Search

Background: Clinical decision support systems (CDSSs) already support community pharmacists in conducting medication reviews (MRs) by identifying important information on interactions and suggesting clinical solutions. However, their impact in terms of quality and time savings is widely unexplored. The aim of our study was to investigate whether MRs are performed faster and better with or without using a CDSS. Methods: In a randomized controlled study with a cross-over design, 71 pharmacists performed a total of four MRs, two with and two without the use of a CDSS. The primary endpoint was defined as the time required for the MRs. The secondary endpoints were the number of predefined relevant drug-related problems (DRPs) detected and pharmacist satisfaction. Results: Without the use of a CDSS, pharmacists needed between 25.7% and 30.7% more time to perform a MR than with a CDSS. In addition, significantly more relevant DRPs were detected in the MRs with CDSS than without CDSS (70% vs. 50%; p = 0.0037). Furthermore, participants stated that they felt more confident using a CDSS for MRs than without. Conclusions: Our results demonstrate that MRs can be performed both faster and better when using a CDSS than without. Consequently, community pharmacists benefit from the use of CDSSs for MRs, as do patients in terms of their drug therapy safety. [ABSTRACT FROM AUTHOR]

In children, vital distress events, particularly respiratory, go unrecognized. To develop a standard model for automated assessment of vital distress in children, we aimed to construct a prospective high-quality video database for critically ill children in a pediatric intensive care unit (PICU) setting. The videos were acquired automatically through a secure web application with an application programming interface (API). The purpose of this article is to describe the data acquisition process from each PICU room to the research electronic database. Using an Azure Kinect DK and a Flir Lepton 3.5 LWIR attached to a Jetson Xavier NX board and the network architecture of our PICU, we have implemented an ongoing high-fidelity prospectively collected video database for research, monitoring, and diagnostic purposes. This infrastructure offers the opportunity to develop algorithms (including computational models) to quantify vital distress in order to evaluate vital distress events. More than 290 RGB, thermographic, and point cloud videos of each 30 s have been recorded in the database. Each recording is linked to the patient's numerical phenotype, i.e., the electronic medical health record and high-resolution medical database of our research center. The ultimate goal is to develop and validate algorithms to detect vital distress in real time, both for inpatient care and outpatient management. [ABSTRACT FROM AUTHOR]

Clinical decision support systems (CDSSs) are intended to detect drug-related problems in real time and might be of value in healthcare institutions with a clinical pharmacy team. The objective was to report the detection of drug-related problems through a CDSS used by an existing clinical pharmacy team over 22 months. It was a retrospective single-center study. A CDSS was integrated in the clinical pharmacy team in July 2019. The investigating clinical pharmacists evaluated the pharmaceutical relevance and physician acceptance rates for critical alerts (i.e., alerts for drug-related problems arising during on-call periods) and noncritical alerts (i.e., prevention alerts arising during the pharmacist's normal work day) from the CDSS. Of the 3612 alerts triggered, 1554 (43.0%) were critical, and 594 of these 1554 (38.2%) prompted a pharmacist intervention. Of the 2058 (57.0%) noncritical alerts, 475 of these 2058 (23.1%) prompted a pharmacist intervention. About two-thirds of the total pharmacist interventions (PI) were accepted by physicians; the proportion was 71.2% for critical alerts (i.e., 19 critical alerts per month vs. 12.5 noncritical alerts per month). Some alerts were pharmaceutically irrelevant—mainly due to poor performance by the CDSS. Our results suggest that a CDSS is a useful decision-support tool for a hospital pharmacist's clinical practice. It can help to prioritize drug-related problems by distinguishing critical and noncritical alerts. However, building an appropriate organizational structure around the CDSS is important for correct operation. [ABSTRACT FROM AUTHOR]

The use of artificial intelligence in geriatrics is very promising and relevant, as the diagnosis of a geriatric patient is a complex, experience-based, and time-consuming process that involves a variety of questionnaires and subjective and inaccurate patient responses. This paper proposes the explainable artificial intelligence-based (XAI) clinical decision support system (CDSS) to assess nutrition-related factors (symptoms) and to determine the likelihood of geriatric patient health risks associated with four syndromes: malnutrition, oropharyngeal dysphagia, dehydration, and eating disorders in dementia. The proposed system's prototype was tested under real conditions at the geriatric department of Lithuanian University of Health Sciences Kaunas Hospital. The subjects of this study were 83 geriatric patients with various health conditions. The assessments of the nutritional status and syndromes of the patients provided by the CDSS were compared with the diagnoses of the physicians obtained using standard assessment methods. The results show that proposed CDSS can efficiently diagnose nutrition-related geriatric syndromes with high accuracy: 87.95% for malnutrition, 87.95% for oropharyngeal dysphagia, 90.36% for eating disorders in dementia, and 86.75% for dehydration. The research confirms that the proposed XAI-based CDSS is an effective tool, able to assess nutrition-related health risk factors and their dependencies and, in some cases, makes even a more accurate decision than a less experienced physician. [ABSTRACT FROM AUTHOR]

Pharmacogenomic (PGx) information can guide drug and dose selection, optimize therapy outcomes, and/or decrease the risk of adverse drug events (ADEs). This report demonstrates the impact of a pharmacist-led medication evaluation, with PGx assisted by a clinical decision support system (CDSS), of a patient with multiple comorbidities. Following several sub-optimal pharmacotherapy attempts, PGx testing was recommended. The results were integrated into the CDSS, which supported the identification of clinically significant drug–drug, drug–gene, and drug–drug–gene interactions that led to the phenoconversion of cytochrome P450. The pharmacist evaluated PGx results, concomitant medications, and patient-specific factors to address medication-related problems. The results identified the patient as a CYP2D6 intermediate metabolizer (IM). Duloxetine-mediated competitive inhibition of CYP2D6 resulted in phenoconversion, whereby the patient’s CYP2D6 phenotype was converted from IM to poor metabolizer for CYP2D6 co-medication. The medication risk score suggested a high risk of ADEs. Recommendations that accounted for PGx and drug-induced phenoconversion were accepted. After 1.5 months, therapy changes led to improved pain control, depression status, and quality of life, as well as increased heart rate, evidenced by patient-reported improved sleep patterns, movement, and cognition. This case highlights the pharmacist’s role in using PGx testing and a CDSS to identify and mitigate medication-related problems to optimize medication regimen and medication safety [ABSTRACT FROM AUTHOR]

The clinical decision support system provides an automatic diagnosis of human diseases using machine learning techniques to analyze features of patients and classify patients according to different diseases. An analysis of real-world electronic health record (EHR) data has revealed that a patient could be diagnosed as having more than one disease simultaneously. Therefore, to suggest a list of possible diseases, the task of classifying patients is transferred into a multi-label learning task. For most multi-label learning techniques, the class imbalance that exists in EHR data may bring about performance degradation. Cross-Coupling Aggregation (COCOA) is a typical multi-label learning approach that is aimed at leveraging label correlation and exploring class imbalance. For each label, COCOA aggregates the predictive result of a binary-class imbalance classifier corresponding to this label as well as the predictive results of some multi-class imbalance classifiers corresponding to the pairs of this label and other labels. However, class imbalance may still affect a multi-class imbalance learner when the number of a coupling label is too small. To improve the performance of COCOA, a regularized ensemble approach integrated into a multi-class classification process of COCOA named as COCOA-RE is presented in this paper. To provide disease diagnosis, COCOA-RE learns from the available laboratory test reports and essential information of patients and produces a multi-label predictive model. Experiments were performed to validate the effectiveness of the proposed multi-label learning approach, and the proposed approach was implemented in a developed system prototype. [ABSTRACT FROM AUTHOR]

Simple Summary: Tumor therapy in many human malignancies, including head and neck cancer, is increasingly demanding due to advances in diagnostics and individualized treatments. Multidisciplinary tumor boards, especially molecular tumor boards, consider a great amount of information to find the optimal treatment decision. Clinical decision support systems can help in optimizing this complex decision-making process. We designed a digital patient model based on conditional probability algorithms as Bayesian networks to support the decision-making process regarding treatment with approved immunotherapeutic agents (Nivolumab and Pembrolizumab). The model is able to process relevant clinical information to recommend a certain immunotherapeutic agent based on literature, approval, and guidelines. New diagnostic methods and novel therapeutic agents spawn additional and heterogeneous information, leading to an increasingly complex decision-making process for optimal treatment of cancer. A great amount of information is collected in organ-specific multidisciplinary tumor boards (MDTBs). By considering the patient's tumor properties, molecular pathological test results, and comorbidities, the MDTB has to consent an evidence-based treatment decision. Immunotherapies are increasingly important in today's cancer treatment, resulting in detailed information that influences the decision-making process. Clinical decision support systems can facilitate a better understanding via processing of multiple datasets of oncological cases and molecular genetic information, potentially fostering transparency and comprehensibility of available information, eventually leading to an optimum treatment decision for the individual patient. We constructed a digital patient model based on Bayesian networks to combine the relevant patient-specific and molecular data with depended probabilities derived from pertinent studies and clinical guidelines to calculate treatment decisions in head and neck squamous cell carcinoma (HNSCC). In a validation analysis, the model can provide guidance within the growing subject of immunotherapy in HNSCC and, based on its ability to calculate reliable probabilities, facilitates estimation of suitable therapy options. We compared actual treatment decisions of 25 patients with the calculated recommendations of our model and found significant concordance (Cohen's κ = 0.505, p = 0.009) and 84% accuracy. [ABSTRACT FROM AUTHOR]

Breast cancer is the most frequently diagnosed cancer in women, with more than 2.1 million new diagnoses worldwide every year. Personalised treatment is critical to optimising outcomes for patients with breast cancer. A major advance in medical practice is the incorporation of Clinical Decision Support Systems (CDSSs) to assist and support healthcare staff in clinical decision-making, thus improving the quality of decisions and overall patient care whilst minimising costs. The usage and availability of CDSSs in breast cancer care in healthcare settings is increasing. However, there may be differences in how particular CDSSs are developed, the information they include, the decisions they recommend, and how they are used in practice. This systematic review examines various CDSSs to determine their availability, intended use, medical characteristics, and expected outputs concerning breast cancer therapeutic decisions, an area that is known to have varying degrees of subjectivity in clinical practice. Utilising the methodology of Kitchenham and Charter, a systematic search of the literature was performed in Springer, Science Direct, Google Scholar, PubMed, ACM, IEEE, and Scopus. An overview of CDSS which supports decision-making in breast cancer treatment is provided along with a critical appraisal of their benefits, limitations, and opportunities for improvement. [ABSTRACT FROM AUTHOR]