Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.
200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). ⋯ Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.
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Even in the information-rich environment of hospitals, health-care providers face challenges in addressing their various information needs. Through a study of a patient-care team in a tertiary care Surgical Intensive Care Unit (SICU), we expanded our understanding of health-care providers' information needs in two important ways. ⋯ We found that organizational information was extremely important to SICU team members. Furthermore, the first resource that team members utilized was not electronic or paper but rather human: another team member.
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Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. ⋯ We present recommendations for incorporating support for each of these areas into point-of-care clinical information systems that provide access to shared patient records. Finally, we discuss general design approaches for incorporating this type of support, including the need for workers to maintain awareness of the activities of others, and the need to integrate communication with the presentation of the health record.
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A security system was developed as part of a patient records research database project intended for both local and multi-site studies. A comprehensive review of ethical foundations and legal environment was undertaken, and a security system comprising both administrative policies and computer tools was developed. ⋯ Systems fitting this model were implemented at two academic medical centers. Security features of commercial database systems were found to be adequate for basic enforcement of approved research protocols.
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Comparative Study
Neural network modeling to predict the hypnotic effect of propofol bolus induction.
Dose requirements of propofol to achieve loss of consciousness depend on the interindividual variability. Until now when propofol was administered by a single bolus, how to define the optimal individual dose and to assess its hypnotic effect have not been clearly studied. The goal of this study is to develop an artificial neural network model to predict the hypnotic effect of propofol on the basis of common clinical parameters. ⋯ The bispectral index of EEG was used to record the consciousness level of patients and served as the output factor. The predictive results of neural net models were superior to that of clinician. This model could potentially help determine the optimal dose of propofol and thus reduce the anesthetic cost.