Information Technology to Support Improved Care For Chronic Illness

BackgroundIn populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative impact of specific informatics technologies on chronic illness care.ObjectiveTo summarize knowledge and increase expert consensus regarding informatics components that support improvement in chronic illness care.DesignA systematic review of the literature was performed. "Use case" models were then developed, based on the literature review, and guidance from clinicians and national quality improvement projects. A national expert panel process was conducted to increase consensus regarding information system components that can be used to improve chronic illness care.ResultsThe expert panel agreed that informatics should be patient-centered, focused on improving outcomes, and provide support for illness self-management. They concurred that outcomes should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that interactive, sequential, disorder-specific treatment pathways be implemented to quickly provide clinicians with patient clinical status, treatment history, and decision support.ConclusionsSpecific informatics strategies have the potential to improve care for chronic illness. Software to implement these strategies should be developed, and rigorously evaluated within the context of organizational efforts to improve care

How accurate is an LCD screen version of the Pelli–Robson test?

Purpose: To evaluate the accuracy and repeatability of a computer-generated Pelli–Robson test displayed on liquid crystal display (LCD) systems compared to a standard Pelli–Robson chart. Methods: Two different randomized crossover experiments were carried out for two different LCD systems for 32 subjects: 6 females and 10 males (40.5 ± 13.0 years) and 9 females and 7 males (27.8 ± 12.2 years), respectively, in the first and second experiment. Two repeated measurements were taken with the printed Pelli–Robson test and with the LCDs at 1 and 3 m. To test LCD reliability, measurements were repeated after 1 week. Results: In Experiment 1, contrast sensitivity (CS) measured with LCD1 resulted significantly higher than Pelli–Robson both at 1 and at 3 m of about 0.20 log 1/C in both eyes (p < 0.01). Bland–Altman plots showed a proportional bias for LCD1 measures. LCD1 measurements showed reasonable repeatability: ICC was 0.83 and 0.65 at 1 and 3 m, respectively. In Experiment 2, CS measured with LCD2 resulted significantly lower than Pelli–Robson both at 1 and at 3 m of about 0.10 log 1/C in both eyes (p < 0.01). Bland–Altman plots did not show any proportional bias for LCD2 measures. LCD2 measurements showed sufficient repeatability: ICC resulted 0.51 and 0.65 at 1 and 3 m, respectively. Conclusions: Computer-generated versions of Pelli–Robson test, displayed on LCD systems, do not provide accurate results compared to classic Pelli–Robson printed version. Clinicians should consider that Pelli–Robson computer-generated versions could be non-interchangeable to the printed version

Anormalidades do potencial evocado visual por padrão reverso em pacientes com esclerose múltipla definida Pattern reversal visual evoked potential abnormalities in patients with defined multiple sclerosis

O potencial evocado visual por padrão reverso, obtido por padrões de 14' e 28', foi analisado retrospectivamente em 28 pacientes com diagnóstico de esclerose múltipla definida. Observamos respostas anormais em 27/28 (96,4%) pacientes, em 31/36 (86%) dos olhos considerados sintomáticos e em 16/20 (80%) dos ollhos assintomáticos. Classificando os achados em cada olho segundo as respostas obtidas aos dois estímulos, observamos uma possível relação entre essa classificação e a gravidade de comprometimento visual pela doença. Detectamos em alguns olhos anormalidades isoladas do N75 e também de P100 apenas à estimulação de 28'. Dessa forma, a técnica empregada foi considerada sensível e pôde definir inclusive comprometimento visual subclínico. Entretanto, não teve sensibilidade absoluta para detectar anormalidades em alguns olhos sintomáticos. O tipo de resposta aos estímulos empregados pode sugerir o grau de extensão de envolvimento do sistema visual pela doença. Os achados mostram ainda o envolvimento irregular e predominante das fibras mais centrais da visão pela esclerose múltipla, e sugerem processadores neurais distintos e paralelos para as respostas aos dois padrões utilizados.<br>The pattern reversal visual evoked potential with checks of 14' and 28' was restropectivelly studied in 28 patients with definite multiple sclerosis. We observed abnormal responses in 27/28 (96.4%) patients, in 31/36 (86%) of symptomatic eyes, and in 16/20 (80%) of asymptomatic eyes. When we classified the abnormalities in each eye according to the findings obtained with each check, there was a correlation between the pattern of abnormalities and the severity of visual involvement. Occasionally there were isolated abnormalities of N75 or only in P100 obtained with 28' checks. In conclusion the methodology applied was very sensible in detecting abnormalities in visual pathway. We could classify the findings in each eye and correlate them with the severity of visual involvement. The findings showed uneven distribution of lesions in visual pathway, affecting preferentially the central vision afferents