1
|
Jeanson F, Farkouh ME, Godoy LC, Minha S, Tzuman O, Marcus G. Medical calculators derived synthetic cohorts: a novel method for generating synthetic patient data. Sci Rep 2024; 14:11437. [PMID: 38763934 PMCID: PMC11102910 DOI: 10.1038/s41598-024-61721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/08/2024] [Indexed: 05/21/2024] Open
Abstract
This study shows that we can use synthetic cohorts created from medical risk calculators to gain insights into how risk estimations, clinical reasoning, data-driven subgrouping, and the confidence in risk calculator scores are connected. When prediction variables aren't evenly distributed in these synthetic cohorts, they can be used to group similar cases together, revealing new insights about how cohorts behave. We also found that the confidence in predictions made by these calculators can vary depending on patient characteristics. This suggests that it might be beneficial to include a "normalized confidence" score in future versions of these calculators for healthcare professionals. We plan to explore this idea further in our upcoming research.
Collapse
Affiliation(s)
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - Lucas C Godoy
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - Sa'ar Minha
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Oran Tzuman
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Gil Marcus
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
2
|
Akbasli IT, Serin O. Digital Response to Physical Crises: The Role of an E-Health Platform in the 2023 Southern Turkey Earthquakes. Disaster Med Public Health Prep 2024; 18:e57. [PMID: 38591261 DOI: 10.1017/dmp.2024.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
The catastrophic earthquakes that struck Southern Turkey in 2023 highlighted the pressing need for effective disaster management strategies. The unprecedented scale of the crisis tested the robustness of traditional healthcare responses and highlighted the potential of e-health solutions. Despite the deployment of Emergency Medical Teams, initial responders - primarily survivors of the earthquakes - faced an enormous challenge due to their lack of training in mass-casualty situations. An e-health platform was introduced to support these first responders, offering tools for drug calculations, case management guidelines, and a deep learning model for pediatric X-ray analysis. This commentary presents an analysis of the platform's use and contributes to the growing discourse on integrating digital health technologies in disaster response and management.
Collapse
Affiliation(s)
- Izzet Turkalp Akbasli
- Hacettepe University Faculty of Medicine, Department of Pediatric Emergency, Ankara, Turkey
- The Center for Life Support Practice and Research, Hacettepe University, Ankara, Turkey
| | - Oguzhan Serin
- The Center for Life Support Practice and Research, Hacettepe University, Ankara, Turkey
- Digital Health, Faculty of Engineering, University of Bristol, Bristol, UK
| |
Collapse
|
3
|
Abell B, Naicker S, Rodwell D, Donovan T, Tariq A, Baysari M, Blythe R, Parsons R, McPhail SM. Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review. Implement Sci 2023; 18:32. [PMID: 37495997 PMCID: PMC10373265 DOI: 10.1186/s13012-023-01287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Successful implementation and utilization of Computerized Clinical Decision Support Systems (CDSS) in hospitals is complex and challenging. Implementation science, and in particular the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, may offer a systematic approach for identifying and addressing these challenges. This review aimed to identify, categorize, and describe barriers and facilitators to CDSS implementation in hospital settings and map them to the NASSS framework. Exploring the applicability of the NASSS framework to CDSS implementation was a secondary aim. METHODS Electronic database searches were conducted (21 July 2020; updated 5 April 2022) in Ovid MEDLINE, Embase, Scopus, PyscInfo, and CINAHL. Original research studies reporting on measured or perceived barriers and/or facilitators to implementation and adoption of CDSS in hospital settings, or attitudes of healthcare professionals towards CDSS were included. Articles with a primary focus on CDSS development were excluded. No language or date restrictions were applied. We used qualitative content analysis to identify determinants and organize them into higher-order themes, which were then reflexively mapped to the NASSS framework. RESULTS Forty-four publications were included. These comprised a range of study designs, geographic locations, participants, technology types, CDSS functions, and clinical contexts of implementation. A total of 227 individual barriers and 130 individual facilitators were identified across the included studies. The most commonly reported influences on implementation were fit of CDSS with workflows (19 studies), the usefulness of the CDSS output in practice (17 studies), CDSS technical dependencies and design (16 studies), trust of users in the CDSS input data and evidence base (15 studies), and the contextual fit of the CDSS with the user's role or clinical setting (14 studies). Most determinants could be appropriately categorized into domains of the NASSS framework with barriers and facilitators in the "Technology," "Organization," and "Adopters" domains most frequently reported. No determinants were assigned to the "Embedding and Adaptation Over Time" domain. CONCLUSIONS This review identified the most common determinants which could be targeted for modification to either remove barriers or facilitate the adoption and use of CDSS within hospitals. Greater adoption of implementation theory should be encouraged to support CDSS implementation.
Collapse
Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Amina Tariq
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Robin Blythe
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rex Parsons
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
4
|
Visweswaran S, Sadhu EM, Morris MM, Samayamuthu MJ. Clinical Algorithms with Race: An Online Database. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.04.23292231. [PMID: 37461462 PMCID: PMC10350134 DOI: 10.1101/2023.07.04.23292231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Some clinical algorithms incorporate a person's race, ethnicity, or both as an input variable or predictor in determining diagnoses, prognoses, treatment plans, or risk assessments. Inappropriate use of race and ethnicity in clinical algorithms at the point of care may exacerbate health disparities and promote harmful practices of race-based medicine. This article describes a comprehensive search of online resources, the scientific literature, and the FDA Drug Label Information that uncovered 39 race-based risk calculators, six laboratory test results with race-based reference ranges, one race-based therapy recommendation, and 15 medications with race-based recommendations. These clinical algorithms based on race are freely accessible through an online database. This resource aims to raise awareness about the use of race-based clinical algorithms and track the progress made toward eradicating the inappropriate use of race. The database will be actively updated to include clinical algorithms based on race that were previously omitted, along with additional characteristics of these algorithms.
Collapse
Affiliation(s)
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
- The Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eugene M. Sadhu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michele M. Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
5
|
Kummer B, Shakir L, Kwon R, Habboushe J, Jetté N. Usage Patterns of Web-Based Stroke Calculators in Clinical Decision Support: Retrospective Analysis. JMIR Med Inform 2021; 9:e28266. [PMID: 34338647 PMCID: PMC8369374 DOI: 10.2196/28266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 06/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Clinical scores are frequently used in the diagnosis and management of stroke. While medical calculators are increasingly important support tools for clinical decisions, the uptake and use of common medical calculators for stroke remain poorly characterized. Objective We aimed to describe use patterns in frequently used stroke-related medical calculators for clinical decisions from a web-based support system. Methods We conducted a retrospective study of calculators from MDCalc, a web-based and mobile app–based medical calculator platform based in the United States. We analyzed metadata tags from MDCalc’s calculator use data to identify all calculators related to stroke. Using relative page views as a measure of calculator use, we determined the 5 most frequently used stroke-related calculators between January 2016 and December 2018. For all 5 calculators, we determined cumulative and quarterly use, mode of access (eg, app or web browser), and both US and international distributions of use. We compared cumulative use in the 2016-2018 period with use from January 2011 to December 2015. Results Over the study period, we identified 454 MDCalc calculators, of which 48 (10.6%) were related to stroke. Of these, the 5 most frequently used calculators were the CHA2DS2-VASc score for atrial fibrillation stroke risk calculator (5.5% of total and 32% of stroke-related page views), the Mean Arterial Pressure calculator (2.4% of total and 14.0% of stroke-related page views), the HAS-BLED score for major bleeding risk (1.9% of total and 11.4% of stroke-related page views), the National Institutes of Health Stroke Scale (NIHSS) score calculator (1.7% of total and 10.1% of stroke-related page views), and the CHADS2 score for atrial fibrillation stroke risk calculator (1.4% of total and 8.1% of stroke-related page views). Web browser was the most common mode of access, accounting for 82.7%-91.2% of individual stroke calculator page views. Access originated most frequently from the most populated regions within the United States. Internationally, use originated mostly from English-language countries. The NIHSS score calculator demonstrated the greatest increase in page views (238.1% increase) between the first and last quarters of the study period. Conclusions The most frequently used stroke calculators were the CHA2DS2-VASc, Mean Arterial Pressure, HAS-BLED, NIHSS, and CHADS2. These were mainly accessed by web browser, from English-speaking countries, and from highly populated areas. Further studies should investigate barriers to stroke calculator adoption and the effect of calculator use on the application of best practices in cerebrovascular disease.
Collapse
Affiliation(s)
- Benjamin Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Clinical Informatics, Mount Sinai Health System, New York, NY, United States
| | | | | | - Joseph Habboushe
- MD Aware LLC, New York, NY, United States.,Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
6
|
Seiberth S, Terstegen T, Strobach D, Czock D. Accuracy of freely available online GFR calculators using the CKD-EPI equation. Eur J Clin Pharmacol 2020; 76:1465-1470. [PMID: 32562002 PMCID: PMC7481157 DOI: 10.1007/s00228-020-02932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
Purpose Estimated glomerular filtration rate (eGFR) as calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for detection of chronic kidney disease and drug dose adjustment. The purpose of the present study was to investigate the accuracy of freely available eGFR online calculators. Methods All identified CKD-EPI online calculators were run with five reference cases differing in age, sex, serum creatinine, and ethnicity. Conversion from eGFRindexed (unit ml/min per 1.73 m2) to eGFRnon-indexed (unit ml/min) and creatinine unit from milligramme/decilitre to micromole/litre was checked, if available. Results Only 36 of 47 calculators (76.6%) produced accurate eGFR results for all reference cases. Eight of 47 (17.0%) calculators were considered as faulty because of errors relating to ethnicity (4 calculators), to conversion of the eGFR unit (2 calculators), to erroneous eGFR values without obvious explanation (2 calculators), to conversion of the creatinine unit (1 calculator), and to an error in the eGFR unit displayed (1 calculator). Overall, 28 errors were found (range 59 to 147% of the correct eGFR value), the majority concerning calculation of eGFRindexed and the conversion to eGFRnon-indexed. Only 7 of 47 (14.9%) calculators offered conversion of the eGFR unit. Conclusions Erroneous calculations that might lead to inappropriate clinical decision-making were found in 8 of 47 calculators. Thus, online calculators should be evaluated more thoroughly after implementation. Conversion of eGFR units that might be needed for drug dose adjustments should be implemented more often. Electronic supplementary material The online version of this article (10.1007/s00228-020-02932-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sarah Seiberth
- Hospital Pharmacy, University Hospital, LMU Munich, Munich, Germany
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Munich, Germany
| | - Theresa Terstegen
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dorothea Strobach
- Hospital Pharmacy, University Hospital, LMU Munich, Munich, Germany
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Munich, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
7
|
Abstract
Among clinicians, the users of medical calculators have expanded in recent years to an unprecedented number. The usefulness of some of these calculators is sometimes debatable, and experienced professionals may at times be right in avoiding their use; however, many may simply be unaware of the very existence of medical calculators applicable to their field of interest. The authors felt that this latter scenario might possibly apply to hepatocellular carcinoma (HCC). Hence, the authors concisely reviewed 10 free online medical calculators proposed in the last 8 years, categorizing them on the basis of the purpose for which they were developed (risk of harboring or developing HCC, N=4; prognostication in established HCC, N=6). In addition, the authors tried to establish the success each calculator has had so far in the medical community, by 2 criteria: having been included in the more popular app of medical calculators and being highly cited in the scientific literature.
Collapse
|