Biomedical subjects

Michael Apkon

Publications and source records attributed to Michael Apkon.

3 recordsLinked to original sources

PubMed2005

A randomized outpatient trial of a decision-support information technology tool.

BACKGROUND: Decision-support information technology is often adopted to improve clinical decision making, but it is rarely rigorously evaluated. Congress mandated the evaluation of Problem-Knowledge Couplers (PKC Corp, Burlington, Vt), a decision-support tool proposed for the Department of Defense's new health information network. METHODS: This was a patient-level randomized trial conducted at 2 military practices. A total of 936 patients were allocated to the intervention group and 966 to usual care. Couplers were applied before routine ambulatory clinic visits. The primary outcome was quality of care, which was assessed based on the total percentage of any of 24 health care quality process measures (opportunities to provide evidence-based care) that were fulfilled. Secondary outcomes included medical resources consumed within 60 days of enrollment and patient and provider satisfaction. RESULTS: There were 4639 health care opportunities (2374 in the Coupler group and 2265 in the usual-care group), with no difference in the proportion of opportunities fulfilled (33.9% vs 30.7%; P = .12). Although there was a modest improvement in performance on screening/preventive measures, it was offset by poorer performance on some measures of acute care. Coupler patients used more laboratory and pharmacy resources than usual-care patients (logarithmic mean difference, 71 dollars). No difference in patient satisfaction was observed between groups, and provider satisfaction was mixed. CONCLUSION: This study provides no strong evidence to support the utility of this decision-support tool, but it demonstrates the value of rigorous evaluation of decision-support information technology.

Adult↗

PubMed2005

Persistent hyperglycemia in critically ill children.

OBJECTIVES: To determine the prevalence and prognostic significance of hyperglycemia among critically ill nondiabetic children. STUDY DESIGN: We performed a retrospective cohort study using point-of-care blood glucose measurements, hospital administrative databases, and a computerized information system; 942 nondiabetic patients admitted to our Pediatric Intensive Care Unit (PICU) from October 2000 to September 2003 were included. The prevalence of hyperglycemia was based on initial PICU glucose measurement, highest value within 24 hours, and highest value measured during PICU stay up to 10 days after the first measurement. Primary outcome was in-hospital death with PICU lengths of stay (LOS) as secondary outcome. RESULTS: Through the use of three cutoff values (120 mg/dL, 150 mg/dL, and 200 mg/dL), the prevalence of hyperglycemia was 16.7% to 75.0%. The relative risk (RR) for dying increased for maximum glucose within 24 hours >150 mg/dL (RR, 2.50; 95% confidence interval (CI), 1.26 to 4.93) and highest glucose within 10 days >120 mg/dL (RR, 5.68; 95% CI, 1.38 to 23.47). LOS was decreased for admission glucose >120 mg/dL and 150 mg/dL but increased for all threshold values for maximum glucose within 10 days. CONCLUSIONS: Hyperglycemia occurs frequently among critically ill nondiabetic children and is correlated with a greater in-hospital mortality rate and longer LOS.

Blood Glucose↗

PubMed2003

Decision analysis and clinical uncertainty.

Decision analysis is a tool to aid decision-making in the face of uncertainty. Typically, clinical decision-making involves the selection of one or more therapeutic alternatives when the outcome of that decision cannot fully be known at the time the decision must be made. Uncertainty derives from imperfections in diagnostic testing, uncertainty about the natural history of disease, the random nature of iatrogenic complications, and the impact of patient-specific factors or comorbid conditions. Decision analysis seeks to optimize the expected outcome of a decision, incorporating the probabilistic nature of this uncertainty. Decision analysis is applied here to a common problem in intensive care units-the treatment of suspected ventilator-associated pneumonia. Recent applications of decision analysis in the pediatric literature are also used to illustrate the scope and limitations of this tool in clinical practice.

Decision Support Techniques↗