AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
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AMIA Annu Symp Proc · Jan 2003
Randomized Controlled Trial Clinical TrialIntelligent intravenous infusion pumps to improve medication administration safety.
Intravenous (IV) medications are vital in the management of hospitalized patients. Inpatients frequently receive several IV medications concurrently, and these are commonly delivered with infusion pump systems. In particular, critically ill patients receive potent "high-alert" IV drugs, many with narrow safety margins requiring careful nursing titration. ⋯ Although errors in prescribing are often intercepted, administration errors do not get caught with most current systems While several safety improvements in IV infusion pump design have reduced mechanical complications, errors with IV drug administration such as incorrect programming persist. Intelligent IV infusion pumps have integrated software to provide point of care decision support (DS). This software includes drug library profiles configured for specific patient care units and includes programming of safety limits for drug/dose calculations.
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AMIA Annu Symp Proc · Jan 2003
Adapting current Arden Syntax knowledge for an object oriented event monitor.
Arden Syntax for Medical Logic Module (MLM)1 was designed for writing and sharing task-specific health knowledge in 1989. Several researchers have developed frameworks to improve the sharability and adaptability of Arden Syntax MLMs, an issue known as "curly braces" problem. Karadimas et al proposed an Arden Syntax MLM-based decision support system that uses an object oriented model and the dynamic linking features of the Java platform.2 Peleg et al proposed creating a Guideline Expression Language (GEL) based on Arden Syntax's logic grammar.3 The New York Presbyterian Hospital (NYPH) has a collection of about 200 MLMs. In a process of adapting the current MLMs for an object-oriented event monitor, we identified two problems that may influence the "curly braces" one: (1) the query expressions within the curly braces of Arden Syntax used in our institution are cryptic to the physicians, institutional dependent and written ineffectively (unpublished results), and (2) the events are coded individually within a curly braces, resulting sometimes in a large number of events - up to 200.
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The problem of developing a curriculum for biomedical informatics is highly dependent on how we choose to define and practice the field. Numerous authors have questioned how to position biomedical informatics along the continuum of formal, empirical and engineering disciplines. A concern with current educational programs in biomedical informatics is that students finish without a clear understanding of the relation between theory and practice, or worse, with the impression that the field does not possess any theoretical basis. ⋯ We posit that that knowledge of formalization is necessary to build testable empirical models, and that model-driven approaches are necessary for deploying information systems that can be evaluated in a meaningful way. A curricular framework is proposed that identifies a set of methods, techniques and theories that have broad applicability within the domain of biomedicine, and which can span a wide range of application areas: bioinformatics, imaging informatics, clinical informatics and public health informatics. A stronger linkage between theory and practice will result in students who are empowered to create effective and lasting solutions to biomedical problems.
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AMIA Annu Symp Proc · Jan 2003
Albumin versus crystalloid therapy in the management of hepatorenal syndrome: a model for using meta analysis in cost effectiveness studies and the design of clinical trials.
We applied traditional methods of gathering, integrating and summarizing findings of current literature, with new approaches for assessing the cost effectiveness of two treatments for hepatorenal syndrome (HRS). Findings of this cost effectiveness study are used to form a proposal for a multi-center prospective clinical trial, to assess the economic and clinical benefits of albumen versus crystalloid therapy in the care of these patients. Our initial findings suggest that albumin therapy is superior to standard crystalloid therapy, in the treatment of HRS patients. The number of survival days appears to increase with this form of therapy per dollar cost, while patients await liver transplantation.
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AMIA Annu Symp Proc · Jan 2003
Discharge communiqué: use of a workflow byproduct to generate an interim discharge summary.
Medical problems left unresolved during hospitalizations (along with recommended outpatient evaluations, test results pending at discharge, and discharge medication regimens) are often documented in patients' discharge summaries. However, studies have demonstrated that discharge summaries are frequently unavailable or inaccessible at post discharge visit(s). Interim discharge summaries have been shown to improve the flow of information between inpatient and outpatient physicians. ⋯ The New SignOut System captures signout information and generates discharge communiqués immediately upon discharge. From June 2002-January 2003 7926 discharge communiqués were made available on 7926 patients and there were 12,920 look-ups of communiqués. Studies concur that 40-50% of patients will not have an available discharge summary making communiqués the primary source of clinical information on prior hospitalization for outpatient physicians.