A Case of Acute Liver Failure in a Patient on Isoniazid Prophylaxis for Latent Tuberculosis.

Isoniazid (INH) is widely used for latent despite the known risk of liver injury, with severe hepatitis occurring in up to 1% of patients. We report a patient who presented with two weeks of anorexia, nausea, and jaundice following six months of INH monotherapy for latent tuberculosis (TB). After other causes of liver injury were ruled out, she underwent a liver biopsy showing submassive necrosis, hepatocellular dropout, and lobular inflammation with no evidence of fibrosis.

The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records. A Systematic Literature Review.

Background: The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet.

Objectives: To provide a systematic review of peer-reviewed literature about the ICF's use in EHRs, including related challenges and benefits.

Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.

Objectives: Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non-ST elevation myocardial infarction (NSTEMI) in the emergency department (ED).

Methods: A retrospective, cohort study was conducted during a 42-month period of all patients 24 years or older suspected of having ACS as defined by receiving an electrocardiogram and at least 1 cardiac biomarker test.

Impact of an Electronic Clinical Decision Support Tool for Emergency Department Patients With Pneumonia.

Study Objective: Despite evidence that guideline adherence improves clinical outcomes, management of pneumonia patients varies in emergency departments (EDs). We study the effect of a real-time, ED, electronic clinical decision support tool that provides clinicians with guideline-recommended decision support for diagnosis, severity assessment, disposition, and antibiotic selection.

Methods: This was a prospective, controlled, quasi-experimental trial in 7 Intermountain Healthcare hospital EDs in Utah's urban corridor.

A systematic review of the implementation and impact of asthma protocols.

Background: Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow.

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: a randomized clinical trial.

Objective: The use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision.

Exploring the frontier of electronic health record surveillance: the case of postoperative complications.

Background: The aim of this study was to build electronic algorithms using a combination of structured data and natural language processing (NLP) of text notes for potential safety surveillance of 9 postoperative complications.

Methods: Postoperative complications from 6 medical centers in the Southeastern United States were obtained from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) registry. Development and test datasets were constructed using stratification by facility and date of procedure for patients with and without complications.

An asthma management system in a pediatric emergency department.

Introduction: Pediatric asthma exacerbations account for >1.8 million emergency department (ED) visits annually. Asthma guidelines are intended to guide time-dependent treatment decisions that improve clinical outcomes; however, guideline adherence is inadequate.

Relationships among initial hospital triage, disease progression and mortality in community-acquired pneumonia.

Background And Objective: Appropriate triage of patients with community-acquired pneumonia (CAP) may improve morbidity, mortality and use of hospital resources. Worse outcomes from delayed intensive care unit (ICU) admission have long been suspected but have not been verified.

Methods: In a retrospective study of consecutive patients with CAP admitted from 1996-2006 to the ICUs of a tertiary care hospital, we measured serial severity scores, intensive therapies received, ICU-free days, and 30-day mortality.

Predictors of patient length of stay in 9 emergency departments.

Objectives: Prolonged emergency department (ED) length of stay (LOS) is linked to adverse outcomes, decreased patient satisfaction, and ED crowding. This multicenter study identified factors associated with increased LOS.

Methods: This retrospective study included 9 EDs from across the United States.

Detecting temporal expressions in medical narratives.

Background: Clinical practice and epidemiological information aggregation require knowing when, how long, and in what sequence medically relevant events occur. The Temporal Awareness and Reasoning Systems for Question Interpretation (TARSQI) Toolkit (TTK) is a complete, open source software package for the temporal ordering of events within narrative text documents. TTK was developed on newspaper articles.

The effect of computerized provider order entry (CPOE) on ordering patterns for chest pain patients in the emergency department.

This study addressed the effect of CPOE implementation on chest pain ordering patterns for patients in the emergency department. Retrospective order data was collected to assess the implementation. 300 randomly selected, time matched patients with a chief complaint of chest pain were selected in a before/after study.

Interventions to safeguard system effectiveness during periods of emergency department crowding.

This article summarizes the proceedings of a breakout session, "Interventions to Safeguard System Effectiveness," at the 2011 Academic Emergency Medicine consensus conference, "Interventions to Assure Quality in the Crowded Emergency Department." Key definitions fundamental to understanding the effectiveness of emergency care during periods of emergency department (ED) crowding are outlined. Next, a proposed research agenda to evaluate interventions directed at improving emergency care effectiveness is outlined, and the paper concludes with a prioritization of those interventions based on breakout session participant discussion and evaluation.

The birth and evolution of a discipline devoted to information in biomedicine and health care. As reflected in its longest running journal.

Background: The journal Methods of Information in Medicine, founded in 1962, has now completed its 50th volume. Its publications during the last five decades reflect the formation of a discipline that deals with information in biomedicine and health care.

Objectives: To report about 1) the journal's origin, 2) the individuals who have significantly contributed to it, 3) trends in the journal's aims and scope, 4) influential papers and 5) major topics published in Methods over the years.

Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.

Study Objective: We examine variability among emergency physicians in rate of hospitalization for patients with pneumonia and the effect of variability on clinical outcomes.

Methods: We studied 2,069 LDS Hospital emergency department (ED) patients with community-acquired pneumonia who were aged 18 years or older during 1996 to 2006, identified by International Classification of Diseases, Ninth Revision coding and compatible chest radiographs. We extracted vital signs, laboratory and radiographic results, hospitalization, and outcomes from the electronic medical record.

Variations in crowding and ambulance diversion in nine emergency departments.

Objectives: The primary study aim was to examine the variations in crowding when an emergency department (ED) initiates ambulance diversion.

Methods: This retrospective, multicenter study included nine geographically disparate EDs. Daily ED operational variables were collected during a 12-month period (January 2009 to December 2009), including total number of ED visits, mean overall length of stay (LOS), number of ED beds, and hours on ambulance diversion.

A computerized pneumococcal vaccination reminder system in the adult emergency department.

Background: Pneumococcal vaccination is an effective strategy to prevent invasive pneumococcal disease in the elderly. Emergency department (ED) visits present an underutilized opportunity to increase vaccination rates; however, designing a sustainable vaccination program in an ED is challenging. We examined whether an information technology supported approach would provide a feasible and sustainable method to increase vaccination rates in an adult ED.

Measures of crowding in the emergency department: a systematic review.

Objectives: Despite consensus regarding the conceptual foundation of crowding, and increasing research on factors and outcomes associated with crowding, there is no criterion standard measure of crowding. The objective was to conduct a systematic review of crowding measures and compare them in conceptual foundation and validity.

Methods: This was a systematic, comprehensive review of four medical and health care citation databases to identify studies related to crowding in the emergency department (ED).

Methods in year 50: preserving the past and preparing for the future.

Background: Founded in 1962 and, therefore, the oldest international journal in medical informatics, Methods of Information in Medicine will publish its 50th volume in 2011. At the start of the journal's sixth decade, a discussion on the journal's profile seems appropriate.

Objectives: To report on the new opportunities for online access to Methods publications as well as on the recent strategic decisions regarding the journal's aims and editorial policies.

Evaluating the effects of increasing surgical volume on emergency department patient access.

Aim: To determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access.

Methods: A stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital.

CURB-65 pneumonia severity assessment adapted for electronic decision support.

Background: Accurate severity assessment is crucial to the initial management of community-acquired pneumonia (CAP). The CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) score contains data that are entered routinely in electronic medical records and are, thus, electronically calculable. The aim of this study was to determine whether an electronically generated severity estimate using CURB-65 elements as continuous and weighted variables better predicts 30-day mortality than the traditional CURB-65.

Factors affecting stress in emergency medicine residents while working in the ED.

Objectives: The aim of this study was to identify factors other than work hours in the emergency department (ED) work environment contributing to resident stress.

Methods: This study involved a prospective cohort evaluation of emergency medicine residents in the ED. Twelve surveys were collected from 18 subjects, 4 each from the day, evening, and night shifts.

Characterizing waiting room time, treatment time, and boarding time in the emergency department using quantile regression.

Objectives: The objective was to characterize service completion times by patient, clinical, temporal, and crowding factors for different phases of emergency care using quantile regression (QR).

Methods: A retrospective cohort study was conducted on 1-year visit data from four academic emergency departments (EDs; N = 48,896-58,316). From each ED's clinical information system, the authors extracted electronic service information (date and time of registration; bed placement, initial contact with physician, disposition decision, ED discharge, and disposition status; inpatient medicine bed occupancy rate); patient demographics (age, sex, insurance status, and mode of arrival); and clinical characteristics (acuity level and chief complaint) and then used the service information to calculate patients' waiting room time, treatment time, and boarding time, as well as the ED occupancy rate.