228 research outputs found
Examining the Relationship between Clinical Decision Support and Performance Measurement
In concept and practice, clinical decision support (CDS) and performance measurement represent distinct approaches to organizational change, yet these two organizational processes are interrelated. We set out to better understand how the relationship between the two is perceived, as well as how they jointly influence clinical practice. To understand the use of CDS at benchmark institutions, we conducted semistructured interviews with key managers, information technology personnel, and clinical leaders during a qualitative field study. Improved performance was frequently cited as a rationale for the use of clinical reminders. Pay-for-performance efforts also appeared to provide motivation for the use of clinical reminders. Shared performance measures were associated with shared clinical reminders. The close link between clinical reminders and performance measurement causes these tools to have many of the same implementation challenges
Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation
<p>Abstract</p> <p>Background</p> <p>Based on barriers to the use of computerized clinical decision support (CDS) learned in an earlier field study, we prototyped design enhancements to the Veterans Health Administration's (VHA's) colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder.</p> <p>Methods</p> <p>In a controlled simulation experiment, 12 primary care providers (PCPs) used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison. Quantitative measurements were based on a usability survey, workload assessment instrument, and workflow integration survey. We also collected qualitative data on both designs.</p> <p>Results</p> <p>Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted aspects of usability and workflow integration but not workload. The qualitative analysis revealed broad support across participants for the design enhancements with specific suggestions for improving the reminder further.</p> <p>Conclusions</p> <p>This study demonstrates the value of a human-computer interaction evaluation in informing the redesign of information tools to foster uptake, integration into workflow, and use in clinical practice.</p
Dynamical frustration in ANNNI model and annealing
Zero temperature quench in the Axial Next Nearest Neighbour Ising (ANNNI)
model fails to bring it to its ground state for a certain range of values of
the frustration parameter , the ratio of the next nearest neighbour
antiferromagnetic interaction strength to the nearest neighbour one. We apply
several annealing methods, both classical and quantum, and observe that the
behaviour of the residual energy and the order parameter depends on the value
of strongly. Classical or thermal annealing is found to be adequate
for small values of .
However, neither classical nor quantum annealing is effective at values of
close to the fully frustrated point , where the residual
energy shows a very slow algebraic decay with the number of MCS.Comment: 6 pages,10 figures, to be published in Proceedings of " The
International Workshop on Quantum annealing and other Optimization Methods
Cluster Monte Carlo study of multi-component fluids of the Stillinger-Helfand and Widom-Rowlinson type
Phase transitions of fluid mixtures of the type introduced by Stillinger and
Helfand are studied using a continuum version of the invaded cluster algorithm.
Particles of the same species do not interact, but particles of different types
interact with each other via a repulsive potential. Examples of interactions
include the Gaussian molecule potential and a repulsive step potential.
Accurate values of the critical density, fugacity and magnetic exponent are
found in two and three dimensions for the two-species model. The effect of
varying the number of species and of introducing quenched impurities is also
investigated. In all the cases studied, mixtures of -species are found to
have properties similar to -state Potts models.Comment: 25 pages, 5 figure
Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort
(C) The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.Financial disclosure: This project was supported by the
National Institute on Aging (R01 AG030611), the National
Center for Research Resources (5UL1RR025741), and the
National Center for Advancing Translational Sciences (Grant
8UL1TR000150). The content is solely the responsibility of the
authors and does not necessarily represent the official views of
the National Institutes of Health. Smith is currently supported
by a Cancer Research UK Fellowship
Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study - A Randomized Clinical Trial
Background: Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives: Administration of pimobendan (0.4-0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac-related death, or euthanasia. Animals: 360 client-owned dogs with MMVD with left atrial-to-aortic ratio >= 1.6, normalized left ventricular internal diameter in diastole >= 1.7, and vertebral heart sum >10.5. Methods: Prospective, randomized, placebo-controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac-related death, or euthanasia. Results: Median time to primary endpoint was 1228 days (95% CI: 856-NA) in the pimobendan group and 766 days (95% CI: 667-875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47-0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952-NA) in the pimobendan group and 902 days (95% CI: 747-1061) in the placebo group) (P = .012). Conclusions and Clinical Importance: Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit
Primary Xenografts of Human Prostate Tissue as a Model to Study Angiogenesis Induced by Reactive Stroma
Characterization of the mechanism(s) of androgen-driven human angiogenesis could have significant implications for modeling new forms of anti-angiogenic therapies for CaP and for developing targeted adjuvant therapies to improve efficacy of androgen-deprivation therapy. However, models of angiogenesis by human endothelial cells localized within an intact human prostate tissue architecture are until now extremely limited. This report characterizes the burst of angiogenesis by endogenous human blood vessels in primary xenografts of fresh surgical specimens of benign prostate or prostate cancer (CaP) tissue that occurs between Days 6–14 after transplantation into SCID mice pre-implanted with testosterone pellets. The wave of human angiogenesis was preceded by androgen-mediated up-regulation of VEGF-A expression in the stromal compartment. The neo-vessel network anastomosed to the host mouse vascular system between Days 6–10 post-transplantation, the angiogenic response ceased by Day 15, and by Day 30 the vasculature had matured and stabilized, as indicated by a lack of leakage of serum components into the interstitial tissue space and by association of nascent endothelial cells with mural cells/pericytes. The angiogenic wave was concurrent with the appearance of a reactive stroma phenotype, as determined by staining for α-SMA, Vimentin, Tenascin, Calponin, Desmin and Masson's trichrome, but the reactive stroma phenotype appeared to be largely independent of androgen availability. Transplantation-induced angiogenesis by endogenous human endothelial cells present in primary xenografts of benign and malignant human prostate tissue was preceded by induction of androgen-driven expression of VEGF by the prostate stroma, and was concurrent with and the appearance of a reactive stroma phenotype. Androgen-modulated expression of VEGF-A appeared to be a causal regulator of angiogenesis, and possibly of stromal activation, in human prostate xenografts
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