User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication in a Randomized Trial.

Objectives:  To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia.

Methods:  Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner.

Wearable Device Health Data Mapping to Open mHealth and FHIR Data Formats.

Health data collected by wearables and apps can be useful as part of patient-generated health data (PGHD) or personal health data for medical diagnosis or general health monitoring. Mobile health apps are more and more accepted, generate evidence and might be increasingly used in personal medicine. Data retrieved from wearables and apps are mostly not following a medical data standard and cannot be retrieved from the vendors in a straightforward way.

Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.

Background: Decision making in the Emergency Department (ED) requires timely identification of clinical information relevant to the complaints. Existing information retrieval solutions for the electronic health record (EHR) focus on patient cohort identification and lack clinical relevancy ranking. We aimed to compare knowledge-based (KB) and unsupervised statistical methods for ranking EHR information by relevancy to a chief complaint of chest or back pain among ED patients.

A clinician survey of using speech recognition for clinical documentation in the electronic health record.

Objective: To assess the role of speech recognition (SR) technology in clinicians' documentation workflows by examining use of, experience with and opinions about this technology.

Materials And Methods: We distributed a survey in 2016-2017 to 1731 clinician SR users at two large medical centers in Boston, Massachusetts and Aurora, Colorado. The survey asked about demographic and clinical characteristics, SR use and preferences, perceived accuracy, efficiency, and usability of SR, and overall satisfaction.

Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study.

Purpose: The red-hair phenotype, which is often produced by mutations in the melanocortin-1 receptor gene, has been associated with an increase in sedative, anesthetic, and analgesic requirements in both animal and human studies. Nevertheless, the clinical implications of this phenomenon in red-haired patients undergoing surgery are currently unknown.

Methods: In a secondary analysis of a prospective trial of intraoperative awareness, red-haired patients were identified and matched with five control patients, and the relative risk for intraoperative awareness was determined.

Association between intraoperative electroencephalographic suppression and postoperative mortality.

Background: Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression.

Methods: This observational study included 2662 adults enrolled in the B-Unaware or BAG-RECALL trials.

Increased risk of intraoperative awareness in patients with a history of awareness.

Background: Patients with a history of intraoperative awareness with explicit recall (AWR) are hypothesized to be at higher risk for AWR than the general surgical population. In this study, the authors assessed whether patients with a history of AWR (1) are actually at higher risk for AWR; (2) receive different anesthetic management; and (3) are relatively resistant to the hypnotic actions of volatile anesthetics.

Methods: Patients with a history of AWR and matched controls from three randomized clinical trials investigating prevention of AWR were compared for relative risk of AWR.

Distributed representation of chemical features and tunotopic organization of glomeruli in the mouse olfactory bulb.

In the mammalian brain, similar features of the sensory stimuli are often represented in proximity in the sensory areas. However, how chemical features are represented in the olfactory bulb has been controversial. Questions have been raised as to whether specific chemical features of the odor molecules are represented by spatially clustered olfactory glomeruli.

Prevention of intraoperative awareness in a high-risk surgical population.

Background: Unintended intraoperative awareness, which occurs when general anesthesia is not achieved or maintained, affects up to 1% of patients at high risk for this complication. We tested the hypothesis that a protocol incorporating the electroencephalogram-derived bispectral index (BIS) is superior to a protocol incorporating standard monitoring of end-tidal anesthetic-agent concentration (ETAC) for the prevention of awareness.

Methods: We conducted a prospective, randomized, evaluator-blinded trial at three medical centers.

Measurement of glomerular filtration rate in ICU patients using 99mTc-DTPA and inulin.

Improved and reliable methods for assessing glomerular filtration rate (GFR) in intensive care patients are needed in light of known deficiencies using creatinine clearance. We compared simultaneous two-hour clearances of inulin (CIn), creatinine (CCr), and 99mTc-diethylenetriaminepentaacetic acid (CDTPA) in 18 medical or surgical intensive care patients (range, 49 to 92 years old) with blood urea nitrogen (BUN) levels greater than 17.9 mmol/liter (0.

Bacteriophage concentration from water by filter chromatography.

The efficiency of an electropositive filter for membrane chromatography of viruses was examined using coliform phages T1, T4, lambda and Salmonella phage P22. Phages diluted in dechlorinated tap water were adsorbed to filters at neutral pH and eluted by 3% beef extract in 0.05 M glycine buffer at selected alkaline pH values.