The high prevalence of PIMs in elderly is a major healthcare concern and indicates the need for medication monitoring systems. Most PIM CDSS have shown positive effects respecting PIM prescription but these results were more consistently in hospital settings compared with ambulatory care. We describe the post-implementation evaluation of a PIM CDSS for general practitioners (GP) in the ambulatory setting and explore GP interactions with the PIM alerts. The CDSS generated 3218 unique alerts and involved 2863 elderly patients. Benzodiazepines was the drug with the most alerts triggered. Only 129 (4 %) were opened by GP during patient appointments. We need to develop an understanding of how alerts should be designed and display information to support the workflow of general practitioners. Pos-implementation evaluations are the key of CDSS improvements.
Breast cancer represents 23% of all cancers diagnosed among women each year. BRCA1 and BRCA2 are tumor suppressor genes related to the most frequent form of hereditary breast and ovarian cancer, as well as other types of cancer. The aim of this work is to describe the development of Clinical Decision Support Systems (CDSS) for referral to genetic counseling in patients at increased risk of pathogenic variants in BRCA1 and BRCA2, and to describe results during the pilot study implementation (from January 5, 2021 to March 5, 2021). To achieve integration and system interoperability, we used FHIR and CDS-Hooks within the CDSS development. A total of 142 alerts were triggered by the system for 72 physicians in 98 patients. Results showed an acceptance rate for the recommendation of 2.1%, which could improve using intrusive alerts in all of the hooks.
Objetivos: Demoras en el diagnóstico y la falta de consulta a nefrología (CN) se podrían asociar a peor pronóstico en pacientes con lesión renal aguda (LRA) internados. El objetivo fue analizar su prevalencia, impacto y reconocimiento por medio del registro en la historia clínica (HC) y el impacto de la CN. Materiales y métodos: Desarrollamos un recurso electrónico de detección automática de LRA mediante cambios en la creatinina. Resultados: Incluimos 35,730 episodios. La edad media fue 59.4 ± 20.5 años, el 56.1% eran mujeres. Presentaron LRA 4,101 pacientes (11.5%). La edad y las comorbilidades fueron mayores en pacientes con LRA, al igual que los días de internación (13.3 vs. 4) y la mortalidad (13.9 vs. 3%). La LRA se asoció a un riesgo de mortalidad intrahospitalaria elevado (odds ratio [OR]: 3.4; intervalo de confianza del 95% [IC 95%]: 3.04-3.87; p < 0.0001). El registro de LRA en la HC y la CN fueron del 20.3 y 17.5% respectivamente. Al ajustar el modelo por la gravedad del paciente, la CN redujo el riesgo de mortalidad (OR: 0.74; IC 95%: 0.55-0.98; p < 0.04). Conclusiones: La LRA es prevalente con alta morbimortalidad. Es subdiagnosticada y la CN reduce el riesgo de mortalidad. Los recursos electrónicos de diagnóstico podrían ser útiles para mitigar su impacto.
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