Biomedical subjects

Dominik Aronsky

Publications and source records attributed to Dominik Aronsky.

At least 19 recordsLinked to original sources

PubMed2007

The prevalence and inaccessibility of Internet references in the biomedical literature at the time of publication.

OBJECTIVES: To determine the prevalence and inaccessibility of Internet references in the bibliography of biomedical publications when first released in PubMed. METHODS: During a one-month observational study period (Feb 21 to Mar 21, 2006) the Internet citations from a 20% random sample of all forthcoming publications released in PubMed during the previous day were identified. Attempts to access the referenced Internet citations were completed within one day and inaccessible Internet citations were recorded. RESULTS: The study included 4,699 publications from 844 different journals. Among the 141,845 references there were 840 (0.6%) Internet citations. One or more Internet references were cited in 403 (8.6%) articles. From the 840 Internet references, 11.9% were already inaccessible within two days after an article's release to the public. CONCLUSION: The prevalence of Internet citations in journals included in PubMed is small (<1%); however, the inaccessibility rate at the time of publication is considered substantial. Authors, editors, and publishers need to take responsibility for providing accurate and accessible Internet references.

Access to Information↗

PubMed2006

Providers' beliefs, attitudes, and behaviors before implementing a computerized pneumococcal vaccination reminder.

BACKGROUND: The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce. OBJECTIVES: To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system. METHODS: An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system. RESULTS: Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination. CONCLUSIONS: Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative.

Academic Medical Centers↗

PubMed2006

The measurement of daily surge and its relevance to disaster preparedness.

This article reviews what is known about daily emergency department (ED) surge and ED surge capacity and illustrates its potential relevance during a catastrophic event. Daily ED surge is a sudden increase in the demand for ED services. There is no well-accepted, objective measure of daily ED surge. The authors propose that daily and catastrophic ED surge can be measured by the magnitude of the surge, as well as by the nature and severity of the illnesses and injuries that patients present with during the surge. The magnitude of an ED surge can be measured by the patient arrival rate per hour. The nature and severity of the surge can be measured by the type (e.g., trauma vs. infection vs. biohazard) and acuity (e.g., triage level) of the surge. Surge capacity is defined as the extent to which a system can respond to a rapid and sizeable increase in the demand for resources. ED surge capacity includes multiple dimensions, such as systems, space, staffing, and supplies. A multidimensional measure is needed that reflects both the core components and their relative contribution to ED surge capacity. Although many types of factors may influence ED surge capacity, relatively little formal research has been conducted in this area. A better understanding of daily ED surge capacity and influencing factors will improve our ability to simulate the potential impact that different types of catastrophic events may have on the surge capacity of hospital EDs nationwide.

Crowding↗

PubMed2006

Identifying asthma exacerbations in a pediatric emergency department: a feasibility study.

BACKGROUND: Asthma is a common pediatric chronic disease and is estimated to account for more than 2million emergency department visits per year. Asthma guidelines have demonstrated improved outcomes, but remain underutilized due to several barriers. Computerized methods to automatically identify asthma exacerbations may be beneficial to initiate guideline recommended treatment, but have not been described. The goal of the study was to examine the accuracy of an algorithm to identify asthma patients at triage in real-time using only electronically available data. METHODS: During a 9-month period, the five most frequent presenting chief complaints for Emergency Department asthma patients aged 2-18 years were identified and accounted for >95% of asthma visits: wheezing, shortness of breath, fever, cough, and dyspnea. During a following 1-month period (November 2004), medical records of all patients with one of the five chief complaints were reviewed to establish a reference standard diagnosis. An asthma identification algorithm was developed that considered only data available in electronic format at the time of triage and included the presenting chief complaint, information from the computerized problem list (past medical history; current medications, such as beta-agonists, steroids, and other asthma medications), and ICD-9 billing codes from previous encounters. RESULTS: From 1835 Emergency Department visits, 368 visits (154 with asthma) had one of the five chief complaints and were included. A problem list was available in 203 (55.2%) and an ICD-9 code in 68 (18.5%) patients. Wheezing accounted for 56.5% of asthma visits, while fever was the most frequent chief complaint among all patients (43.8%). The asthma identification algorithm had a sensitivity of 44.8% (95% CI: 36.8-53.0%), a specificity of 91.6% (CI: 87.0-94.9%), a positive predictive value of 79.3% (CI: 69.3-87.3%) and a negative predictive value of 69.8% (CI: 64.0-75.1%). The positive and negative likelihood ratios were 5.3 (CI: 3.3-8.6) and 0.6 (CI: 0.5-0.7), respectively. CONCLUSION: The simple identification algorithm demonstrated good accuracy for identifying asthma episodes. The algorithm may represent a promising and feasible approach to create computerized reminders or automatic triggers that can facilitate the initiation of guideline-based asthma treatment in the Emergency Department.

Adolescent↗

PubMed2006

Biomedical informatics applications for asthma care: a systematic review.

Asthma is a common condition associated with significant patient morbidity and health care costs. Although widely accepted evidence-based guidelines for asthma management exist, unnecessary variation in patient care remains. Application of biomedical informatics techniques is one potential way to improve care for asthmatic patients. We performed a systematic literature review to identify computerized applications for clinical asthma care. Studies were evaluated for their clinical domain, developmental stage and study design. Additionally, prospective trials were identified and analyzed for potential study biases, study effects, and clinical study characteristics. Sixty-four papers were selected for review. Publications described asthma detection or diagnosis (18 papers), asthma monitoring or prevention (13 papers), patient education (13 papers), and asthma guidelines or therapy (20 papers). The majority of publications described projects in early stages of development or with non-prospective study designs. Twenty-one prospective trials were identified, which evaluated both clinical and non-clinical impacts on patient care. Most studies took place in the outpatient clinic environment, with minimal study of the emergency department or inpatient settings. Few studies demonstrated evidence of computerized applications improving clinical outcomes. Further research is needed to prospectively evaluate the impact of using biomedical informatics to improve care of asthmatic patients.

Asthma↗

PubMed2006

The life and death of URLs in five biomedical informatics journals.

OBJECTIVE: To determine the decay rate of Uniform Record Locators (URLs) in the reference section of biomedical informatics journals. METHODS: URL references were collected from printed journal articles of the first and middle issues of 1999-2004 and electronically available in-press articles in January 2005. We limited this set to five biomedical informatics journals: Artificial Intelligence in Medicine, International Journal of Medical Informatics, Journal of the American Medical Informatics Association: JAMIA, Methods of Information in Medicine, and Journal of Biomedical Informatics. During a 1-month period, URL access attempts were performed eight times a day at regular intervals. RESULTS: Of the 19,108 references extracted from 606 printed and 86 in-press articles, 1112 (5.8%) references contained a URL. Of the 1049 unique URLs, 726 (69.2%) were alive, 230 (21.9%) were dead, and 93 (8.9%) were comatose. URLs from in-press articles included 212 URLs, of which 169 (79.7%) were alive, 21 (9.9%) were dead, and 22 (10.4%) were comatose. The average annual decay, or link rot, rate was 5.4%. CONCLUSION: The URL decay rate in biomedical informatics journals is high. A commonly accepted strategy for the permanent archival of digital information referenced in scholarly publications is urgently needed.

Bibliometrics↗

PubMed2006

Tracking workload in the emergency department.

OBJECTIVE: The primary objective of this study was to create a methodology for measuring transient levels of physician workload in a live emergency department (ED) environment. BACKGROUND: Characterizing, defining, and measuring aspects of this interrupt-driven work environment represent the preliminary steps in addressing impending issues concerning ED overcrowding, efficiency, and patient and provider safety. METHODS: A time-motion task analysis was conducted. Twenty emergency medicine (EM) physicians were observed for 180-min intervals in an ED of an academic medical center. Near continuous workload measures were developed and used to track changing workload levels in time. These measures were taken from subjective, objective, and physiological perspectives. The NASA-Task Load Index was administered to each physician after observational sessions to measure subjective workload. Physiological measurements were taken throughout the duration of the observation to measure stress response. Additional information concerning physicians' patient quantity and patient complexity was extracted from the ED information system. RESULTS: Graphical workload profiles were created by combining observational and subjective data with system state data. Methodologies behind the creation of workload profiles are discussed, the workload profiles are compared, and quantitative and qualitative analyses are conducted. CONCLUSION: Using human factors methods to measure workload in a setting such as the ED proves to be challenging but has relevant application in improving the efficiency and safety of EM. APPLICATION: Techniques implemented in this research are applicable in managing ED staff and real-time monitoring of physician workload.

Emergency Service, Hospital↗

PubMed2005

Emergency physicians' behaviors and workload in the presence of an electronic whiteboard.

BACKGROUND: As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload. METHODS: The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests. RESULTS: Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload. CONCLUSION: The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.

Electronics↗

PubMed2005

Creating and validating a pneumococcal vaccination registry.

Healthy People 2010 set a goal of 90% vaccination rate for pneumococcal vaccine in elderly patients. We developed a keyword search, using pharmacy orders for Pneumovax as a gold standard, to determine patient eligibility for a computerized pneumococcal vaccination registry. The keyword search captured 98% of vaccinations in the validation dataset. A total of 4,768 patients matched at least one keyword in the search and were added to the immunization registry. Through our search, we found a 63% vaccination rate in the primary care patient population older than 65, leaving 37% of the high risk population still needing vaccinations.

Aged↗

PubMed2005

Using Bayesian networks to predict survival of liver transplant patients.

The relative scarcity of grafts available for liver transplantation highlights the need to identify patients likely to have good outcomes after treatment. We used transplant information from the United Network for Organ Sharing database to construct a Bayesian network model to predict 90-day graft survival. The final model incorporated a set of 29 pre-transplant variables, and it achieved performance, as measured by area under the receiver operating characteristic curve, of 0.674 by cross-validation and 0.681 on an independent validation set. The results showed a positive predictive value of 91%, while the negative predictive value was lower at 30%. With additional refinement and validation, our model may be useful as an adjunct to clinical experience in identifying patients most likely to have good outcomes following liver transplantation.

Adult↗

PubMed2005

Implementation of computerized provider order entry in the emergency department: impact on ordering patterns in patients with chest pain.

The impact of implementing a Computerized Provider Order Entry System on ordering patterns is unknown. This study evaluated ordering patterns for CBC, ECG, chest x-ray, BMP, and cardiac enzymes in randomly selected chest pain patients in an adult Emergency Department pre- and post-implementation. The average number of orders documented was significantly higher after implementation for ECG and chest x-ray, but not for the other exams. Order completion times did not change.

Blood Chemical Analysis↗

PubMed2005

The life and death of URLs in five biomedical informatics journals.

With the increased use of the World Wide Web has come an increase in the number of Uniform Resource Locator (URL) references cited in journals. Out of the 17,698 references we collected from five biomedical informatics journals between 1999 and 2005, 6.8% contained URLs. Overall, 22.6% of these URLs were inaccessible. In-press articles had 10.8% unavailable URLs. Approaches that guarantee permanent access to URL citations of scientific publications are needed.

Bibliometrics↗

PubMed2005

Prompting clinicians: a systematic review of preventive care reminders.

Prompting clinicians to offer preventive care procedures has been shown to increase the use of these procedures. This study is an update of a systematic review examining the effect of reminder systems on offers of preventive care to patients. Of 1,404 eligible studies, 23 were included. The studies were evaluated according to their intervention type and use of computerized methods. We found that although computerized reminder systems have become more common, paper-based reminders were the most effective reminder strategy.

Humans↗

PubMed2005

A feasibility study for the computerized recruitment of subjects for research studies.

Email messages are a common communication approach to recruit individuals for research studies. We examined the content of 264 consecutive, electronic recruitment solicitations and evaluated whether the content would provide the necessary structure and expressiveness to implement a computerized recruitment tool within an electronic medical record. Email messages frequently included unspecific and temporal concepts that may challenge the fully automated recruitment process.

Biomedical Research↗

PubMed2005

Predicting hospital admission for Emergency Department patients using a Bayesian network.

Hospital admission delays in the Emergency Department (ED) reduce volume capacity and contribute to the nation's ED diversion problem. This study evaluated the accuracy of a Bayesian network for the early prediction of hospital admission status using data from 16,900 ED encounters. The final model included nine variables that are commonly available in many ED settings. The area under the receiver operating characteristic curve was 0.894 (95% CI: 0.887-0.902) for the validation set. The system had high accuracy an may be used to alert clinicians to initiate admission processes earlier during a patient's ED encounter.

Area Under Curve↗

PubMed2005

Computerized provider order entry in the emergency department: pilot evaluation of a return on investment analysis instrument.

The Vanderbilt Center for Better Health conducted a workflow analysis study to determine the benefits of implementing a computerized provider order entry system in the adult Emergency Department. Time savings by role was 1619 hours/year for nurses, 815 for medical receptionist, -95 for attendings, and -100 for residents. Translating time savings into bottom line savings (FTE/overtime reduction, additional charges) resulted in $31,424 in time savings and $40,000 cost savings (paper forms).

Adult↗

PubMed2005

Estimating patient's length of stay in the Emergency Department with an artificial neural network.

Predicting a patient's expected length of stay for an Emergency Department encounter is valuable to anticipate impending operational bottlenecks that may lead to diversion. We developed and validated an artificial neural network using data from >16,000 patients using clinical and operational parameters that are commonly available early during an encounter. Performance on the training set predicted length of stay within an average of 2 hours (sigmae2<500), but declined to an average of 7.5 hours (sigmae2<6000) in the validation set. Chief complaint specific trials using the most frequent chief complaints, however, predicted within an average of 3.5 hours (sigmae2 <145), with similar validation.

Adult↗

PubMed2004

Accuracy of references in five biomedical informatics journals.

OBJECTIVE: To determine the rate and type of errors in biomedical informatics journal article references. METHODS: References in articles from the first 2004 issues of five biomedical informatics journals, Journal of the American Medical Informatics Association, Journal of Biomedical Informatics, International Journal of Medical Informatics, Methods of Information in Medicine, and Artificial Intelligence in Medicine were compared with MEDLINE for journal, authors, title, year, volume, and page number accuracy. If discrepancies were identified, the reference was compared with the original publication. Two reviewers independently evaluated each reference. RESULTS: The five journal issues contained 37 articles. Among the 656 eligible references, 225 (34.3%) included at least one error. Among the 225 references, 311 errors were identified. One or more errors were found in the bibliography of 31 (84%) of the 37 articles. The reference error rates by journal ranged from 22.1% to 40.7%. Most errors (39.0%) occurred in the author element, followed by the journal (31.2%), title (17.7%), page (7.4%), year (3.5%), and volume (1.3%) information. CONCLUSION: The study identified a considerable error rate in the references of five biomedical informatics journals. Authors are responsible for the accuracy of references and should more carefully check them, possibly using informatics-based assistance.

Bibliographies as Topic↗