Getting off obesity island: how informationists can enhance clinical decision support

Clinical decision support (CDS) will play a key role in improving the health of patients; informationists can support the development of CDS systems by indexing rule libraries and mapping the system logic. This work can help rule developers make more informed choices and understand how rules are related conceptually and operationally. With a map, rules can be written to bridge isolated concepts (islands) and rules that are no longer needed can be weeded. Here we explore the added value that informationists bring to projects by reporting on the role of informationists working on a pediatric CDS

Identifying Inconsistencies and Reporting Deficits in Therapeutic Massage and Bodywork (TMB) Case Reports: A Systematic Review and TMB Adapted CAse REport (CARE) Guidelines Audit

poster abstractIntroduction: Case reports are a fundamental tool through which practitioners in applied disciplines are able to inform research and impact their field by detailing the presentation, treatment, and follow-up of a single individual they’ve encountered in practice. Ideally, published case reports contribute to reductions in the research/practice gap by allowing practitioners to describe current practice situations and outcomes to researchers. Unfortunately, inconsistencies in case reporting across applied disciplines have limited the impact of these fundamental sources of clinical evidence. In 2013, reporting guidelines for case reports (CARE guidelines) were published to standardize the reporting of medical case reports. In recognition of discipline differences and reporting needs, the therapeutic massage and bodywork (TMB) adapted CARE guidelines were published in late 2014 to specifically guide reporting of case reports involving massage therapy applied as a treatment. The TMB adapted CARE guidelines identified 5 primary case report components (pre-manuscript, Introduction, Case Presentation, Results, and Discussion), each with unique subcomponents (e.g., title, keywords, abstract for the pre-manuscript component) ranging in number from 6 - 31. By checking off each component and subcomponent included in any given case report, a summary score for TMB adapted CARE guidelines compliance (range: 0 – 65) can be derived. In order to determine whether the consistency of TMB case reporting is improved after publication of the TMB adapted CARE guidelines, a pre-guideline state of TMB case reports is needed. The current study seeks to provide rich descriptive statistics about the state of TMB related case reports in the literature prior to 2015. Methods: A systematic review using PubMed and CINAHL databases identified 935 unique citations using first the MeSH term “Therapy, Soft Tissue” as the subject heading and publication type “case reports” and then a keyword search in PubMed (acupressure, shiatsu, zhi ya, chih ya, reflexology, rolfing, bodywork, massage, case report, case reports, case study, case studies NOT carotid sinus massage, heart massage, cardiac massage, animals) and CINAHL (subject headings: massage therapists, massage, reflexology, case study). Study inclusion/exclusion criteria required: case report, human, English, peer-reviewed, published prior to 2015. Administered massage treatment(s) had to have been from a professional TMB practitioner who had a role in the case’s reporting and publication. N=34 articles met inclusion criteria and were reviewed by two independent reviewers. Through a REDCap data collection form, components and subcomponents of the TMB adapted CARE reporting guidelines included in each article were identified. Variable coding and descriptive statistics were completed using SAS 9.3 by a non-reviewing team member. TMB adapted CARE reporting compliance scores were determined for each case report. Results: Preliminary results for n=30 (final presentation to include all N=34) indicate mean compliance scores = 40.3 (±9.2) and ranged from 10-50. Article sections with the most robust scoring included pre-manuscript items and introduction with average section scores obtaining 75% and 70% of the possible points, respectively. Case presentation and results sections scored the poorest, obtaining an average of 58% and 53% of the possible points, respectively. Conclusions: Case reports in the TMB field published before possible exposure to the TMB adapted CARE guidelines demonstrate inconsistent and deficient reporting. If case reports in the TMB field are to have an impact, consistent and rigorous reporting must be adopted. In an effort to improve the state and impact of TMB case reports in the literature, TMB practitioners should use the TMB adapted CARE guidelines as a checklist when preparing their case reports for publication

Identifying Inconsistencies and Reporting Deficits in Therapeutic Massage and Bodywork (TMB) Case Reports Authored by TMB Practitioners: a TMB-Adapted CAse REport (CARE) Guidelines Audit Through 2014

INTRODUCTION: Case reports are a fundamental tool through which therapeutic massage and bodywork (TMB) practitioners can inform research and impact their field by detailing the presentation, treatment, and follow-up of a single individual encountered in practice. Inconsistencies in case reporting limit their impact as fundamental sources of clinical evidence. Using the TMB-adapted CAse REport (CARE) guidelines, the current study sought to provide a rich description regarding the reporting quality of TMB practitioner authored TMB case reports in the literature. METHODS: 1) Systematic identification of published, peer-reviewed TMB case reports authored by TMB practitioners following PRISMA recommendations; 2) audit development based on TMB-adapted CARE guidelines; 3) audit implementation; and 4) descriptive analysis of audit scores. RESULTS: Our search identified 977 articles and 35 met study inclusion criteria. On average, TMB case reports included approximately 58% of the total items identified as necessary by the TMB-adapted CARE guidelines. Introduction sections of case reports had the best item reporting (80% on average), while Case Presentation (54%) and Results (52%) sections scored moderately overall, with only 20% of necessary Practitioner Description items included on average. Audit scores revealed inconsistent abstract reporting and few audited case reports including client race (20%), perspective (26%), and occupation/activities (40%); practitioner practice setting (12%), training (12%), scope-of-practice (29%), and credentialing (20%); adverse events or lack thereof (17%); and some aspect of informed consent (34%). Treatment descriptor item reporting varied from high to low. Various implications of concern are discussed. CONCLUSION: The current audit and descriptive analysis highlight several reporting inconsistencies in TMB case reports prior to 2015. Reporting guidelines for case reports are important if standards for, and impact of, TMB case reports are desired. Adherence to reporting specifications outlined by the TMB-adapted CARE guidelines could improve the impact and usability of TMB case reports in research, education, and practice

Mapping the rules: conceptual and logical relationships in a system for pediatric clinical decision support

The Child Health Improvement through Computer Automation (CHICA) system uses evidence-based guidelines and information collected in the clinic and stored in an electronic medical record (EMR) to inform physician and patient decision making. CHICA helps physicians to identify and select relevant screenings and also provides personalized, just-in-time information for patients. This system relies on a database of Medical Logic Modules (MLMS) written in the Arden Rules syntax. These MLMs store observations (StorObs) during the clinical encounter which trigger potential screenings and preventive health interventions for discussion with the patient or for follow up at the next visit. This poster shows how informationists worked with the CHICA team to describe the MLMs using standard vocabularies, including Medical Subject Headings (MeSH) and Logical Observation Identifiers Names and Codes (LOINC). After assigning keywords to the database of MLMs, the informationists used visualization tools to generate maps. These maps show how rules are related by logic (shared StorObs) and by concept (shared vocabulary). The CHICA team will use these maps to identify gaps in the clinical decision support database and (if needed) to develop rules which bridge related but currently isolated concepts.NIH 1R01LM010923-0

Data visualization for truth maintenance in clinical decision support systems

Background and objectives The goal is to inform proactive initiatives to expand the knowledge base of clinical decision support systems. Design and setting We describe an initiative in which research informationists and health services researchers employ visualization tools to map logic models for clinical decision support within an electronic health record. Materials and methods We mapped relationships using software for social network analysis: NodeXL and CMAP. We defined relationships by shared observations, such as two Arden rules within medical logic modules that consider the same clinical observation, or by the presence of common keywords that were used to label rules according to standardized vocabularies. Results We studied the Child Health Improvement through Computer Automation (CHICA) system, an electronic medical record that contains 170 unique variables representing discrete clinical observations. These variables were used in 300 medical logic modules (MLM's) that prompted health care providers to deliver preventive counseling or otherwise served as clinical decision support. Using data visualization tools, we generated maps that illustrate connections, or lack thereof, between clinical topics within CHICA's MLMs. Conclusions The development of such maps may allow multiple disciplines commonly interacting over EMR platforms, and various perspectives (clinicians, programmers, informationists) to work more effectively as teams to refine the EMR by programming logic routines to address co-morbidities or other instances where domains of medical knowledge should be connected

The role of informationists in delivering geospatial intelligence to health care professionals

Three informationists at the Indiana University School of Medicine were awarded NLM supplement to work on the Child Health Improvement through Computer Automation (CHICA) system. CHICA is a computer decision support system that interfaces with existing electronic medical record systems (EMRS) and delivers "just in time" patient-relevant guidelines to physicians during the clinical encounter. CHICA-GIS integrates a geographic information system (GIS) with CHICA to refer pediatricians and parents to relevant health services (as needed, for physical activity, dental care, or tutoring) near the patient's neighborhood. The informationists are enhancing the CHICA-GIS system by: improving the accuracy and accessibility of information, managing and mapping the knowledge which undergirds the CHICA-GIS decision support tool, supporting community engagement and consumer health information outreach, and facilitating the dissemination of new CHICA-GIS research results and services. This presentation describes the initial process for approaching and collaborating with researchers, writing the grant and getting funded, and progress on the project goals to date.NIH R01 LM-01092

Serving East African Bioethics information and education needs

Objective: To identify the challenges of supporting the information needs of students and researchers participating in an international research ethics education practicum and exchange between universities in Kenya and the United States. Methods: One component of a grant-funded international research ethics training partnership supports a six-week intensive practicum exchange program. Master's level students from Moi University, Eldoret, Kenya, travel to the Indiana University (IU) School of Medicine-Indianapolis. While at the IU School of Medicine, the Kenyan students use library services to prepare for a mentored research project. As an outcome of the project, students are expected to conduct an extensive literature search that will be used as a foundational component for a thesis that is completed in Kenya. An informationist is embedded in this program to support the information needs of faculty mentors and practicum students. This paper uses narrative reports and program evaluation data to identify the challenges of (1) providing information literacy education, (2) confronting resource inequities, and (3) supporting information needs across cultures and universities in two countries. Results: Two cohorts of Kenyan students completed this practicum. The program leaders and librarians continue to adapt the information skills sessions to meet student interests and needs. Teaching has been a challenge because students demonstrate a wide range of technical sophistication. Some have extensive computing experience, but others struggle with Internet navigation, account authentication, and common technology skills. In the second cohort, the students worked well in pairs to find relevant research ethics materials while using the university's information portals and subscription resources. In both cohorts, students expressed a desire for a slower instruction pace and for additional sessions. Students were frequent customers for reference support. Librarians observed a preference for print monographs. While confirming a need for both print and electronic resources, practicum students have initiated a small and growing library of print materials for bioethics research at Moi University. Conclusion: Teaching information skills to a small group of adult students with a wide range of educational experiences is a challenge when students are working in a new (information rich) environment. Student evaluations have expressed an appreciation for instruction customized to their interests and needs, a slow delivery style, and opportunities for one-to-one instruction

Enhancing research on a clinical decision support and geographic information system: getting involved as informationists

In 2012, the National Library of Medicine (NLM) funded its first ever administrative supplement for informationists. The purpose of these grants is to enhance multidisciplinary basic and clinical research by integrating information specialists (informationists) on research teams in order to improve the capture, organization, and management of biomedical research data. Three informationists at the Indiana University School of Medicine were awarded one of these supplements to work on the Child Health Improvement through Computer Automation (CHICA) system. CHICA is a computer decision support system that interfaces with existing electronic medical record systems (EMRS) and delivers "just in time" patient-relevant guidelines to physicians during the clinical encounter. CHICA-GIS integrates a geographic information system (GIS) with CHICA to refer pediatricians and parents to relevant health services (as needed, for physical activity, dental care, or tutoring) near the patient's neighborhood. The informationists are enhancing the CHICA-GIS system by: improving the accuracy and accessibility of information, managing and mapping the knowledge which undergirds the CHICA-GIS decision support tool, supporting community engagement and consumer health information outreach, and facilitating the dissemination of new CHICA-GIS research results and services. This paper describes the initial process for approaching and collaborating with researchers, writing the grant and getting funded, and progress on the project goals to date.NIH R01 LM-010923, "Delivering Geospatial Intelligence to Health Care Professionals

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms