Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? – a time series analysis

Background: Hepatic surgery is characterized by complicated operations with a significant periand postoperative risk for the patient. We developed a web-based, high-granular research database for comprehensive documentation of all relevant variables to evaluate new surgical techniques. Methods: To integrate this research system into the clinical setting, we designed an interactive decision support component. The objective is to provide relevant information for the surgeon and the patient to assess preoperatively the risk of a specific surgical procedure. Based on five established predictors of patient outcomes, the risk assessment tool searches for similar cases in the database and aggregates the information to estimate the risk for an individual patient. Results: The physician can verify the analysis and exclude manually non-matching cases according to his expertise. The analysis is visualized by means of a Kaplan-Meier plot. To evaluate the decision support component we analyzed data on 165 patients diagnosed with hepatocellular carcinoma (period 1996–2000). The similarity search provides a two-peak distribution indicating there are groups of similar patients and singular cases which are quite different to the average. The results of the risk estimation are consistent with the observed survival data, but must be interpreted with caution because of the limited number of matching reference cases. Conclusion: Critical issues for the decision support system are clinical integration, a transparent and reliable knowledge base and user feedback.

[1]  F. Schildberg,et al.  Jet-cutting Supported by High Frequency Current: New Technique for Hepatic Surgery , 1997, World Journal of Surgery.

[2]  KAVEH G. SHOJANIA,et al.  Research Paper: Reducing Vancomycin Use Utilizing a Computer Guideline: Results of a Randomized Controlled Trial , 1998, J. Am. Medical Informatics Assoc..

[3]  Peter Murchie,et al.  Treating hypertension with guidelines in general practice , 2004, BMJ : British Medical Journal.

[4]  Joel H. Saltz,et al.  caGrid: design and implementation of the core architecture of the cancer biomedical informatics grid , 2006, Bioinform..

[5]  M. Fine,et al.  A prediction rule to identify low-risk patients with community-acquired pneumonia. , 1997, The New England journal of medicine.

[6]  Steen Andreassen,et al.  Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. , 2006, The Journal of antimicrobial chemotherapy.

[7]  Daniel A. Keim,et al.  Visual database exploration techniques , 1997 .

[8]  Arild Faxvaag,et al.  Task-oriented evaluation of electronic medical records systems: development and validation of a questionnaire for physicians , 2004, BMC Medical Informatics Decis. Mak..

[9]  Leon N. Cooper,et al.  MEMORIES AND MEMORY: A PHYSICIST'S APPROACH TO THE BRAIN , 2000 .

[10]  T A Pryor,et al.  Rationale for the Arden Syntax. , 1994, Computers and biomedical research, an international journal.

[11]  D. Pencheon,et al.  Guidelines in general practice: the new Tower of Babel? , 1998, BMJ.

[12]  Mary Etta Mills,et al.  Linkage of patient records to support continuity of care: Issues and future directions. , 2006, Studies in health technology and informatics.

[13]  S. Michie,et al.  Interventions to improve antibiotic prescribing practices for hospital inpatients. , 2017, The Cochrane database of systematic reviews.

[14]  M Dugas,et al.  Clinical applications of Intranet-technology. , 1997, Studies in health technology and informatics.

[15]  Omolola Ogunyemi,et al.  GLIF3: the evolution of a guideline representation format , 2000, AMIA.

[16]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[17]  E. Mizraji.  Vector logics: the matrix-vector representation of logical calculus , 1992 .

[18]  Julie M. Fiskio,et al.  Evaluating physician satisfaction regarding user interactions with an electronic medical record system , 1999, AMIA.

[19]  Paulo J. G. Lisboa,et al.  A review of evidence of health benefit from artificial neural networks in medical intervention , 2002, Neural Networks.

[20]  G. Zahlmann,et al.  Impact of virtual reality imaging on hepatic liver tumor resection: calculation of risk , 2000, Langenbeck's Archives of Surgery.

[21]  Katharina Morik,et al.  Erratum to "Knowledge discovery and knowledge validation in intensive care" , 2000, Artif. Intell. Medicine.

[22]  Emmy Rood,et al.  Use of a computerized guideline for glucose regulation in the intensive care unit improved both guide-line adherence and glucose regulation , 2005 .

[23]  John Fox,et al.  Disseminating medical knowledge: the PROforma approach , 1998, Artif. Intell. Medicine.

[24]  W. Poole,et al.  Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. , 2002, Pediatrics.

[25]  N Freemantle,et al.  Printed educational materials: effects on professional practice and health care outcomes. , 2000, The Cochrane database of systematic reviews.

[26]  Ronald E. Rice,et al.  Social worlds, individual differences, and implementation: Predicting attitudes toward a medical information system , 1991, Inf. Manag..

[27]  Yuval Shahar,et al.  ASBRU: A TASK-SPECIFIC, INTENTION-BASED, AND TIME-ORIENTED LANGUAGE FOR REPRESENTING SKELETAL PLANS , 1999 .

[28]  Juan Lin,et al.  Fuzzy Decisions in Modular Neural Networks , 2001, Int. J. Bifurc. Chaos.

[29]  K. Thursky,et al.  Use of computerized decision support systems to improve antibiotic prescribing , 2006, Expert review of anti-infective therapy.

[30]  E. Mizraji,et al.  Multiplicative contexts in associative memories. , 1994, Bio Systems.

[31]  Juan Lin,et al.  A dynamical approach to logical decisions , 1997, Complex..

[32]  Trevor A Sheldon,et al.  What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews , 2004, BMJ : British Medical Journal.

[33]  Jonathan M. Teich,et al.  Research Paper: Implementation of Physician Order Entry: User Satisfaction and Self-Reported usage Patterns , 1996, J. Am. Medical Informatics Assoc..

[34]  P Szolovits,et al.  Artificial intelligence in medicine. Where do we stand? , 1987, The New England journal of medicine.

[35]  Sharon E Straus,et al.  What has evidence based medicine done for us? , 2004, BMJ : British Medical Journal.

[36]  J M Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2004, International Journal of Technology Assessment in Health Care.

[37]  S. Little.  The Trouble with Computers: Usefulness, Usability, and Productivity, Thomas K. Landauer, Cambridge, MA, MIT Press, 1995, x + 425 pp. US$27.50 (hbk), ISBN 0 262 1 2186 7 , 1997 .

[38]  Martin Dugas,et al.  Intranet-Based Clinical Data Entry , 1999, AMIA.

[39]  Anthony Randal McIntosh,et al.  Towards a network theory of cognition , 2000, Neural Networks.

[40]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[41]  G Meyer,et al.  [Prognostic factors in gallbladder carcinoma as a decision aid for reoperation]. , 1997, Langenbecks Archiv fur Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress.

[42]  L. Saiman,et al.  Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists' practices. , 2002, Pediatrics.

[43]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[44]  J F Potter,et al.  Extract from : , 2009 .

[45]  Vice President,et al.  An Introduction to Expert Systems , 1989 .

[46]  Teuvo Kohonen,et al.  Associative memory. A system-theoretical approach , 1977 .

[47]  S. Burnett,et al.  A physician-pharmacist model for the surveillance of blood pressure in the community: a feasibility study , 2001, Journal of Human Hypertension.

[48]  Nada Lavrac,et al.  Selected techniques for data mining in medicine , 1999, Artif. Intell. Medicine.

[49]  S. Damodaran,et al.  A simple intervention to improve hospital antibiotic prescribing , 2003, The Medical journal of Australia.

[50]  Silvana Quaglini,et al.  A patient workflow management system built on guidelines , 1997, AMIA.

[51]  E Mizraji,et al.  Context-dependent associations in linear distributed memories. , 1989, Bulletin of mathematical biology.

[52]  Hans-Peter Kriegel,et al.  Visual classification: an interactive approach to decision tree construction , 1999, KDD '99.

[53]  John Fox,et al.  Application of Information Technology: The Syntax and Semantics of the PROforma Guideline Modeling Language , 2003, J. Am. Medical Informatics Assoc..

[54]  Ivar Jacobson,et al.  The unified modeling language reference manual , 2010 .

[55]  Gustav Mikkelsen,et al.  Concordance of information in parallel electronic and paper based patient records , 2001, Int. J. Medical Informatics.

[56]  E Mizraji,et al.  Memories in context. , 1999, Bio Systems.

[57]  Jean YH Yang,et al.  Bioconductor: open software development for computational biology and bioinformatics , 2004, Genome Biology.

[58]  C. Loan.  The ubiquitous Kronecker product , 2000 .

[59]  Guus Schreiber,et al.  Knowledge Engineering and Management: The CommonKADS Methodology , 1999 .

[60]  H. Lærum,et al.  Doctors' use of electronic medical records systems in hospitals: cross sectional survey , 2001, BMJ : British Medical Journal.

[61]  M. Babić,et al.  Immunohistochemical evaluation of the HER-2 protein in the infiltrative lobular breast cancer. , 2006, Medicinski arhiv.

[62]  F. Haaijer-Ruskamp,et al.  Improving compliance with hospital antibiotic guidelines: a time-series intervention analysis. , 2005, The Journal of antimicrobial chemotherapy.

[63]  Ambuj K. Singh,et al.  Dimensionality reduction for similarity searching in dynamic databases , 1998, SIGMOD '98.

[64]  Leon N. Cooper,et al.  A possible organization of animal memory and learning , 1973 .

[65]  M. Sughayer,et al.  Prevalence of hormone receptors and HER2/neu in breast cancer cases in Jordan , 2008, Pathology & Oncology Research.

[66]  F W Schildberg,et al.  A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter. , 1995, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[67]  Katharina Morik,et al.  Knowledge discovery and knowledge validation in intensive care , 2000, Artif. Intell. Medicine.

[68]  G Hripcsak,et al.  Writing Arden Syntax Medical Logic Modules. , 1994, Computers in biology and medicine.

[69]  H. Karakayalı,et al.  Clinical findings and HER-2/neu gene amplification status of breast carcinoma patients , 2008, Pathology & Oncology Research.

[70]  V L Yu,et al.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. , 1993 .

[71]  Kylie L Easton,et al.  Empiric management of community‐acquired pneumonia in Australian emergency departments , 2005, The Medical journal of Australia.

[72]  Eduardo Mizraji,et al.  A cognitive architecture that solves a problem stated by Minsky , 2001, IEEE Trans. Syst. Man Cybern. Part B.

[73]  Yuval Shahar,et al.  Synthesis of Research: EON: A Component-Based Approach to Automation of Protocol-Directed Therapy , 1996, J. Am. Medical Informatics Assoc..

[74]  Ulf Grenander,et al.  SOME PROPERTIES OF A NEURAL MODEL FOR MEMORY , 1995 .

[75]  E. Perotti,et al.  Estrategias para el diagnóstico de sepsis neonatal tardía , 2005 .

[76]  Nick Booth,et al.  The PRODIGY project-the iterative development of the release one model , 1999, AMIA.

[77]  Antibiotic guidelines: improved implementation is the challenge , 2002, The Medical journal of Australia.

[78]  Karin A Thursky,et al.  Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit. , 2006, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[79]  Michael I. Jordan,et al.  The Handbook of Brain Theory and Neural Networks , 2002 .

[80]  Karl J. Friston.  Imaging neuroscience: principles or maps? , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[81]  Peter Szolovits,et al.  Categorical and Probabilistic Reasoning in Medicine Revisited , 1993, Artif. Intell..

[82]  Silvana Quaglini,et al.  Guideline-based careflow systems , 2000, Artif. Intell. Medicine.

[83]  Lucy Hederman,et al.  Representing clinical guidelines in UMl: a comparative study. , 2002, Studies in health technology and informatics.

[84]  Bryony Dean Franklin,et al.  Clinical decision support systems and antibiotic use , 2007, Pharmacy World & Science.

[85]  G. Town,et al.  Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. , 1996, Thorax.

[86]  Gernot Wassmer,et al.  Hypertension guidelines and their limitations – the impact of physicians’ compliance as evaluated by guideline awareness , 2001, Journal of hypertension.

[87]  Omolola Ogunyemi,et al.  Using features of Arden Syntax with object-oriented medical data models for guideline modeling , 2001, AMIA.

[88]  Eduardo Mizraji,et al.  Semantic graphs and associative memories. , 2004, Physical review. E, Statistical, nonlinear, and soft matter physics.

[89]  Yuval Shahar,et al.  The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines , 1998, Artif. Intell. Medicine.

[90]  Juan C. Valle-Lisboa,et al.  Elman topology with sigma-pi units: An application to the modeling of verbal hallucinations in schizophrenia , 2005, Neural Networks.