Validation of a guideline-based decision support system for the diagnosis of primary headache disorders based on ICHD-3 beta

BACKGROUND: China may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem. METHODS: We developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China. RESULTS: We found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache. CONCLUSIONS: With high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China

An ant colony optimization algorithm-based classification for the diagnosis of primary headaches using a website questionnaire expert system

The purpose of this research was to evaluate the classification accuracy of the ant colony optimization algorithm for the diagnosis of primary headaches using a website questionnaire expert system that was completed by patients. This cross-sectional study was conducted in 850 headache patients who randomly applied to hospital from three cities in Turkey with the assistance of a neurologist in each city. The patients filled in a detailed web-based headache questionnaire. Finally, neurologists' diagnosis results were compared with the classification results of an ant colony optimization-based classification algorithm. The ant colony algorithm for diagnosis classified patients with 96.9412% overall accuracy. Diagnosis accuracies of migraine, tension-type, and cluster headaches were 98.2%, 92.4%, and 98.2% respectively. The ant colony optimization-based algorithm has a successful classification potential on headache diagnosis. On the other hand, headache diagnosis using a website-based algorithm will be useful for neurologists in order to gather quick and precise results as well as tracking patients for their headache symptoms and medication usage by using electronic records from the Internet

Does a simple educational exercise influence practice in acute tonsillitis in children?

Aim: To assess the concordance of treatment of children attending with tonsillitis in Paediatric Accident and Emergency with established guidelines, and subsequent review of the management of this condition after a simple educational exercise. Methods: An audit on children with tonsillitis was carried out amongst doctors working in the Paediatric Accident and Emergency Department during a three month period in 2009. Eleven doctors completed an anonymous questionnaire requesting details on presentation, symptoms, investigations and treatment of children presenting with acute tonsillitis. The results obtained from this questionnaire were compared to NICE guidelines and modified Centor (McIsaac) criteria, and fed back to the participating doctors together with copies of these guidelines via a simple, structured educational exercise. Three months later, a second identical questionnaire was again completed by the same cohort of doctors. Results: The first questionnaire showed that there was a tendency towards unnecessary prescription of antibiotics and investigations in children with acute tonsillitis, when compared to recommendations in the guidelines. Following educational feedback, the second questionnaire showed a reduction in antibiotic prescriptions by 9% (p=0.5) and investigations by 37% (p=0.1). Compliance with guidelines had improved significantly with regard to non-prescribing of antibiotics with a fever of 1cm and presence of underlying disease although these changes were not statistically significant. Conclusion: Although doctors were initially only partly compliant with established guidelines for children with acute tonsillitis, compliance improved significantly after a simple educational exercise.peer-reviewe

DEVELOPMENT OF A PROTOTYPE OF MALARIA CLINICAL DIAGNOSTIC DECISION SUPPORT SYSTEM

Introduction : Malaria is a public health problem that still causes mortality, particularly in high risk population. Kabupaten Nias is one of the malaria endemic areas. Malaria diagnosis is mainly determined according to physical examination, despite the fact that laboratory examination is the gold standard of malaria diagnosis. To help health workers in diagnosing malaria accurately, it is necessary to develop a decision support system for malaria diagnosis.Objectives: To develop a prototype of malaria diagnostic decision support system.Methods: It was a descriptive study with action research design to explore each phase in the development of a prototype of malaria diagnostic decision support system. Participants of the study consisted of 5 general practitioners in RSU Gunungsitoli and 2 nurses in Puskesmas Gunungsitoli.Results: The study created an application model of computer-based malaria diagnostic decision support system designed using PHP programming language and MySQL database. This system worked by entering malaria clinical symptoms into the expert system, and data of symptoms were processed by the expert system to determine diagnosis and medical advice that was useful to assist health staff in making decision.Conclusion: Malaria diagnostic decision support system that had been developed attracted the interest of health workers and help them in diagnosing malaria clinically.Keywords: diagnostic decision support system, prototype, malaria, computer application, Gunungsitol

Do decision support systems influence variation in prescription?

<p>Abstract</p> <p>Background</p> <p>Translating scientific evidence into daily practice is problematic. All kinds of intervention strategies, using educational and/or directive strategies, aimed at modifying behavior, have evolved, but have been found only partially successful. In this article the focus is on (computerized) decision support systems (DSSs). DSSs intervene in physicians' daily routine, as opposed to interventions that aim at influencing knowledge in order to change behavior. We examined whether general practitioners (GPs) are prescribing in accordance with the advice given by the DSS and whether there is less variation in prescription when the DSS is used.</p> <p>Methods</p> <p>Data were used from the Second Dutch National Survey of General Practice (DNSGP2), collected in 2001. A total of 82 diagnoses, 749811 contacts, 133 physicians, and 85 practices was included in the analyses. GPs using the DSS daily were compared to GPs who do not use the DSS. Multilevel analyses were used to analyse the data. Two outcome measures were chosen: whether prescription was in accordance with the advice of the DSS or not, and a measure of concentration, the Herfindahl-Hirschman Index (HHI).</p> <p>Results</p> <p>GPs who use the DSS daily prescribe more according to the advice given in the DSS than GPs who do not use the DSS. Contradictory to our expectation there was no significant difference between the HHIs for both groups: variation in prescription was comparable.</p> <p>Conclusion</p> <p>We studied the use of a DSS for drug prescribing in general practice in the Netherlands. The DSS is based on guidelines developed by the Dutch College of General Practitioners and implemented in the Electronic Medical Systems of the GPs. GPs using the DSS more often prescribe in accordance with the advice given in the DSS compared to GPs not using the DSS. This finding, however, did not mean that variation is lower; variation is the same for GPs using and for GPs not using a DSS. Implications of the study are that DSSs can be used to implement guidelines, but that it should not be expected that variation is limited.</p

Implementation of a Treatment Plan in a Rural Health Clinic for Patients with a Diagnosis of Migraine Headache

The purpose of this practice dissertation was to improve the quality of care and outcomes for patients in a small, rural health clinic with a diagnosis of migraine headache. The Institute for Clinical Systems Improvement (ICSI) prepared a health care guideline for the diagnosis and treatment of headaches (Beithon et al., 2013). As part of this guideline, aims and measures were provided for the purpose of quality improvement in migraine headache management (Beithon et al., 2013). The guidelines state the purpose of Aim #5 is to, “increase the percentage of patients with migraine headache who have a treatment plan” (Beithon et al., 2013, p.47), which was measured by the overall percentage of patients with treatment plans utilized to manage the diagnosis (Beithon et al., 2013). This quality improvement measure was accomplished through the implementation of a migraine-specific treatment plan (Silberstein, 2000) that is part of the electronic medical record (EMR) for all patients with a migraine diagnosis within the rural health clinic. The patients included in the project had a migraine diagnosis defined by the International Classification of Diseases, 9th Edition (ICD-9) codes 346.0 through 346.93 (Medicode, 1996), and were between the ages of 18 and 65. The goal of this project was to not only make the treatment plan available within the EMR, but also to achieve greater than 80% compliance by the providers in the clinic for the implementation of the individualized treatment plans for each qualified patient. The clinic achieved a 93% implementation rate as 26 out of 29 qualifying patients seen during the 45-day implementation period received a treatment plan during the visit

Oncologic Emergencies: Immune-Based Cancer Therapies and Complications

Cancer therapies have undergone several recent advancements. Current cancer treatments include immune-based therapies comprised of checkpoint inhibitors, and adoptive immunotherapy; each treatment has the potential for complications that differ from chemotherapy and radiation. This review evaluates immune-based therapies and their complications for emergency clinicians. Therapy complications include immune-related adverse events (irAE), cytokine release syndrome (CRS), autoimmune toxicity, and chimeric antigen receptor (CAR) T-cell-related encephalopathy syndrome (CRES). Immune-related adverse events are most commonly encountered with checkpoint inhibitors and include dermatologic complications, pneumonitis, colitis/diarrhea, hepatitis, and endocrinopathies. Less common irAEs include nephritis, myocardial injury, neurologic toxicity, ocular diseases, and musculoskeletal complications. CRS and CRES are more commonly associated with CAR T-cell therapy. CRS commonly presents with flu-like illness and symptoms resembling sepsis, but severe myocardial and pulmonary disease may occur. Critically ill patients require resuscitation, broad-spectrum antibiotics, and hematology/oncology consultation