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Improving Outcomes with Clinical Decision Support: An Implementer's Guide

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Jerry Osheroff
josheroff@tmitconsulting.com
... There are many digital decision-making tools that have been integrated into healthcare delivery, serving both clinicians and patients. Clinical Decision Support Systems (CDSS) aim to enhance healthcare delivery by leveraging health information to improve clinician decisionmaking [9]. For example, a review by Chima et al [10] highlighted the role of CDSS in aiding cancer diagnosis in primary healthcare and concluded that CDSS have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. ...
... Whilst many technologies target clinicians, there is a rapid expansion of patient-facing technology as individuals increasingly utilize digital tools for health management [9]. A review by Bouaoud et al. [14] exploring (telemedicine, telemonitoring and digital therapeutics technologies) for HNC patients and caregivers showed that patients were satisfied with these tools, because of the ability of the tools to facilitate early detection of health problems. ...
... The study revealed that five diseases-stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer-contribute to 39% of malpractice costs. Because the complexity of medical conditions is positively correlated to poor outcomes [12], AI can be employed to improve decisions when multimodal data (EMR (Electronic Medical Record) and LIS (Laboratory Information System)) are required [13]. CDS systems compare patient data with previously collected data sets of similar casuistics to calculate a desired endpoint [14]. ...
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In a rapidly changing technology landscape, “Clinical Decision Support” (CDS) has become an important tool to improve patient management. CDS systems offer medical professionals new insights to improve diagnostic accuracy, therapy planning, and personalized treatment. In addition, CDS systems provide cost-effective options to augment conventional screening for secondary prevention. This review aims to (i) describe the purpose and mechanisms of CDS systems, (ii) discuss different entities of algorithms, (iii) highlight quality features, and (iv) discuss challenges and limitations of CDS in clinical practice. Furthermore, we (v) describe contemporary algorithms in oncology, acute care, cardiology, and nephrology. In particular, we consolidate research on algorithms across diseases that imply a significant disease and economic burden, such as lung cancer, colorectal cancer, hepatocellular cancer, coronary artery disease, traumatic brain injury, sepsis, and chronic kidney disease.
... A clinical decision support system (CDSS) aims to meliorate healthcare by integrating clinical information, patient information, and other health information (Osheroff 2012). These systems provide patient-specific assessments and recommendations by matching individual personal characteristics with a clinical information base (Sim et al. 2001). ...
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Mental and neurological disorders significantly impact global health. This systematic review examines the use of artificial intelligence (AI) techniques to automatically detect these conditions using electroencephalography (EEG) signals. Guided by Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA), we reviewed 74 carefully selected studies published between 2013 and August 2024 that used machine learning (ML), deep learning (DL), or both of these two methods to detect neurological and mental health disorders automatically using EEG signals. The most common and most prevalent neurological and mental health disorder types were sourced from major databases, including Scopus, Web of Science, Science Direct, PubMed, and IEEE Xplore. Epilepsy, depression, and Alzheimer's disease are the most studied conditions that meet our evaluation criteria, 32, 12, and 10 studies were identified on these topics, respectively. Conversely, the number of studies meeting our criteria regarding stress, schizophrenia, Parkinson's disease, and autism spectrum disorders was relatively more average: 6, 4, 3, and 3, respectively. The diseases that least met our evaluation conditions were one study each of seizure, stroke, anxiety diseases, and one study examining Alzheimer's disease and epilepsy together. Support Vector Machines (SVM) were most widely used in ML methods, while Convolutional Neural Networks (CNNs) dominated DL approaches. DL methods generally outperformed traditional ML, as they yielded higher performance using huge EEG data. We observed that the complex decision process during feature extraction from EEG signals in ML‐based models significantly impacted results, while DL‐based models handled this more efficiently. AI‐based EEG analysis shows promise for automated detection of neurological and mental health conditions. Future research should focus on multi‐disease studies, standardizing datasets, improving model interpretability, and developing clinical decision support systems to assist in the diagnosis and treatment of these disorders.
... Prognostic models are useful for estimating disease severity and survival and can serve as helpful medical decision-making tools for guiding patient care. [5][6][7] Studies have demonstrated that the MELD sore has been useful in predicting mortality in several groups of patients, including patients on the waiting list for liver transplantation, hospitalized patients with hepatic decompensation, ambulatory patients with non-cholestatic liver disease, and patients with primary biliary cholangitis. 8 In a study by Roth et al., the in-hospital mortality was 0.8%, 2.8%,3.0% ...
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Objective: This study aimed to find the frequency of mortality and length of hospital stay in patients with liver cirrhosis based on their MELD score at admission. We also aim to study prognostication in cirrhotic patients using MELD scores at admission. Materials and Methods: A descriptive cross-sectional study was conducted in the Medical Department of Khyber Teaching Hospital Peshawar from 17/10/2019 to 17/4/2020. A total of 100 patients were observed. Investigations required for the calculation of the MELD score were done from the hospital laboratory. Admitted patients were followed for study outcome in-hospital mortality and length of hospital stay for at least 30 days. All information was noted in the predesigned proforma. RESULTS: One hundred patients were analyzed among which the mean age was 53 years with SD ± 7.11. Forty-two percent were male and 58% were female. In-hospital mortality was observed in 8(8%) while mean hospital stay was 7 days with a standard deviation ± 4.12 in patients presenting with liver cirrhosis mortality was observed in patients with a MELD score of less than 20. However, mortality was 6.89% in patients with a MELD score of 20-29 and 42.85 % in those with a MELD score of more than 30. CONCLUSION: The frequency of in-hospital mortality was 8% and the mean length of hospital stay was 7± 4.12 days in patients with liver cirrhosis. For patients with higher MELD scores, the hospital stay and mortality increased. Key Words: in-hospital mortality, mean length of hospital stay, MELD score
... CDS systems have been in use since the 1990's and provide "a process for enhancing health-related decisions and actions with pertinent, organized, clinical knowledge, and patient information to improve health and healthcare delivery" [3]. Although there are CDS platforms for burn care, they use mobile phones, record sharing services, and video-based telemedicine to provide CDS for burn care [4][5][6]. ...
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Critical care injuries, such as burn trauma, require specialized skillsets and knowledge. A clinical decision support system to aid clinicians in providing burn patient management can increase proficiency and provide knowledge content for specific interventions. In austere environments, decision support tools can be used to aid in decision making and task guidance when skilled personnel or resources are limited. Therefore, we developed a novel software system that utilizes augmented reality (AR) capabilities to provide enhanced step-by-step instructions based on best practices for managing burn patients. To better understand how new technologies, such as AR, can be used for burn care management, we developed a burn care application for use on a heads-up display. We developed four sub-set applications for documenting and conducting burn wound mapping, fluid resuscitation, medication calculations, and an escharotomy. After development, we conducted a usability study utilizing the System Usability Scale, pre- and post- simulation surveys, and after-action reviews to evaluate the AR-based software application in a simulation scenario. Results of the study indicate that the decision support tool has generalized usability and subjects were able to use the software as intended. Here we present the first use case of a comprehensive burn management system utilizing augmented reality capabilities to deliver care.
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Define mHealth and mobile technologies • Discuss three mobile technology uses cases in a clinical setting • Discuss the shortcomings of medical apps for smartphones • Enumerate the challenges of mHealth in low and middle-income countries • Identify the software development kits (SDKs) for the iPhone and Android OS
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