A Clinical Decision Support System for Remote Monitoring of Cardiovascular Disease Patients: A Clinical Study Protocol

International visualization analysis of research hotspots and development trends in the study of clinical decision support systems utilizing CiteSpace

Objective

This study aims to elucidate the current status and trends in clinical decision support systems (CDSS). It will analyze the direction of research development in this field and provide valuable references for future research and the application of CDSS.

Methods

We conducted a search of the Web of Science Core Collection database from January 2014 to May 2024 to identify relevant literature on clinical decision support systems. CiteSpace (6.2. R4) software was utilized to visualize and analyze various aspects of the included literature, including publication volume, country of origin, authors, institutions, cited literature, keywords, and keyword clustering, and to generate corresponding graphs.

Results

A total of 2,668 articles were ultimately included in this study. The scholar with the highest number of publications is Professor Adam from the Department of Biomedical Information at Vanderbilt University in the United States. The top five countries contributing to this research are the United States, the United Kingdom, Germany, the Netherlands, and China. Based on an analysis of cited literature and keyword clustering, the research primarily focuses on predicting biochemical recurrence, cardiovascular disease, clinical guidelines, evidence-based computerized decision support systems, and intensive care units. The prominent topics in this field include artificial intelligence, natural language processing, venous thromboembolism, user-centered design, and emergency medicine.

Conclusion

Research on CDSS is demonstrating an upward trend and shows promising development prospects. Artificial intelligence, natural language processing, and user-centered design are the future trends.

The Construction and Application of a Clinical Decision Support System for Cardiovascular Diseases: Multimodal Data-Driven Development and Validation Study

Background

Due to the acceleration of the aging population and the prevalence of unhealthy lifestyles, the incidence of cardiovascular diseases (CVDs) in China continues to grow. However, due to the uneven distribution of medical resources across regions and significant disparities in diagnostic and treatment levels, the diagnosis and management of CVDs face considerable challenges.

Objective

The purpose of this study is to build a cardiovascular diagnosis and treatment knowledge base by using new technology, form an auxiliary decision support system, and integrate it into the doctor's workstation, to improve the assessment rate and treatment standardization rate. This study offers new ideas for the prevention and management of CVDs.

Methods

This study designed a clinical decision support system (CDSS) with data, learning, knowledge, and application layers. It integrates multimodal data from hospital laboratory information systems, hospital information systems, electronic medical records, electrocardiography, nursing, and other systems to build a knowledge model. The unstructured data were segmented using natural language processing technology, and medical entity words and entity combination relationships were extracted using IDCNN (iterated dilated convolutional neural network) and TextCNN (text convolutional neural network). The CDSS refers to global CVD assessment indicators to design quality control strategies and an intelligent treatment plan recommendation engine map, establishing a big data analysis platform to achieve multidimensional, visualized data statistics for management decision support.

Results

The CDSS system is embedded and interfaced with the physician workstation, triggering in real-time during the clinical diagnosis and treatment process. It establishes a 3-tier assessment control through pop-up windows and screen domination operations. Based on the intelligent diagnostic and treatment reminders of the CDSS, patients are given intervention treatments. The important risk assessment and diagnosis rate indicators significantly improved after the system came into use, and gradually increased within 2 years. The indicators of mandatory control, directly became 100% after the CDSS was online. The CDSS enhanced the standardization of clinical diagnosis and treatment.

Conclusions

This study establishes a specialized knowledge base for CVDs, combined with clinical multimodal information, to intelligently assess and stratify cardiovascular patients. It automatically recommends intervention treatments based on assessments and clinical characterizations, proving to be an effective exploration of using a CDSS to build a disease-specific intelligent system.

Nurses' perspectives on ethical aspects of telemedicine. A scoping review

BACKGROUND

Changes in health needs led to an increase in virtual care practices such as telemedicine. Nursing plays an essential role in this practice as it is the key to accessing the healthcare system. It is important that this branch of nursing is developed considering all the ethical aspects of nursing care, and not just the legal concepts of the practice. However, this question has not been widely explored in the literature and it is of crucial relevance in the new concept of care.

OBJECTIVE

The purpose of this scoping review is to identify the ethical aspects of the development of telemedicine from a nursing practice perspective.

METHODS

A scoping review of the literature based on Arksey and O'Malley's framework. The search was conducted in Scopus, PubMed/MEDLINE and CINAHL databases, from 2012 to 2022. A total of 1322 articles were retrieved, of which 12 met the inclusion criteria.

ETHICAL CONSIDERATIONS

The research was conducted in accordance with the best scientific practices.

FINDINGS

The most relevant aspects were the safety of the patient, the benefits for the user and the digital competence of the professionals. Informed consent and patient's willingness to use new technologies were relevant to the practice, as was person-centered care and how telemedicine can influence the quality of the therapeutic relationship. Another relevant issue was the concern about professional competence for optimal outcomes.

CONCLUSION

It is necessary to further explore and develop the ethical aspects of the new practices, disassociating them from the legal aspects only. Professionals demand more training providing them with more competence and confidence.

Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome

BACKGROUND

Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post-acute coronary syndrome (ACS).

OBJECTIVES

TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS.

METHODS

Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat.

RESULTS

A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group.

CONCLUSIONS

The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634).

The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review

BACKGROUND

Multimorbidity, the presence of more than one condition in a single individual, is a global health issue in primary care. Multimorbid patients tend to have a poor quality of life and suffer from a complicated care process. Clinical decision support systems (CDSSs) and telemedicine are the common information and communication technologies that have been used to reduce the complexity of patient management. However, each element of telemedicine and CDSSs is often examined separately and with great variability. Telemedicine has been used for simple patient education as well as more complex consultations and case management. For CDSSs, there is variability in data inputs, intended users, and outputs. Thus, there are several gaps in knowledge about how to integrate CDSSs into telemedicine and to what extent these integrated technological interventions can help improve patient outcomes for those with multimorbidity.

OBJECTIVE

Our aims were to (1) broadly review system designs for CDSSs that have been integrated into each function of telemedicine for multimorbid patients in primary care, (2) summarize the effectiveness of the interventions, and (3) identify gaps in the literature.

METHODS

An online search for literature was conducted up to November 2021 on PubMed, Embase, CINAHL, and Cochrane. Searching from the reference lists was done to find additional potential studies. The eligibility criterion was that the study focused on the use of CDSSs in telemedicine for patients with multimorbidity in primary care. The system design for the CDSS was extracted based on its software and hardware, source of input, input, tasks, output, and users. Each component was grouped by telemedicine functions: telemonitoring, teleconsultation, tele-case management, and tele-education.

RESULTS

Seven experimental studies were included in this review: 3 randomized controlled trials (RCTs) and 4 non-RCTs. The interventions were designed to manage patients with diabetes mellitus, hypertension, polypharmacy, and gestational diabetes mellitus. CDSSs can be used for various telemedicine functions: telemonitoring (eg, feedback), teleconsultation (eg, guideline suggestions, advisory material provisions, and responses to simple queries), tele-case management (eg, sharing information across facilities and teams), and tele-education (eg, patient self-management). However, the structure of CDSSs, such as data input, tasks, output, and intended users or decision-makers, varied. With limited studies examining varying clinical outcomes, there was inconsistent evidence of the clinical effectiveness of the interventions.

CONCLUSIONS

Telemedicine and CDSSs have a role in supporting patients with multimorbidity. CDSSs can likely be integrated into telehealth services to improve the quality and accessibility of care. However, issues surrounding such interventions need to be further explored. These issues include expanding the spectrum of medical conditions examined; examining tasks of CDSSs, particularly for screening and diagnosis of multiple conditions; and exploring the role of the patient as the direct user of the CDSS.

Implementation of the Management of Anticoagulation in the Periprocedural Period App into an Electronic Health Record: A Cost-Effectiveness Analysis

The Management of Anticoagulation in the Periprocedural Period (MAPPP) app is a free tool providing up-to-date guidelines on the periprocedural management of patients on long-term anticoagulants. After validating its effectiveness in the post-procedural period, we aimed to study its overall cost-effectiveness. SF-12 surveys were sent to eligible patients, converted into SF-6D forms, and subsequently into quality-adjusted life years (QALYs) to calculate the incremental cost-effectiveness ratio (ICER). The number of 30-day readmissions was used to calculate hospitalization costs, utilizing publicly available data. From 1/1/2018 to 1/31/2019, 642 patients were screened for enrollment, with an overall response rate of 94% (164/175) among the consented and 49% (164/336) among all eligible patients. The average QALY score was 0.7134 (95% CI [0.6836, 0.7431]) for the patients whose treatment plan followed the MAPPP app recommendations (acceptance group) and 0.7104 (95% CI [0.6760, 0.7448]) for those who did not (rejection group), without statistically significant differences. The difference in ICER scores was -$429 866.67, with the negative sign demonstrating that acceptance was the dominant strategy. By utilizing QALYs and ICER scores we have shown that the acceptance of MAPPP app recommendations is the dominant strategy for the periprocedural management of patients on long-term anticoagulation.

Some Things Change, Some Things Stay the Same: Trends in Canadian Education in Paediatric Cardiology and the Cardiac Sciences

Education in paediatric cardiology has evolved along with clinical care. The availability and application of new technologies in education, in particular, have had a significant impact. Artificial intelligence; virtual, augmented, and mixed reality learning tools; and gamification of learning have all resulted in new opportunities for today's trainees compared with those of the past. A new training model is also being used. Though currently focused on residency education, competency-based medical education is also being applied to undergraduate education in some Canadian medical schools. Competency-based medical education offers a more transparent relationship between education and physicians' social contract with society. It provides greater accountability for programmes and learners to teach and learn the skills required to function as competent specialists. However, it has not come without challenges. Coincident with the application of this model for learners, there has been increased educational accountability for physicians in practice and for the institutions training them. Despite these changes, some things have remained the same. On the positive side, the importance of good clinical teachers to effective learning remains constant. Unfortunately, the mistreatment of learners within our education system also remains and is perhaps the most important challenge facing medical education in Canada today. Learning to be better teachers and learner advocates is an important goal for all of those involved in educating Canadian medical learners.