Тексты на английском
<<  WTP Server Tools Open House Review: The Biological Basis of Audition  >>
Content for this session is at: http://faculty
Content for this session is at: http://faculty
Index to all Years in Review (9)
Index to all Years in Review (9)
RCT speed dating
RCT speed dating
Clinical Decision Support for Patients: Psychological and Behavioral
Clinical Decision Support for Patients: Psychological and Behavioral
Practice of Informatics: New technologies
Practice of Informatics: New technologies
Practice of Informatics: New technology “Are you sure about that
Practice of Informatics: New technology “Are you sure about that
Top Ten List of Notable Events in the Past 12 months
Top Ten List of Notable Events in the Past 12 months
Top 10 events
Top 10 events
Top 10 events
Top 10 events
Top 10 events
Top 10 events
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Lindberg DA, Ball MJ
Lindberg DA, Ball MJ
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Biomedical Informatics 2013 Year in Review Notable publications and
Картинки из презентации «По технология 4 класс днем 1апреля» к уроку английского языка на тему «Тексты на английском»

Автор: pulleyj. Чтобы познакомиться с картинкой полного размера, нажмите на её эскиз. Чтобы можно было использовать все картинки для урока английского языка, скачайте бесплатно презентацию «По технология 4 класс днем 1апреля.ppt» со всеми картинками в zip-архиве размером 3060 КБ.

По технология 4 класс днем 1апреля

содержание презентации «По технология 4 класс днем 1апреля.ppt»
Сл Текст Сл Текст
1Biomedical Informatics 2013 Year in 54groups 2-3x more likely to get screening
Review Notable publications and events in (up to 65% of those getting highest
Informatics since the 2012 AMIA Symposium. intensity intervention) Boston Univ:
Nominated by the Fellows of the American increase from 35% compliance to 43% in
College of Medical Informatics and getting CRC screening among those in
presented by Daniel R. Masys, MD Affiliate either intervention arm vs. usual care.
Professor Biomedical and Health 55Clinical Decision Support for
Informatics University of Washington, Patients: Cancer Detection and Care (3
Seattle. studies). Conclusions Netherlands: Men
2Content for this session is at: eligible for both prostatectomy and
http://faculty.washington.edu/dmasys/YearI radiotherapy mostly preferred
Review or Google: “AMIA Year in Review” prostatectomy, and the treatment choice
includes citation lists and links and this was influenced by the hospital they
PowerPoint. visited. Giving patients evidence-based
3Index to all Years in Review (9). information by means of a decision aid,
http://faculty.washington.edu/dmasys/YearI led to an increase in brachytherapy. Group
Review. Health: Compared with usual care, a
4Design for this Session. Originally centralized, EHR-linked, mailed CRC
modeled on American College of Physician screening program led to twice as many
“Update” sessions which focused on high persons being current for CRC screening
impact randomized clinical trials over 2 years. Boston Univ: Decision
literature Has evolved toward broader aid-assisted SDM has a modest impact on
coverage of the subdisciplines of CRC screening uptake. Importance Continues
biomedical informatics Has both a a sustained trend that giving patients
literature search and a professional peer information directly changes health
nomination component by Fellows of the choices vs. usual care. Caution: studies
American College of Medical Informatics. also consistent with a Hawthorne effect
5It takes a Village… Special thanks to and show information dose intensity
these 30 ACMI Fellows: Harold Lehmann Yves proportional to outcome.
Lussier Alexa McCray Blackford Middleton 56Clinical Decision Support for
Joyce Mitchell Lucila Ohno-Machado Judy Patients: Psychological and Behavioral
Ozbolt Ted Shortliffe Dean Sittig Kent Health. Reference Arndt J, et. al, The
Spackman David States Jaap Suermondt interactive effect of mortality reminders
Jonathan Teich Mark Tuttle Bonnie Westra. and tobacco craving on smoking topography.
Jos Aarts Andrew Balas David Bates Chris Health Psychol. 2013 May;32(5):525-32.
Chute Jim Cimino Don Detmer Gunther Source Department of Psychological
Eysenbach Reed Gardner Bill Hersh Betsy Sciences, University of Missouri, Columbia
Humphreys George Hripcsak Bonnie Kaplan Aim Although fatal consequences of smoking
Ross Koppel Ira Kalet Zak Kohane. are often highlighted in health
6Source of Content for Session. communications, the question of how
Literature review of RCTs indexed by MeSH awareness of death affects actual smoking
term “Medical Informatics”, “Clinical behavior has yet to be addressed. Two
Decision Support”, “Telemedicine” & experiments informed by the terror
descendents, or keywords “Internet”, management health model were conducted to
“mobile” and publication date between examine this issue. Previous research
November 2012 and October 2013. Further suggested that effects of mortality
qualified by involvement of >100 reminders on health-related decisions are
providers or patients Literature review of often moderated by relevant individual
clinical bioinformatics and computational difference or situational variables.
biology papers of past 12 months. 57Clinical Decision Support for
7Source of Content for Session. Poll of Patients: Psychological and Behavioral
American College of Medical Informatics Health. Reference Arndt J, et. al, The
fellows list for other types of interactive effect of mortality reminders
informatics literature (new methods and and tobacco craving on smoking topography.
technologies, concept and issues papers) Health Psychol. 2013 May;32(5):525-32.
and notable events New for 2013: Methods In both studies, relatively light
Invitation to informatics journals via smokers completed a brief questionnaire
their ACMI editorial board members to about cigarette cravings, were reminded of
nominate 5 top publications Dessert: the their mortality or a control topic, and
Top Ten Events of the Year. then smoked five puffs from a cigarette
8New for 2013. RCT ‘speed dating’: while the volume, duration, and velocity
summaries of interventional trials by of their inhalations was recorded. Results
application type and subject domain Significant craving ? death reminder
People’s choice: ACMI Fellow nominations interactions emerged in both experiments.
of notable literature *not* their own After reminders of mortality, stronger
Editor’s Choice: journal editors top 5. cravings predicted greater smoking
9RCT speed dating. RCT speed dating intensity. Further, reminders of mortality
Given the ubiquity of mobile electronics increased smoking intensity for those with
among AMIA Symposium attendees, synopses stronger cravings in both studies. There
of new findings from the literature are was also some indication that mortality
given with just enough content to allow reminders decreased smoking intensity for
attendees to determine whether they wish those with weaker cravings.
to access the complete article. Either 58Clinical Decision Support for
during the session in real time, later at Patients: Psychological and Behavioral
their convenience, or as a diversion from Health. Reference Arndt J, et. al, The
incessant Tweeting and Facebook posting. interactive effect of mortality reminders
;-). and tobacco craving on smoking topography.
10Notable 2013 informatics events, Health Psychol. 2013 May;32(5):525-32.
trends and literature. EHRs pass the Conclusions “These findings indicate a
tipping point Clinical decision support nuanced effect of mortality reminders on
confronts scalability challenges smoking intensity and suggest that careful
Telemedicine, particularly for chronic consideration needs to be given to when
disease monitoring and psychiatric and how reminders of death are used in
interventions, continues to work (but communications about smoking.” Importance
without attention to cost-effectiveness). Stress a smoker and he’s gonna wanna light
Personal genomes and their issues get up…
closer to the bedside The power of a 593 New CDSS RCTs showing no difference
website… for intervention vs. control. References
11New Literature Highlights: Clinical Duke JD, et. al, Adherence to drug-drug
Informatics. Clinical Decision Support interaction alerts in high-risk patients:
Telemedicine The practice of clinical a trial of context-enhanced alerting. J Am
informatics: new methods and technologies. Med Inform Assoc. 2013 May 1;20(3):494-8.
12Clinical Decision Support. 24 new RCTs [Riegenstrief Institute, Indianapolis]
published meeting search criteria November Beeckman D, et. al, A multi-faceted
2012 – October 2013. RCT Speed Dating. tailored strategy to implement an
13Clinical Decision Support for electronic clinical decision support
Providers: Infectious Diseases. Reference system for pressure ulcer prevention in
Kempe A, et. al, Population-based versus nursing homes: a two-armed randomized
practice-based recall for childhood controlled trial. Int J Nurs Stud. 2013
immunizations: a randomized controlled Apr;50(4):475-86. [Dept Public Health,
comparative effectiveness trial. Am J Ghent Univ., Belgium] Nieuwlaat R, et. al,
Public Health. 2013 Jun;103(6):1116-23 Randomised comparison of a simple warfarin
Source Children's Outcomes Research dosing algorithm versus a computerised
Program, The Children's Hospital, Denver, anticoagulation management system for
CO Aim To compare the effectiveness and control of warfarin maintenance therapy.
cost-effectiveness of population-based Thromb Haemost. 2012 Dec;108(6):1228-35.
recall (Pop-recall) versus practice-based [McMaster University, Ontario, Canada].
recall (PCP-recall) at increasing 603 New CDSS RCTs showing no difference
immunizations among preschool children. for intervention vs. control. Intervention
Methods Cluster-randomized trial involving Riegenstrief: 6-month randomized
children aged 19 to 35 months needing controlled trial involving 1029 outpatient
immunizations in 8 rural and 6 urban physicians randomized to getting or not
Colorado counties. In Pop-recall counties, getting “context-enhanced” drug-drug
recall was conducted centrally using the interaction alerts on high risk patients
Colorado Immunization Information System with hyperkalemia, on multiple drugs known
(CIIS). In PCP-recall counties, practices to cause the condition. High risk =
were invited to attend webinar training baseline potassium >5.0 mEq/l and/or
using CIIS and offered financial support creatinine ?1.5 mg/dl. Enhancement: show
for mailings. The percentage of up-to-date recent lab values. Belgium: interactive
(UTD) and vaccine documentation were education, CDSS reminders, feedback and
compared 6 months after recall. ‘organizational leadership’ program to
14Clinical Decision Support for promote adherence to pressure ulcer
Providers: Infectious Diseases. Reference prevention guideline-based care for 118
Kempe A, et. al, Population-based versus healthcare professionals with 464 at risk
practice-based recall for childhood nursing home residents. McMaster: Simple
immunizations: a randomized controlled one-step warfarin dosing algorithm
comparative effectiveness trial. Am J compared to a widely used computerized
Public Health. 2013 Jun;103(6):1116-23. dosing system (DAWN AC) for dosing in 1068
Results, cont’d Ten of 195 practices (5%) warfarin Pts followed by an
implemented recall in PCP-recall counties. anticoagulation clinic.
Among children needing immunizations, 613 New CDSS RCTs showing no difference
18.7% became UTD in Pop-recall versus for intervention vs. control. Results
12.8% in PCP-recall counties (P < Riegenstrief: No significant difference in
.001); 31.8% had documented receipt of 1 alert adherence in high-risk patients
or more vaccines in Pop-recall versus between the intervention group (15.3%) and
22.6% in PCP-recall counties (P < the control group (16.8%) (p=0.71).
.001). Costs for Pop-recall versus Belgium: No significant improvement was
PCP-recall were $215 versus $1981 per observed on pressure ulcer prevalence or
practice and $17 versus $62 per child the knowledge of the professionals.
brought UTD.. Conclusions Population-based McMaster: The mean time in therapeutic
recall conducted centrally was more range was 71.0% (standard deviation [SD]
effective and cost-effective at increasing 23.2) for the computerized system and
immunization rates in preschool children. 71.9% (SD 22.9) for the algorithm; p-value
15Clinical Decision Support for for non-inferiority=0.002; p-value for
Providers: Infectious Diseases. Reference superiority=0.34). Importance One reason
Kempe A, et. al, Population-based versus why RCTs need to be done…
practice-based recall for childhood 62Methods and Issues in Clinical
immunizations: a randomized controlled Decision Support. References Zhou L, et.
comparative effectiveness trial. Am J al, Structured representation for core
Public Health. 2013 Jun;103(6):1116-23 elements of common clinical decision
Importance A message about the difficulty, support interventions to facilitate
effectiveness and cost of implementation knowledge sharing. Stud Health Technol
of systems approaches to improving public Inform. 2013;192:195-9.* [Partners
health through independent practices. A Healthcare, Wellesley] Kawamoto K, et. al,
warning about 21st century herd immunity… Key principles for a national clinical
16Clinical Decision Support for decision support knowledge sharing
Providers: Infectious diseases. Reference framework: synthesis of insights from
Chambers LW, et. al, Impact of the Ottawa leading subject matter experts. J Am Med
Influenza Decision Aid on healthcare Inform Assoc. 2013 Jan 1;20(1):199-207.*
personnel's influenza immunization [Dept Biomed Informatics, Univ Utah] Dixon
decision: a randomized trial. J Hosp BE, et. al, A pilot study of distributed
Infect. 2012 Nov;82(3):194-202. Source knowledge management and clinical decision
Bruy?re Research Institute, Ottawa, support in the cloud. Artif Intell Med.
Ontario, Canada. Aim To assess the impact 2013 Sep;59(1):45-53.* [Indiana Univ.,
of a web based decision support tool, and Indianapolis].
ascertain whether its use would increase 63Methods and Issues in Clinical
the level of confidence in healthcare Decision Support. Aims & Methods
workers' influenza immunization decision Partners: to identify key requirements for
and positively affect their intent to be the representation of five widely utilized
immunized. Methods Single-center, CDS intervention types: alerts and
single-blind, parallel-group, randomized reminders, order sets, infobuttons,
controlled trial of web-based educational documentation templates/forms, and
program on influenza immunization. relevant data presentation. Utah:
17Clinical Decision Support for ONC-sponsored expert panel convened to
Providers: Infectious diseases. Reference identify key principles for establishing a
Chambers LW, et. al, Impact of the Ottawa national clinical decision support (CDS)
Influenza Decision Aid on healthcare knowledge sharing framework. Indiana:
personnel's influenza immunization build and test a prototype CDS rules
decision: a randomized trial. J Hosp engine in the cloud and securely transmit
Infect. 2012 Nov;82(3):194-202. Results data to the service and receive real time
Eight per cent (151 of 1886) of the alerts and reminders for hypertension,
unimmunized healthcare personnel were diabetes, and coronary artery disease.
randomized. Of 107 eligible respondents, Results Partners: developed and validated
48 were in the Ottawa Influenza Decision an XML schema, available via public portal
Aid (OIDA) group and 59 in the control Utah: knowledge sharing roadmap developed
group. A statistically significant (P = Indiana: 1139 Pt encounters successfully
0.020) greater improvement in confidence exchanged; lessons learned. Found cloud
in immunization decision was observed in architecture feasible.
the OIDA group compared with the control 64Unintended Consequences of CDSS
group. The post-OIDA intent to be Systems: Information Overload. References
immunized in the OIDA and control groups Dixon BJ, et. al, Surgeons blinded by
compared to the pre-OIDA intent to be enhanced navigation: the effect of
immunized showed that the OIDA had a augmented reality on attention. Surg
significant effect on reducing uncertainty Endosc. 2013 Feb;27(2):454-61. [Univ.
(P = 0.035).. Toronto, Canada] Singh H, et. al,
18Clinical Decision Support for Information overload and missed test
Providers: Infectious diseases. Reference results in electronic health record-based
Chambers LW, et. al, Impact of the Ottawa settings. JAMA Intern Med. 2013 Apr
Influenza Decision Aid on healthcare 22;173(8):702-4. [Houston VA and UTHSC
personnel's influenza immunization Houston] Phansalkar S, et. al, Drug-drug
decision: a randomized trial. J Hosp interactions that should be
Infect. 2012 Nov;82(3):194-202 Conclusions non-interruptive in order to reduce alert
Using an accessible, balanced, fatigue in electronic health records. J Am
understandable format for all healthcare Med Inform Assoc. 2013 May
personnel about their influenza 1;20(3):489-93.* [Partners HealthCare
immunization decision appears to have an Systems, Wellesley].
impact on both healthcare personnel's 65Unintended Consequences of CDSS
confidence in their immunization decision Systems: Information Overload.
and in their intent to be immunized. Interventions Toronto: Endoscopic
Importance Healthcare professionals are navigation exercise on a cadaveric
also people and patients in other roles specimen. The subjects randomized to
Don’t assume they do not also need either a standard endoscopic view
decision support for their personal health (control) or an augmented reality view
decisions. consisting of an endoscopic video fused
19Clinical Decision Support for with anatomic contours. Two unexpected
Providers: Infectious diseases. Reference findings were presented in close proximity
Forrest CB, et. al, Improving adherence to to the target point: one critical
otitis media guidelines with clinical complication and one foreign body (screw).
decision support and physician feedback. Task completion time, accuracy, and
Pediatrics. 2013 Apr;131(4):e1071-81. recognition of findings were recorded.
Source Department of Pediatrics, Houston VA: survey of VA primary care
Children's Hospital of Philadelphia Aim To physicians regarding potential for and
assess the effects of electronic health actual experience of missed lab results in
record-based clinical decision support EHR system; sociotechnical analysis of
(CDS) and physician performance feedback results Partners: expert panel to address
on adherence to guidelines for acute alert fatigue and 90% override rate of
otitis media (AOM) and otitis media with drug-drug interactions.
effusion (OME). Methods Factorial-design 66CDSS Unintended Consequences. Results
cluster randomized trial with primary care Toronto: Detection of the complication was
practices (n = 24) as the unit of 0/15 in the AR group versus 7/17 in the
randomization and visits as the unit of control group (p = 0.008). Detection of
analysis. Between December 2007 and the screw was 1/15 (AR) and 7/17 (control)
September 2010, data were collected from (p = 0.041). Houston VA: 56% of 2590 PCPs
139,305 otitis media visits made by 55,779 reported that EHR notification system made
children aged 2 months to 12 years. it possible to miss test results, and 30%
20Clinical Decision Support for had experienced that. Median number of
Providers: Infectious diseases. Reference alerts PCPs reported receiving each day
Forrest CB, et. al, Improving adherence to was 63; 86.9% perceived the quantity of
otitis media guidelines with clinical alerts they received to be excessive, and
decision support and physician feedback. 69.6% reported receiving more alerts than
Pediatrics. 2013 Apr;131(4):e1071-81. they could effectively manage (marker of
Methods, cont’d When activated, the CDS information overload). Partners: created
system provided guideline-based list of 33 class-based low-priority DDI
recommendations individualized to the that do not warrant being interruptive
patient's history and presentation. alerts in EHR. In one institution, these
Monthly physician feedback reported accounted for 36% of the interactions
adherence to guideline-based care, changes displayed. Importance The art and science
over time, and comparisons to others in of systems development: more information
the practice and network. Results is not necessarily better.
Comprehensive care (all recommended 67Avoiding Unintended Consequences:
guidelines were adhered to) was Implementation Science. Reference Novak
accomplished for 15% of AOM and 5% of OME LL, et. al, Mediation of adoption and use:
visits during the baseline period. The a key strategy for mitigating unintended
increase from baseline to intervention consequences of health IT implementation.
periods in adherence to guidelines was J Am Med Inform Assoc. 2012
larger for CDS compared with non-CDS Nov-Dec;19(6):1043-9.* Source
visits for comprehensive care, pain Implementation Science Lab, Dept
treatment, adequate diagnostic evaluation Biomedical Informatics, Vanderbilt Univ.,
for OME, and amoxicillin as first-line Nashville Aim Analyze the work of nurse
therapy for AOM. mediators in adoption and use of a barcode
21Clinical Decision Support for medication administration (BCMA) system in
Providers: Infectious diseases. Reference an inpatient setting. Methods Ethnographic
Forrest CB, et. al, Improving adherence to methods: field notes from observations,
otitis media guidelines with clinical documents, and email communications. This
decision support and physician feedback. variety of sources enabled triangulation
Pediatrics. 2013 Apr;131(4):e1071-81 of findings between activities observed,
Results, cont’d Although performance discussed in meetings, and reported in
feedback was associated with improved emails.
antibiotic prescribing for AOM and pain 68Avoiding Unintended Consequences:
treatment, the joint effects of CDS and Implementation Science. Reference Novak
feedback on guideline adherence were not LL, et. al, Mediation of adoption and use:
additive. There was marked variation in a key strategy for mitigating unintended
use of the CDS system, ranging from 5% to consequences of health IT implementation.
45% visits across practices. Conclusions J Am Med Inform Assoc. 2012
Clinical decision support and performance Nov-Dec;19(6):1043-9. Results Mediation
feedback are both effective strategies for work integrated the BCMA tool with nursing
improving adherence to otitis media practice, anticipating and solving
guidelines. Combining the 2 interventions implementation problems. Three themes of
is no better than either delivered alone. mediation work include: resolving
Importance Easy to show statistically challenges related to coordination,
significant gains when starting with low integrating the physical aspects of BCMA
baselines Only in clinical informatics is into everyday practice, and advocacy work.
15% compliance considered a win… Conclusions Institutionally supported
22Clinical Decision Support for clinicians who facilitate adoption and use
Providers: Infectious diseases. Reference of health IT systems can improve the
Robbins GK, et. al, Efficacy of a clinical safety and effectiveness of implementation
decision-support system in an HIV through the management of unintended
practice: a randomized trial. Ann Intern consequences. Technology use mediation can
Med. 2012 Dec 4;157(11):757-66. Source provide decision-makers with theoretically
Div. of Infectious Diseases, Massachusetts durable, empirically grounded evidence for
General Hospital Aim To test the efficacy designing implementations.
of a CDSS in improving HIV outcomes in an 69Clinical Decision Support for
outpatient clinic. Methods Randomized, Providers and Patients. Questions and
controlled trial in the MGH HIV clinic. Comments.
Computer alerts were generated for 70Telemedicine. 25 new ‘medium and
virologic failure (HIV RNA level >400 large’ RCTs published November 2012 –
copies/mL after a previous HIV RNA level October 2013. 6 cardiovascular diseases 3
?400 copies/mL), evidence of suboptimal diabetes 17 Psychiatric and behavioral
follow-up, and 11 abnormal laboratory test health 1 each: infectious diseases,
results. Providers received interactive medication management, joint replacement
computer alerts, facilitating appointment rehab, trauma/life support training,
rescheduling and repeated laboratory contraception, physiotherapy, atopic
testing, for half of their patients and dermatitis.
static alerts for the other half. Primary 71Telemedicine – blood pressure control
end point was change in CD4 cell count. 5 RCTs. References Margolis KL, et. al,
Other end points included time to clinical Effect of home blood pressure
event, 6-month suboptimal follow-up, and telemonitoring and pharmacist management
severe laboratory toxicity. on blood pressure control: a cluster
23Clinical Decision Support for randomized clinical trial. JAMA. 2013 Jul
Providers: Infectious diseases. Reference 3;310(1):46-56. [HealthPartners, MN]
Robbins GK, et. al, Efficacy of a clinical McKinstry B, et. al, Telemonitoring based
decision-support system in an HIV service redesign for the management of
practice: a randomized trial. Ann Intern uncontrolled hypertension: multicentre
Med. 2012 Dec 4;157(11):757-66 Results 33 randomised controlled trial. BMJ. 2013 May
HIV care providers followed 1011 patients 24;346:f3030. [Univ Edinburgh, UK] Bove
with HIV. In intervention group, mean AA, et. al, Managing hypertension in urban
increase in CD4 cell count was greater (P underserved subjects using telemedicine--a
= 0.040) and the rate of 6-month clinical trial. Am Heart J. 2013
suboptimal follow-up was lower (20.6 vs. Apr;165(4):615-21. [Temple Univ Schl of
30.1 events per 100 patient-years; P = Med, Philadelphia] Magid DJ, et. al, A
0.022) than those in the control group. pharmacist-led, American Heart Association
Median time to next scheduled appointment Heart360 Web-enabled home blood pressure
was shorter in the intervention group than monitoring program. Circ Cardiovasc Qual
in the control group after a suboptimal Outcomes. 2013 Mar 1;6(2):157-63. [Kaiser
follow-up alert (1.71 vs. 3.48 months; P Permanente Colorado] Jackson GL, et. al,
< 0.001) and after a toxicity alert Racial differences in the effect of a
(2.79 vs. >6 months; P = 0.072). > telephone-delivered hypertension disease
90% of providers supported adopting the management program. J Gen Intern Med. 2012
CDSS as part of standard care. Conclusions Dec;27(12):1682-9. [Durham VA].
A CDSS using interactive provider alerts 72Telemedicine – blood pressure control.
improved CD4 cell counts and clinic Interventions All studies included home
follow-up for patients with HIV. telemonitoring, with as needed telephone
24Clinical Decision Support for intervention by health professional
Providers: Infectious diseases. Reference [pharmacist, nurse, PCP] Results All
Robbins GK, et. al, Efficacy of a clinical studies showed statistically significant
decision-support system in an HIV and sustained lowering of BP associated
practice: a randomized trial. Ann Intern with telemedicine intervention, relative
Med. 2012 Dec 4;157(11):757-66 Importance to usual care. All showed effectiveness.
Smart does not equal reliable (and Only UK NHS study commented on cost-
patients pay the penalty for the effectiveness, noting the higher level of
difference) Top tier academic centers also NHS resources required. Commentary Extends
benefit from systems level CDSS blood pressure management literature that
interventions targeted to important has always shown improvement with a higher
process and clinical outcome measures. intensity intervention compared to usual
25Clinical Decision Support for care. None answer the question of
Providers: Infectious diseases. Reference comparative effectiveness (i.e., same
Were MC, et. al, Computer-generated additional resources put into telemedicine
reminders and quality of pediatric HIV vs. put into an alternative care
care in a resource-limited setting. enhancement). Another Hawthorne effect
Pediatrics. 2013 Mar;131(3):e789-96. conundrum. Probably time for a moratorium
Source Department of Medicine, Indiana on home telemonitoring studies of blood
University School of Medicine Aim To pressure control that do not address
evaluate the impact of clinician-targeted cost-benefit.
computer-generated reminders on compliance 73Telemedicine – diabetes (3 RCTs).
with HIV care guidelines in a References Tang PC, et. al, Online disease
resource-limited setting. Methods management of diabetes: engaging and
Randomized, controlled trial in an HIV motivating patients online with enhanced
referral clinic in Kenya caring for resources-diabetes (EMPOWER-D), a
HIV-infected and HIV-exposed children randomized controlled trial. J Am Med
(<14 years of age). For children Inform Assoc. 2013 May 1;20(3):526-34.
randomly assigned to the intervention [Palo Alto Medical Foundation, Palo Alto,
group, printed patient summaries CA] Trief PM, et. al, Adherence to
containing computer-generated diabetes self care for white,
patient-specific reminders for overdue African-American and Hispanic American
care recommendations were provided to the telemedicine participants: 5 year results
clinician at the time of the child's from the IDEATel project. Ethn Health.
clinic visit. For children in the control 2013;18(1):83-96. [SUNY Upstate Medical
group, clinicians received the summaries, University, Syracuse, NY] Stone RA, et.
but no computer-generated reminders. al, The Diabetes Telemonitoring Study
26Clinical Decision Support for Extension: an exploratory randomized
Providers: Infectious diseases. Reference comparison of alternative interventions to
Were MC, et. al, Computer-generated maintain glycemic control after withdrawal
reminders and quality of pediatric HIV of diabetes home telemonitoring. J Am Med
care in a resource-limited setting. Inform Assoc. 2012 Nov-Dec;19(6):973-9.
Pediatrics. 2013 Mar;131(3):e789-96. [VA Pittsburgh. PA].
Methods, cont’d Compared differences 74Telemedicine - diabetes. Interventions
between the intervention and control Palo Alto: 415 pts with Type II DM
groups in completion of overdue tasks, randomized to usual care or to (1)
including HIV testing, laboratory wirelessly uploaded home glucometer
monitoring, initiating antiretroviral readings with graphical feedback; (2)
therapy, and making referrals. Results comprehensive patient-specific diabetes
During the 5-month study period, 1611 summary status report; (3) nutrition and
patients (49% female, 70% HIV-infected) exercise logs; (4) insulin record; (5)
were eligible to receive at least 1 online messaging with the patient's health
computer-generated reminder (ie, had an team; (6) nurse care manager and dietitian
overdue clinical task). There was a providing advice and medication
fourfold increase in the completion of management; and (7) personalized text and
overdue clinical tasks when reminders were video educational 'nuggets' dispensed
availed to providers over the course of electronically by the care team.
the study (68% intervention vs 18% 75Telemedicine - diabetes.
control, P < .001). Orders also Interventions, cont’d SUNY upstate:
occurred earlier for the intervention randomized medically underserved Medicare
group (77 days, SD 2.4 days) compared with patients (n=1665) to telemedicine case
the control group (104 days, SD 1.2 days) management (televideo educator visits,
(P < .001). Response rates to reminders individualized goal-setting/problem
varied significantly by type of reminder solving) or usual care. Hispanic and
and between clinicians. African-American educators delivered the
27Clinical Decision Support for intervention in Spanish if needed.
Providers: Infectious diseases. Reference Pittsburgh VA: After completion of home
Were MC, et. al, Computer-generated monitoring + telephone med management
reminders and quality of pediatric HIV trial, 150 participants randomized to home
care in a resource-limited setting. monitoring without med management or
Pediatrics. 2013 Mar;131(3):e789-96 monthly phone calls without
Conclusions Clinician-targeted, telemonitoring.
computer-generated clinical reminders are 76Telemedicine - diabetes. Results Palo
associated with a significant increase in Alto: Intervention group had better A1c’s
completion of overdue clinical tasks for at six and 12 months compared to usual
HIV-infected and exposed children in a care. SUNY upstate: Intervention groups
resource-limited setting. Importance A A1c better than control. Adherence was a
serendipitous bookend to the Mass General significant mediator of A1c (p<0.001)
study that had a similar intervention and and minority subjects were consistently
similar design. Resource rich or resource less adherent than whites. Also, greater
poor settings, patients benefit from their comorbidity and diabetes symptoms
clinicians having a systems infrastructure predicted poorer adherence, greater
to improve consistency of care. duration of diabetes and more years of
28Clinical Decision Support for education predicted better adherence.
Providers: Medication Management. Pittsburgh VA: HbA1c improvements seen in
Reference Piazza G, et. al, Randomized original telemedicine intervention were
trial of physician alerts for sustained six months after reducing
thromboprophylaxis after discharge. Am J intensity of intervention. Comment Same
Med. 2013 May;126(5):435-42. Source therapy intensity problem and lack of
Cardiovascular Division, Brigham and cost-effectiveness analysis as BP
Women's Hospital, Boston Aim To test telemonitoring studies.
whether a thromboprophylaxis alert to an 77Telemedicine – Psychiatric and
Attending Physician before discharge would behavioral health Depression (6 RCTs).
increase the rate of extended References Glozier N, et. al,
out-of-hospital prophylaxis and, in turn, Internet-delivered cognitive behavioural
reduce the incidence of symptomatic venous therapy for adults with mild to moderate
thromboembolism at 90 days. Methods From depression and high cardiovascular disease
April 2009 to January 2010, enrolled risks: a randomised attention-controlled
hospitalized Medical Service patients trial. PLoS One. 2013;8(3):e59139. [Univ.
using a previously developed point score Sydney, Australia] Fortney JC, et. al,
system to identify Pts at high risk for Practice-based versus telemedicine-based
venous thromboembolism who were not collaborative care for depression in rural
ordered to receive thromboprophylaxis federally qualified health centers: a
after discharge. A multicenter trial with pragmatic randomized comparative
Pts randomized by computer in a 1:1 ratio effectiveness trial. Am J Psychiatry. 2013
to the alert group or the control group. Apr 1;170(4):414-25. [Univ Arkansas,
29Clinical Decision Support for Little Rock] Moreno FA, et. al, Use of
Providers: Medication Management. standard Webcam and Internet equipment for
Reference Piazza G, et. al, Randomized telepsychiatry treatment of depression
trial of physician alerts for among underserved Hispanics. Psychiatr
thromboprophylaxis after discharge. Am J Serv. 2012 Dec;63(12):1213-7. [Univ
Med. 2013 May;126(5):435-42. Results 2513 Arizona].
eligible patients from 18 study sites. 78Telemedicine – Psychiatric and
Patients in the alert group were more than behavioral health Depression, cont’d (6
twice as likely to receive RCTs). References Hunkeler EM, et. al, A
thromboprophylaxis at discharge as web-delivered care management and patient
controls (22.0% vs 9.7%, P <.0001). self-management program for recurrent
Based on intent-to-treat analysis, depression: a randomized trial. Psychiatr
symptomatic venous thromboembolism at 90 Serv. 2012 Nov;63(11):1063-71. [Permanente
days (99.9% follow-up) occurred in 4.5% of Medical Group, Oakland, CA] Moritz S, et.
patients in the alert group, compared with al, The more it is needed, the less it is
4.0% of controls (hazard ratio 1.12; 95% wanted: attitudes toward face-to-face
confidence interval, 0.74-1.69). Rate of intervention among depressed patients
major bleeding at 30 days in the alert undergoing online treatment. Depress
group was similar to that of the control Anxiety. 2013 Feb;30(2):157-67.
group (1.2% vs 1.2%, hazard ratio 0.94; [University Medical Center
95% confidence interval, 0.44-2.01). Hamburg-Eppendorf, Hamburg, Germany]
30Clinical Decision Support for Lintvedt OK, et. al, Evaluating the
Providers: Medication Management. effectiveness and efficacy of unguided
Reference Piazza G, et. al, Randomized internet-based self-help intervention for
trial of physician alerts for the prevention of depression: a randomized
thromboprophylaxis after discharge. Am J controlled trial. Clin Psychol Psychother.
Med. 2013 May;126(5):435-42. Conclusions 2013 Jan-Feb;20(1):10-27. [University of
Alerting providers to extend Troms?, Norway.].
thromboprophylaxis after hospital 79Telemedicine – Psychiatric and
discharge in Medical Service patients behavioral health Depression, cont’d (6
increased the rate of prophylaxis but did RCTs). Intervention 5 of 6 trials used
not decrease the rate of symptomatic web-based variants of Cognitive Behavioral
venous thromboembolism. Importance Therapy for mild to moderate depression.
Improved process does not equal improved 6th trial (Univ. Arizona) was a
outcome. Be sure to measure both if ‘classical’ telemedicine study with webcam
feasible. + audio (cf. Skype) interaction at a
31Clinical Decision Support for distance between psychiatrist and patient.
Providers: Behavioral health. Reference All compared to usual care. Results All
Rindal DB, et. al, Computer-assisted showed statistically significant
guidance for dental office improvement in depressive symptoms vs.
tobacco-cessation counseling: a randomized usual care controls. None addressed
controlled trial. Am J Prev Med. 2013 cost-effectiveness Commentary Telemedicine
Mar;44(3):260-4. Source HealthPartners for mild depression joins blood pressure
Institute for Education and Research, control and diabetic glucose control in
Minneapolis Aim To determine whether the ‘no further need to prove efficacy;
dentists and dental hygienists would what is needed are cost and comparative
assess interest in quitting tobacco, effectiveness analyses, adjusted for
deliver a brief intervention, and refer to intensity of interventions.
a tobacco quitline more frequently as 80Telemedicine – Studies showing No
reported by patients if given difference between intervention &
computer-assisted guidance in an control (3). References Wagner G, et. al,
electronic patient record versus a control Internet-delivered cognitive-behavioural
group providing usual care. Methods A therapy v. conventional guided self-help
blocked, group-randomized trial was for bulimia nervosa: long-term evaluation
conducted from November 2010 to April of a randomised controlled trial. Br J
2011. Randomization was conducted at the Psychiatry. 2013 Feb;202:135-41. [Medical
clinic level. Patients nested within University of Vienna, Austria] Schopf T,
clinics represented the lowest-level unit et. al, Impact of interactive web-based
of observation. Participants were patients education with mobile and email-based
in HealthPartners dental clinics. support of general practitioners on
Intervention clinics were given a treatment and referral patterns of
computer-assisted tool that suggested patients with atopic dermatitis:
scripts for patient discussions. randomized controlled trial. J Med
32Clinical Decision Support for Internet Res. 2012 Dec 5;14(6):e171.
Providers: Behavioral health. Reference [University Hospital of North-Norway,
Rindal DB, et. al, Computer-assisted Troms?, Norway] Cartwright M, et. al,
guidance for dental office Effect of telehealth on quality of life
tobacco-cessation counseling: a randomized and psychological outcomes over 12 months
controlled trial. Am J Prev Med. 2013 (Whole Systems Demonstrator telehealth
Mar;44(3):260-4. Methods, cont’d Usual questionnaire study): nested study of
care clinics provided care without the patient reported outcomes in a pragmatic,
tool. Primary outcomes were cluster randomised controlled trial. BMJ.
post-appointment patient reports of the 2013 Feb 26;346:f653. [City University
provider assessing interest in quitting, London, London, UK].
delivering a brief intervention, and 81Health Applications of Mobile
referring them to a quitline. Results Electronics. 7 new ‘medium and large’ RCTs
Patient telephone surveys (72% response published November 2012 – October 2013. 1
rate) indicated that providers assessed featuring data acquisition via smart
interest in quitting (control 70% vs phones 6 featuring healthcare
intervention 87%, p=0.0006); discussed interventions via iPads, smartphones, SMS
specific strategies for quitting (control text enabled phones.
26% vs intervention 47%, p=0.003); and 82Health Applications of Mobile
referred the patient to a tobacco quitline Electronics Acquiring data from study
(control 17% vs intervention 37%, p=0.007) participants. Reference Kristj?nsd?ttir
more frequently with the support of a ?B, et. al, A smartphone-based
computer-assisted tool integrated into the intervention with diaries and
electronic health record. therapist-feedback to reduce
33Clinical Decision Support for catastrophizing and increase functioning
Providers: Behavioral health. Reference in women with chronic widespread pain:
Rindal DB, et. al, Computer-assisted randomized controlled trial. J Med
guidance for dental office Internet Res. 2013 Jan 7;15(1):e5.
tobacco-cessation counseling: a randomized [Institute of Nursing, University College
controlled trial. Am J Prev Med. 2013 of Applied Sciences, Oslo, Norway].
Mar;44(3):260-4. Conclusions Clinical 83Health Applications of Mobile
decision support embedded in electronic Electronics Acquiring data from study
health records can effectively help participants. Intervention 1 face-to-face
providers deliver tobacco interventions. session and 4 weeks of written
Support CDSS approach to improve communication via a smartphone diary app
provider-delivered tobacco cessation. for 140 women with chronic widespread pain
Importance Healthcare providers of all Summary outcomes Reduced ‘catastophizing’
types have an important role in promoting Improved functioning and symptom levels
healthy behaviors, and everybody on the vs. usual care.
team can benefit from CDSS. 84Health Applications of Mobile
34Clinical Decision Support for Electronics Delivering Healthcare
Providers: Inpatient safety. Reference interventions (4 RCTs). References Junod
Chen YY, et. al, Using a criteria-based Perron N, et. al, Text-messaging versus
reminder to reduce use of indwelling telephone reminders to reduce missed
urinary catheters and decrease urinary appointments in an academic primary care
tract infections. Am J Crit Care. 2013 clinic: a randomized controlled trial. BMC
Mar;22(2):105-14. Source Taipei Veterans Health Serv Res. 2013 Apr 4;13:125.
General Hospital, Taipei, Taiwan Aim To [Geneva University Hospitals, Switzerland]
determine whether a reminder approach Lin H, et. al, Effectiveness of a short
reduces the use of urinary catheters and message reminder in increasing compliance
the incidence of catheter-associated with pediatric cataract treatment: a
urinary tract infections. Methods A randomized trial. Ophthalmology. 2012
randomized control trial was performed in Dec;119(12):2463-70. [Guangzhou, China]
2 respiratory intensive care units in a Evans WD, et. al, Pilot evaluation of the
2990-bed tertiary referral medical center. text4baby mobile health program. BMC
Patients who had urinary catheters in Public Health. 2012 Nov 26;12:1031. George
place for more than 2 days from April Washington Univ.] Mbuagbaw L, et. al, The
through November 2008 were randomly Cameroon Mobile Phone SMS (CAMPS) trial: a
assigned to either the intervention group randomized trial of text messaging versus
(use of a criteria-based reminder to usual care for adherence to antiretroviral
remove the catheter) or the control group therapy. PLoS One. 2012;7(12):e46909.
(no reminder). [Yaound? Central Hospital, Cameroon].
35Clinical Decision Support for 85Health Applications of Mobile
Providers: Inpatient safety. Reference Electronics Delivering Healthcare
Chen YY, et. al, Using a criteria-based interventions (3 RCTs). Interventions
reminder to reduce use of indwelling Geneva, Switzerland: automated SMS text
urinary catheters and decrease urinary messages vs. telephone appointment
tract infections. Am J Crit Care. 2013 reminders for 6450 primary care patients,
Mar;22(2):105-14. . Results A total of 278 Guangzhou, China: automated SMS text
patients were entered on-study. message appointment reminders to 258
Utilization rate of indwelling urinary parents for childhood cataract surgery
catheters was decreased by 22% in the followup appts . George Washington U:
intervention group compared with the educational text messages via SMS to cell
control group (relative risk, 0.78; 95% phones of 123 traditionally underserved
CI, 0.76-0.80; P < .001). Intervention pregnant women and new mothers to change
significantly shortened the median their health, health care beliefs,
duration of catheterization (7 days vs 11 practices, and behaviors in order to
days for the control group; P < .001). improve clinical outcomes Cameroon: 200
The success rate for removing the HIV-positive adults on ART randomized to
catheters in the intervention group by day receive a weekly standardized motivational
7 was 88%. The reminder intervention text message about important of taking HIV
reduced the incidence of meds, versus usual care alone.
catheter-associated infections by 48% 86Health Applications of Mobile
(relative risk, 0.52; 95% CI, 0.32-0.86; P Electronics Delivering Healthcare
= .009) in the intervention group compared interventions (11 RCTs). Results Swiss,
with the control group. Chinese, and GWU interventions showed
36Clinical Decision Support for statistically significant improved outcome
Providers: Inpatient safety. Reference measures using the cell phone intervention
Chen YY, et. al, Using a criteria-based vs. control group. Cameroon intervention
reminder to reduce use of indwelling did not improve ARV therapy adherence. One
urinary catheters and decrease urinary complaint about loss of confidentiality.
tract infections. Am J Crit Care. 2013 87Telemedicine and Health Applications
Mar;22(2):105-14. Conclusions Use of a of Mobile Electronics. Questions and
criteria-based reminder to remove Comments.
indwelling urinary catheters can diminish 88The Practice of Clinical Informatics
the use of urinary catheterization and and Bioinformatics. New methods,
reduce the likelihood of technologies, position papers, reviews.
catheter-associated urinary infections. 89Practice of Informatics: Models and
This reminder approach can prevent new methods papers (5*). References Smith
catheter-associated urinary infections, SW and Koppel R. Healthcare information
and its use should be strongly considered technology's relativity problems: a
as a way to enhance the safety of typology of how patients' physical
patients. Importance A classical inpatient reality, clinicians' mental models, and
alerting based CDSS study with both a healthcare information technology differ.
process outcome and a gratifying J Am Med Inform Assoc. 2013 Jun 26.*
disease-related outcome. [Dartmouth, Hanover, NH] An analysis of 45
37Clinical Decision Support for scenarios of ‘misalignment between
Providers: Care transitions. Reference patients' physical realities, clinicians'
Dalal AK, et.. al. Impact of an automated mental models, and EHRs, and
email notification system for results of categorization into 5 types. Notes that
tests pending at discharge: a EHRs both reflect and shape care, and
cluster-randomized controlled trial. J Am intended to be useful to healthcare IT
Med Inform Assoc. 2013 Oct 23. Source designers and implementers reducing the
Division of General Medicine and Primary unintended negative consequences of their
Care, Brigham and Women's Hospital, Boston use.
Aim To evaluate the impact of a system 90Practice of Informatics: Models and
that notified physicians of test results new methods papers, cont’d. References
pending at discharge (TPAD) on Lauer MS and D’Agostino RB. The randomized
self-reported awareness of TPAD results by registry trial--the next disruptive
responsible physicians, a necessary technology in clinical research? N Engl J
intermediary step to improve management of Med. 2013 Oct 24;369(17):1579-81.* [NIH
TPAD results. Methods A cluster-randomized NHLBI] Describes a low cost, high
controlled trial at a major hospital efficiency model for organizing EHR data
affiliated with an integrated healthcare into RCTs using consented registries of
delivery network in Boston, Massachusetts. patients with specific conditions, and
Adult patients with TPADs who were analyzing real world outcomes. Boland MR,
discharged from inpatient general medicine et. al, Discovering medical conditions
and cardiology services were assigned to associated with periodontitis using linked
the intervention or usual care arm if electronic health records. J Clin
their inpatient attending physician and Periodontol. 2013 May;40(5):474-82.* [DBMI
primary care physician (PCP) were both Columbia Univ., NYC] Describes a
randomized to the same study arm. high-throughput method for associating
38Clinical Decision Support for periodontitis with systemic diseases using
Providers: Care transitions. Reference linked electronic medical and dental
Dalal AK, et.. al. Impact of an automated records, with validation of previously
email notification system for results of reported associations and discovery of a
tests pending at discharge: a new one (BPH).
cluster-randomized controlled trial. J Am 91Practice of Informatics: Models and
Med Inform Assoc. 2013 Oct 23. . Methods, new methods papers, cont’d. References
cont’d Surveyed these physicians 72 h Cassa CA, et. al, A novel,
after all TPAD results were finalized. The privacy-preserving cryptographic approach
primary outcome was awareness of TPAD for sharing sequencing data. J Am Med
results by attending physicians. Secondary Inform Assoc. 2013 Jan 1;20(1):69-76.
outcomes included awareness of TPAD [Div. Genetics, Brigham and Womens\
results by PCPs, awareness of actionable Describes a novel way to securely share
TPAD results, and provider satisfaction.. genetic sequence data via public networks
Results 441 patients analyzed Sent surveys by encrypting it using a key derived from
to attending physicians and PCPs with the sequence itself. Samwald M, et. al,
response rate of 63%. Pharmacogenomics in the pocket of every
39Clinical Decision Support for patient? A prototype based on quick
Providers: Care transitions. Reference response codes. J Am Med Inform Assoc.
Dalal AK, et.. al. Impact of an automated 2013 May 1;20(3):409-12. [Medical
email notification system for results of University of Vienna, Austria] Describes
tests pending at discharge: a method for encoding personal molecular
cluster-randomized controlled trial. J Am variation data with a two-dimensional
Med Inform Assoc. 2013 Oct 23. Results, barcode that can be carried in a patient's
cont’d Intervention attending physicians wallet. Encoded data about 385 genetic
and PCPs were significantly more aware of polymorphisms and were able to decode and
TPAD results (76% vs 38%, p<0.001; 57% interpret quickly with common mobile
vs 33%, p=0.004, respectively). devices.
Intervention attending physicians tended 92Practice of Informatics: New
to be more aware of actionable TPAD technologies. References Loughran SP, et.
results (59% vs 29%, p=0.13). One hundred al, No increased sensitivity in brain
and eighteen (85%) and 43 (63%) activity of adolescents exposed to mobile
intervention attending physician and PCP phone-like emissions. Clin Neurophysiol.
survey respondents, respectively, were 2013 Jul;124(7):1303-8. [Univ Zurich,
satisfied with this intervention. Switzerland] Key findings: Concurrent
40Clinical Decision Support for mobile phone RF emissions do not change
Providers: Care transitions. Reference the EEGs or cognitive performance of
Dalal AK, et.. al. Impact of an automated teenagers. Tennant JN, et. al, Reliability
email notification system for results of and validity of a mobile phone for
tests pending at discharge: a radiographic assessment of ankle injuries:
cluster-randomized controlled trial. J Am a randomized inter- and intraobserver
Med Inform Assoc. 2013 Oct 23. Conclusions agreement study. Foot Ankle Int. 2013
Automated email notification represents a Feb;34(2):228-33. Key findings: RCT of
promising strategy for managing TPAD Apple fourth generation iPod Touch vs. 23
results, potentially mitigating an in. PACS computer monitor for diagnosing
unresolved patient safety concern. 16 different ankle injury radiographs. 93
Importance Use of asynchronous messaging orthopaedic surgeons diagnostic accuracy
via secure email can help with transitions as good with mobile device as with
of care (handoffs) when patient has left workstation; 2/3 comfortable using it vs.
the inpatient environment. dedicated display device.
41Clinical Decision Support for 93Practice of Informatics: New
Providers: Diagnostic Accuracy. Reference technologies. Reference Kim H, et. al,
Szucs-Farkas Z, et. al, Comparison of Kinematic data analysis for post-stroke
dual-energy subtraction and electronic patients following bilateral versus
bone suppression combined with unilateral rehabilitation with an upper
computer-aided detection on chest limb wearable robotic system. IEEE Trans
radiographs: effect on human observers' Neural Syst Rehabil Eng. 2013
performance in nodule detection. AJR Am J Mar;21(2):153-64. [UC Santa Cruz, EE
Roentgenol. 2013 May;200(5):1006-13. Dept.] Key finding: teaching stroke
Source University Hospital and University patients with a wearable robot arm to play
of Bern, Berne, Switzerland Aim To compare high intensity video games improves their
the effect of dual-energy subtraction and control of the robot.
bone suppression software alone and in 94Practice of Informatics: New
combination with computer-aided detection technology “Are you sure about that?”
(CAD) on the performance of human candidate. Reference Cai Y, et. al, Design
observers in lung nodule detection. and development of a Virtual Dolphinarium
Methods One hundred one patients with from for children with autism. IEEE Trans
one to five lung nodules measuring 5-29 mm Neural Syst Rehabil Eng. 2013
and 42 subjects with no nodules were Mar;21(2):208-17. [Nanyang Technological
retrospectively selected and randomized. University, Singapore] Key finding:
Three independent radiologists marked Proposal to use an immersive 3D
suspicious-appearing lesions on the environment to create an underwater world
original chest radiographs, dual-energy where autistic children can act as dolphin
subtraction images, and bone-suppressed trainers to learn (nonverbal)
images before and after postprocessing communication through hand gestures with
with CAD. the virtual dolphins. (Made my head swim).
42Clinical Decision Support for 95New literature category: Editor’s
Providers: Diagnostic Accuracy. Reference Choice.
Szucs-Farkas Z, et. al, Comparison of 96Journal of the American Medical
dual-energy subtraction and electronic Informatics Association (JAMIA): Editor’s
bone suppression combined with Choice. References Witten DM, et. al,
computer-aided detection on chest Scientific research in the age of omics:
radiographs: effect on human observers' the good, the bad, and the sloppy. J Am
performance in nodule detection. AJR Am J Med Inform Assoc. 2013 Jan 1;20(1):125-7.
Roentgenol. 2013 May;200(5):1006-13. Notes high potential for errors in ‘omics
Methods Marks of the observers and CAD science and calls for an online,
marks were compared with CT as the open-access, postpublication, peer review
reference standard. Data were analyzed system that will increase the
using nonparametric tests and receiver accountability of scientists for the
operating characteristic methods. Results quality of their research and improve
Using dual-energy subtraction alone (p = ability of readers to distinguish good
0.0198) or CAD alone (p = 0.0095) improved from sloppy science. White RW, et. al,
the detection rate compared with using the Web-scale pharmacovigilance: listening to
original conventional chest radiograph. signals from the crowd. J Am Med Inform
The combination of bone suppression and Assoc. 2013 May 1;20(3):404-8. [Microsoft
CAD provided the highest sensitivity Research, Redmond, WA] Showed how novel
(51.6%) and the original non-enhanced drug-drug interactions can be data mined
conventional chest radiograph alone from internet search engine logs.
provided the lowest (46.9%; p = 0.0049). 97Journal of the American Medical
Dual-energy subtraction and bone Informatics Association (JAMIA): Editor’s
suppression provided the same Choices, cont’d. References Radley DC, et.
false-positive (p = 0.2702) and al, Reduction in medication errors in
true-positive (p = 0.8451) rates. hospitals due to adoption of computerized
43Clinical Decision Support for provider order entry systems. J Am Med
Providers: Diagnostic Accuracy. Reference Inform Assoc. 2013 May 1;20(3):470-6.
Szucs-Farkas Z, et. al, Comparison of [Institute for Healthcare Improvement,
dual-energy subtraction and electronic Cambridge, MA] A systematic literature
bone suppression combined with review and meta-analysis to derive a
computer-aided detection on chest summary estimate of the effect of CPOE on
radiographs: effect on human observers' medication errors. Processing a
performance in nodule detection. AJR 2013 prescription drug order through a CPOE
May;200(5):1006-13. Results Up to 22.9% of system decreased the likelihood of error
lesions were found only by the CAD program on that order by 48%. Estimated a 12.5%
and were missed by the readers. reduction in medication errors, or ?17.4
Conclusions Dual-energy subtraction and million medication errors averted in the
the electronic bone suppression image USA in 2008. Embi PJ, et. al, Computerized
enhancement provided similar detection provider documentation: findings and
rates for pulmonary nodules, which were implications of a multisite study of
better than baseline radiograph. CAD alone clinicians and administrators. J Am Med
or combined with bone suppression can Inform Assoc. 2013 Jul-Aug;20(4):718-26.
significantly improve the sensitivity of [DBMI, Ohio State Univ.] Held 14 focus
human observers for pulmonary nodule groups at five Department of Veterans
detection. Importance Image analysis Affairs facilities, Found CPD has
extracts new value from a familiar and dramatically changed documentation
inexpensive imaging test. processes, impacting multiple groups, and
44Clinical Decision Support for current systems do not meet user needs due
Providers: Reducing Costs. Reference to being electronic version of paper
Gimbel RW, et. al, Radiation exposure and chart. .
cost influence physician medical image 98Journal of the American Medical
decision making: a randomized controlled Informatics Association (JAMIA): Editor’s
trial. Med Care. 2013 Jul;51(7):628-32. Choices, cont’d. References Deutsch MB,
Source Department of Biomedical et. al, Electronic medical records and the
Informatics, Uniformed Services University transgender patient: recommendations from
of the Health Sciences, Bethesda, MD Aim the World Professional Association for
To determine whether safety and cost Transgender Health EMR Working Group. J Am
information will change physician medical Med Inform Assoc. 2013
image decision making. Methods Jul-Aug;20(4):700-3. [UCSF] Working group
Double-blinded, randomized controlled recommendations for EMR coding and care of
trial. Following standardized case transgender and gender variant persons,
presentation, physicians made an initial addressing issue that transgender patients
imaging choice. This was followed by the may have a chosen name and gender identity
presentation of guidelines, radiation that differs from their current legally
exposure and health risk, and cost designated name and sex. Addresses
information. sex-specific health information, for
45Clinical Decision Support for example, a man with a cervix or a woman
Providers: Reducing Costs. Reference with a prostate.
Gimbel RW, et. al, Radiation exposure and 99Journal of Biomedical Informatics
cost influence physician medical image (JBI): Editor’s Choice. References Rothman
decision making: a randomized controlled MJ, et. al, Development and validation of
trial. Med Care. 2013 Jul;51(7):628-32. . a continuous measure of patient condition
Results Approximately half (57 of 112, using the Electronic Medical Record. J
50.9%) of participants initially selected Biomed Inform. 2013 Oct;46(5):837-48.
computed tomography (CT). When presented [PeraHealth, Inc., Charlotte, NC] Used 26
with guideline recommendations, clinical measurements from four EMR
participants did not modify their initial categories: nursing assessments, vital
imaging choice (P=0.197). A significant signs, laboratory results and cardiac
reduction (56.3%, P<0.001) in CT rhythms, then constructed a heuristic
ordering occurred after presentation of model to predict hospital readmission and
radiation exposure/health risk mortality, independent of specific disease
information;ordering changed to magnetic diagnosis. Weiskopf NG, et. al, Defining
resonance imaging or ultrasound (US). A and measuring completeness of electronic
significant reduction (48.3%, P<0.001) health records for secondary use. J Biomed
in CT and magnetic resonance imaging Inform. 2013 Oct;46(5):830-6. [DBMI
ordering occurred after presentation of Columbia Univ. NYC] Describes four
Medicare reimbursement information; prototypical definitions of EHR
ordering changed to US. The majority of completeness and approaches to the
physicians (31 of 40, 77.5%) selecting US measurement of completeness. Applied these
never modified their ordering. No measures representative data from local
significant relationship between physician clinical data warehouse and and found that
demographics and decision making was by any definition, the number of complete
observed. records in the clinical database is far
46Clinical Decision Support for lower than the nominal total.
Providers: Reducing Costs. Reference 100Journal of Biomedical Informatics
Gimbel RW, et. al, Radiation exposure and (JBI): Editor’s Choices, cont’d.
cost influence physician medical image References Friedman C, et. al, Natural
decision making: a randomized controlled language processing: state of the art and
trial. Med Care. 2013 Jul;51(7):628-32. prospects for significant progress, a
Conclusions Physician decision making can workshop sponsored by the National Library
be influenced by safety and cost of Medicine. J Biomed Inform. 2013
information and the order in which Oct;46(5):765-73. Workshop report that
information is provided to physicians can provides overview of the state of the art,
affect their decisions. Importance An strategies for advancing the field,
opportunity for ‘multidimensional’ obstacles that need to be addressed, and
decision support. recommendations for a research agenda
47Clinical Decision Support for intended to advance the field of NLP. Post
Providers: Increasing Income. Reference AR, et. al, The Analytic Information
Freundlich RE, et. al, A randomized trial Warehouse (AIW): a platform for analytics
of automated electronic alerts using electronic health record data. J
demonstrating improved reimbursable Biomed Inform. 2013 Jun;46(3):410-24.
anesthesia time documentation. J Clin Describes an architecture for an Analytic
Anesth. 2013 Mar;25(2):110-4 Source Information Warehouse that supports
Department of Anesthesiology, University transforming data represented in different
of Michigan Medical School, Ann Arbor, MI physical schemas into a common data model
Aim To investigate whether alerting for anaysis, along with open source
providers to errors results in improved software to accomplish that. .
documentation of reimbursable anesthesia 101Journal of Biomedical Informatics
care Methods Prospective randomized (JBI): Editor’s Choices, cont’d.
controlled trial in the U of M operating References Valizadegan H, et. al, Learning
rooms. Anesthesia cases were evaluated to classification models from multiple
determine whether they met the definition experts. J Biomed Inform. 2013 Sep 13.
for appropriate anesthesia start time over pii: S1532-0464(13)00122-6. Describes a
4 separate, 45-day calendar cycles: the new multi-expert learning framework that
pre-study period, study period, immediate assumes the class labels are provided by
post-study period, and 3-year follow-up multiple experts and that these experts
period. During the study period, providers may differ in their class label
were randomly assigned to either a control assessments. Explicitly models different
or an alert group. sources of disagreements and permits
48Clinical Decision Support for combining of labels from different human
Providers: Increasing Income. Reference experts to obtain: a consensus
Freundlich RE, et. al, A randomized trial classification model Tests the proposed
of automated electronic alerts framework by building a model for the
demonstrating improved reimbursable problem of detection of the Heparin
anesthesia time documentation. J Clin Induced Thrombocytopenia (HIT) where
Anesth. 2013 Mar;25(2):110-4. Methods examples are labeled by three experts.
Providers in the alert cohort received an Shows how new method is better than
automated alphanumeric page if the standard machine learning approaches.
anesthesia start time occurred 102New Literature Highlights:
concurrently with the patient entering the Bioinformatics and Computational Biology.
OR, or more than 30 minutes before New molecular findings relevant to Human
entering the OR Three years after the Health and Disease See 2013 Year in Review
intervention period, overall compliance website: Google: “AMIA Year in Review”.
was analyzed to assess learned behavior. 103Top Ten List of Notable Events in the
Results Baseline compliance was 33% ± 5%. Past 12 months.
During the intervention period, providers 104Top 10 events. 10 - NY Times article
in the alert group showed 87% ± 6% headlines "Search of DNA Sequences
compliance compared with 41% ± 7% Reveals Full Identities“… then title
compliance in the control group (P < changed. - January 17, 2013.
0.001). Long-term follow-up after 105Top 10 events. 10 - NY Times:
cessation of the alerts showed 85% ± 4% "Search of DNA Sequences Reveals Full
compliance. Identities 9 - SNOMED CT and LOINC to be
49Clinical Decision Support for linked – July 24, 2013.
Providers: Increasing Income. Reference 106Top 10 events. 10 - NY Times:
Freundlich RE, et. al, A randomized trial "Search of DNA Sequences Reveals Full
of automated electronic alerts Identities 9 - SNOMED CT and LOINC to be
demonstrating improved reimbursable linked 8 - Supreme Court rules genes
anesthesia time documentation. J Clin cannot be patented – June 16, 2013.
Anesth. 2013 Mar;25(2):110-4 Conclusions 107Top 10 events. 10 - NY Times:
Automated electronic reminders for "Search of DNA Sequences Reveals Full
time-based billing charges are effective Identities” 9 - SNOMED CT and LOINC to be
and result in improved ongoing linked 8 - Supreme Court rules genes
reimbursement. Importance Notable cannot be patented 7 - NIH funds
persistent educational effect seldom consortium for genome variants of clinical
observed in CDSS studies (but perhaps significance – Sept 25, 2013.
predictable since most CDSS interventions 108
do not directly align with personal 109Top 10 events. 10 - NY Times:
self-interest). Hopefully equal attention "Search of DNA Sequences Reveals Full
was given to clinical effectiveness and Identities” 9 - SNOMED CT and LOINC to be
patient safety decision support. Perhaps linked 8 - Supreme Court rules genes
Detroit should ask U of M for a consult… cannot be patented 7 - NIH funds
50Clinical Decision Support for consortium for genome variants of clinical
Providers and Patients: Infectious significance 6 - White House tells federal
Disease. Reference Fiks AG, et. al, agencies: research data needs to be shared
Effectiveness of decision support for - Feb 22, 2013.
families, clinicians, or both on HPV 110
vaccine receipt. Pediatrics. 2013 111Top 10 events. 10 - NY Times:
Jun;131(6):1114-24. Source Pediatric "Search of DNA Sequences Reveals Full
Research Consortium, Children's Hospital Identities” 9 - SNOMED CT and LOINC to be
of Philadelphia Aim To improve human linked 8 - Supreme Court rules genes
papillomavirus (HPV) vaccination rates, we cannot be patented 7 - NIH funds
studied the effectiveness of targeting consortium for genome variants of clinical
automated decision support to families, significance 6 - White House tells federal
clinicians, or both. Methods Twenty-two agencies: research data needs to be shared
primary care practices cluster-randomized 5 - EHR adoption by hospitals nearly 70%
to receive a 3-part clinician-focused in US. October 2013.
intervention (education, electronic health 112
record-based alerts, and audit and 113Top 10 events. 10 - NY Times:
feedback) or none. 22,486 girls aged 11 to "Search of DNA Sequences Reveals Full
17 years due for HPV vaccine dose 1, 2, or Identities” 9 - SNOMED CT and LOINC to be
3 were randomly assigned within each linked 8 - Supreme Court rules genes
practice to receive family-focused cannot be patented 7 - NIH funds
decision support with educational consortium for genome variants of clinical
telephone calls. Randomization established significance 6 - White House tells federal
4 groups: family-focused, agencies: research data needs to be shared
clinician-focused, combined, and no 5 - EHR adoption by hospitals nearly 70%
intervention. in US. 4 - Court: providers do not
51Clinical Decision Support for necessarily liability to patients when
Providers and Patients: Infectious medical records are stolen. October 2013.
Disease. Reference Fiks AG, et. al, 114
Effectiveness of decision support for 115Top 10 events. 10 - NY Times:
families, clinicians, or both on HPV "Search of DNA Sequences Reveals Full
vaccine receipt. Pediatrics. 2013 Identities” 9 - SNOMED CT and LOINC to be
Jun;131(6):1114-24. Methods Measured linked 8 - Supreme Court rules genes
decision support effectiveness by final cannot be patented 7 - NIH funds
vaccination rates and time to vaccine consortium for genome variants of clinical
receipt, standardized for covariates and significance 6 - White House tells federal
limited to those having received the agencies: research data needs to be shared
previous dose for HPV #2 and 3. 1-year 5 - EHR adoption by hospitals nearly 70%
study began in May 2010. Results Among in US. 4 - Court: providers do not
controls, vaccination rates for HPV #1, 2, necessarily liability to patients when
and 3 were 16%, 65%, and 63%. The combined medical records are stolen. 3 - Clinical
intervention increased vaccination rates informatics exam given for the first time,
by 9, 8, and 13 percentage points, October 7-18, 2013.
respectively. Control group achieved 15% 116
vaccination for HPV #1 and 50% vaccination 117Top 10 events. 10 - NY Times:
for HPV #2 and 3 after 318, 178, and 215 "Search of DNA Sequences Reveals Full
days. The combined intervention Identities” 9 - SNOMED CT and LOINC to be
significantly accelerated vaccination by linked 8 - Supreme Court rules genes
151, 68, and 93 days. cannot be patented 7 - NIH funds
52Clinical Decision Support for consortium for genome variants of clinical
Providers and Patients: Infectious significance 6 - White House tells federal
Disease. Reference Fiks AG, et. al, agencies: research data needs to be shared
Effectiveness of decision support for 5 - EHR adoption by hospitals nearly 70%
families, clinicians, or both on HPV in US. 4 - Court: providers do not
vaccine receipt. Pediatrics. 2013 necessarily liability to patients when
Jun;131(6):1114-24. Results, cont’d The medical records are stolen. 3 - Clinical
clinician-focused intervention was more informatics exam given for the first time,
effective than the family-focused October 7-18, 2013 2 - Morrie Collen turns
intervention for HPV #1, but less 100.
effective for HPV #2 and 3. Conclusions A 118Lindberg DA, Ball MJ. Methods Inf Med.
clinician-focused intervention was most 2013 Oct 11;52(5):371-3.
effective for initiating the HPV 119And the #1 top event of 2013 is…
vaccination series, whereas a 120Top 10 events. 10 - NY Times:
family-focused intervention promoted "Search of DNA Sequences Reveals Full
completion. Decision support directed at Identities” 9 - SNOMED CT and LOINC to be
both clinicians and families most linked 8 - Supreme Court rules genes
effectively promotes HPV vaccine series cannot be patented 7 - NIH funds
receipt. Importance Healthcare is a team consortium for genome variants of clinical
sport. Engage as many players as possible significance 6 - White House tells federal
(Participatory Medicine) for promoting agencies: research data needs to be shared
healthy behaviors. 5 - EHR adoption by hospitals nearly 70%
53Clinical Decision Support for in US. 4 - Court: providers do not
Patients: Cancer Detection and Care (3 necessarily liability to patients when
studies). References van Tol-Geerdink JJ, medical records are stolen. 3 - Clinical
et. al, Choice between prostatectomy and informatics exam given for the first time,
radiotherapy when men are eligible for October 7-18, 2013 2 - Morrie Collen turns
both: a randomized controlled trial of 100 1 - Healthcare.gov inadvertently shows
usual care vs decision aid. BJU Int. 2013 the societal power of the web.
Apr;111(4):564-73. [Department of 121
Radiation Oncology, Radboud University 122
Medical Centre, Netherlands]. Green BB, 1232103 Top 10 events. 10 - NY Times:
et. al, An automated intervention with "Search of DNA Sequences Reveals Full
stepped increases in support to increase Identities” 9 - SNOMED CT and LOINC to be
uptake of colorectal cancer screening: a linked 8 - Supreme Court rules genes
randomized trial. Ann Intern Med. 2013 Mar cannot be patented 7 - NIH funds
5;158(5 Pt 1):301-11. [Group Health consortium for genome variants of clinical
Research Institute, Seattle] Schroy PC significance 6 - White House tells federal
3rd, et. al, Aid-assisted decision making agencies: research data needs to be shared
and colorectal cancer screening: a 5 - EHR adoption by hospitals nearly 70%
randomized controlled trial. Am J Prev in US. 4 - Court: providers do not
Med. 2012 Dec;43(6):573-83.e [Department necessarily liability to patients when
of Medicine, Boston University, Boston]. medical records are stolen. 3 - Clinical
54Clinical Decision Support for informatics exam given for the first time,
Patients: Cancer Detection and Care (3 2 - Morrie Collen turns 100 1 -
studies). Interventions Netherlands: Healthcare.gov inadvertently shows the
online decision aid for newly diagnosed societal power of the web.
prostate cancer patients to help choose 124Special thanks to these 30 ACMI
between surgery, external beam radiation Fellows: Harold Lehmann Yves Lussier Alexa
or brachytherapy, in 240 patients with McCray Blackford Middleton Joyce Mitchell
localized cancer. Group Health Seattle: Lucila Ohno-Machado Judy Ozbolt Ted
EHR-linked automated mailings +/- Shortliffe Dean Sittig Kent Spackman David
telephone assistance +/- nurse navigation States Jaap Suermondt Jonathan Teich Mark
vs. usual care, to promote colorectal Tuttle Bonnie Westra. Jos Aarts Andrew
cancer screening, in 4675 adults aged Balas David Bates Chris Chute Jim Cimino
50-73 followed by 21 medical centers Don Detmer Gunther Eysenbach Reed Gardner
Boston Univ.: Shared Decision Making Bill Hersh Betsy Humphreys George Hripcsak
decision aid +/- personalized risk Bonnie Kaplan Ross Koppel Ira Kalet Zak
assessment vs. usual care to promote Kohane.
colorectal cancer screening in 825 adults 125Content for this session is at:
aged 50-75 Results Netherlands: more http://faculty.washington.edu/dmasys/YearI
patients chose brachytherapy, fewer Review or Google: “AMIA Year in Review”
undecided as a result of using the includes citation lists and links and this
decision aid. Group Health: intervention PowerPoint.
По технология 4 класс днем 1апреля.ppt
http://900igr.net/kartinka/anglijskij-jazyk/po-tekhnologija-4-klass-dnem-1aprelja-206765.html
cсылка на страницу

По технология 4 класс днем 1апреля

другие презентации на тему «По технология 4 класс днем 1апреля»

«The green movement» - Green color which is used by participants of movement as the general emblem, serves as a symbol of the nature, hope and updating. The countries in which there are offices Greenpeace. One of the largest victories гринписовцев in the given campaign can name refusal of flooding of an oil platform brent spar as it contained many toxic substances.

«The animals» - The ANIMALS of our planet. The animals which live in the OCEAN. POLAR BEAR. ZEBRA. GORILLA. PANDA. KOALA. SEA-HORSE. FISH. LION. PENGUIN. STARFISH. BOBCAT. FOX. SEAL. REINDEER. The animals which live in the polar regions. WHALE. The animals which live in the desert. WOMBAT. FLAMINGO. BEAR. PARROT. The animals which live in Australia.

«Женщина the woman» - Chicken’s mind- Куриные мозги. Муж - голова, жена- шея; куда хочу- туда верчу. Бабий язык, куда ни завались, достанет. От нашего ребра нам не ждать добра; Женский интеллект. Баба слезами беде помогает. A woman’s tongue wags like a lamb’s tail. Холостому помогай боже, а женатому хозяйка поможет. « Der mann»- нем.

«The english-speaking countries» - USA. Great Britain. The English-speaking countries. Disneyland. Scotland. Australia.

«Youth subcultures» - subculture. rocker. raver. biker. goth. mod. punk. hacker. hippie. skinhead.

«Family and friends» - Do your parents understand you. Smoking. New words. Computer games. Look at the photos. Dieting. Look at the photos and find more appropriate word. Family and friends. Семья и друзья. Рекомендации к применению данной презентации. Речевая разминка. Films. Fashion music. School problems. Краткий конспект урока.

Тексты на английском

46 презентаций о текстах на английском
Урок

Английский язык

29 тем
Картинки