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《The Journal for Nurse Practitioners》2019,15(7):496-501
Since its diagnostic inception, autism has garnered stigma and fear, often to the exclusion of action. Early detection and treatment of autism spectrum disorders have become crucial priorities of the National Institutes of Health. The primary care provider is the point of entry to the health care system for infants/children showing risk factors for autism spectrum disorders and/or symptoms of the disorder. Despite the existence of low-cost, well-tested developmental screening tools, many primary care providers rely solely on clinical judgment to ascertain developmental status. Current best screening practices were determined by a review of the literature. Key recommendations are highlighted. 相似文献
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Brian R. Holroyd MD Michael J. Bullard MD Timothy A.D. Graham MD MSc Brian H. Rowe MD MSc 《Academic emergency medicine》2007,14(11):942-948
Information technologies, and specifically clinical decision support systems (CDSSs), are tools that can support the process of knowledge translation in the delivery of emergency department (ED) care. It is essential that during the implementation process, careful consideration be given to the workflow and culture of the ED environment where the system is to be utilized. Despite significant literature addressing factors contributing to successful deployment of these systems, the process is frequently problematic. Careful research and analysis are essential to evaluate the impact of the CDSS on the delivery of ED care, its influence on the health care providers, and the impact of the CDSS on clinical decision-making processes and information behaviors. The logistical and educational implications of CDSSs in the ED must also be considered. The specialty of emergency medicine must actively collaborate with other stakeholders in the design, implementation, and evaluation of CDSSs that will be utilized during the delivery of care to our patients. 相似文献
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《The Journal for Nurse Practitioners》2014,10(10):803-812
Using health information technology to facilitate decision support and consumer engagement is a major component of federal electronic health record meaningful use (MU) criteria. Health information technology has the potential to improve primary care and track outcomes in the persistent problem of childhood obesity. We describe a computerized decision support tool we developed to gather patient information, raise family awareness of risks, facilitate patient-centered counseling, and implement clinical quality measures for childhood obesity. It has bilingual capacity, can be used in community screening and pediatric primary care, and provides tailored patient education materials that promote patient engagement. 相似文献
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《The Journal for Nurse Practitioners》2019,15(8):550-552
Fetal alcohol spectrum disorders (FASDs) encompass a myriad of biological, psychological, and physiological variants. In primary care, FASDs are not routinely screened for, while prevalence rates remain high at 5% to 9%. Alcohol screening and brief intervention is an evidence-based practice that identifies those who may be consuming alcohol at risky levels and provides a brief motivation-enhancing intervention. FASDs are completely preventable when women do not consume alcohol during the prenatal period, and nurse practitioners who provide patient-centered primary care to women are ideally positioned to help in the prevention FASDs 相似文献
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Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists'' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy. 相似文献
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Ryuhei Wada Jiro Takeuchi Tsukasa Nakamura Tomohiro Sonoyama Shinji Kosaka Chisa Matsumoto Mio Sakuma Yoshinori Ohta Takeshi Morimoto 《Applied clinical informatics》2020,11(5):846
Background Medication dose adjustment is crucial for patients with renal dysfunction (RD). The assessment of renal function is generally mandatory; however, the renal function may change during the hospital stay and the manual assessment is sometimes challenging. Objective We developed the clinical decision support system (CDSS) that provided a recommended dose based on automated calculated renal function. Methods We conducted a prospective cohort study in a single teaching hospital in Japan. All hospitalized patients were included except for obstetrics/gynecology and pediatric wards between September 2013 and February 2015. The CDSS was implemented on December 2013. Renal and hepatic dysfunction (HD) were defined as changes in the estimated glomerular filtration rate (eGFR) and alanine aminotransferase or alkaline phosphatase levels based on these measurements during hospital stay. These measurements were obtained before (phase I), after (phase II), and 1 year after (phase III) the CDSS implementation. Results We included 6,767 patients (phase I: 2,205; phase II: 2,279; phase III: 2,283). The patients'' characteristics were similar among phases. Changes in eGFR were similar among phases, but the incidence of RD increased in phase III (phase I: 228 [10.3%]; phase II: 260 [11.4%]; phase III: 296 [13.0%], p = 0.02). However, the differences in incidences of RD were not statistically significant after adjusting for eGFR at baseline and age. The incidences of HD were also similar among phases (phase I: 175 [13.2%]; phase II: 171 [12.9%]; phase III: 167 [12.2%], p = 0.72). Conclusion The CDSS implementation did not affect the incidence of renal and HD and changes in renal and hepatic function among hospitalized patients. The effectiveness of the CDSS with renal-guided doses should be investigated with respect to other endpoints. 相似文献
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