Clinical care improvement with use of health information technology focusing on evidence based medicine

The effect of computerized decision support systems on cardiovascular risk factors: a systematic review and meta-analysis

Background

Cardiovascular risk management (CVRM) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease. Computerized decision support systems (CDSS) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies. The effect on cardiovascular risk factor management is yet to be confirmed.

Methods

We performed a systematic review and meta-analysis evaluating the effects of CDSS on CVRM, defined as the change in absolute values and attainment of treatment goals of systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-c) and HbA1c. Also, CDSS characteristics related to more effective CVRM were identified. Eligible articles were methodologically appraised using the Cochrane risk of bias tool. We calculated mean differences, relative risks, and if appropriate (I² < 70%), pooled the results using a random-effects model.

Results

Of the 14,335 studies identified, 22 were included. Four studies reported on SBP, 3 on LDL-c, 10 on CVRM in patients with type II diabetes and 5 on guideline adherence. The CDSSs varied considerably in technical performance and content. Heterogeneity of results was such that quantitative pooling was often not appropriate. Among CVRM patients, the results tended towards a beneficial effect of CDSS, but only LDL-c target attainment in diabetes patients reached statistical significance. Prompting, integration into the electronical health record, patient empowerment, and medication support were related to more effective CVRM.

Conclusion

We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment. Some features of CDSS seem more promising than others. However, the variability in CDSS characteristics and heterogeneity of the results – emphasizing the immaturity of this research area - limit stronger conclusions. Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment.

Electronic supplementary material

The online version of this article (10.1186/s12911-019-0824-x) contains supplementary material, which is available to authorized users.

National Minimum Data Set for Antimicrobial Resistance Management: Toward Global Surveillance System

BACKGROUND

Success of infection treatment depends on the availability of accurate, reliable, and comprehensive data, information, and knowledge at the point of therapeutic decision-making. The identification of a national minimum data set will support the development and implementation of an effective surveillance system. The goal of this study was to develop a national antimicrobial resistance surveillance minimum data set.

METHODS

In this cross-sectional and descriptive study, data were collected from selected pioneering countries and organizations which have national or international antimicrobial resistance surveillance systems. A minimum data set checklist was extracted and validated. The ultimate data elements of the minimum data set were determined by applying the Delphi technique.

RESULTS

Through the Delphi technique, we obtained 80 data elements in 8 axes. The resistance data categories comprised basic, clinical, electronic reporting, infection control, microbiology, pharmacy, World Health Organization-derived, and expert-recommended data. Relevance coding was extracted based on the Iranian electronic health record coding system.

CONCLUSION

This study provides a set of data elements and a schematic framework for the implementation of an antimicrobial resistance surveillance system. A uniform minimum data set was created based on key informants' opinions to cover essential needs in the early implementation of a global antimicrobial resistance surveillance system in Iran.

Awareness and using of medical students about mobile health technology in clinical areas

CONFLICT OF INTEREST

NONE DECLARED.

INTRODUCTION

Necessity of data transmission and getting contact with specialists is so evident in impassable regions. In order to solve such problems, there are different solutions one of which is mobile health technology. Being small and user-friendly, easy to enter data and having low expense are some of its advantages. This study aims to define the association between awareness of medical students in clinical stage about mobile health technology application and the rate of their using this technology in educational hospital of Isfahan in 2011.

METHOD

The study is a cross-sectional analytical application research. Sixty medical students were selected as samples from a society of 240 medical students. A researcher-made questionnaire was used. The questionnaire included 21 multiple choice and 15 yes no questions, which were corrected to reach a score. A researcher-made checklist with 5-fold Likert scale was used to define the rate of applying such technology. The reliability of questionnaire was confirmed through a test-retest. The collected data were analyzed with the help of SPSS software in descriptive and deductive statistics level.

FINDINGS

The highest percentage of awareness about mobile health technology among medical students in the clinical stage of Azzahra educational hospital is 45.6 in nature areas, and their lowest percentage of awareness is 17.8 in the infrastructure area. In addition, their mean awareness of all areas is 54.4. The highest percentage of using mobile health technology by medical students is 14.6 in the education area, and their lowest percentage of usage is 6.8 in the treatment area. Their mean usage of all areas is 9.4 as well.

CONCLUSION

The rate of awareness and application of mobile health technology is not favorable. Except for treatment, there is no significant association between the rate of awareness and application of mobile health technology.