Display and perception of risk: Analysis of decision support system display and its impact on perceived clinical risk of sepsis-induced health deterioration.

Despite acknowledging the value of clinical decision support systems (CDSS) in identifying risk for sepsis-induced health deterioration in-hospitalized patients, the relationship between display features, decision maker characteristics, and recognition of risk by the clinical decision maker remains an understudied, yet promising, area. The objective of this study is to explore the relationship between CDSS display design and perceived clinical risk of in-hospital mortality associated with sepsis. The study utilized data collected through in-person experimental sessions with 91 physicians from the general medical and surgical floors who were recruited across 12 teaching hospitals within the United States.

Proximity of Cellular and Physiological Response Failures in Sepsis.

Sepsis is a devastating multi-stage health condition with a high mortality rate. Its complexity, prevalence, and dependency of its outcomes on early detection have attracted substantial attention from data science and machine learning communities. Previous studies rely on individual cellular and physiological responses representing organ system failures to predict health outcomes or the onset of different sepsis stages.

The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment.

Objective: The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED).

Design: Retrospective data analysis study.

Setting: ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital.

Risky Business: Predicting patient mortality at a glance.

Clinicians are constantly forecasting patient trajectories to make critical point of care decisions intended to influence clinical outcomes. Little is known, however, about how providers interpret mortality risk against validated scoring systems. This research aims to understand how providers forecast mortality specifically for that of patients with sepsis.

FUTURES: Forecasting the Unexpected Transfer to Upgraded REsources in Sepsis.

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients' clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

Parkes Weber syndrome associated with two somatic pathogenic variants in .

Parkes Weber syndrome is associated with autosomal dominant inheritance, caused by germline heterozygous inactivating changes in the gene, characterized by multiple micro arteriovenous fistulas and segmental overgrowth of soft tissue and skeletal components. The focal nature and variable expressivity associated with this disease has led to the hypothesis that somatic "second hit" inactivating changes in are necessary for disease development. We report a 2-yr-old male with extensive capillary malformation and segmental overgrowth of his lower left extremity.

The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis.

Purpose: To examine the cost-effectiveness of a series (total of 3 injections) of intra-articular platelet-rich plasma (PRP) injections in comparison to that of hyaluronic acid (HA) viscosupplementation for the treatment of symptomatic knee osteoarthritis.

Methods: Outcome data regarding the use of PRP or HA injections for the treatment of symptomatic knee osteoarthritis were determined from the highest-quality data (Level I) available in the literature until 2015. Health utility values were then derived from these high-quality data.

Heroin Adulterated with the Novel Synthetic Cannabinoid, 5F-MDMB-PINACA: A Case Series.

Introduction: Heroin can be adulterated with various substances that may or may not have pharmacological effects. Here we report a case series of 8 patients who presented to the emergency department after overdose with intravenous heroin preparation adulterated with the synthetic cannabinoid methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (5F-MDMB-PINACA).

Case Series: Except for one patient, all of them presented with a typical initial opioid toxidrome consisting of central nervous system and respiratory depression along with pinpoint pupils.

Notice to comply: A systematic review of clinician compliance with guidelines surrounding acute hospital-based infection management.

Purpose: To identify and characterize studies evaluating clinician compliance with infection-related guidelines, and to explore trends in guideline design and implementation strategies.

Data Sources: PubMed database, April 2017. Followed the PRISMA Statement for systematic reviews.

Everything but the Kitchen Sink: A Mixed Methods Approach to Health IT Usability Testing.

Usability testing has become a necessary step to successfully implement health information technology, but despite the expanded variety of usability methods, systems still are not guaranteed to meet user needs in a hectic and dynamic healthcare environment. The present work discusses some of the metrics employed with the intent of usability testing clinical decision support alerts for the early identification of sepsis patients. By utilizing methods such as eye tracking, think aloud protocols, human computer interaction, and more, health information technology can be adequately developed to ensure effective, efficacious, and optimal integration.

The value of missing information in severity of illness score development.

Objective: We aim to investigate the hypothesis that using information about which variables are missing along with appropriate imputation improves the performance of severity of illness scoring systems used to predict critical patient outcomes.

Study Design And Setting: We quantify the impact of missing and imputed variables on the performance of prediction models used in the development of a sepsis-related severity of illness scoring system. Electronic health records (EHR) data were compiled from Christiana Care Health System (CCHS) on 119,968 adult patients hospitalized between July 2013 and December 2015.

Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis.

In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance.

Effect of Levocarnitine vs Placebo as an Adjunctive Treatment for Septic Shock: The Rapid Administration of Carnitine in Sepsis (RACE) Randomized Clinical Trial.

Importance: Sepsis induces profound metabolic derangements, while exogenous levocarnitine mitigates metabolic dysfunction by enhancing glucose and lactate oxidation and increasing fatty acid shuttling. Previous trials in sepsis suggest beneficial effects of levocarnitine on patient-centered outcomes.

Objectives: To test the hypothesis that levocarnitine reduces cumulative organ failure in patients with septic shock at 48 hours and, if present, to estimate the probability that the most efficacious dose will decrease 28-day mortality in a pivotal phase 3 clinical trial.

Microsimulation Model Using Christiana Care Early Warning System (CEWS) to Evaluate Physiological Deterioration.

While physiological warning signs prior to deterioration events during hospitalization have been widely studied, evaluating clinical interventions, such as rapid response team (RRT) activations, based on scoring systems remains an understudied area. Simulation of physiological deterioration patterns represented by scoring systems can facilitate testing different RRT policies without disturbing care processes. Christiana Care Early Warning System (CEWS) is a scoring system developed at the study hospital to detect the physiological warning signs and inform RRT activations.

Not all organ dysfunctions are created equal - Prevalence and mortality in sepsis.

Purpose: While organ dysfunctions within sepsis have been widely studied, interaction between measures of organ dysfunction remains an understudied area. The objective of this study is to quantify the impact of organ dysfunction on in-hospital mortality in infected population.

Materials And Methods: Descriptive and multivariate analyses of retrospective data including patients (age ≥ 18 years) hospitalized at the study hospital from July 2013 to April 2016 who met the criteria for an infection visit (62,057 unique visits).

SIGNALING SEPSIS SCENARIO DEVELOPMENT & VALIDATION.

Patient-based scenario-driven usability tests are routinely created for health information technology and clinical decision support evaluations. Due to low clinician awareness of sepsis, a study was undertaken to understand clinician performance and preference of different display types for sepsis clinical decision support through multi-centered usability testing. Patient-based clinical scenarios were created to mimic the environment in which providers would interact with clinical decision support.

Data-driven approach to Early Warning Score-based alert management.

Background: Increasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.

Evaluation of User-Interface Alert Displays for Clinical Decision Support Systems for Sepsis.

Background: Hospitals are increasingly turning to clinical decision support systems for sepsis, a life-threatening illness, to provide patient-specific assessments and recommendations to aid in evidence-based clinical decision-making. Lack of guidelines on how to present alerts has impeded optimization of alerts, specifically, effective ways to differentiate alerts while highlighting important pieces of information to create a universal standard for health care providers.

Objective: To gain insight into clinical decision support systems-based alerts, specifically targeting nursing interventions for sepsis, with a focus on behaviors associated with and perceptions of alerts, as well as visual preferences.

The design of decisions: Matching clinical decision support recommendations to Nielsen's design heuristics.

Objective: While general design heuristics exist for graphic user interfaces, it remains a challenge to facilitate the implementation of these heuristics for the design of clinical decision support. Our goals were to map a set of recommendations for clinical decision support design found in current literature to Jakob Nielsen's traditional usability heuristics and to suggest usability areas that need more investigation.

Materials And Methods: Using a modified nominal group process, the research team discussed, classified, and mapped recommendations, organized as interface, information, and interaction, to design heuristics.

A usability and safety analysis of electronic health records: a multi-center study.

To characterize the variability in usability and safety of EHRs from two vendors across four healthcare systems (2 Epic and 2 Cerner). Twelve to 15 emergency medicine physicians participated from each site and completed six clinical scenarios. Keystroke, mouse click, and video data were collected.

Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension.

Background: The lower rate of primary outcome events in the intensive treatment group in SPRINT (Systolic Pressure Intervention Trial) was associated with increased clinically significant serious adverse events (SAEs). In 2017, the American College of Cardiology/American Heart Association issued risk-based blood pressure treatment guidelines. The authors hypothesized that stratification of the SPRINT population by degree of future cardiovascular disease (CVD) risk might identify a group which could benefit the most from intensive treatment.