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Lung - Transbronchial lung cryobiopsy (TBLC) is a promising technique that is evolving as a standard diagnostic procedure in the diagnosis of interstitial lung disease. However, there are a variety... 相似文献
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Breast cancer subtype intertumor heterogeneity: MRI‐based features predict results of a genomic assay
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M. Sue Kirkman MD Vanessa Jones Briscoe PhD NP CDE Nathaniel Clark MD MS RD Hermes Florez MD MPH PhD Linda B. Haas PHC RN CDE Jeffrey B. Halter MD Elbert S. Huang MD MPH Mary T. Korytkowski MD Medha N. Munshi MD Peggy Soule Odegard BS PharmD CDE Richard E. Pratley MD Carrie S. Swift MS RD BC‐ADM CDE 《Journal of the American Geriatrics Society》2012,60(12):2342-2356
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Boustani MA Campbell NL Khan BA Abernathy G Zawahiri M Campbell T Tricker J Hui SL Buckley JD Perkins AJ Farber MO Callahan CM 《Journal of general internal medicine》2012,27(5):561-567
Background
Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.Objective
Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.Design
A randomized controlled clinical trial.Setting
A public hospital in Indianapolis.Population
A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female.Intervention
A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs.Measurements
Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.Results
Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11).Conclusion
A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-1994-8) contains supplementary material, which is available to authorized users.KEY WORDS: cognitive impairment, clinical trial, decision support, hospitalized elders 相似文献29.
Jacklyn Cho BS Brittany Toffey MD Ariel F. Silva NP Ariel Shalev MD Monika M. Safford MD Erica Phillips MD MS Ann Lee BS Faith Wiggins BS MS Elissa Kozlov PhD Emma K. Tsui PhD MPH Nicola Dell PhD Ariel C. Avgar PhD Susan J. Andreae PhD MPH Madeline R. Sterling MD MPH MS 《Health services research》2023,58(3):697-704