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Milenko Tanasijevic

Publications and source records attributed to Milenko Tanasijevic.

5 recordsLinked to original sources
PubMed2006

Return on investment for a computerized physician order entry system.

OBJECTIVE: Although computerized physician order entry (CPOE) may decrease errors and improve quality, hospital adoption has been slow. The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital over ten years. DESIGN: Cost and benefit estimates of a hospital CPOE system at Brigham and Women's Hospital (BWH), a 720-adult bed, tertiary care, academic hospital in Boston. MEASUREMENTS: Institutional experts provided data about the costs of the CPOE system. Benefits were determined from published studies of the BWH CPOE system, interviews with hospital experts, and relevant internal documents. Net overall savings to the institution and operating budget savings were determined. All data are presented as value figures represented in 2002 dollars. RESULTS: Between 1993 and 2002, the BWH spent $11.8 million to develop, implement, and operate CPOE. Over ten years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million given the institutional 80% prospective reimbursement rate. The CPOE system elements that resulted in the greatest cumulative savings were renal dosing guidance, nursing time utilization, specific drug guidance, and adverse drug event prevention. The CPOE system at BWH has resulted in substantial savings, including operating budget savings, to the institution over ten years. CONCLUSION: Other hospitals may be able to save money and improve patient safety by investing in CPOE systems.

Academic Medical Centers↗
PubMed2005

Validation of a method to replace frozen section during parathyroid exploration by using the rapid parathyroid hormone assay on parathyroid aspirates.

HYPOTHESIS: The parathyroid hormone (PTH) content of tissue aspirates is an accurate indicator of parathyroid tissue and can replace frozen section during parathyroid surgery. DESIGN AND SETTINGS: Prospective data collection in a tertiary care hospital with a single surgeon. PATIENTS: One hundred sixty-seven consecutive patients completing limited parathyroid explorations. INTERVENTIONS: Parathyroid adenomas removed during limited parathyroid exploration were aspirated through a 22-gauge needle into 0.5 mL isotonic sodium chloride solution and the solution held on ice in a purple-top tube. Aspirates of in situ thyroid tissue were also taken for comparison. Samples were then assessed to monitor the physiologic impact of the surgery. MAIN OUTCOME MEASUREMENTS: The PTH content of tissue aspirates was compared with histologic identification of removed putative parathyroid tissue. RESULTS: Elevated tissue PTH content was associated with the identification of origin as parathyroid in every case. Tissue aspirates from pathologically proven parathyroid tissue had a mean PTH level of at least 1691 pg/mL, with 160 having values exceeding the upper limit of the assay. This measure was significantly higher than values obtained from thyroid aspirates, which had a mean PTH level of 88 pg/mL (P<.01), reflective of blood levels at the time of aspiration. Using the 99% confidence interval of histologically confirmed parathyroid glands as the lower limit of a positive test result at 1610 pg/mL, tissue aspirate PTH assay has a sensitivity of 97% and a specificity of 100%. CONCLUSIONS: Positive identification of removed tissue as parathyroid is necessary adjunct to limited parathyroid exploration, where decreases in false positive blood PTH levels can be a result of operative manipulation of the neck. Analysis of tissue PTH content during the same assay that is being used for assessing blood PTH concentration is an efficient and accurate method for identifying the tissue with certainty. This measure also prevents the occasional ambiguity in frozen sections of parathyroid tissue that apparently contain thyroidlike colloid material.

Adenoma↗
PubMed2004

Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia.

OBJECTIVES: The aim of this study was to determine the effect of transient myocardial ischemia on circulating natriuretic peptide levels. BACKGROUND: Natriuretic peptides are released by the heart in response to wall stress. We hypothesized that transient myocardial ischemia would cause acute changes in circulating natriuretic peptide levels. METHODS: B-type natriuretic peptide (BNP), N-terminal fragment of BNP pro-hormone (NT-pro-BNP), and N-terminal fragment of atrial natriuretic peptide pro-hormone (NT-pro-ANP) levels were measured in 112 patients before, immediately after, and 4 h after exercise testing with nuclear perfusion imaging. RESULTS: Baseline levels of BNP were associated with the subsequent severity of provoked ischemia, with median levels of 43, 62, and 101 pg/ml in patients with none, mild-to-moderate, and severe inducible ischemia, respectively (p = 0.03). Immediately after exercise, the median increase in BNP was 14.2 pg/ml in patients with mild-to-moderate ischemia (p = 0.0005) and 23.7 pg/ml in those with severe ischemia (p = 0.017). In contrast, BNP levels only rose by 2.3 pg/ml in those who did not develop ischemia (p = 0.31). A similar relationship was seen between baseline NT-pro-BNP levels and inducible ischemia, but the changes in response to ischemia were less pronounced. NT-pro-ANP levels rose with exercise in both ischemic and non-ischemic patients. When added to traditional clinical predictors of ischemia, a post-stress test BNP >or=80 pg/ml remained a strong and independent predictor of inducible myocardial ischemia (odds ratio 3.0, p = 0.025). CONCLUSIONS: Transient myocardial ischemia was associated with an immediate rise in circulating BNP levels, and the magnitude of rise was proportional to the severity of ischemia. These findings demonstrate an important link between the severity of an acute ischemic insult and the circulating levels of BNP.

Atrial Natriuretic Factor↗
PubMed2003

Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality.

While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. Furthermore, providers make many errors, and clinical decision support can be useful for finding and preventing such errors. Over the last eight years the authors have implemented and studied the impact of decision support across a broad array of domains and have found a number of common elements important to success. The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality.

Decision Making, Computer-Assisted↗