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Chaparro, Juan D., Cory Hussain, Jennifer A. Lee, Jessica Hehmeyer, Manjusri Nguyen, and Jeffrey Hoffman. "Reducing Interruptive Alert Burden Using Quality Improvement Methodology." Applied Clinical Informatics 11, no. 01 (January 2020): 046–58. http://dx.doi.org/10.1055/s-0039-3402757.
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Abstract Background Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The “pop-up” or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Objectives Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. Methods We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. Results A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. Conclusion Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.
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McGreevey, John D., Colleen P. Mallozzi, Randa M. Perkins, Eric Shelov, and Richard Schreiber. "Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems." Applied Clinical Informatics 11, no. 01 (January 2020): 001–12. http://dx.doi.org/10.1055/s-0039-3402715.
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Abstract Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan. Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts. Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human–computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians. Results The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship. Conclusion Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.
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Dexheimer, Judith, Eric Kirkendall, Michal Kouril, Philip Hagedorn, Thomas Minich, Leo Duan, Monifa Mahdi, Rhonda Szczesniak, and S. Andrew Spooner. "The Effects of Medication Alerts on Prescriber Response in a Pediatric Hospital." Applied Clinical Informatics 08, no. 02 (April 2017): 491–501. http://dx.doi.org/10.4338/aci-2016-10-ra-0168.
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Summary Objective: More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider’s response to any EHR alert. The primary goal was to evaluate the effects of alert burden on user response to the alerts. Methods: We performed a retrospective study of medication alerts over a 24-month period (1/2013–12/2014) in a large pediatric academic medical center. The institutional review board approved this study. The primary outcome measure was alert salience, a measure of whether or not the prescriber took any corrective action on the order that generated an alert. We estimated the ideal number of alerts to maximize salience. Salience rates were examined for providers at each training level, by day of week, and time of day through logistic regressions. Results: While salience never exceeded 38%, 49 alerts/day were associated with maximal salience in our dataset. The time of day an order was placed was associated with alert salience (maximal salience 2am). The day of the week was also associated with alert salience (maximal salience on Wednesday). Provider role did not have an impact on salience. Conclusion: Alert burden plays a role in influencing provider response to medication alerts. An increased number of alerts a provider saw during a one-day period did not directly lead to decreased response to alerts. Given the multiple factors influencing the response to alerts, efforts focused solely on burden are not likely to be effective. Citation: Dexheimer JW, Kirkendall ES, Kouril M, Hagedorn PA, Minich T, Duan LL, Mahdi M, Szczesniak R, Spooner SA. The effects of medication alerts on prescriber response in a pediatric hospital. Appl Clin Inform 2017; 8: 491–501 https://doi.org/10.4338/ACI-2016-10-RA-0168
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Bubp, Jeff L., Michelle A. Park, Joan Kapusnik-Uner, Thong Dang, Karl Matuszewski, Don Ly, Kevin Chiang, Sek Shia, and Brian Hoberman. "Successful deployment of drug-disease interaction clinical decision support across multiple Kaiser Permanente regions." Journal of the American Medical Informatics Association 26, no. 10 (April 15, 2019): 905–10. http://dx.doi.org/10.1093/jamia/ocz020.
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Abstract Objective The study sought to develop a criteria-based scoring tool for assessing drug-disease knowledge base content and creation of a subset and to implement the subset across multiple Kaiser Permanente (KP) regions. Materials and Methods In Phase I, the scoring tool was developed, used to create a drug-disease alert subset, and validated by surveying physicians and pharmacists from KP Northern California. In Phase II, KP enabled the alert subset in July 2015 in silent mode to collect alert firing rates and confirmed that alert burden was adequately reduced. The alert subset was subsequently rolled out to users in KP Northern California. Alert data was collected September 2015 to August 2016 to monitor relevancy and override rates. Results Drug-disease alert scoring identified 1211 of 4111 contraindicated drug-disease pairs for inclusion in the subset. The survey results showed clinician agreement with subset examples 92.3%-98.5% of the time. Postsurvey adjustments to the subset resulted in KP implementation of 1189 drug-disease alerts. The subset resulted in a decrease in monthly alerts from 32 045 to 1168. Postimplementation monthly physician alert acceptance rates ranged from 20.2% to 29.8%. Discussion Our study shows that drug-disease alert scoring resulted in an alert subset that generated acceptable interruptive alerts while decreasing overall potential alert burden. Following the initial testing and implementation in its Northern California region, KP successfully implemented the disease interaction subset in 4 regions with additional regions planned. Conclusions Our approach could prevent undue alert burden when new alert categories are implemented, circumventing the need for trial live activations of full alert category knowledge bases.
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Elias, Pierre, Eric Peterson, Bob Wachter, Cary Ward, Eric Poon, and Ann Marie Navar. "Evaluating the Impact of Interruptive Alerts within a Health System: Use, Response Time, and Cumulative Time Burden." Applied Clinical Informatics 10, no. 05 (October 2019): 909–17. http://dx.doi.org/10.1055/s-0039-1700869.
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Abstract Background Health systems often employ interruptive alerts through the electronic health record to improve patient care. However, concerns of “alert fatigue” have been raised, highlighting the importance of understanding the time burden and impact of these alerts on providers. Objectives Our main objective was to determine the total time providers spent on interruptive alerts in both inpatient and outpatient settings. Our secondary objectives were to analyze dwell time for individual alerts and examine both provider and alert-related factors associated with dwell time variance. Methods We retrospectively evaluated use and response to the 75 most common interruptive (“popup”) alerts between June 1st, 2015 and November 1st, 2016 in a large academic health care system. Alert “dwell time” was calculated as the time between the alert appearing on a provider's screen until it was closed. The total number of alerts and dwell times per provider per month was calculated for inpatient and outpatient alerts and compared across alert type. Results The median number of alerts seen by a provider was 12 per month (IQR 4–34). Overall, 67% of inpatient and 39% of outpatient alerts were closed in under 3 seconds. Alerts related to patient safety and those requiring more than a single click to proceed had significantly longer median dwell times of 5.2 and 6.7 seconds, respectively. The median total monthly time spent by providers viewing alerts was 49 seconds on inpatient alerts and 28 seconds on outpatient alerts. Conclusion Most alerts were closed in under 3 seconds and a provider's total time spent on alerts was less than 1 min/mo. Alert fatigue may lie in their interruptive and noncritical nature rather than time burden. Monitoring alert interaction time can function as a valuable metric to assess the impact of alerts on workflow and potentially identify routinely ignored alerts.
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Knight, Amy M., Joyce Maygers, Kimberly A. Foltz, Isha S. John, Hsin Chieh Yeh, and Daniel J. Brotman. "The Effect of Eliminating Intermediate Severity Drug-Drug Interaction Alerts on Overall Medication Alert Burden and Acceptance Rate." Applied Clinical Informatics 10, no. 05 (October 2019): 927–34. http://dx.doi.org/10.1055/s-0039-3400447.
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Abstract Objective This study aimed to determine the effects of reducing the number of drug-drug interaction (DDI) alerts in an order entry system. Methods Retrospective pre–post analysis at an urban medical center of the rates of medication alerts and alert acceptance during a 5-month period before and 5-month period after the threshold for firing DDI alerts was changed from “intermediate” to “severe.” To ensure that we could determine varying response to each alert type, we took an in-depth look at orders generating single alerts. Results Before the intervention, 241,915 medication orders were placed, of which 25.6% generated one or more medication alerts; 5.3% of the alerts were accepted. During the postintervention period, 245,757 medication orders were placed of which 16.0% generated one or more medication alerts, a 37.5% relative decrease in alert rate (95% confidence interval [CI]: −38.4 to −36.8%), but only a 9.6% absolute decrease (95% CI: −9.4 to −9.9%). 7.4% of orders generating alerts were accepted postintervention, a 39.6% relative increase in acceptance rate (95% CI: 33.2–47.2%), but only a 2.1% absolute increase (95% CI: 1.8–2.4%). When only orders generating a single medication alert were considered, there was a 69.1% relative decrease in the number of orders generating DDI alerts, and an 85.7% relative increase in the acceptance rate (95% CI: 58.6–126.2%), though only a 1.8% absolute increase (95% CI: 1.3–2.3%). Conclusion Eliminating intermediate severity DDI alerts resulted in a statistically significant decrease in alert burden and increase in the rate of medication alert acceptance, but alert acceptance remained low overall.
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Simpao, Allan F., Luis M. Ahumada, Bimal R. Desai, Christopher P. Bonafide, Jorge A. Gálvez, Mohamed A. Rehman, Abbas F. Jawad, Krisha L. Palma, and Eric D. Shelov. "Optimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard." Journal of the American Medical Informatics Association 22, no. 2 (October 15, 2014): 361–69. http://dx.doi.org/10.1136/amiajnl-2013-002538.
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Abstract Objective To develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project. Methods We used visual analytics software to develop the dashboard. We collaborated with the hospital-wide Clinical Decision Support committee to perform three interventions successively deactivating clinically irrelevant drug–drug interaction (DDI) alert rules. We analyzed the impact of the interventions on care providers’ and pharmacists’ alert and override rates using an interrupted time series framework with piecewise regression. Results We evaluated 2 391 880 medication alerts between January 31, 2011 and January 26, 2014. For pharmacists, the median alert rate prior to the first DDI deactivation was 58.74 alerts/100 orders (IQR 54.98–60.48) and 25.11 alerts/100 orders (IQR 23.45–26.57) following the three interventions (p<0.001). For providers, baseline median alert rate prior to the first round of DDI deactivation was 19.73 alerts/100 orders (IQR 18.66–20.24) and 15.11 alerts/100 orders (IQR 14.44–15.49) following the three interventions (p<0.001). In a subgroup analysis, we observed a decrease in pharmacists’ override rates for DDI alerts that were not modified in the system from a median of 93.06 overrides/100 alerts (IQR 91.96–94.33) to 85.68 overrides/100 alerts (IQR 84.29–87.15, p<0.001). The medication serious safety event rate decreased during the study period, and there were no serious safety events reported in association with the deactivated alert rules. Conclusions An alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists’ frequency of selecting the ‘cancel’ option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts.
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Capan, Muge, Stephen Hoover, Kristen E. Miller, Carmen Pal, Justin M. Glasgow, Eric V. Jackson, and Ryan C. Arnold. "Data-driven approach to Early Warning Score-based alert management." BMJ Open Quality 7, no. 3 (August 2018): e000088. http://dx.doi.org/10.1136/bmjoq-2017-000088.
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BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.
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Tsang, H. C., P. Mathias, N. Hoffman, and M. B. Pagano. "Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S123—S124. http://dx.doi.org/10.1093/ajcp/aqaa161.270.
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Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.
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Chaparro, Juan D., Jonathan M. Beus, Adam C. Dziorny, Philip A. Hagedorn, Sean Hernandez, Swaminathan Kandaswamy, Eric S. Kirkendall, Allison B. McCoy, Naveen Muthu, and Evan W. Orenstein. "Clinical Decision Support Stewardship: Best Practices and Techniques to Monitor and Improve Interruptive Alerts." Applied Clinical Informatics 13, no. 03 (May 2022): 560–68. http://dx.doi.org/10.1055/s-0042-1748856.
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AbstractInterruptive clinical decision support systems, both within and outside of electronic health records, are a resource that should be used sparingly and monitored closely. Excessive use of interruptive alerting can quickly lead to alert fatigue and decreased effectiveness and ignoring of alerts. In this review, we discuss the evidence for effective alert stewardship as well as practices and methods we have found useful to assess interruptive alert burden, reduce excessive firings, optimize alert effectiveness, and establish quality governance at our institutions. We also discuss the importance of a holistic view of the alerting ecosystem beyond the electronic health record.
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Segal, G., A. Segev, A. Brom, Y. Lifshitz, Y. Wasserstrum, and E. Zimlichman. "Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting." Journal of the American Medical Informatics Association 26, no. 12 (August 7, 2019): 1560–65. http://dx.doi.org/10.1093/jamia/ocz135.
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Abstract Background Drug prescription errors are made, worldwide, on a daily basis, resulting in a high burden of morbidity and mortality. Existing rule-based systems for prevention of such errors are unsuccessful and associated with substantial burden of false alerts. Objective In this prospective study, we evaluated the accuracy, validity, and clinical usefulness of medication error alerts generated by a novel system using outlier detection screening algorithms, used on top of a legacy standard system, in a real-life inpatient setting. Materials and Methods We integrated a novel outlier system into an existing electronic medical record system, in a single medical ward in a tertiary medical center. The system monitored all drug prescriptions written during 16 months. The department’s staff assessed all alerts for accuracy, clinical validity, and usefulness. We recorded all physician’s real-time responses to alerts generated. Results The alert burden generated by the system was low, with alerts generated for 0.4% of all medication orders. Sixty percent of the alerts were flagged after the medication was already dispensed following changes in patients’ status which necessitated medication changes (eg, changes in vital signs). Eighty-five percent of the alerts were confirmed clinically valid, and 80% were considered clinically useful. Forty-three percent of the alerts caused changes in subsequent medical orders. Conclusion A clinical decision support system that used a probabilistic, machine-learning approach based on statistically derived outliers to detect medication errors generated clinically useful alerts. The system had high accuracy, low alert burden and low false-positive rate, and led to changes in subsequent orders.
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Czock, David, Michael Konias, Hanna M. Seidling, Jens Kaltschmidt, Vedat Schwenger, Martin Zeier, and Walter E. Haefeli. "Tailoring of alerts substantially reduces the alert burden in computerized clinical decision support for drugs that should be avoided in patients with renal disease." Journal of the American Medical Informatics Association 22, no. 4 (April 24, 2015): 881–87. http://dx.doi.org/10.1093/jamia/ocv027.
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Abstract Objective Electronic alerts are often ignored by physicians, which is partly due to the large number of unspecific alerts generated by decision support systems. The aim of the present study was to analyze critical drug prescriptions in a university-based nephrology clinic and to evaluate the effect of different alerting strategies on the alert burden. Methods In a prospective observational study, two advanced strategies to automatically generate alerts were applied when medication regimens were entered for discharge letters, outpatient clinic letters, and written prescriptions and compared to two basic reference strategies. Strategy A generated alerts whenever drug-specific information was available, whereas strategy B generated alerts only when the estimated glomerular filtration rate of a patient was below a drug-specific value. Strategies C and D included further patient characteristics and drug-specific information to generate even more specific alerts. Results Overall, 1012 medication regimens were entered during the observation period. The average number of alerts per drug preparation in medication regimens entered for letters was 0.28, 0.080, 0.019, and 0.011, when using strategy A, B, C, or D (P<0.001, for comparison between the strategies), leading to at least one alert in 87.5%, 39.3%, 13.5%, or 7.81 % of the regimens. Similar average numbers of alerts were observed for medication regimens entered for written prescriptions. Conclusions The prescription of potentially hazardous drugs is common in patients with renal impairment. Alerting strategies including patient and drug-specific information to generate more specific alerts have the potential to reduce the alert burden by more than 90 %.
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Horn, John, and Stephen Ueng. "The Effect of Patient-Specific Drug-Drug Interaction Alerting on the Frequency of Alerts: A Pilot Study." Annals of Pharmacotherapy 53, no. 11 (July 11, 2019): 1087–92. http://dx.doi.org/10.1177/1060028019863419.
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Background: False-positive drug-drug interaction alerts are frequent and result in alert fatigue that can result in prescribers bypassing important alerts. Development of a method to present patient-appropriate alerts is needed to help restore alert relevance. Objective: The purpose of this study was to assess the potential for patient-specific drug-drug interaction (DDI) alerts to reduce alert burden. Methods: This project was conducted at a tertiary care medical center. Seven of the most frequently encountered DDI alerts were chosen for developing patient-specific, algorithm-based DDI alerts. For each of the DDI pairs, 2 algorithms featuring different values for modifying factors were made. DDI alerts from the 7 drug pairs were collected over 30 days. Outcome measures included the number of DDI alerts generated before and after patient-specific algorithm application to the same patients over the same time period. Results: A total of 14 algorithms were generated, and each was evaluated by comparing the number of alerts generated by our existing, customized clinical decision support (CDS) software and the patient-specific algorithms. The CDS DDI alerting software generated an average of 185.3 alerts per drug pair over the 30-day study period. Patient-specific algorithms reduced the number of alerts resulting from the algorithms by 11.3% to 93.5%. Conclusion and Relevance: Patient-specific DDI alerting is an innovative and effective approach to reduce the number of DDI alerts, may potentially increase the appropriateness of alerts, and may decrease the potential for alert fatigue.
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Gadhiya, Kinjal, Edgar Zamora, Salim M. Saiyed, David Friedlander, and David C. Kaelber. "Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions." Applied Clinical Informatics 12, no. 02 (March 2021): 355–61. http://dx.doi.org/10.1055/s-0041-1729167.
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Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.
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Baysari, Melissa T., Wu Yi Zheng, Ling Li, Johanna Westbrook, Richard O. Day, Sarah Hilmer, Bethany Annemarie Van Dort, et al. "Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug–drug interaction alerts." BMJ Open 9, no. 8 (August 2019): e026034. http://dx.doi.org/10.1136/bmjopen-2018-026034.
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IntroductionDrug–drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients’ medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems.Methods and analysisA controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10–15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6–12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems.Ethics and disseminationThis research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.
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Kirkendall, Eric S., Michal Kouril, Judith W. Dexheimer, Joshua D. Courter, Philip Hagedorn, Rhonda Szczesniak, Dan Li, Rahul Damania, Thomas Minich, and S. Andrew Spooner. "Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records." Journal of the American Medical Informatics Association 24, no. 2 (August 9, 2016): 295–302. http://dx.doi.org/10.1093/jamia/ocw086.
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Objectives: Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications. Materials and Methods: We created an order and alert analysis system that identified antibiotic medication orders and evaluated user response to dosing alerts. Orders associated with overridden alerts were examined for evidence of administration and the delivered dose was compared to pharmacy-derived dosing rules to confirm true overdoses. True overdose cases were reviewed for association with known ADEs. Results: Of 55 546 orders reviewed, 539 were true overdose orders, which lead to 1965 known overdose administrations. Documentation of loose stools and diarrhea was significantly increased following drug administration in the overdose group. Dosing rule thresholds were altered to reflect clinically accurate dosing. These rule changes decreased overall alert burden and improved the salience of alerts. Discussion: Electronic algorithm-based detection systems can identify antibiotic overdoses that are clinically relevant and are associated with known ADEs. The system also serves as a platform for evaluating the effects of modifying electronic dosing rules. These modifications lead to decreased alert burden and improvements in response to decision support alerts. Conclusion: The success of this test case suggests that gains are possible in reducing medication errors and improving patient safety with automated algorithm-based detection systems. Follow-up studies will determine if the positive effects of the system persist and if these changes lead to improved safety outcomes.
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Strachna, Olga, Onur Asan, and Peter D. Stetson. "Managing Critical Patient-Reported Outcome Measures in Oncology Settings: System Development and Retrospective Study." JMIR Medical Informatics 10, no. 11 (November 3, 2022): e38483. http://dx.doi.org/10.2196/38483.
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Background Remote monitoring programs based on the collection of patient-reported outcome (PRO) data are being increasingly adopted in oncology practices. Although PROs are a great source of patient data, the management of critical PRO data is not discussed in detail in the literature. Objective This first-of-its-kind study aimed to design, describe, and evaluate a closed-loop alerting and communication system focused on managing PRO-related alerts in cancer care. Methods We designed and developed a novel solution using an agile software development methodology by incrementally building new capabilities. We evaluated these new features using participatory design and the Fit between Individuals, Task, and Technology framework. Results A total of 8 questionnaires were implemented using alerting features, resulting in an alert rate of 7.82% (36,838/470,841) with 13.28% (10,965/82,544) of the patients triggering at least one alert. Alerts were reviewed by 501 staff members spanning across 191 care teams. All the alerts were reviewed with a median response time of 1 hour (SD 185 hours) during standard business hours. The most severe (red) alerts were documented 56.83% (2592/4561) of the time, whereas unlabeled alerts were documented 27.68% (1298/4689) of the time, signaling clinician concordance with the alert thresholds. Conclusions A PRO-based alert and communication system has some initial benefits in reviewing clinically meaningful PRO data in a reasonable amount of time. We have discussed key system design considerations, workflow integration, and the mitigation of potential impact on the burden of care teams. The introduction of a PRO-based alert and communication system provides a reliable mechanism for care teams to review and respond to patient symptoms quickly. The system was standardized across many different oncology settings, demonstrating system flexibility. Future studies should focus on formally evaluating system usability through qualitative methods.
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Choi, Yongsoo, Garam Byun, and Jong-Tae Lee. "The Effects of Particulate Matter Alert on Urban Park Visitation in Seoul, Korea: Using Segmented Regression." International Journal of Environmental Research and Public Health 19, no. 22 (November 21, 2022): 15372. http://dx.doi.org/10.3390/ijerph192215372.
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To reduce the health burden from particulate matter (PM), the Korean government implemented a nationwide PM10 (particles less than 10 µg/m3 in diameter) alert system in 2015. The policy was intended to reduce PM exposure by advising people to refrain from outdoor activities on highly polluted days. The present study aimed to estimate the effect of the PM10 alert system on people’s daily outdoor activity patterns using urban park (specifically, Children’s Grand Park) visitation data from Seoul, South Korea, from 2014–2019. Segmented regression was fitted to estimate whether the number of visitors to the park decreased on the days with PM10 alerts. PM10 concentration of 80 µg/m3, the cut-off point for a “Bad” alert, was set as a threshold, and discontinuity at the threshold and change in the relative risk after the threshold was tested. Time series regression was used to estimate the dose–response line between the ambient PM10 concentration and the daily number of park visitors. The number of park visitors decreased by 11.8% (relative risk: 0.881, 95% confidence interval: 0.808, 0.960) when a “Bad” alert was issued (PM10 level above 80 µg/m3) compared to when the alert level was “Normal” (PM10 level less than 80 µg/m3). The present study found evidence that the PM10 alert influenced people’s daily outdoor activities in Seoul, Korea. As the main purpose of the PM alert is to encourage people to refrain from outdoor activities, evaluating the relationship between PM alerts and behavior patterns can help to grasp the effectiveness of the policy. Further efforts should be made to investigate whether the observed behavioral change leads to reductions in health outcomes caused by PM.
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Rauenzahn, Sherri L., Susanne Schmidt, Nazneen Ali, and Laura LaNiel Tenner. "Utilization of an electronic medical record trigger to promote palliative care consultation in ambulatory oncology." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18201-e18201. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18201.
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e18201 Background: Research insupportive care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent supportive care in patients with advanced cancer and high symptom burden, integrating supportive services is challenging. Our aims were to 1) implement an electronic medical record (EMR) provider alert of high symptom burden based on Edmonton Symptom Assessment Scale (ESAS) criteria and 2) determine the impact an alert has on supportive service referrals. Methods: ESAS scores were implemented in medical ambulatory oncology clinics to quantitatively assess symptom burden. An EMR alert was programmed for a total ESAS score > 30 and any single response of ≥9 to capture approximately 15% of our high symptom burden patient population. The provider could elect to accept the alert placing an order for palliative consultation or decline the prompt. Referral rates and symptom assessment scores were followed as metrics for EMR alert efficiency. Results: Over 10 months, 9,710 patient visits used the ESAS system resulting in 7,707 fully completed ESAS scores (79.4% completion rate). There were 78 total consults to palliative care, a referral rate of less than 1% of the population, which was unchanged from prior to trigger implementation. Of the total completed ESAS forms, the trigger alerted 686 times (8.9% of patient visits) with only 55 of those triggers leading to a supportive care referral (8.0%). Conclusions: This project highlights the challenges of an EMR based alert system and the need for continued efforts to improve supportive care referrals through provider education and tool implementation. [Table: see text]
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Seidling, Hanna M., Ulrike Klein, Matthias Schaier, David Czock, Dirk Theile, Markus G. Pruszydlo, Jens Kaltschmidt, Gerd Mikus, and Walter E. Haefeli. "What, if all alerts were specific – Estimating the potential impact on drug interaction alert burden." International Journal of Medical Informatics 83, no. 4 (April 2014): 285–91. http://dx.doi.org/10.1016/j.ijmedinf.2013.12.006.
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Brown, Ellen L., Nicole Ruggiano, and James T. Meadows. "The Caregiver Burden Alert: A Graphic Tool for Dementia Caregiver Burden Screening and Referral." Home Health Care Management & Practice 30, no. 3 (December 12, 2017): 103–9. http://dx.doi.org/10.1177/1084822317743476.
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Annually, 5.4 million people are affected by Alzheimer’s disease and other forms of dementia (AD), most of whom are cared for by unpaid family caregivers and are medically supervised by primary care providers (PCPs). AD caregivers report feelings of satisfaction in their ability to provide care, though they often experience caregiver burden (CB) from the extensive physical and emotional effort involved in AD caregiving, especially when providing care to someone with advanced AD. Standardized measures have been developed to assess for CB among AD caregivers, and effective interventions have been developed for reducing CB. However, there currently lacks a standardized, feasible approach for CB screening. This article presents an innovative, evidence-based tool to prompt CB screening and referrals among AD caregivers receiving home care services.
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Hernandez, Karen, Mahmoud El-Tamer, Jonathan Gurman, Robin Moulder, Reshma Nevrekar, Donna Robinson, Kimberly Sarwan-Vega, and Svetlana Granovsky. "Clinical decision support to reduce laterality ordering errors for breast imaging procedures." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 241. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.241.
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241 Background: Data showed 46 modifications to breast imaging orders upon patient arrival to the Radiology Department, in a 4 month period (Sept-Dec 2014.) Upon further investigation, we found that patients were arriving in radiology, scheduled for exams for which the laterality needed to be modified prior to the exam. (The most frequent occurrence was a patient with a history of a unilateral mastectomy, arriving in radiology for a bilateral mammogram.) These laterality order errors were traced back to either the referring LIP requesting the exam, or to the referring office’s clerical staff transcribing the order. The ordering errors came from many different referring services. Methods: Our objective was to develop Clinical Decision Support in our Clinical Information System (CIS,) to offer an upfront alert of a potentially incorrect laterality when a user was entering or transcribing an order, prompting the user to confirm that the correct exam had been ordered before scheduling took place. The Health Informatics team developed a Medical Logic Module (MLM) in CIS which cross-checks the surgical history in the Clinical Documentation Operative Notes with the current CIS order; if a mismatch is found, the alert fires. Results: In the first 2 months (Dec 2016-Jan 2017), 110 alerts were generated. Fifty-seven alerts flagged users of incorrect orders which were corrected before being scheduled; 21 MLM alerts were acknowledged and comments entered explaining the need for the test; 32 alerts did not generate an order (and in most of these instances, the user backed out and entered the incorrect order again; upon the second time seeing the alert, they changed the order, resulting in many of the 57 changed orders referenced above). Conclusions: The MLM alert allows for immediate feedback to the user entering an order with a potentially incorrect laterality. Not only does this reduce the time and burden associated with investigating and modifying these orders upon patient arrival; more importantly, it ensures orders are entered correctly from the start, reducing the possibility of an incorrect exam taking place.
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Callander, Emily J., and Stephanie M. Topp. "Health inequality in the tropics and its costs: a Sustainable Development Goals alert." International Health 12, no. 5 (January 17, 2020): 395–410. http://dx.doi.org/10.1093/inthealth/ihz112.
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Abstract Background It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP). Methods We constructed a series of concentration indices showing between-country inequalities in disability-adjusted life years (DALYs), taken from the Global Burden of Disease Study. We then utilized a non-linear least squares model to estimate the influence of health on GDP and counterfactual analysis to assess the GDP for each country had there been no between-country inequality. Results The poorest 25% of the tropical population had 68% of the all-cause DALYs burden in 2015; 82% of the communicable, maternal, neonatal and nutritional DALYs burden; 55% of the non-communicable disease DALYs burden and 61% of the injury DALYs burden. An increase in the all-cause DALYs rate of 1/1000 resulted in a 0.05% decrease in GDP. If there were no inequality between countries in all-cause DALY rates, most high-income countries would see a modest increase in GDP, with low- and middle-income countries estimated to see larger increases. Conclusions There are large and growing inequalities in health in the tropics and this has significant economic cost for lower-income countries.
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Seiler, Amber, Sarah Rosemas, Jiani Zhou, and John Rogers. "UTILIZATION OF REMOTE REPROGRAMMING TO MANAGE INSERTABLE CARDIAC MONITOR ARRHYTHMIA ALERT BURDEN." Cardiovascular Digital Health Journal 3, no. 4 (August 2022): S23—S24. http://dx.doi.org/10.1016/j.cvdhj.2022.07.054.
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Drees, Marci, Michael Winiarz, Zugui Zhang, Robert Dressler, and Stephen C. Eppes. "88. A Behavioral Economic Approach to C. difficile Testing Stewardship." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S60. http://dx.doi.org/10.1093/ofid/ofaa439.133.
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Abstract Background To decrease inappropriate testing for C. difficile patients, we first employed an alert, followed by a hard stop (based on lack of documented diarrhea or laxative use), that could be overridden only by calling the laboratory. We describe a behavioral economic approach to test overrides that decreased the burden on both clinicians and laboratory staff without encouraging unnecessary testing. Methods Our 2-hospital, > 1200-bed community-based academic healthcare system has performed PCR-only C. diff testing since January 2015. We implemented our initial laxative alert, which did not prohibit testing, in March 2015. In April 2017, we launched a “hard-stop” alert that cancelled orders without documented diarrhea or recent laxative use. The provider could override by calling the laboratory and documenting the laboratorian’s name in the order; no further justification was required, but entries were intermittently monitored. In August 2019, we allowed clinicians to document their clinical justification instead of making this additional call, while emphasizing that rationales would be monitored for validity (Fig 1). We measured number of C. diff tests completed/month, overrides, and CDI standardized infection ratios (SIRs). We performed time-series analysis to account for each of these test ordering changes. Figure 1: Image of C. diff alert Results At baseline, we observed a mean of 448 (SD, ±25) C. diff orders per month. The initial laxative alert led to a sustained decrease in monthly C. diff orders by 17% (p < 0.001; Fig 2). Another sustained decrease in monthly C. diff orders of an additional 29% (p< 0.001) occurred after the “hard stop” alert. Overall, C. diff orders decreased by 40% (3.5% per month). After introduction of the clinical justification documentation, to date we have not observed significant trends in C. diff override rates. The CDI SIR decreased from 0.9 (95% CI, 0.77- 1.04) in 2016 to 0.52 (0.42–0.64) in 2019. Figure 2: Interrupted time series analysis Conclusion An iterative process to improve C. diff testing stewardship resulted in sustained improvements in C. diff ordering and hospital onset CDI cases. Behavioral economic approaches emphasizing the importance of clinical reasoning allowed us to reduce burden on clinicians and laboratory staff without increasing inappropriate testing. Disclosures All Authors: No reported disclosures
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Lusiana, Merry, Tati Nuryati, Toha Muhaimin, and Rizki Edmi Edison. "Perilaku Waspada Stroke Pengidap Hipertensi." Health and Medical Journal 3, no. 2 (July 1, 2021): 33–36. http://dx.doi.org/10.33854/heme.v3i2.680.
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Introduction: Non infectious disease is a major health problem especially in developing countries. Among those, stroke always be the leading one that occurs followed by health burden. Some factors in increasing of mortality and disability due to stroke are lack of understanding of risk factors and awareness to early signs especially among people with hypertension. If the factors those influence the knowledge, awareness, and others stroke alert behaviors are known, promotive or prevention acts could be done by health workers. Aims: The aim of this study is to find out the stroke alert behavior among them that conducted at Puskesmas Cengkareng of West Jakarta on July and August 2020. Method: 116 patients were participated to fill the questionnaire and analyzed with cross-sectional design. Results: Our study revealed that knowledge, perception of utility, and perception to level of disease severity is the most influenced factor to stroke alert behavior.
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McCabe, Pamela J., Kristin Vickers Douglas, Debra L. Barton, Christine Austin, Adriana Delgado, and Holli A. DeVon. "Feasibility Testing of the Alert for AFib Intervention." Western Journal of Nursing Research 39, no. 2 (July 11, 2016): 252–72. http://dx.doi.org/10.1177/0193945916656609.
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Improving early detection and treatment of atrial fibrillation (AF) is critical because untreated AF is a major contributor to stroke and heart failure. We sought to generate knowledge about the feasibility of conducting a randomized controlled trial to test the effect of the Alert for AFib intervention on knowledge, attitudes, and beliefs about treatment-seeking for signs and symptoms of AF. Adults ≥65 years old (96% White) at risk for developing AF were randomized to receive the Alert for AFib intervention ( n = 40) or an attention control session ( n = 40). Feasibility goals for recruitment, participant retention, adherence, perceived satisfaction and burden, and intervention fidelity were met. From baseline to study completion, knowledge ( p = .005) and attitudes ( p < .001) about treatment-seeking improved more in the intervention group compared with the control group. Results support testing the effectiveness of the Alert for AFib intervention in a large trial.
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Wilson, C. M., S. Tobin, and R. C. Young. "The exploding worldwide cancer burden." International Journal of Gynecologic Cancer 14, no. 1 (January 2004): 1–11. http://dx.doi.org/10.1136/ijgc-00009577-200401000-00001.
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Although age-adjusted cancer death rates have started to decline in the United States and other developed nations – thanks in large part to widespread screening programs that detect cancers at early, treatable stages – cancer in developing countries is on the rise. Ironically, rising life expectancy in those nations along with the adoption of ‘Western’ lifestyles will leave many more people vulnerable to cancer. Unfortunately, the early detection tools and treatment technology that have helped control cancer in wealthier lands are often not readily available in many other countries.Much of this increased cancer burden will take the form of cancers that affect women – not only breast, cervical, and other gynecologic cancers but colorectal cancer, lung cancer, and other malignancies related to tobacco. Physicians specializing in cancer care for women need to be alert to every opportunity to improve cancer screening and prevention among the growing, aging populations of less-developed countries.Less precise but less costly and more widely available screening techniques may save thousands more lives than the most sophisticated technology because low-cost programs can be applied widely instead of being reserved for a fortunate few. In addition, education and prevention efforts directed toward tobacco use need to be put in place to help stem an epidemic of tobacco-related cancers that has largely peaked in developed countries but looms ominously in the future of developing nations.
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Vaidyanathan, Ambarish, Shubhayu Saha, Ana M. Vicedo-Cabrera, Antonio Gasparrini, Nabill Abdurehman, Richard Jordan, Michelle Hawkins, Jeremy Hess, and Anne Elixhauser. "Assessment of extreme heat and hospitalizations to inform early warning systems." Proceedings of the National Academy of Sciences 116, no. 12 (March 4, 2019): 5420–27. http://dx.doi.org/10.1073/pnas.1806393116.
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Heat early warning systems and action plans use temperature thresholds to trigger warnings and risk communication. In this study, we conduct multistate analyses, exploring associations between heat and all-cause and cause-specific hospitalizations, to inform the design and development of heat–health early warning systems. We used a two-stage analysis to estimate heat–health risk relationships between heat index and hospitalizations in 1,617 counties in the United States for 2003–2012. The first stage involved a county-level time series quasi-Poisson regression, using a distributed lag nonlinear model, to estimate heat–health associations. The second stage involved a multivariate random-effects meta-analysis to pool county-specific exposure–response associations across larger geographic scales, such as by state or climate region. Using results from this two-stage analysis, we identified heat index ranges that correspond with significant heat-attributable burden. We then compared those with the National Oceanic and Atmospheric Administration National Weather Service (NWS) heat alert criteria used during the same time period. Associations between heat index and cause-specific hospitalizations vary widely by geography and health outcome. Heat-attributable burden starts to occur at moderately hot heat index values, which in some regions are below the alert ranges used by the NWS during the study time period. Locally specific health evidence can beneficially inform and calibrate heat alert criteria. A synchronization of health findings with traditional weather forecasting efforts could be critical in the development of effective heat–health early warning systems.
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DRAKE, JOHN M., and REUBEN P. KELLER. "Environmental Justice Alert: Do Developing Nations Bear the Burden of Risk for Invasive Species?" BioScience 54, no. 8 (2004): 719. http://dx.doi.org/10.1641/0006-3568(2004)054[0719:ejaddn]2.0.co;2.
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O'Shea, C., K. Campbell, J. Hendriks, A. Brooks, D. Lau, and P. Sanders. "Remote Monitoring Alert Burden from Implantable Cardioverter Defibrillators: An Analysis of >4000 Patients." Heart, Lung and Circulation 28 (2019): S316. http://dx.doi.org/10.1016/j.hlc.2019.06.421.
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McGowen, Chelsea L., Nicole E. Caston, Sheila K. McElhany, Bryanna E. Diaz, Carrie C. McNair, Jeffrey Franks, Courtney J. Andrews, et al. "Trajectory of symptoms reported in remote symptom monitoring over the course of oncology treatment for gynecologic cancers." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 270. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.270.
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270 Background: Patients now have the ability to utilize electronic patient reported outcomes (ePROs) for remote symptom monitoring (RSM). This analysis seeks to better understand trajectory of reported symptoms during treatment for patients with gynecologic cancer participating in RSM. Methods: We approached patients with gynecological cancer initiating treatment at the Mitchell Cancer Institute (MCI) between 7/1/21-4/30/2022. Patients were eligible if they were starting chemotherapy, targeted therapy, or immunotherapy for a new cancer. Patients seeking a second opinion were excluded. Enrolled patients received symptom survey (PRO-CTCAE questions) via text or email once per week. Initially, only severe alerts were forwarded to the clinical care team; moderate alerts were forwarded to clinical teams once they were comfortable with alert management. Patients completed symptom assessments for 24 weeks or until withdrawal. Patient age at enrollment, race, sex, cancer type, cancer stage, and PROs were abstracted from electronic health records and the PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Results: A total of 60 female patients with gynecological cancer were enrolled; 33% were Black or African American and 67% were White; median age was 61 years (IQR 53-68). Seventy-eight percent (47/60) of patients reported 379 symptoms with at least one moderate or severe alert during this time period; 32% considered moderate and 68% considered severe. Overall, the most frequently reported symptom was pain (29%). At baseline (week 0), 14% and 41% of 56 patients reported moderate symptoms and severe symptoms, respectively. Symptom burden decreased over time with 4% and 7% of 27 patients who completed a survey at 12 weeks reporting moderate and severe symptoms. Specific symptom trajectories followed similar patterns. Conclusions: In our sample, patients reported the majority of symptoms during the first three months of treatment. Symptom trajectory decreased with time, suggesting symptoms are being effectively monitored and addressed by the clinical teams engaging in RSM. Future research is needed to understand if symptom improvement translates to increased quality of life, decreased hospitalizations, and increased survival for patients, as well as lessen the burden of call volume on the clinical team.
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Jones, C., L. Audas, N. Kureshi, L. Kamintsky, L. Fenerty, L. Wilson, C. Atkinson, A. Friedman, and DB Clarke. "P.185 Impact-detecting helmets as indicators of concussion and blood brain barrier integrity in university football players." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S73. http://dx.doi.org/10.1017/cjn.2021.461.
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Background: Repetitive sub-concussive head impacts have been associated with changes in brain architecture and neurological symptoms. In this study, we examined the association between repetitive sub-concussive impacts, impact burden, and blood brain barrier (BBB) integrity in university football players. Methods: 59 university football players were followed over the 2019 season. Athletes with diagnosed concussion and those sustaining impacts that alerted a sideline impact monitor (relayed by ferroelectric helmet sensors) underwent dynamic contrast-enhanced MRI (DCE-MRI) within one week of injury/alert, and 4 weeks following initial incident. Results: Helmets recorded 2648 impacts over 48 cumulative hours. 8 concussions occurred during the 2019 season (2.82 per 1000 activity hours). On average, athletes with a diagnosed concussion had 55.3 impacts to the front sensor, compared to 14.1 in non-concussed athletes. Athletes who consented to DCE-MRI (n=5) had 10.78% BBB-D within a week of concussion/alert, and 6.77% BBB-D at 4-weeks. Conclusions: We show quantification of BBB integrity relative to head impact burden for the first time. This preliminary study highlights the potential of impact-detecting helmets to provide relevant impact characteristics and offers a foundation for future work on neurological consequences of repetitive sub-concussive impacts.
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Damaso, Clarissa R. "The 2022 monkeypox outbreak alert: Who is carrying the burden of emerging infectious disease outbreaks?" Lancet Regional Health - Americas 13 (September 2022): 100315. http://dx.doi.org/10.1016/j.lana.2022.100315.
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Yordanov, Youri, Agnes Dechartres, Xavier Lescure, Caroline Apra, Pascaline Villie, Jerome Marchand-Arvier, Erwan Debuc, Aurélien Dinh, and Patrick Jourdain. "Covidom, a Telesurveillance Solution for Home Monitoring Patients With COVID-19." Journal of Medical Internet Research 22, no. 10 (October 22, 2020): e20748. http://dx.doi.org/10.2196/20748.
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In a matter of months, COVID-19 has escalated from a cluster of cases in Wuhan, China, to a global pandemic. As the number of patients with COVID-19 grew, solutions for the home monitoring of infected patients became critical. This viewpoint presents a telesurveillance solution—Covidom—deployed in the greater Paris area to monitor patients with COVID-19 in their homes. The system was rapidly developed and is being used on a large scale with more than 65,000 registered patients to date. The Covidom solution combines an easy-to-use and free web application for patients (through which patients fill out short questionnaires on their health status) with a regional control center that monitors and manages alerts (triggered by questionnaire responses) from patients whose health may be deteriorating. This innovative solution could alleviate the burden of health care professionals and systems while allowing for rapid response when patients trigger an alert.
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GROHS, P., B. PINEAU, G. KAC, L. GUTMANN, and G. MEYER. "Readmission of known MRSA carriers and MRSA colonization pressure in hospital." Epidemiology and Infection 141, no. 6 (September 11, 2012): 1181–86. http://dx.doi.org/10.1017/s0950268812001847.
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SUMMARYReadmission of asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) carriers may contribute to the hospital reservoir. Using an electronic alert system, we assessed the weight of readmission of known MRSA carriers on MRSA colonization pressure in a hospital setting. During the 2004–2010 period, 2058 alerts were generated for 1060 inpatients. A total of 486/1060 patients (46%) were readmitted at least once, and 330/486 (64·4%) were readmitted <3 months after discharge. A mean of 20 MRSA patients were present on the same day (from 40 in 2004 to eight in 2010). The number of MRSA patient-days was 34 575, i.e. 2·5% of the 1 366 277 patient-days of the study period, and 17 737 (51·3%) MRSA patient-days were due to readmission of known MRSA carriers. The number of new MRSA cases was partly correlated with the number of MRSA patients hospitalized (R2 = 0·49). Rapid electronic identification of these patients proved essential in decreasing the global burden of MRSA in our hospital.
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Giraldi, Guglielmo, Marzietta Montesano, Christian Napoli, Paola Frati, Raffaele La Russa, Alessandro Santurro, Matteo Scopetti, and Giovanni B. Orsi. "Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs." Current Pharmaceutical Biotechnology 20, no. 8 (August 28, 2019): 643–52. http://dx.doi.org/10.2174/1389201020666190408095811.
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Background: The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. Objective: The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital. Methods: The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant’Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost. Results: Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient. Conclusion: The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.
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Jans, Lennart, Anne Jurik, Iwona Sudoł-Szopińska, Claudia Schueller-Weidekamm, Iris Eshed, and Winston Rennie. "Anterior Chest Wall in Axial Spondyloarthritis: Imaging, Interpretation, and Differential Diagnosis." Seminars in Musculoskeletal Radiology 22, no. 02 (April 2018): 197–206. http://dx.doi.org/10.1055/s-0038-1639472.
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AbstractAnterior chest wall (ACW) inflammation is not an uncommon finding in patients with axial spondyloarthritis (ax-SpA) and reportedly occurs in 26% of these patients. Radiologists may only be familiar with spinal and peripheral joint imaging, possibly due to the inherent challenges of ACW imaging on some cross-sectional imaging modalities. Knowledge of relevant joint anatomy and the location of sites of inflammation allows the interpreting radiologist to better plan appropriate imaging tests and imaging planes. Accurate assessment of disease burden, sometimes in the absence of clinical findings, may alert the treating rheumatologist, allowing a better estimation of disease burden, increased accuracy of potential imaging scoring systems, and optimize assessment and response to treatment. This article reviews salient anatomy and various imaging modalities to optimize diagnosis, important differential diagnoses, and the interpretation of ACW imaging findings in ax-SpA.
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Pedersen, Birgith, Lisbeth Uhrenfeldt, Heidi Ramlov Jacobsen, and Lone Jørgensen. "The role of responsibility in oncological emergency telephone calls." Nursing Ethics 26, no. 7-8 (April 8, 2019): 2071–84. http://dx.doi.org/10.1177/0969733019839214.
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Background: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. Research objective: The aim was to explore the meaning of responsibility as it appeared in patients’ or caregivers’ experiences of calling an oncological emergency telephone. Design, participants and context: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. Ethical considerations: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. Findings: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to ‘be watchful and alert’, ‘report symptoms the right way’ and ‘do crosschecking’ and (2) to deal with the burden of responsibility was to ‘feel safe when dealing with the burden of responsibility’ and ‘be relieved from the burden of responsibility’. Discussion: Too much responsibility and a potential imbalance between healthcare professionals’ expectations and callers’ knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. Conclusion: The meaning of responsibility appeared in the participants’ capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.
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Araújo, Denizar Vianna, Luciana Bahia, and Steffan Frosi Stella. "The Economic Burden of HIV/AIDS and Myocardial Infarction Treatment in Brazil." Scientific World Journal 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/864962.
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Objective. To analyze the expenses of HIV/AIDS and acute myocardial infarction (AMI) treatment in Brazil.Methods. A search in the Brazilian epidemiological database (DATASUS) on AMI and AIDS hospitalizations and their costs was done from January 1998 to December 2011. The number of HIV/AIDS cases and antiretroviral treatment (ART) costs was obtained from public Brazilian databases.Results. In 5 years, HIV/AIDS cases increased 38.5%, mainly in patients aged 25–49. There were 180,640 patients in ART in 2007 at a cost of R$ 3,920 per patient/year. The hospitalizations due to AIDS were stable over the last 13 years; however, the hospitalizations due to AMI have increased 78%. In 2007, the expenses with hospitalizations for HIV/AIDS and AMI (25–49 years) were approximately 0.12 and 1.52% of the Ministry of Health budget allocated to reimburse inpatient costs. The expenses on ART totaled 1.5% of the total budget (all age groups).Conclusion. The prevalence of HIV/AIDS is still increasing in Brazil. There are scientific evidences suggesting an increased incidence of AIM in this population. Considering the high costs for the treatment of both diseases, an economic analysis is important to alert health managers to strengthen the preventive measures to guarantee the financial sustainability of such treatment.
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Shi, Qiuling, Ju-Whei Lee, Xin Shelley Wang, Michael J. Fisch, Victor T. Chang, Lynne Wagner, and Charles S. Cleeland. "Testing Symptom Severity Thresholds and Potential Alerts for Clinical Intervention in Patients With Cancer Undergoing Chemotherapy." JCO Oncology Practice 16, no. 9 (September 2020): e893-e901. http://dx.doi.org/10.1200/jop.19.00403.
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PURPOSE: Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS: We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group–American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n = 642), colorectal (n = 486), or lung cancer (n = 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds RESULTS: At the guideline-recommended threshold of ≥ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated ≥ 4 at the initiate survey. When the threshold was increased to ≥ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION: The burden to clinicians from an alert threshold of ≥ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level.
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O'Brien, Mary R., Barbara A. Jack, Karen Kinloch, Oliver Clabburn, and Katherine Knighting. "The Carers' Alert Thermometer (CAT): supporting family carers of people living with motor neurone disease." British Journal of Neuroscience Nursing 15, no. 3 (June 2, 2019): 114–24. http://dx.doi.org/10.12968/bjnn.2019.15.3.114.
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Background: Burden and distress among family carers of people living with motor neurone disease (MND) are reported widely. Evidence-based screening tools to help identify these carers' needs and plan appropriate support are urgently needed. Aim: To pilot the Carers' Alert Thermometer (CAT), a triage tool developed to identify carers' needs, with family carers of people living with MND to determine its usefulness in identifying their need for support. Methods: Training workshops with MND Association visitors (AVs) and staff in southwest and northwest England, followed by implementation of the CAT. A self-completed online survey and semi-structured telephone interview evaluated use of the CAT. Findings: Sixteen participants completed the online survey with 11 volunteering to be interviewed. The CAT has potential to map change over time, help to focus on carers' needs and improve communication with carers. Conclusion: The CAT provides a structure enabling AVs to engage in a meaningful process with family carers to identify and discuss their needs.
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Dent, D'Ambra, Stacey A. Ingram, Valerie Lawhon, Omer Jamy, Smith Giri, Julie Scott, Nadia Still, Debra Wujcik, and Gabrielle Betty Rocque. "Patient responses to weekly electronic patient-reported outcomes." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 182. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.182.
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182 Background: Home-based symptom monitoring using patient reported outcomes has been shown to reduce symptom burden and hospitalizations, while improving quality of life and overall. The primary goal of this study was to evaluate the early feasibility of home-based symptom monitoring. Methods: This prospective single-arm pilot study evaluated a two-part education and technology intervention (home-based symptom monitoring) for clinicians treating Multiple Myeloma (MM) and Acute Myeloid Leukemia (AML) patients. Inclusion criteria included patients ≥ 60 who were anticipating a treatment decision. Participants completed a baseline survey and then enrolled into the PROmpt® symptom monitoring platform, which used text or email to prompt weekly symptom surveys. Patients receive an auto-generated self-management plan based on electronic patient reported outcomes (ePRO). If severe symptoms were reported (score of > 7/10), alerts were sent to clinical nurses. Outcomes for this study included proportion of patient approach who agreed to participate, patient completion rates (completion of weekly surveys), compliance rate (completion of total surveys), number of alerts generated, and type of alert. Feasibility was defined as a completion rate of > 70%. Results: Between September 1, 2020 –May 19, 2021; 114 patients were screened, 77 were approached, and 35 were enrolled (18) MM, (17) AML patients. Of non-participants, 11 were not seeking care at the institution, 10 patients were uninterested or did not have a smartphone, 9 patients were ineligible, and 9 were unsure and left with information about the study, 3 declined enrollment. The majority (80%) or participants were ages 60-74; 20% of patients were ages 75+. Over the 13-week period, AML patients completed 195/220 (compliance rate of 89%). The average completion rate was 92%. For MM, 192/233 surveys were completed (82% compliance rate). The average completion rate was 94%. For AML, 9 was the average number of completed surveys and the average number for MM was 8. Over 3 months, there were 294 moderate to severe alerts generated for AML and MM patients. For AML patients, there were 40 fatigue, 25 constipation, 21 pain, 17 decreased appetite, 11 insomnia, 11 rash, 6 anxiety, 7 dyspnea/cough, 7 diarrhea, 5 depression/sadness, 4 nausea/ vomiting, 4 mouth/ throat sores, 3 neuropathy, 3 fever, and 2 alerts for other symptoms. Within a 3 month time span for MM patients, there was 35 pain, 21 constipation, 18 fatigue, 11 rash, 10 neuropathy, 9 anxiety, 7 insomnia, 6 depression/sadness, 4 decreased appetite, 4 other symptom, and 1 nausea/vomiting alert. Conclusions: This study demonstrated early feasibility with over 80% of patient completing their surveys with a high compliance rate. Future analysis will include both final implementation outcomes as well as patient outcomes for all patients within the study.
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Boston, Kelley M., Luis Ostrosky-Zeichner, Misti G. Ellsworth, and Tawanna A. McInnis-Cole. "1623. Implementation of Electronic Readmission Alert for Discharged Patients Reduces Risk of Secondary Measles Exposure Events." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S592. http://dx.doi.org/10.1093/ofid/ofz360.1487.
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Abstract Background Measles is a highly infectious illness that is causing increased numbers of outbreaks in the United States. Patients involved in a healthcare measles exposure and who have been discharged before identification of exposure are at risk of becoming infectious in the community, and may seek healthcare within their infectious window, creating a secondary exposure risk for healthcare systems. A measles exposure in an integrated healthcare system occurred, resulting in patient exposures in multiple locations at three campuses, including two community-based emergency departments and three inpatient units. There were 159 patients who were included in the exposure group; 123 were exposed in an ED, and 36 were exposed in an inpatient setting. Ninety-four percent (149/159) of the patients had been discharged at the time of measles case identification and were in the pre-infectious phase of illness. Of those, 36 percent (54/149) presented back to the healthcare system within the potentially infectious window; these 54 patients had 97 individual healthcare contacts in the potentially infectious period following the exposure event. Sixty-one of the 97 return visits (63%) were within the window in which the exposed patients were potentially infectious. Return locations included the three exposure facilities and inpatient and outpatient locations at 10 other system campuses. Methods An alert system was developed within the electronic medical record that identified patients that were involved in the exposure, and guided clinicians to mask and place in airborne isolation until measles immunity was verified. Results The alert activated 13 days after the exposure was identified, and identified 100% of returns to healthcare at all sites within the system, representing 48% of all potential secondary exposure events (29 /61). No secondary exposures or transmission occurred. Conclusion Measles exposures are an enormous burden on healthcare organizations and public health systems. When exposures occur, healthcare organizations need systems to rapidly identify discharged patients who may return within the potentially infectious window. Rapid development of electronic readmission alerts can help standardize identification and reduce the risk of subsequent exposure. Disclosures All authors: No reported disclosures.
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Pérez-Lago, Laura, Marta Herranz, Yurena Navarro, María Jesús Ruiz Serrano, Pilar Miralles, Emilio Bouza, and Darío García-de-Viedma. "Clonal Complexity in Mycobacterium tuberculosis Can Hamper Diagnostic Procedures." Journal of Clinical Microbiology 55, no. 5 (February 15, 2017): 1388–95. http://dx.doi.org/10.1128/jcm.00149-17.
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ABSTRACT Clonal complexity is increasingly accepted in Mycobacterium tuberculosis infection, including mixed infections by ≥2 strains, which usually occur in settings with a high burden of tuberculosis and/or a high risk of overexposure to infected patients. Mixed infections can hamper diagnostic procedures; obtaining an accurate antibiogram is difficult when the susceptibility patterns of the strains differ. Here, we show how mixed infections can also prove challenging for other diagnostic procedures, even outside settings where mixed infections are traditionally expected. We show how an unnoticed mixed infection in an HIV-positive patient diagnosed in Madrid, Spain, with differences in the representativeness of the coinfecting strains in different sputum samples, markedly complicated the resolution of a laboratory cross-contamination false positivity alert.
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Queiroz-Telles, Flá vio de, Paula Massaroni Peçanha Pietrobom, Marcos Rosa Júnior, Rodrigo de Melo Baptista, and Paulo Mendes Peçanha. "New Insights on Pulmonary Paracoccidioidomycosis." Seminars in Respiratory and Critical Care Medicine 41, no. 01 (January 30, 2020): 053–68. http://dx.doi.org/10.1055/s-0039-3400544.
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AbstractParacoccidioidomycosis (PCM) is one of the most relevant systemic endemic mycoses in Latin American countries, especially in South American countries, with endemic and hyperendemic areas. The real burden of PCM may be underestimated because of a lack of compulsory case notification. Recent phylogenetic data revealed that Paracoccidioides brasiliensis comprises several cryptic species including P. brasiliensis and P. lutzii. However, the genetic biodiversity of Paracoccidioides does not affect the clinical manifestations or therapeutic response to therapy. Lung involvement is a common finding, especially in patients experiencing the chronic form of the disease, and, because of its similarities with tuberculosis, clinicians must be alert to the possibility of PCM in patients with chronic respiratory manifestations and epidemiological risk factors for this fungal disease.
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Henostroza, German, Stephanie M. Topp, Sisa Hatwiinda, Katie R. Maggard, Winifreda Phiri, Jennifer B. Harris, Annika Krüüner, et al. "The High Burden of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in a Large Zambian Prison: A Public Health Alert." PLoS ONE 8, no. 8 (August 14, 2013): e67338. http://dx.doi.org/10.1371/journal.pone.0067338.
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Offodile, Anaeze Chidiebele, Domenica Delgado, Yu-Li Lin, Danielle Geyen, Christopher Miller, Sanchita Jain, Janice Finder, Sanjay Shete, Michael J. Overman, and Susan K. Peterson. "Implementation of electronic patient-reported outcomes and biometrics surveillance for the management of chemotherapy-related symptom burden: Results from a decentralized feasibility pilot study." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 425. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.425.
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425 Background: Monitoring patient-reported outcomes (PROs) in the ambulatory setting is an effective modality for chemotherapy-related symptom management. However, much is unknown about the utility of active surveillance of vital signs (i.e. biometrics) in this context. Such an undertaking is also highly complex with technology, workflow, and patient experience components. This decentralized pilot study aimed to investigate the implementation and feasibility of nurse-led active surveillance of chemotherapy-related symptom burden via the electronic collection of PROs and biometrics. Methods: Consecutive adult patients with gastrointestinal (GI) or thoracic cancer, at high risk for emergency room (ER) visits based on published criteria, were approached. Consenting patients performed daily reporting of symptom burden via the Patient reported Outcomes version of the Common Terminology Criteria for Adverse Events and biometrics over a one-month period. Biometric data (pulse, blood pressure, oxygen saturation, weight, and temperature) was captured via Bluetooth-enabled sensors which were integrated with a HIPAA-compliant, secure tablet interface that also enabled the provision of self-care materials and video conferencing. Data, including pre-specified threshold alerts, were sent to a web-based dashboard monitored by a registered nursing team, who triaged patient alerts based on standard operating procedures. Acceptability, appropriateness, and feasibility were measured via validated instruments. Program adherence was defined as the completion of > 70% of PRO survey and biometric reporting requirements ≥ 4 days per week. Patient satisfaction, technology ease of use, and ER admission rates were also collected. Results: Over an eight-month period, thirty-six patients consented to participate, and twenty-five (60% GI) completed the study. Participants had a mean age of 58.0 (range 36-74), mean ECOG score of 0.88, were 52% female, and were predominantly stage IV or recurrent disease (72%). Program adherence rate was 73% and mean scores for acceptability, feasibility, and appropriateness were 4.63, 4.56, and 4.46 respectively. Alert distribution were 28% PROs, 70% biometrics and 2% patient-initiated communication. System usability scale and Net Promoter Score were 88 and 55 respectively. Scores for patient satisfaction score and technology ease of use were 94% and 100% respectively. The rate of ER visits over the pilot period was 8%. Conclusions: Implementation of active surveillance of chemotherapy-related symptom burden via self-reporting of PROs and biometrics is highly acceptable, feasible, and appropriate to patients. It is also associated with low ER visitation rates relative to historical values and high rates of patient satisfaction and ease of use. Clinical trial information: NCI202107464.
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Lai, Jin-Shei, Devin Peipert, Sally Jensen, Megan Urban, Stewart Goldman, and Alicia Lenzen. "QOL-16. SYMON-SAYS (SYMPTOM MONITORING & SYSTEMATIC ASSESSMENT AND REPORTING SYSTEM IN YOUNG SURVIVORS) PROGRAM HAS THE POTENTIAL TO DECREASE SYMPTOM BURDEN ON CHILDREN WITH CANCER." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii244. http://dx.doi.org/10.1093/neuonc/noac209.943.
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Abstract AIMS The unrelieved symptoms and side effects of often-aggressive cancer treatments can lead to poor outcomes. SyMon-SAYS was developed to minimize symptom management barriers and symptom burdens by routinely collecting and interpreting patient-reported outcomes in pediatric oncology ambulatory settings. This paper reports the preliminary results of the 16-week SyMon-SAYS trial. METHODS Children (ages 8-17) with cancer (on-therapy or within 6-M post-treatment) were randomly assigned to either intervention (IG; weeks 1-16 intervention) or waitlist (WG; weeks 1-8 waitlist, weeks 9-16 intervention) group. Children in the intervention phase reported on 9 symptoms (fatigue, sadness, itch, pain, worry, appetite, nausea, sleep, headache) weekly via an electronic medical record patient portal. Scores exceeding a pre-defined threshold triggered an alert to the treatment team. Parents completed a symptom management barriers questionnaire (SMBQ) at baseline, weeks 8 (primary time-point and analyzed in this paper) and 16. Mixed-effects models were used to evaluate symptom burden over time. RESULTS Data from 75 children (37 IG, 38 WG) were analyzed (mean age=13.3 years, 58.8% male, 74.7% white). Of them, 43.9% had leukemia, and 17.5% brain tumor. On average, the IG completed 11 (possible min=0 max=16) and the WG completed 5 (possible min=0 max=8) symptom checklists; of them, 60% triggered symptom alerts. Results of the mixed-effects models showed significantly (p< 0.05) improvement in fatigue, sadness, worry, appetite and headache. No significant changes were found on others. For SMBQ, IG parents reported significantly in favor of “enough time with my child's doctors/nurses to talk about symptoms” than WG parents from baseline to week 8. No significant differences between IG and WG over time on other SMBQ items. CONCLUSIONS Our preliminary findings showed SyMon-SAYS alleviated emotional related symptoms over time. Physical symptoms might be related more to disease severity and treatment intensity, which we plan to investigate when more data is available.
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Dai, Wei, Wenhong Feng, Yuanqiang Zhang, Xin Shelley Wang, Yangjun Liu, Cecilia Pompili, Wei Xu, et al. "Patient-Reported Outcome-Based Symptom Management Versus Usual Care After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial." Journal of Clinical Oncology 40, no. 9 (March 20, 2022): 988–96. http://dx.doi.org/10.1200/jco.21.01344.
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PURPOSE We aimed to evaluate the efficacy and feasibility of patient-reported outcome (PRO)-based symptom management in the early period after lung cancer surgery. METHODS Before surgery, patients with clinically diagnosed lung cancer were randomly assigned 1:1 to receive postoperative PRO-based symptom management or usual care. All patients reported symptoms on MD Anderson Symptom Inventory-Lung Cancer presurgery, daily postsurgery, and twice a week after discharge for up to 4 weeks via an electronic PRO system. In the intervention group, treating surgeons responded to overthreshold electronic alerts driven by any of the five target symptom scores (score ≥ 4 on a 0-10 scale for pain, fatigue, disturbed sleep, shortness of breath, and coughing). The control group patients received usual care and no alerts were generated. The primary outcome was the number of symptom threshold events (any target symptom with a score of ≥ 4) at discharge. Per-protocol analyses were conducted. RESULTS Of the 166 participants, 83 were randomly allocated to each group. At discharge, the intervention group reported fewer symptom threshold events than the control group (median [interquartile range], 0 [0-2] v 2 [0-3]; P = .007). At 4 weeks postdischarge, this difference was maintained between the intervention and control groups (median [interquartile range], 0 [0-0] v 0 [0-1]; P = .018). The intervention group had a lower complication rate than the control group (21.5% v 40.6%; P = .019). Surgeons spent a median of 3 minutes managing an alert. CONCLUSION PRO-based symptom management after lung cancer surgery showed lower symptom burden and fewer complications than usual care for up to 4 weeks postdischarge.