.18 [SD 0.73], after intervention 3.92 [SD 0.70], range 1-5) which was statistically significant (P = 0.005). Mean scores also improved across five of six components of the composite score (mean improvement 0.75, range: 0.53-0.92), four of which were statistically significant (P = 0.001-0.038). Most (59%) respondents reported that they used the CDSS frequently. CONCLUSIONS: Convenient access to a CDSS resulted in greater than expected utilization as well as higher resident satisfaction with and confidence in materials provided. A CDSS is a promising tool offering quick access to high-quality information in challenging trainee environments.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Cirurgia Geral/educação , Internato e Residência , Criança , Humanos , Qualidade da Assistência à Saúde
4.
Bull Cancer ; 106(12): 1144-1151, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31590925

RESUMO

The Ethics committee of Gustave Roussy cancer center is devoted to both reflection and action. The group has 40 members, professionals, patients and outside experts. These meet in plenary meetings or in specific working sessions and intervene at the request of any professional faced with ethical questions in the care. This Ethics Committee has voluntarily a double vocation: on one hand, a reflective group on major issues of ethics in health and its involvement in hospital life; on the other hand, a working group embedded in the daily lives of the care. The themes addressed at the meetings (plenary sessions, annual meetings) include shared-decision making, advance directives, refusal of care, religious aspects, or biomedical research… Daily activity centered on the care revolves around several times a week meetings, in various services, "Supportive Collegial Meetings" such as proposed in the 3rd French Cancer Plan; these include nursing staff members, oncologists, intensive and palliative care specialists, psychologist, around difficult medical and/or ethical situations. In case of situation requiring an urgent discussion, a referral to the Ethics Committee brings together within 24hours four to five members of the Committee and the care team. Moreover, the Ethics Committee helped develop Aid to Decision making Form upon care gradation for hospitalized cancer patients. Through these interventions on a daily basis, assistance of professionals, reflexive vocation or even delivery of training, the Ethics Committee contributes to an acculturation around anticipation and collegiality in the care. Its double polarity aims to reconcile "philosophical time' for the ethics process, and the connection with the routine issues raised by patients, their families and caregivers.


Assuntos
Institutos de Câncer/ética , Comissão de Ética , Temas Bioéticos , Institutos de Câncer/organização & administração , Tomada de Decisão Clínica/ética , Congressos como Assunto/organização & administração , Sistemas de Apoio a Decisões Clínicas , França , Humanos
5.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31570649

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral condition and the second most common chronic illness in children. The observance of specific behaviors in multiple settings have remained the most successful method for diagnosing the condition, and although there are differences in specific areas of the brain, and a high heritability estimate (∼76%), they are not diagnostically specific. Medications, and particularly stimulant medication, have undergone rigorous studies to document their efficacy dating back to the 1970s. Likewise, behavioral interventions in the form of parent training and classroom programs have demonstrated robust efficacy during the same time period. Both medication and behavioral interventions are symptomatic treatments. The availability of only symptomatic treatments places ADHD in the same category as other chronic conditions such as diabetes and asthma. Successful treatment of most individuals requires ongoing adherence to the therapy. Improved communication between patients and their families, primary and mental health providers, and school personnel is necessary for effective ADHD treatment. Further enhancement of electronic systems to facilitate family, school, and provider communication can improve monitoring of ADHD symptoms and functional performance. The American Academy of Pediatrics ADHD guidelines were initially developed to help primary care clinicians address the needs of their patients with ADHD and were further refined with the second revision in 2019.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Comportamento Infantil , Sistemas de Apoio a Decisões Clínicas , Manual Diagnóstico e Estatístico de Transtornos Mentais , História do Século XX , História do Século XXI , Humanos , Poder Familiar , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Software , Transição para Assistência do Adulto
8.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556505

RESUMO

The number of laparoscopic cholecystectomies in the Netherlands has increased significantly in recent years. However, there is a large variation in practice. This is a sign of inefficient use of cholecystectomy. Cholecystectomy is the treatment of choice in patients with uncomplicated symptomatic gallstones, but 30% of the patients has persistent pain after surgery. In a large prospective multicentre randomised trial, a restrictive strategy was compared to usual care in patients with symptomatic gallstones. The results show suboptimal pain reduction in both groups. There were fewer cholecystectomies in the restrictive strategy group and no difference in gallstone related complications between the groups. It is therefore still unclear which patients with gallstones and abdominal symptoms should undergo cholecystectomy. The data could be used in new studies to construct algorithms for patient selection. In the meantime, the use of a decision aid is recommended. Well-informed patients can, in consultation with their doctors, opt for cholecystectomy or a conservative approach. This strategy will lead to fewer unnecessary cholecystectomies.


Assuntos
Colecistectomia Laparoscópica/métodos , Sistemas de Apoio a Decisões Clínicas , Técnicas de Apoio para a Decisão , Cálculos Biliares/cirurgia , Seleção de Pacientes , Adulto , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos
9.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31511313

RESUMO

BACKGROUND: Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients <3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients <3 years of age. Our objective was to reduce RSTs in the ED in patients aged <3 years by 50% in 18 months. METHODS: We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children <3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged <3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis. RESULTS: The mean number of RSTs ordered per month in patients aged <3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project. CONCLUSIONS: Our interventions led to a successful and sustained reduction of RSTs in patients aged <3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.


Assuntos
Serviço Hospitalar de Emergência , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Faringite/microbiologia , Infecções Estreptocócicas/diagnóstico , Procedimentos Desnecessários , Pré-Escolar , Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Feminino , Humanos , Capacitação em Serviço , Masculino , Missouri , Streptococcus pyogenes/isolamento & purificação
10.
Eur J Paediatr Neurol ; 23(5): 692-706, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31481303

RESUMO

Early onset cerebellar Ataxia (EOAc) comprises a large group of rare heterogeneous disorders. Determination of the underlying etiology can be difficult given the broad differential diagnosis and the complexity of the genotype-phenotype relationships. This may change the diagnostic work-up into a time-consuming, costly and not always rewarding task. In this overview, the Childhood Ataxia and Cerebellar Group of the European Pediatric Neurology Society (CACG-EPNS) presents a diagnostic algorithm for EOAc patients. In seven consecutive steps, the algorithm leads the clinician through the diagnostic process, including EOA identification, application of the Inventory of Non-Ataxic Signs (INAS), consideration of the family history, neuro-imaging, laboratory investigations, genetic testing by array CGH and Next Generation Sequencing (NGS). In children with EOAc, this algorithm is intended to contribute to the diagnostic process and to allow uniform data entry in EOAc databases.


Assuntos
Algoritmos , Sistemas de Apoio a Decisões Clínicas , Degenerações Espinocerebelares/diagnóstico , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino
11.
RECIIS (Online) ; 13(3): 569-577, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1016996

RESUMO

O uso de aplicativos vem crescendo na área da saúde, tornando-se rotina diária na prática dos profissionais e estudantes. Portanto, conhecer benefícios e riscos de seu uso faz-se necessário. O objetivo do estudo aqui apresentado é verificar opiniões e atitudes relatadas por estudantes de medicina a respeito do uso de aplicativos no cotidiano ambulatorial de um hospital-escola. Trata-se de um estudo transversal desenvolvido, em 2017, em Recife, Pernambuco, Brasil, no qual se utilizaram questionários autoaplicáveis presencialmente em uma população de 73 estudantes concluintes do curso de medicina. Os resultados revelaram que a maioria (95,9%) dos estudantes referiram possuir smartphone e 98,6% afirmaram utilizar dispositivos móveis com intuito acadêmico. A finalidade mais comum do uso de aplicativos foi a de consulta de fármacos existentes (93,2%) e quase a totalidade dos estudantes (98,6%) confia nos aplicativos utilizados. Porém, foi questionado se o uso na rotina interfere na relação profissional-paciente. Concluímos que o uso de aplicativos é uma realidade crescente, mas que ainda há discordâncias sobre seus benefícios e malefícios.


The use of applications has been growing in the field of health, becoming a daily routine in the practice of professionals and students. Therefore, knowing the benefits and risks of its use is necessary. The study presented here aims to verify the opinions and attitudes reported by medical students about the use of applications in the outpatient routine in a teaching hospital. It is a cross-sectional study and it was developed in 2017 in Recife, in the state of Pernambuco, Brazil, using a self-administered questionnaire asked by 73 students of the last year of medicine undergraduate degree. The results reveal that the majority (95.9%) of the students reported having a smartphone and 98.6% specified that they use mobile devices for academic purposes. The most common purpose of using applications was to consult existing drugs (93.2%) and almost all students (98.6%) believe that the applications used are reliables. However, there are doubts if routine use interferes with the professional-patient relationship. We concluded that the use of applications is growing, but there are still disagreements about its benefits and harms.


El uso de aplicaciones viene creciendo en el área de la salud y se ha convertido en rutina diaria en la práctica de los profesionales y estudiantes. Por lo tanto, conocer los beneficios y riesgos de su uso se hace necesario. El objetivo del estudio presentado aquí es verificar opiniones y actitudes relatadas por estudiantes de medicina acerca del uso de aplicaciones en el cotidiano del ambulatorio de un hospital escuela. Un estudio transversal ha sido desarrollado en 2017 en Recife, en el estado de Pernambuco, Brasil, utilizando un cuestionario autoaplicable presencialmente en 73 estudiantes del último año de la graduación del grado en medicina. Los resultados mostran que la mayoría (95,9%) de los estudiantes mencionó poseer teléfono inteligente y 98,6% afirmaron utilizar dispositivos movibles con intención académica. La finalidad más común del uso de aplicaciones fue la de consulta de fármacos existentes (93,2%) y casi la totalidad de los estudiantes (98,6%) confía en las aplicaciones utilizadas. Sin embargo, ha sido cuestionado si el uso en la rutina interfiere en la relación profesional-paciente. Nosotros concluimos que el uso de aplicaciones es creciente, pero todavía hay desacuerdos sobre sus beneficios y maleficios.


Assuntos
Humanos , Estudantes de Medicina , Educação Médica , Aplicativos Móveis , Estudo Observacional , Smartphone , Desempenho Acadêmico , Relações Médico-Paciente , Prática Profissional , Pessoal de Saúde , Sistemas de Apoio a Decisões Clínicas , Computadores de Mão , Mídias Sociais
12.
N Z Med J ; 132(1500): 89-94, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415503

RESUMO

There is a strong body of evidence that supports identifying and managing people according to their risk of a future cardiovascular (CVD) event. Since 2012 the New Zealand public health sector has achieved 90% CVD risk assessment (CVDRA) for each eligible person across New Zealand using a modified version of an overseas risk equation, through incentivising Primary Health Organisation (PHO) performance. In 2018 the New Zealand Ministry of Health endorsed the use of a suite of four new CVDRA equations which were developed using the large NZ Predict cohort (500,000 people). These equations more accurately reflect an individual's CVD risk and incorporate both traditional CVD risk factors, such as smoking and diabetes, but also sociodemographic factors including ethnicity and a deprivation score. The new CVDRA equations are an important tool to address the major inequities in CVD incidence, prevalence and mortality in Aotearoa-New Zealand. However, while the new equations provide more accurate assessment of risk, they are more complicated and therefore more prone to error if not properly validated and systematically implemented. To take advantage of this important opportunity to address equity in heart health we need strategic vision and national leadership. In this paper we make the case that to most safely and cost effectively implement the new equations, the Ministry of Health (MOH) should support a unified national CVD risk generator. A single, electronic, national CVD risk generator would: a) ensure national consistency and quality control-a single set of validated and current equations would be available to both clinicians and patients; b) avoid substantial replication of effort and cost in both developing and validating multiple calculators; c) enable central collection of the encrypted dataset required to develop more accurate risk assessment equations in population subgroups, both now and in the future, as CVD risk evolves; d) provide a platform to facilitate systematic and consistent national CVD risk communication and management; and e) facilitate ease of updating the tool and practice in the future as changes to the algorithm are agreed.


Assuntos
Doenças Cardiovasculares/epidemiologia , Equidade em Saúde , Medição de Risco/métodos , Adulto , Idoso , Sistemas de Apoio a Decisões Clínicas , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Atenção Primária à Saúde , Fatores Socioeconômicos
13.
IEEE Pulse ; 10(4): 25-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31395530

RESUMO

About this Series This is the sixth and last article in a series on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided background on health care, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. The third introduced SMART on FHIR which, based on its wide adoption, has become the default standard FHIR app platform. The fourth looked at clinical decision support, arguably the single most important provider-facing use case for FHIR. The fifth introduced the personal health record and tools that can utilize the data stored in it as an important use case for FHIR in support of patients. This article looks at the future uses of FHIR with a particular emphasis on those that might impact on research uses of health data. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of healthcare or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).


Assuntos
Sistemas de Apoio a Decisões Clínicas/tendências , Assistência à Saúde/tendências , Registros Eletrônicos de Saúde/tendências , Nível Sete de Saúde/tendências , Software/tendências , Humanos
14.
Yi Chuan ; 41(8): 746-753, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31447425

RESUMO

Personal genomic information benefits from accumulated big data and its application is no longer limited to scientific research. Presently, it is undergoing the transformation to daily medical practice. Systematic arrangement, archiving and rational utilization of disease-related genomic information is an important foundation of future precision medicine. Hemoglobinopathy is prevalent in southern China, but its molecular pathological basis has racial specificity. To facilitate clinical diagnosis and genetic screening of hemoglobinopathy in southern China, we established the LOVD gene data management system for the variation and phenotype spectrum of hemoglobinopathy. Then we designed an integrated and efficient on-line auxiliary accurate diagnosis and risk assessment system in order to assist clinicians to make comprehensive diagnosis and genetic counseling in a short time based on cloud standardized annotated library of specific hemoglobinopathy variants and diagnostic repository. The methodology and experience of improving the clinical decision-making efficiency of diseases with big data and artificial intelligence technology can be used as an example in the clinical and preventive application of other diseases.


Assuntos
Bases de Dados Genéticas , Sistemas de Apoio a Decisões Clínicas , Hemoglobinopatias/genética , Mutação , China , Aconselhamento Genético , Testes Genéticos , Humanos
16.
Stud Health Technol Inform ; 265: 86-91, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431582

RESUMO

We report from the initial steps of a collaboration project between two post-doctoral projects, both using a qualitative action research approach to address challenges related to shifting from a free text to a structured EPR system constituting important preconditions for establishing advanced decision support and reuse of healthcare data. We have started to explore three areas that may influence this process related to: 1) Legislative challenges of getting access to all relevant healthcare data. 2) Challenges of exchanging data between silo systems and open platform systems. 3) Replacing a free text silo EPR with an open platform system - and the practical challenges of defining the content of the context sensitive structured EPR. Hence, we ask the following research questions: How to address challenges related to the shift from free text to structured EPR systems? How will the need for semantic interoperability between different EPRs influence the goal of advanced clinical decision support? Empirically, we draw on the regional FRESK program (2017-2022), in the North Norwegian Health Region, which includes implementing both a new regional open platform based EPR system, and a proprietary medical chart system.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Assistência à Saúde , Humanos , Noruega
17.
Stud Health Technol Inform ; 265: 134-140, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431589

RESUMO

Designing and implementing clinical decision support (CDS) in health care has been challenging. Attempts have been made to design and implement CDS to support clinical procedures, but many of these CDSs have met user resistance. One possible explanation for the lack of acceptability can be the poor design of the CDS. In this study, we describe the design of PE Dx, a CDS built to support the diagnosis of pulmonary embolism (PE) in the emergency department (ED) using human factors methods.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Embolia Pulmonar , Serviço Hospitalar de Emergência , Humanos
18.
Scand J Trauma Resusc Emerg Med ; 27(1): 76, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426839

RESUMO

Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. AIM: The aim was to investigate the nature, deployment, and factors influencing EMS clinicians' clinical reasoning by means of a review. METHOD: Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, "grey literature," and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians' clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. RESULTS: This review showed that EMS clinicians' clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use "workarounds" to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. CONCLUSION: Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.


Assuntos
Tomada de Decisão Clínica , Serviços Médicos de Emergência , Docentes de Medicina , Adaptação Psicológica , Comunicação , Sistemas de Apoio a Decisões Clínicas , Humanos , Relações Interprofissionais , Relações Médico-Paciente , Gestão da Segurança , Padrão de Cuidado , Confiança
19.
Emerg Infect Dis ; 25(9)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441428

RESUMO

To evaluate a classification system to support clinical decisions for treatment of contaminated deep wounds at risk for an invasive fungal infection (IFI), we studied 246 US service members (413 wounds) injured in Afghanistan (2009-2014) who had laboratory evidence of fungal infection. A total of 143 wounds with persistent necrosis and laboratory evidence were classified as IFI; 120 wounds not meeting IFI criteria were classified as high suspicion (patients had localized infection signs/symptoms and had received antifungal medication for >10 days), and 150 were classified as low suspicion (failed to meet these criteria). IFI patients received more blood than other patients and had more severe injuries than patients in the low-suspicion group. Fungi of the order Mucorales were more frequently isolated from IFI (39%) and high-suspicion (21%) wounds than from low-suspicion (9%) wounds. Wounds that did not require immediate antifungal therapy lacked necrosis and localized signs/symptoms of infection and contained fungi from orders other than Mucorales.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Infecções Fúngicas Invasivas/prevenção & controle , Militares , Traumatismo Múltiplo , Infecção dos Ferimentos/prevenção & controle , Campanha Afegã de 2001- , Aspergillus/isolamento & purificação , Fusarium/isolamento & purificação , Humanos , Infecções Fúngicas Invasivas/classificação , Infecções Fúngicas Invasivas/microbiologia , Mucorales/isolamento & purificação , Estados Unidos , Infecção dos Ferimentos/classificação , Infecção dos Ferimentos/microbiologia
20.
Stud Health Technol Inform ; 264: 318-322, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437937

RESUMO

Clinical decision support systems (CDSS) will play increasing role in improving quality of medical care for critically ill patients. However, due to limitations in current informatics infrastructure, CDSS do not always have complete information on state of supporting physiologic monitoring devices, which can limit input data available to CDSS. This is especially true in use case of mechanical ventilation (MV), where current CDSS have no knowledge of critical ventilation settings, such as ventilation mode. To enable MV CDSS make accurate recommendations related to ventilator mode, we developed a highly performant machine learning model that is able to perform per-breath classification of five of most widely used ventilation modes in USA with average F1-score of 97.52%. We also show how our approach makes methodologic improvements over previous work and is highly robust to missing data caused by software/sensor error.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Humanos , Aprendizado de Máquina , Monitorização Fisiológica , Respiração Artificial , Ventiladores Mecânicos
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