Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/1/gps4599.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/2/gps4599_am.pd

Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113710/1/lary25363.pd

Prospect patents, data markets, and the commons in data-driven medicine : openness and the political economy of intellectual property rights

Scholars who point to political influences and the regulatory function of patent courts in the USA have long questioned the courts’ subjective interpretation of what ‘things’ can be claimed as inventions. The present article sheds light on a different but related facet: the role of the courts in regulating knowledge production. I argue that the recent cases decided by the US Supreme Court and the Federal Circuit, which made diagnostics and software very difficult to patent and which attracted criticism for a wealth of different reasons, are fine case studies of the current debate over the proper role of the state in regulating the marketplace and knowledge production in the emerging information economy. The article explains that these patents are prospect patents that may be used by a monopolist to collect data that everybody else needs in order to compete effectively. As such, they raise familiar concerns about failure of coordination emerging as a result of a monopolist controlling a resource such as datasets that others need and cannot replicate. In effect, the courts regulated the market, primarily focusing on ensuring the free flow of data in the emerging marketplace very much in the spirit of the ‘free the data’ language in various policy initiatives, yet at the same time with an eye to boost downstream innovation. In doing so, these decisions essentially endorse practices of personal information processing which constitute a new type of public domain: a source of raw materials which are there for the taking and which have become most important inputs to commercial activity. From this vantage point of view, the legal interpretation of the private and the shared legitimizes a model of data extraction from individuals, the raw material of information capitalism, that will fuel the next generation of data-intensive therapeutics in the field of data-driven medicine

Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use

<p>Abstract</p> <p>Background</p> <p>Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes (<it>International Classification of Diseases, 9^thedition, clinical modification </it>diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text ("chart notation").</p> <p>Methods</p> <p>Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use.</p> <p>Results</p> <p>Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample.</p> <p>Conclusions</p> <p>Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.</p

A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically.</p> <p>Methods</p> <p>This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed.</p> <p>Results</p> <p>The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor.</p> <p>Conclusions</p> <p>The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients.</p

Nursing care practices to improve acute stroke care : a descriptive literature review

Acute stroke starts suddenly, but typically worsens rapidly. Therefore, it is considered as a devastating illness requiring emergent attention and care, considering its adverse effects of leading to a high degree of patients’ mortality and inadvertently physical incapacity. Therefore, the aim of this thesis is to find out nursing practices required for care of acute stroke, and furthermore, to discover recent research in tackling the risk factors and the role of nurses in the care of acute stroke patients. Furthermore, this study is carried out by reviewing literature in order to discover nursing practices in the care of patients with acute stroke, and to study how nursing care of acute stroke can be improved by the enhancement on the use of evidence with regards to the prevention of early complications. The prevention of complications within the first 24 - 48hrs decreases stroke-related mortality, therefore, using the electronic database searches of CINAHL, PubMed and SAGE and considering the inclusion and exclusion criteria. Furthermore, codes retrieved were recorded after which themes were being generated. Hence, the major themes formed were: Nurse led ward round, Goal setting and Nursing support which were further divided into sub-themes. Finally, It has been discovered that the management and care of stroke involves the carrying out of evidence-based approach which could therefore be implemented by professionals within the healthcare team, in order to emphasize the care in recognizing, response, and treatment are delivered in an inclusive approach, and as such, nurse-led ward round has proven to be a powerful tool to empowering nurses to make decisions within their professional capabilities, within which its contribution has had a significant impact on patient care and safety through early detection and prevention of stroke complications, in an acute setting

Implementing system-wide risk stratification approaches: a review of critical success and failure factors

An Evidence Check rapid review brokered by the Sax Institute for the NSW Agency for Clinical Innovatio

Evaluation of the Reliability of Electronic Medical Record Data in Identifying Comorbid Conditions among Patients with Advanced Non-Small Cell Lung Cancer

Background. Traditional methods for identifying comorbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify comorbidities among cancer patients. Methods. Advanced stage NSCLC patients (N = 2, 513) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology&apos;s proprietary oncology-specific EMR system. EMR data were searched for documentation of comorbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the comorbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of comorbidities. Negative predictive values were calculated. Results. The overall prevalence of comorbidities of 22%. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of comorbidities on chart review). Conclusion. Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on comorbid conditions among cancer patients

Interpersonal psychotherapy for depressed adolescents: a systematic review of quantitative studies exploring effectiveness, concomitant findings, and mediating and moderating variables

Depression is one of the leading causes of illness and disability among adolescents. According to the National Institute of Mental Health (2022), almost one-fifth of adolescents ages 12 to 17 years in the United States had at least one major depressive episode in 2020, representing 4.1 million people, and over half did not receive any treatment. An interpersonal approach to therapy for adolescents known as Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), developed by Dr. Laura Mufson, has been regarded as having well-established efficacy in treating depressed adolescents. This systematic review of quantitative studies (without meta-analysis) was conducted to (a) examine the effectiveness of IPT-A and its adaptations in reducing depression across randomized control trials (RCTs); (b) summarize and synthesize the concomitant findings associated with implementation across these RCTs and a range of other quantitative designs, including SMART designs and single group pretest posttest; and (c)identify potential mediating and moderating factors associated with the effectiveness of IPT-A. Data were collected across three electronic databases and included peer-reviewed, English language articles that were published between 1994-2020. The review also included group adaptations of IPT used in developing countries (IPT-G) and a variety of IPT-A adaptations including greater parent involvement (IPT-AP), a briefer version of IPT-A (BIPT-A), and a stepped care model (SCIPT-A). A total of 28 studies were included in this systematic review; 14 addressed the question of effectiveness and a further 14 addressed the question of potential variables of mediation and moderation. Results showed IPT-A is an effective intervention for depressed adolescents and further dissemination in multiple settings would benefit a range of stakeholders. It works in both a group or individual format and is efficacious among varied ethnicities, including with the LatinX community. Last, the approach stimulates the discussion on the fluid relationships between attachment styles and interpersonal relationships, and this relationship to depression

Evidence-Based Policy and Procedure Review System

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based algorithm, this project was designed to provide an efficient and sustainable system for review and revision of policies and procedures in a healthcare setting. The deliverables to the organization are the evidence-based policy and procedure review system toolkit and the results of a pilot the DNP student conducted to demonstrate the use of the toolkit. Included in the pilot results are a detailed time log providing the length of time required to complete the review, recommendations for revisions to policies and procedures utilizing current evidence from literature, a budget analysis, a report of the current state of the organization and how the toolkit will aid in overcoming identified barriers, and recommendations for sustainability. The deliverables include the following: 1) Successful dissemination of the toolkit use to the site manager; 2) increased percentage of policies and procedures meeting compliance requirements for specialty pharmacy accreditation from 3% to 40%; 3) a step-by-step instruction guide for reviewing literature and policies and procedures with the incorporation of best practice evidence; 4) a proposed policy for policy review, and 5) an accurate budget for organizational planning to sustain policy revisions in the future