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Biomedical subjects

E Andrew Balas

Publications and source records attributed to E Andrew Balas.

8 recordsLinked to original sources
PubMed2004

eLearning: a review of Internet-based continuing medical education.

INTRODUCTION: The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. METHODS: Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. RESULTS: Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. DISCUSSION: The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

Computer-Assisted Instruction↗
PubMed2004

Computerized knowledge management in diabetes care.

INTRODUCTION: Many scientific achievements become part of usual diabetes care only after long delays. The purpose of this article is to identify the impact of automated information interventions on diabetes care and patient outcomes and to enable this knowledge to be incorporated into diabetes care practice. METHODS: We conducted systematic electronic and manual searches and identified reports of randomized clinical trials of computer-assisted interventions in diabetes care. Studies were grouped into 3 categories: computerized prompting of diabetes care, utilization of home glucose records in computer-assisted insulin dose adjustment, and computer-assisted diabetes patient education. RESULTS: Among 40 eligible studies, glycated hemoglobin and blood glucose levels were significantly improved in 7 and 6 trials, respectively. Significantly improved guideline compliance was reported in 6 of 8 computerized prompting studies. Three of 4 pocket-sized insulin dosage computers reduced hypoglycemic events and insulin doses. Metaanalysis of studies using home glucose records in insulin dose adjustment documented a mean decrease in glycated hemoglobin of.14 mmol/L (95% confidence interval [CI], 0.11-0.16) and a decrease in blood glucose of.33 mmol/L (95% CI, 0.28-0.39). Several computerized educational programs improved diet and metabolic indicators. DISCUSSION: Computerized knowledge management is becoming a vital component of quality diabetes care. Prompting follow-up procedures, computerized insulin therapy adjustment using home glucose records, remote feedback, and counseling have documented benefits in improving diabetes-related outcomes.

Blood Glucose Self-Monitoring↗
PubMed2003

Internet-enabled interactive multimedia asthma education program: a randomized trial.

OBJECTIVE: To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program. METHODS: Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program. Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking. Pediatric Asthma Care Knowledge Survey, Pediatric Asthma Caregiver's Quality of Life Questionnaire, asthma symptom history, spirometry, and health services utilization data were collected at the initial visit and at 3 and 12 months. RESULTS: Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers, decreased asthma symptom days (81 vs 51 per year), and decreased number of emergency department visits (1.93 vs 0.62 per year) among the intervention group participants. The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids (434 vs 754 micro g [beclomethasone equivalents]) at visit 3. Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits (r = 0.37) and less frequent use of quick-relief medicines (r = 0.30). CONCLUSIONS: Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma.

Adolescent↗
PubMed2002

Teleconsultation practice guidelines: report from G8 Global Health Applications Subproject 4.

This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.

Computer Security↗
PubMed2002

Identifying cost management strategies in dialysis clinics: sustainable savings with positive outcomes.

OBJECTIVES: To examine whether cost management strategies are used in a revenue-constrained environment without compromising clinical effectiveness. STUDY DESIGN: Cross-sectional analysis of monthly cost and acuity-adjusted hospitalization data. METHODS: This research included longitudinal regression analyses involving 10 years of data, 1990 through 1999, from each of 6 dialysis centers. Two sets of regression models were used: one set examined cost interactions and cost trends (P < or = .001); the second set examined clinical outcomes (P < or = .001). Four cost management strategies were examined: (1) selective reductions in targeted cost categories, (2) cost reductions through improved efficiencies, (3) cost avoidance by shifting responsibilities to external parties, and (4) uniform reductions across all cost categories. RESULTS: Managers appeared to have limited opportunity to selectively or uniformly reduce costs because of cost "stickiness" and minimal resource substitutability. Improvements in operational efficiencies and cost shifting to external parties occurred. Over time, however, realized efficiencies increased at a decreasing rate, whereas cost shifting actually declined. Contrary to prior hospital studies, these results indicate significant economies of scale. No statistical correlation was found to indicate that the physician/clinic management teams' use of cost reduction strategies affected acuity-adjusted hospitalizations of dialysis patients. CONCLUSIONS: Strategic models that include both financial and outcomes data can enable healthcare managers to predict both positive and negative results of cost management proposals. These models can help identify aspects of an organization's cost structure that affect sustainable cost savings: cost stickiness, cost substitutability, institutional experience, realized operational improvements, and economies of scale.

Ambulatory Care Facilities↗
PubMed2002

WEB-WAP based telecare.

We have developed two telecare applications based on mobile telephony (WAP) and WEB. The first can be used to request Basic Life Support (BLS) guidelines any time by using a WAP device and to teach people and non-professionals involved in health care emergency situations. The second is a WEB-WAP based tool for medical data retrieval and at-home health care monitoring of chronically ill patients with congestive heart failure (CHF) or diabetes. Medical education content related to these diseases is available on the WEB and on the WAP device. The WAP application uses the features found in the last generation of mobile phones such as better multimedia information presentations, better interactivity capabilities, and enhanced ease of use. Based on these two applications, a promising platform is offered for developing applications in health care, home care, medical monitoring and health education ensuring continuity of care. In the paper we present the preliminary results of a pilot test at Thessaloniki University (Greece) where the WEB-WAP based tool is used to monitor patients with diabetes or CHF.

Chronic Disease↗
PubMed2002

Computable decision modules for patient safety in child health care.

OBJECTIVE: To identify controlled evidence from the child health literature on patient conditions and clinical procedures that resulted in unacceptable adverse outcomes. METHODS: Systematic searches of MEDLINE (1966 to 2001), and Cochrane Database of Systematic Reviews (2001) were done. Studies that met the eligibility criteria, were verified for quality of methodology and lack of conflicting studies. A knowledge base of Child Health Safety Modules was then developed. The knowledge base could be used to transfer controlled evidence on potentially harmful interventions into clinical decision support systems conforming with Arden Syntax, a widely applied computer standard. RESULTS: The searches identified knowledge to create 41 Child Health Safety Modules for medications and procedures in child health care, from 29 randomized controlled trials and 12 non-randomized controlled studies. The modules are focused on 28 medication interventions and 13 other clinical procedures. Eighty five percent of the studies were published between 1997-2001. CONCLUSION: An increasing amount of controlled evidence on risks of adverse outcomes in child health is available to alert clinicians when potential planning errors are about to be overlooked.

Artificial Intelligence↗