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Biomedical subjects

R L Bradshaw

Publications and source records attributed to R L Bradshaw.

9 recordsLinked to original sources
PubMed1999

Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.

200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.

Adult↗
PubMed1999

Effectiveness of an information broker service.

The many disparate databases existing within the same health care organization create confusion and frustration for the consumer trying to get integrated information. The purpose of this research was to create a regional service that would provide a customer oriented information broker service with a single point of contact and guaranteed performance. From 1/98-6/99 there were 34 requests made. 23 were completed on time, eight still in progress and three were late (86.46% on time, average late time 0.76 days). 13 clinical departments used the service. Data was integrated from twelve different data sources. The requests produced about 2 Gigabytes of integrated data (416,666 single spaced pages). The resources required were approximately 1.3 FTE ($65K in direct costs). The cost/page of integrated information was 19 cents. The benefit to cost ratio was at least 3 and most likely higher. Surveys of customers indicated high satisfaction with services and would both utilize the service again and recommend it to others.

Commerce↗
PubMed1998

Automated key process monitors for patient care documentation.

Complete, accurate and timely patient care documentation is an essential part of the practice of medicine. As with any other process in medicine or industry, continuous quality improvement (CQI) is essential to assure the highest quality at the lowest cost. CQI requires objective key process measures that can be assessed routinely. A set of key process monitors designed to assess completeness, accuracy and timeliness were created based on local, regional and national standards. Feasibility was assessed in the LDS Hospital Emergency Department using 31,429 patient visits in the 18 months from June 1995 to November 1996. The logic of the score was programmed into SQL scripts and run against an Oracle database containing the patient care documentation. The results indicate that the chosen key process monitors can be used to provide real time assessment of the patient care documentation process. The general concepts of the key process measures of completeness, accuracy and timeliness are generalizable to many areas of medicine. The overall score provides one method of easily tracking departmental performance while the overall process monitoring database allows powerful, in-depth analysis of individual components of the process. It is recommended that such automated process monitoring tools be integrated into future clinical information systems.

Data Interpretation, Statistical↗
PubMed1996

Testing and validation of computerized decision support systems.

Systematic, through testing of decision support systems (DSSs) prior to release to general users is a critical aspect of high quality software design. Omission of this step may lead to the dangerous, and potentially fatal, condition of relying on a system with outputs of uncertain quality. Thorough testing requires a great deal of effort and is a difficult job because tools necessary to facilitate testing are not well developed. Testing is a job ill-suited to humans because it requires tireless attention to a large number of details. For these reasons, the majority of DSSs available are probably not well tested prior to release. We have successfully implemented a software design and testing plan which has helped us meet our goal of continuously improving the quality of our DSS software prior to release. While requiring large amounts of effort, we feel that the process of documenting and standardizing our testing methods are important steps toward meeting recognized national and international quality standards. Our testing methodology includes both functional and structural testing and requires input from all levels of development. Our system does not focus solely on meeting design requirements but also addresses the robustness of the system and the completeness of testing.

Artificial Intelligence↗
PubMed1988

Axillary vein approach for pulmonic valvuloplasty in infants with iliac vein obstruction.

Repeated pulmonic balloon valvuloplasty from the axillary vein was performed in two infants with initial transvalvular gradients of 131 and 162 mm Hg. The first angioplasty was performed through the femoral vein and improved the valve gradient in both patients. Because of obstruction of the iliac system the axillary vein approach was used for the second angioplasty. The transaxillary pulmonic valvuloplasty decreased the gradient to acceptable levels, and no complications were noticed. The axillary vein approach can be the alternative to the femoral one in cases with obstructed iliac system or interrupted inferior vena cava.

Axillary Vein↗