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At least 343 records · Page 19Linked to original sources
PubMed2004

Technology, work, and information flows: lessons from the implementation of a wireless alert pager system.

The combination of collaborative work practices and information technology affect the flow of information in clinical settings. The introduction of a new technology into these settings can change not only established work practices but also the information flows. In this paper, we examine the introduction of a wireless alerts pager in a surgical intensive care unit (SICU). Through a qualitative study, we analyze the effects that this new information tool had on both the work practices in the SICU and the information flow in the unit. We describe four challenges that SICU staff members faced with respect to the alerts pagers. We found that the pager provided new routes of information to SICU staff but in doing so disrupted existing work practices and information flows.

Attitude of Health Personnel↗
PubMed2004

Unobtrusive monitoring of computer interactions to detect cognitive status in elders.

The U.S. has experienced a rapid growth in the use of computers by elders. E-mail, Web browsing, and computer games are among the most common routine activities for this group of users. In this paper, we describe techniques for unobtrusively monitoring naturally occurring computer interactions to detect sustained changes in cognitive performance. Researchers have demonstrated the importance of the early detection of cognitive decline. Users over the age of 75 are at risk for medically related cognitive problems and confusion, and early detection allows for more effective clinical intervention. In this paper, we present algorithms for inferring a user's cognitive performance using monitoring data from computer games and psychomotor measurements associated with keyboard entry and mouse movement. The inferences are then used to classify significant performance changes, and additionally, to adapt computer interfaces with tailored hints and assistance when needed. These methods were tested in a group of elders in a residential facility.

Aged↗
PubMed2005

Overriding of drug safety alerts in computerized physician order entry.

Many computerized physician order entry (CPOE) systems have integrated drug safety alerts. The authors reviewed the literature on physician response to drug safety alerts and interpreted the results using Reason's framework of accident causation. In total, 17 papers met the inclusion criteria. Drug safety alerts are overridden by clinicians in 49% to 96% of cases. Alert overriding may often be justified and adverse drug events due to overridden alerts are not always preventable. A distinction between appropriate and useful alerts should be made. The alerting system may contain error-producing conditions like low specificity, low sensitivity, unclear information content, unnecessary workflow disruptions, and unsafe and inefficient handling. These may result in active failures of the physician, like ignoring alerts, misinterpretation, and incorrect handling. Efforts to improve patient safety by increasing correct handling of drug safety alerts should focus on the error-producing conditions in software and organization. Studies on cognitive processes playing a role in overriding drug safety alerts are lacking.

Drug Therapy, Computer-Assisted↗
PubMed2004

Multi-compartment medication devices and patient compliance.

Multi-compartment medication compliance devices are widely used in primary care. The aim of this review is to reveal whether they are effective in promoting adherence among non-adherent adults living at home. Searches were undertaken using two electronic databases (Medline (1966-2003) and International Pharmaceutical Abstracts (1970-2002)). Only randomized controlled trials (including crossover studies) were included in the review. Participants had to be non-institutionalized adults receiving one or more prescription medicines each day and displaying problems with adherence. Studies had to compare multi-compartment medication compliance devices to standard packaging and outcome measures and to include either pill counts, biological assays and/or clinical response. Articles were selected if they described a follow up period of at least three months and demonstrated that over 80% of participants had completed the trial. Two studies were identified that met the criteria, reporting data on a total of 148 patients. The findings from the first study found diabetic patients receiving medication in a compliance device demonstrated better glucose control than patients receiving medication in standard packaging. The second study found compliance devices had no impact on blood pressure control in hypertensive patients. Further research needs to be conducted to assess the effectiveness of multi-compartment medication compliance devices in promoting adherence among non-adherent adults living at home.

Adult↗
PubMed1992

Solving medication noncompliance in home care.

The problem of medication noncompliance is frequently encountered by home care nurses and poses a continuous challenge in daily practice. Because of their advantageous position, home care nurses can be instrumental in addressing this problem. This article discusses various types and causes of noncompliance and presents some solutions that can be implemented in the home.

Attitude to Health↗
PubMed1992

Color coding patient medications.

"When I first met Mr. K, he had just been discharged from the hospital, where he was treated for congestive heart failure. This was his third admission this year--his physician thought he might not be taking his medications correctly. The doctor had referred him to our home care agency for instructions in taking his medications and for cardiopulmonary assessment." A home care nurse explains how she developed a simple medication coding method to ensure an elderly patient's independence--and health.

Aged↗
PubMed2001

A comprehensive computerized critical laboratory results alerting system for ambulatory and hospitalized patients.

Automatic alerting systems for key events in medical practice have been proven effective in improving the clinician's response to the event. Most of the systems described in current literature are hospital based, some in intensive care units. We designed a clinical alerting system that screens laboratory results of both hospitalized patients and most of Israel's Southern region ambulatory patients for critical results, using an integrative CDR and its interfaces to the hospital's laboratory information systems. New alerts can be defined and activated using a rule editor. Alerts are generated by screening all new laboratory results that are entered in to the CDR, by a decision engine. The alerts are dispatched to clinicians through a customizable preferred alerting device that can be either e-mail, fax or cellular phone SMS, and enables additional alerting devices as they become available. Clinicians may customize both the alerting method and the critical levels for alert generation, according to individual specific needs. We hope that this versatile and customizable alerting system will suite the needs of both the hospital and the community clinical staff. The system will be implemented and tested in the near future.

Ambulatory Care↗
PubMed2006

Free-text data entry by speech recognition software and its impact on clinical routine.

We conducted a study to evaluate speech recognition software in an otorhinolaryngology unit and to assess its impact on productivity prior to general implementation. Current speech recognition software (IBM ViaVoice, version 10) was implemented on a personal computer with a 2-GHz central processing unit, 256 MB of RAM, and a 30-GB hard disk drive, with and without add-on professional vocabulary for otorhinolaryngology. This vocabulary was added by the automated analysis of an additional 12,257 documents from our department. We compared the word recognition error rates for three different text types and determined their impact on the amount of surgeon's time that was invested in the production of an error-free document. Although error rates without any professional vocabulary database were rather high (operation reports: 38.72%; consultation notes: 27.77%), the patient information was edited with a satisfactory result (10.65%). Best results were obtained with the specialty-related vocabulary database added by the analysis of our own documents (operation reports: 5.45%; consultation notes: 5.21%). An increase in productivity compared with that of conventional transcription was found at an error rate of less than 16%.

Efficiency, Organizational↗
PubMed1995

A tool for provider interaction during patient care: G-CARE.

We have extended the CARE language to facilitate interaction with providers using the Medical Gopher order entry system during patient care to create G-CARE. We have used G-CARE in several randomized controlled trials and for routine clinical applications. The language has evolved and is now able to support nearly all of the decision support. Its flexibility allows G-CARE results to be used at many points throughout the patient care process. Based on actual use of G-CARE, we have found performance issues and lack of dynamically grouped order sets are limitations which need to be addressed.

Decision Making, Computer-Assisted↗
PubMed2004

Reminder-based or on-demand decision support systems: a preliminary study in primary care with the management of hypertension.

ASTI is a guideline-based decision support system for therapeutic prescribing in primary care with two modes of interaction. The "critic mode" operates as a reminder system to detect non guideline-compliant physician drug orders, whereas the "guided mode" operates on demand and provides physician guidance to help her establishing best recommended drug prescriptions for the management of hypertension. A preliminary evaluation study was conducted with 10 GPs to test the complementary nature of both modes of decision support. Results tend to validate our assumption that reminder-based interaction is appropriate for simple cases and that physicians are willing to use on-demand systems as clinical situations become more complex.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Can a simple reminder letter improve numbering of single-family residences?

OBJECTIVE: To determine if a single mailing from the local volunteer fire department can increase the number of homes with proper, visible address numbering. Proper numbering is essential in rapidly locating a house during an emergency response. METHODS: The study was conducted at a suburban/rural fire department providing EMS and fire suppression services to a 22 square mile area with residential mailboxes located at the street. During a hazard identification pre-plan tour, each house was examined and assigned a classification: (A) No number visible on the house or mailbox (improper); (B) Number on only one side of the mailbox (improper); (C) Number on both sides or the end of the mailbox, or visible on the house (proper). The homeowners of all residences with improper numbering (A or B) were sent a one-page letter, discussing the need for proper numbering. The tour was repeated six weeks later to determine whether deficiencies had been corrected. It was prospectively determined that a 25% improvement was sought. RESULTS: During the pre-plan tour, 73 houses were classified as type A, 454 as type B, and 1706 as type C. At the re-visit, 135 (26%) of the type A and B homes had been properly numbered. Correction of deficiencies was better at type A homes (37, or 51%) than at type B homes (98, or 22%) (p < 0.001 by Chi-square). CONCLUSION: For houses with improper numbering, a single mailing from the fire department can be effective in encouraging residents to post proper numbers.

Connecticut↗
PubMed2005

A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals.

OBJECTIVE: To assess the effectiveness of different strategies for increasing the uptake of prophylaxis for venous thromboembolism (VTE) in hospitalized patients through a systematic review of the literature. METHODS: Literature databases and the Internet were searched from 1996 to May 2003. Studies of strategies to improve VTE prophylaxis practice were included. Studies where no policy or guideline was implemented or where the focus of the study was not VTE prevention were excluded. RESULTS: Thirty studies were included. The quality of the available evidence was average with the majority of studies being uncontrolled before and after design and thus limited by the historical nature of much of the available data. Adherence to guidelines and the provision of adequate prophylaxis were poor in studies which relied on passive dissemination of guidelines. In general, the use of multiple strategies was more effective than a single strategy used in isolation. The most effective strategies incorporated a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders, and used audit and feedback to facilitate the iterative refinement of the intervention. There were no studies adequately powered to demonstrate a reduction in rates of VTE. Insufficient evidence was available to make useful comparisons of strategies in terms of costs and resource utilization. CONCLUSIONS: Passive dissemination of guidelines is unlikely to improve VTE prophylaxis practice. A number of active strategies used together, which incorporate some method for reminding clinicians to assess patients for DVT risk and assisting the selection of appropriate prophylaxis, are likely to result in the achievement of optimal outcomes.

Guideline Adherence↗
PubMed1998

Improving influenza vaccination coverage among high-risk patients: a role for computer-supported prevention strategy?

BACKGROUND: Worldwide, population-based influenza vaccination strategies are being developed to trace, immunize and monitor high-risk persons efficiently. Computerized prevention modules may facilitate such a strategy in general practice. OBJECTIVES: We established the applicability of a computerized influenza prevention module and specifically addressed improvement of immunization coverage in high-risk patients during two consecutive influenza vaccination rounds after introduction of the module. METHODS: In this descriptive study, four computerized practices of the Utrecht General Practices Network, covering about 36000 patients, participated. In 1995, all patients with high-risk diseases were traced by relevant tags, ICPC- and ATC-codes, using the module. According to changed Dutch immunization guidelines in 1996, healthy elderly people over 65 years were also traced. Demographical and medical data included age, high-risk disease and vaccine uptake. RESULTS: In October 1995, 3871 high-risk patients were identified (11% of population); overall vaccination coverage was 68%. Over one-third of these patients had not been indicated before. In between the two vaccination rounds, 1104 previously unknown patients with high-risk disease <65 years were found by means of the module's on-line status. In October 1996, 6889 persons, including 2308 healthy elderly, were indicated (19%), and vaccination coverage was 62%. Of 3477 patients whose high-risk diseases were documented in both vaccination rounds, an overall improvement of vaccination coverage from 71 % in 1995 to 76% in 1996 was observed (P < 0.05). Main improvements were found in elderly patients. Immunization rates were highest in those with more than one risk factor, lung or cardiac disease, and lowest in healthy elderly and patients under 65 years with lung, renal or other diseases. CONCLUSION: Computerized prevention modules and CMRs may facilitate population-based prevention of influenza and the use should be further encouraged.

Adult↗
PubMed2004

The smart house for older persons and persons with physical disabilities: structure, technology arrangements, and perspectives.

Smart houses are considered a good alternative for the independent life of older persons and persons with disabilities. Numerous intelligent devices, embedded into the home environment, can provide the resident with both movement assistance and 24-h health monitoring. Modern home-installed systems tend to be not only physically versatile in functionality but also emotionally human-friendly, i.e., they may be able to perform their functions without disturbing the user and without causing him/her any pain, inconvenience, or movement restriction, instead possibly providing him/her with comfort and pleasure. Through an extensive survey, this paper analyzes the building blocks of smart houses, with particular attention paid to the health monitoring subsystem as an important component, by addressing the basic requirements of various sensors implemented from both research and clinical perspectives. The paper will then discuss some important issues of the future development of an intelligent residential space with a human-friendly health monitoring functional system.

Activities of Daily Living↗