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Je NK, Youm S, Chun P. Real world co-prescribing contraindicated drugs with fluconazole and itraconazole. Pharmacoepidemiol Drug Saf 2023; 32:752-762. [PMID: 36812157 DOI: 10.1002/pds.5604] [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: 08/30/2022] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE This study aimed to investigate co-prescribing of contraindicated drugs with fluconazole and itraconazole using real-world nationwide data. METHODS This retrospective cross-sectional study was performed using claims data collected by the Health Insurance Review and Assessment Service (HIRA) of Korea during 2019-2020. To determine the drugs that should be avoided in patients taking fluconazole or itraconazole, Lexicomp® and Micromedex® were used. The co-prescribed medications, co-prescription rates, and potential clinical consequences of the contraindicated drug-drug interactions (DDIs) were investigated. RESULTS Of the 197 118 prescriptions of fluconazole, 2847 co-prescriptions with drugs classified as contraindicated DDI by either Micromedex® or Lexicomp® were identified. Further, of the 74 618 prescriptions of itraconazole, 984 co-prescriptions with contraindicated DDI were identified. Solifenacin (34.9%), clarithromycin (18.1%), alfuzosin (15.1%), and donepezil (10.4%) were frequently found in the co-prescriptions of fluconazole, whereas tamsulosin (40.4%), solifenacin (21.3%), rupatadine (17.8%), and fluconazole (8.8%) were frequently found in the co-prescriptions of itraconazole. In 1105 and 95 co-prescriptions of fluconazole and itraconazole, accounting for 31.3% of all co-prescriptions, potential DDIs were associated with a risk of corrected QT interval (QTc) prolongation. Of the total 3831 co-prescriptions, 2959 (77.2%) and 785 (20.5%) were classified as contraindicated DDI by Micromedex® alone and by Lexicomp® alone, respectively, whereas 87 (2.3%) were classified as contraindicated DDI by both Micromedex® and Lexicomp®. CONCLUSIONS Many co-prescriptions were associated with the risk of DDI-related QTc prolongation, warranting the attention of healthcare providers. Narrowing the discrepancy between databases that provide information on DDIs is required for optimized medicine usage and patient safety.
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Affiliation(s)
- Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Sangsu Youm
- College of Pharmacy, Inje Institute of Pharmaceutical Sciences and Research, Inje University, Gimhae, Republic of Korea
| | - Pusoon Chun
- College of Pharmacy, Inje Institute of Pharmaceutical Sciences and Research, Inje University, Gimhae, Republic of Korea
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2
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Makic MBF, Svoboda E. Staying Informed of Best Evidence to Guide Practice. AACN Adv Crit Care 2023; 34:63-66. [PMID: 36877643 DOI: 10.4037/aacnacc2023372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is Professor, University of Colorado Anschutz Medical Campus, College of Nursing, 13120 E 19th Ave, Aurora, CO 80045
| | - Ellie Svoboda
- Ellie Svoboda is Education Informationist and Instructor, University of Colorado Anschutz Medical Campus, Strauss Health Sciences Library, Aurora, Colorado
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3
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ProDeM: A Process-Oriented Delphi Method for systematic asynchronous and consensual surgical process modelling. Artif Intell Med 2023; 135:102426. [PMID: 36628778 DOI: 10.1016/j.artmed.2022.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
Abstract
Surgical process models support improving healthcare provision by facilitating communication and reasoning about processes in the medical domain. Modelling surgical processes is challenging as it requires integrating information that might be fragmented, scattered, and not process-oriented. These challenges can be faced by involving healthcare domain experts during process modelling. This paper presents ProDeM: a novel Process-Oriented Delphi Method for the systematic, asynchronous, and consensual modelling of surgical processes. ProDeM is an adaptable and flexible method that acknowledges that: (i) domain experts have busy calendars and might be geographically dispersed, and (ii) various elements of the process model need to be assessed to ensure model quality. The contribution of the paper is twofold as it outlines ProDeM, but also demonstrates its operationalisation in the context of a well-known surgical process. Besides showing the method's feasibility in practice, we also present an evaluation of the method by the experts involved in the demonstration.
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4
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Pusic MV, Birnbaum RJ, Thoma B, Hamstra SJ, Cavalcanti RB, Warm EJ, Janssen A, Shaw T. Frameworks for Integrating Learning Analytics With the Electronic Health Record. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:52-59. [PMID: 36849429 PMCID: PMC9973448 DOI: 10.1097/ceh.0000000000000444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.
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Cummings BA. Exploring the role of open book high-stakes examinations in 2021 and beyond. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:49-52. [PMID: 36091731 PMCID: PMC9441113 DOI: 10.36834/cmej.73897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Performance on medical licensing examinations has been previously shown to be predictive of performance in practice. However, licensing examinations are closed-book and real-world medical practice increasingly requires doctors and patients to consult resources to make evidence-informed decisions. To best assess the ability of physicians and physicians-in-practice to avail themselves of point-of-care clinical resources and tools, open-book components may have an emerging role in high-stakes examinations.
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Affiliation(s)
- Beth-Ann Cummings
- Department of Medicine and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
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6
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Antoun J, Lapin J, Beck D. Information retrieval at the point of care of community family physicians in Arab countries. Health Info Libr J 2022; 39:178-184. [PMID: 35396788 DOI: 10.1111/hir.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
This study is based on Jumana Antoun's PhD thesis at Walden University, USA examining the information retrieval behaviour of 72 community family physicians' at the point of care in eight Arab countries in the Eastern Mediterranean. The key findings were that participants looked for digital clinical information at the point of care on average 14.0 times per week with the majority (80.3%) using a mobile phone. Clinical information about medication dosage and side effects was the most sought clinical question, and patient education was the least. Almost half of the participants considered that they often found relevant (55.6%), useful (56.9%) and unbiased (58.3%) information. Whilst none of the factors examined predicted the physicians' self-reported effectiveness and efficiency at information retrieval, the implication for practice points clearly to the barriers and the need for curricula to focus on search strategies using free resources at the point of care.
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Affiliation(s)
- Jumana Antoun
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jennifer Lapin
- Richard W. Riley College of Education and Leadership, Walden University, Minneapolis, Minnesota, USA
| | - Dennis Beck
- Department of Educational Technology, University of Arkansas, Fayetteville, Arkansas, USA
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7
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Kontsioti E, Maskell S, Bensalem A, Dutta B, Pirmohamed M. Similarity and Consistency Assessment of Three Major Online Drug-Drug Interaction Resources. Br J Clin Pharmacol 2022; 88:4067-4079. [PMID: 35362214 PMCID: PMC9545693 DOI: 10.1111/bcp.15341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022] Open
Abstract
AIM To explore the level of agreement on drug-drug interaction (DDI) information listed in three major online drug information resources (DIRs) in terms of: (1) interacting drug pairs; (2) severity rating; (3) evidence rating and (4) clinical management recommendations. METHODS We extracted information from the British National Formulary (BNF), Thesaurus, and Micromedex. Following drug name normalisation, we estimated the overlap of the DIRs in terms of DDI. We annotated clinical management recommendations either manually, where possible, or through application of a machine learning algorithm. RESULTS The DIRs contained 51,481 (BNF), 38,037 (Thesaurus), and 65,446 (Micromedex) drug pairs involved in DDIs. The number of common DDIs across the three DIRs was 6,970 (13.54% of BNF, 18.32% of Thesaurus, and 10.65% of Micromedex). Micromedex and Thesaurus overall showed higher levels of similarity in their severity ratings, while the BNF agreed more with Micromedex on the critical severity ratings and with Thesaurus on the least significant ones. Evidence rating agreement between BNF and Micromedex was generally poor. Variation in clinical management recommendations was also identified, with some categories (i.e. Monitor and Adjust dose) showing higher levels of agreement compared to others (i.e. Use with caution, Wash-out, Modify administration). CONCLUSIONS There is considerable variation in the DDIs included in the examined DIRs, together with variability in categorisation of severity and clinical advice given. DDIs labelled as critical were more likely to appear in multiple DIRs. Such variability in information could have deleterious consequences for patient safety, and there is a need for harmonisation and standardisation.
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Affiliation(s)
- Elpida Kontsioti
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, United Kingdom.,Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - Simon Maskell
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, United Kingdom
| | | | - Bhaskar Dutta
- Patient Safety Center of Excellence, AstraZeneca, Gaithersburg, MD, United States
| | - Munir Pirmohamed
- The Wolfson Centre for Personalized Medicine, MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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8
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Stenzl A, Sternberg CN, Ghith J, Serfass L, Schijvenaars BJA, Sboner A. Application of Artificial Intelligence to Overcome Clinical Information Overload in Urologic Cancer. BJU Int 2021; 130:291-300. [PMID: 34846775 DOI: 10.1111/bju.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the use of artificial intelligence (AI) in medical literature and trial data extraction, and its applications in uro-oncology. This bridging review, which consolidates information from the diverse applications of AI, highlights how AI users can investigate more sophisticated queries than with traditional methods, leading to synthesis of raw data and complex outputs into more actionable and personalized results, particularly in the field of uro-oncology. METHODS Literature and clinical trial searches were performed in PubMed, Dimensions, Embase and Google (1999-2020). The searches focused on the use of AI and its various forms to facilitate literature searches, clinical guidelines development, and clinical trial data extraction in uro-oncology. To illustrate how AI can be applied toaddress questions about optimizing therapeutic decision making and individualizing treatment regimens, the Dimensions-linked information platform was searched for "prostate cancer" keywords (76 publications were identified; 48 were included). RESULTS AI offers the promise of transforming raw data and complex outputs into actionable insights. Literature and clinical trial searches can be automated, enabling clinicians to develop and analyze publications expeditiously on complex issues such as therapeutic sequencing and to obtain updates on documents that evolve at the pace and scope of the landscape. An AI-based platform inclusive of 12 trial databases and >100 scientific literature sources enabled the creation of an interactive visualization. CONCLUSION As the literature and clinical trial landscape continues to grow in complexity and with increasing speed, the ability to pull the right information at the right time from different search engines and resources while excluding social media bias becomes more challenging. This review demonstrates that by applying natural language processing and machine learning algorithms, validated and optimized AI leads to a speedier, more personalized, efficient and focused search compared with traditional methods.
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Affiliation(s)
- Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Cora N Sternberg
- Clinical Director, Englander Institute for Precision Medicine, Professor of Medicine, Weill Cornell Medicine Hematology/Oncology, Sandra and Edward Meyer Cancer Center, New York, NY, USA
| | | | | | | | - Andrea Sboner
- Director of Informatics and Computational Biology, Englander Institute for Precision Medicine; Assistant Professor at the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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9
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Maggio LA, Larsen K, Thomas A, Costello JA, Artino AR. Scoping reviews in medical education: A scoping review. MEDICAL EDUCATION 2021; 55:689-700. [PMID: 33300124 PMCID: PMC8247025 DOI: 10.1111/medu.14431] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. METHOD The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. RESULTS One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. CONCLUSIONS Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.
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Affiliation(s)
- Lauren A. Maggio
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Kelsey Larsen
- Department of Politics, Security, and International AffairsUniversity of Central FloridaOrlandoFLUSA
| | - Aliki Thomas
- School of Physical and Occupational TherapyInstitute of Health Sciences EducationFaculty of MedicineMcGill UniversityMontrealQCCanada
| | | | - Anthony R. Artino
- Department of Health, Human Function, and Rehabilitation SciencesThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
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10
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Aakre CA, Maggio LA, Fiol GD, Cook DA. Barriers and facilitators to clinical information seeking: a systematic review. J Am Med Inform Assoc 2021; 26:1129-1140. [PMID: 31127830 DOI: 10.1093/jamia/ocz065] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/28/2019] [Accepted: 04/19/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study sought to identify barriers to and facilitators of point-of-care information seeking and use of knowledge resources. MATERIALS AND METHODS We searched MEDLINE, Embase, PsycINFO, and Cochrane Library from 1991 to February 2017. We included qualitative studies in any language exploring barriers to and facilitators of point-of-care information seeking or use of electronic knowledge resources. Two authors independently extracted data on users, study design, and study quality. We inductively identified specific barriers or facilitators and from these synthesized a model of key determinants of information-seeking behaviors. RESULTS Forty-five qualitative studies were included, reporting data derived from interviews (n = 26), focus groups (n = 21), ethnographies (n = 6), logs (n = 4), and usability studies (n = 2). Most studies were performed within the context of general medicine (n = 28) or medical specialties (n = 13). We inductively identified 58 specific barriers and facilitators and then created a model reflecting 5 key determinants of information-seeking behaviors: time includes subthemes of time availability, efficiency of information seeking, and urgency of information need; accessibility includes subthemes of hardware access, hardware speed, hardware portability, information restriction, and cost of resources; personal skills and attitudes includes subthemes of computer literacy, information-seeking skills, and contextual attitudes about information seeking; institutional attitudes, cultures, and policies includes subthemes describing external individual and institutional information-seeking influences; and knowledge resource features includes subthemes describing information-seeking efficiency, information content, information organization, resource familiarity, information credibility, information currency, workflow integration, compatibility of recommendations with local processes, and patient educational support. CONCLUSIONS Addressing these determinants of information-seeking behaviors may facilitate clinicians' question answering to improve patient care.
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Affiliation(s)
- Christopher A Aakre
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David A Cook
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Vesco KK, Leo MC, Bulkley JE, Beadle KR, Stoneburner AB, Francisco M, Clark AL. Improving management of the genitourinary syndrome of menopause: evaluation of a health system-based, cluster-randomized intervention. Am J Obstet Gynecol 2021; 224:62.e1-62.e13. [PMID: 32693097 DOI: 10.1016/j.ajog.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genitourinary symptoms are common in postmenopausal women and adversely affect the quality of life. National surveys and data collected from our healthcare system indicate that postmenopausal women with the genitourinary syndrome of menopause often fail to receive appropriate diagnosis or treatment. OBJECTIVE To promote greater detection and treatment of the genitourinary syndrome of menopause, we created and tested a clinician-focused health system intervention that included clinician education sessions and a suite of evidence-based electronic health record tools. STUDY DESIGN Using a cluster-randomized design, we allocated primary care (16) and gynecology (6) clinics to the intervention or control group. From September to November 2014, we provided training about the diagnosis and treatment of genitourinary syndrome of menopause in face-to-face presentations at each intervention clinic and in an online video. We developed clinical decision support tools in the electronic health record that contained an evidence-based, point-of-care knowledge resource, a standardized order set, and a checklist of patient education materials for the patient's after visit summary. The tools aimed to facilitate accurate diagnostic coding and prescribing (SmartSet, SmartRx) along with relevant patient information (SmartText). Clinicians who only performed visits at control clinics received no training or notification about the tools. Our primary outcome was vulvovaginal diagnoses made at well visits for women at the age of 55 years and older from November 15, 2014 to November 15, 2015. We also assessed urinary diagnoses, vaginal estrogen prescriptions, and use of the electronic tools. There was departmental support for the intervention but no prioritization within the healthcare system to incentivize change. RESULTS In the 1-year period, 386 clinicians performed 14,921 well visits for women at the age of 55 years and older. Among the 190 clinicians who performed well visits in the intervention clinics, 109 (57.4%) completed either in-person or online educational training. The proportion of visits that included a vulvovaginal (7.2% vs 5.8%; odds ratio, 1.27; 95% confidence interval, 0.65-2.51) or urinary diagnosis (2.5% vs 3.1%; odds ratio, 0.79; 95% confidence interval, 0.55-1.13) or vaginal estrogen prescription (4.5% vs 3.7%; odds ratio, 1.24; 95% confidence interval, 0.63-2.46) did not differ between study arms. There was a significant interaction for primary care and gynecology, which revealed more vulvovaginal diagnoses by gynecology but not primary care intervention clinics (odds ratio, 1.63; 95% confidence interval, 1.15-2.31), but there was no significant interaction for prescriptions. Clinicians in the intervention clinics were more likely to use decision support tools than those in control clinics-SmartSet (22.2% vs 1.5%; odds ratio, 18.8; 95% confidence interval, 5.5-63.8) and SmartText for patient information (38.0% vs 24.4%; odds ratio, 1.91; 95% confidence interval, 1.10-3.34). A per-protocol analysis revealed similar findings. CONCLUSION Overall, the intervention did not lead to more diagnoses or prescription therapy for postmenopausal genitourinary symptoms but did result in greater distribution of patient information. Gynecology clinicians were more likely to address genitourinary symptoms generally and were more likely to make a vulvovaginal diagnosis after the intervention. Further efforts for improving care should consider ongoing clinician education beginning with enhanced menopause curricula in residency training. Additional interventions to consider include greater access for postmenopausal women to gynecologic care, addressing treatment barriers, and development of national performance metrics.
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Affiliation(s)
- Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR.
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Kate R Beadle
- Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Amanda L Clark
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
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12
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Gerdesköld C, Toth-Pal E, Wårdh I, Nilsson GH, Nager A. Use of online knowledge base in primary health care and correlation to health care quality: an observational study. BMC Med Inform Decis Mak 2020; 20:294. [PMID: 33198720 PMCID: PMC7670813 DOI: 10.1186/s12911-020-01313-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality. Methods The study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used. Results Frequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups. Conclusions Frequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.
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Affiliation(s)
- Christian Gerdesköld
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.
| | - Eva Toth-Pal
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Inger Wårdh
- Department of Dental Medicine, Academic Centre of Geriatric Dentistry, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83, Stockholm, Sweden.,Medibas, Bonnier Healthcare Sweden, Stockholm, Sweden
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13
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Goss KD, Ioerger M, Young V, Flanders RM, Turk MA. A systematic search and technical review of online information pertaining to medical care for people with disability. Disabil Health J 2019; 13:100877. [PMID: 31862260 DOI: 10.1016/j.dhjo.2019.100877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the availability and technical quality of online information related to the medical care of people with disability, despite the potential of this information to alter clinical interactions and treatment decisions. OBJECTIVES This review examines the utility of internet search engines for finding information related to medical care for people with disability, identifies common sources of this online information, and assesses the presence of technical attributes which allow for its critical evaluation. METHODS Exhaustive systematic searches were conducted on two popular search engines (Google and Yahoo) using six search phrases. Resources were coded to categorize presenting organization, format, and technical quality. RESULTS Only 8.9% of results included information related to medical care for people with disability. Analyzed resources were most often from non-profit organizations (31.7%) in website format (60.2%). The composite technical quality score for all included resources had a median and mode of three on a scale of six. CONCLUSIONS Online information related to medical care for people with disability is not only difficult to locate, but has generally low technical quality. These findings have implications for health information professionals, patients, care providers, and information developers.
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Affiliation(s)
- Katherine D Goss
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, United States.
| | - Michael Ioerger
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Virginia Young
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Reed M Flanders
- College of Arts and Sciences, Syracuse University, Syracuse, NY, United States
| | - Margaret A Turk
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, United States
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14
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Hoogland MA. How Medical Students Discover and Use Medical Information Tools. Med Ref Serv Q 2019; 38:347-357. [PMID: 31687903 DOI: 10.1080/02763869.2019.1661197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Many studies have examined how medical faculty and fourth-year medical students use information tools. Few studies have investigated how first, second, and third-year medical students discover and use information tools. In fall 2018, first, second, and third-year medical students received emails describing a study, which included a three-question survey and four interview questions. Of the 525 students, 122 completed the survey and 18 completed interviews. Results showed that clinical students most frequently use UpToDate, but preclinical students use multiple information tools. This report shows librarians can positively influence how preclinical students use information tools during medical school.
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Cook DA, Durning SJ, Sherbino J, Gruppen LD. Management Reasoning: Implications for Health Professions Educators and a Research Agenda. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1310-1316. [PMID: 31460922 DOI: 10.1097/acm.0000000000002768] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Substantial research has illuminated the clinical reasoning processes involved in diagnosis (diagnostic reasoning). Far less is known about the processes entailed in patient management (management reasoning), including decisions about treatment, further testing, follow-up visits, and allocation of limited resources. The authors' purpose is to articulate key differences between diagnostic and management reasoning, implications for health professions education, and areas of needed research.Diagnostic reasoning focuses primarily on classification (i.e., assigning meaningful labels to a pattern of symptoms, signs, and test results). Management reasoning involves negotiation of a plan and ongoing monitoring/adjustment of that plan. A diagnosis can usually be established as correct or incorrect, whereas there are typically multiple reasonable management approaches. Patient preferences, clinician attitudes, clinical contexts, and logistical constraints should not influence diagnosis, whereas management nearly always involves prioritization among such factors. Diagnostic classifications do not necessarily require direct patient interaction, whereas management prioritizations require communication and negotiation. Diagnoses can be defined at a single time point (given enough information), whereas management decisions are expected to evolve over time. Finally, management is typically more complex than diagnosis.Management reasoning may require educational approaches distinct from those used for diagnostic reasoning, including teaching distinct skills (e.g., negotiating with patients, tolerating uncertainty, and monitoring treatment) and developing assessments that account for underlying reasoning processes and multiple acceptable solutions.Areas of needed research include if and how cognitive processes differ for management and diagnostic reasoning, how and when management reasoning abilities develop, and how to support management reasoning in clinical practice.
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Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, director of education science, Office of Applied Scholarship and Education Science, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: http://orcid.org/0000-0003-2383-4633. S.J. Durning is professor of medicine and director, Division of Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. J. Sherbino is assistant dean, Health Professions Education Research, Faculty of Health Sciences, and professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. L.D. Gruppen is professor, Department of Learning Health Sciences, and director, Master of Health Professions Education Program, University of Michigan Medical School, Ann Arbor, Michigan
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Maggio LA, Aakre CA, Del Fiol G, Shellum J, Cook DA. Impact of Clinicians' Use of Electronic Knowledge Resources on Clinical and Learning Outcomes: Systematic Review and Meta-Analysis. J Med Internet Res 2019; 21:e13315. [PMID: 31359865 PMCID: PMC6690166 DOI: 10.2196/13315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/12/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background Clinicians use electronic knowledge resources, such as Micromedex, UpToDate, and Wikipedia, to deliver evidence-based care and engage in point-of-care learning. Despite this use in clinical practice, their impact on patient care and learning outcomes is incompletely understood. A comprehensive synthesis of available evidence regarding the effectiveness of electronic knowledge resources would guide clinicians, health care system administrators, medical educators, and informaticians in making evidence-based decisions about their purchase, implementation, and use. Objective The aim of this review is to quantify the impact of electronic knowledge resources on clinical and learning outcomes. Methods We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library for articles published from 1991 to 2017. Two authors independently screened studies for inclusion and extracted outcomes related to knowledge, skills, attitudes, behaviors, patient effects, and cost. We used random-effects meta-analysis to pool standardized mean differences (SMDs) across studies. Results Of 10,811 studies screened, we identified 25 eligible studies published between 2003 and 2016. A total of 5 studies were randomized trials, 22 involved physicians in practice or training, and 10 reported potential conflicts of interest. A total of 15 studies compared electronic knowledge resources with no intervention. Of these, 7 reported clinician behaviors, with a pooled SMD of 0.47 (95% CI 0.27 to 0.67; P<.001), and 8 reported objective patient effects with a pooled SMD of 0.19 (95% CI 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources—7 studies, not amenable to meta-analytic pooling—the use of electronic knowledge resources was associated with increased frequency of answering questions and perceived benefits on patient care, with variable impact on time to find an answer. A total of 2 studies compared different implementations of the same electronic knowledge resource. Conclusions Use of electronic knowledge resources is associated with a positive impact on clinician behaviors and patient effects. We found statistically significant associations between the use of electronic knowledge resources and improved clinician behaviors and patient effects. When compared with other resources, the use of electronic knowledge resources was associated with increased success in answering clinical questions, with variable impact on speed. Comparisons of different implementation strategies of the same electronic knowledge resource suggest that there are benefits from allowing clinicians to choose to access the resource, versus automated display of resource information, and from integrating patient-specific information. A total of 4 studies compared different commercial electronic knowledge resources, with variable results. Resource implementation strategies can significantly influence outcomes but few studies have examined such factors.
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Affiliation(s)
- Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Christopher A Aakre
- Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jane Shellum
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, United States
| | - David A Cook
- Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Zaidi Z, Larsen D. Commentary: Paradigms, Axiology, and Praxeology in Medical Education Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:S1-S7. [PMID: 30365423 DOI: 10.1097/acm.0000000000002384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This supplement includes 11 research papers accepted by the 2018 Research in Medical Education Committee. In this Commentary, the authors draw the attention of medical educators and researchers to questions about the researcher's philosophical paradigm. Such questions fundamentally guide research-the choice of conceptual frameworks, methods, and methodology. The authors provide a brief overview of research paradigms and the related concept of axiology and praxeology in medical education research. The authors map the 11 accepted research articles, describing the researchers' stated or implied worldviews and the impact on chosen methods. The authors close by encouraging researchers to state the research paradigm behind their research, comment on how they ensured that the methods used displayed consistency with that paradigm, and highlight the value the research adds to everyday education.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is associate professor and associate chief of faculty development, Division of General Internal Medicine, director of scholarship, Department of Medicine, and director of longitudinal portfolios, University of Florida College of Medicine, Gainesville, Florida; ORCID: http://orcid.org/0000-0003-4328-5766. D. Larsen is associate professor of neurology and pediatrics, Department of Neurology, and director of medical student education, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis, Missouri
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