The conference addressed mobile technologies, knowledge-driven applications and computer-assisted decision support, as well as apps designed to support the elderly and those with chronic conditions in their daily lives.

The 23 conference papers, three keynotes and two specially invited contributions included here address the fundamental scientific and methodological challenges of adaptive, autonomous and intelligent pHealth approaches.

This book is open access until the 11 June 2015

http://ebooks.iospress.nl/volume/phealth-2015-proceedings-of-the-12th-international-conference-on-wearable-micro-and-nano-technologies-for-personalized-health-2-4-june-2015-vaumlsterarings-swed

Blobel, B., et al. (Eds.). (2015). pHealth 2015. Studies in Health Technology and Informatics, 211.

Trauma specialists at Sydney’s Westmead hospital have been trialling a new digital application (App) to assist in the quick decision-making needed to treat patients, according to an article from the latest ANZ Journal of Surgery, released by the Royal Australasian College of Surgeons (RACS).

The app, which was released on trial at the start of the year, contains 32 distinct algorithms on single page flow diagrams, using pinch and zoom options as well as jump-words and pop-ups for rapid access to information.

The app was designed to translate existing information into an easily accessible content across multiple platforms.

In the four months following its launch it has been downloaded 733 times and rated 4.5 out of 5 stars, with a small fee applied to allow for updates.

The objective of the app was to allow easy real-time access to trauma algorithms, and therefore reduce omissions or errors. Funding came from a New South Wales Motor Accidents Authority grant and took six months to develop.

Trauma Specialist and study author Jeremy Hsu said a key factor influencing the decision for developing the app was the staffing profile within the hospital, with senior consultants not available on-site 24 hours a day.

“Systems must be created to ensure the best care for the patient, irrespective of the level of attending medical expertise.”

“The algorithms and app have been formulated to provide a safe reproducible framework for the management of trauma patients,” Dr Hsu said.

“The best trauma care lends itself to standardised practice and the widespread use of digital health technology has provided us with opportunities to provide more effective and efficient trauma care.” 

This Australian study explored the use of a cancer risk tool, which implements the QCancer model, in general practitioner consultations and its potential impact on clinical decision making.

The risk tool was perceived by participating GPs as being potentially useful for patients with complex histories. More experienced GPs were distrustful of the risk output, especially when it conflicted with their clinical judgement. Variable interpretation of symptoms meant that there was significant variation in risk assessment.

To access a free full-text version of the article, go to: http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc201546a.html

Chiang, P. P-C., et al. (2015). Implementing a QCancer risk tool into general practice consultations: An exploratory study using simulated consultations with Australian general practitioners. British Journal of Cancer, Advance online publication, 3 March 2015, doi: 10.1038/bjc.2015.46.

Twenty-nine studies were included. "Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities)".

The authors conclude that "... policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs".

Now available to read in free full text at: http://dx.doi.org/10.1016/j.hjdsi.2014.09.002 

Trenaman, L., et al. (2014). The cost-effectiveness of patient decision aids: A systematic review. Healthcare, 2(4), 251–257.

The purpose of this review is to synthesise findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation.

This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organisation, the process of implementation and characteristics of the individual healthcare providers. These included: organisational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs.

The authors conclude that these findings highlight the importance of assessing organisational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers' and organisational perspective.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12875-014-0219-0

Kadu, M. & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care model in primary care: A systematic review. BMC Family Practice, 16:12.

Twenty-eight randomised controlled trials were included and, based on their analysis, the authors conclude that, "across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes".

This article is available to read in free full text at:  http://dx.doi.org/10.2105/AJPH.2014.302164

Moja, L., et al. (2014). Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis. American Journal of Public Health, 104(12), e12-e22.

The study found that in these healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1161/CIRCOUTCOMES.114.001235 or contact your DHB library, or organisational or local library for assistance.

Peiris, D., et al. (2015). Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: The treatment of cardiovascular risk using electronic decision support cluster-randomized trial. Circulation: Cardiovascular Quality & Outomes, Published online before print 13 January 2015, doi: 10.1161/CIRCOUTCOMES.114.001235.

Based on the results of the review, the authors conclude that "cancer-related decision aids have evolved over time, and there is considerable diversity in both format and available evidence. We found strong evidence that cancer-related decision aids increase knowledge without adverse impact on decisional conflict or anxiety. We found moderate- or low-strength evidence that patients using decision aids are more likely to make informed decisions, have accurate risk perceptions, make choices that best agree with their values, and not remain undecided. This review adds to the literature that the effectiveness of cancer-related decision aids does not appear to be modified by specific attributes of decision aid delivery format, content, or other characteristics of their development and implementation. Very limited information was available on other outcomes or on the effectiveness of interventions that target providers to promote shared decision making by means of decision aids".

This systematic review was conducted under contract to the U.S. Agency for Healthcare Research and Quality.

The report is available to download and read in free full text at:  http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=2029&pageaction=displayproduct

Trikalinos TA, Wieland LS, Adam GP, Zgodic A, Ntzani EE. (2014). Decision aids for cancer screening and treatment . Comparative Effectiveness Review No. 145. Rockville, MD: Agency for Healthcare Research and Quality. 

Common themes include: nurse factors affecting usage; patient factors affecting usage; technology and design factors affecting usage; and organisational factors affecting usage. "Two major implications are that these systems may not be designed to support nursing practice and may not be having the intended effect on patient care and quality".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/CIN.0000000000000110 or contact your DHB library, or organisational or local library for assistance.

Piscotty, R. and Kalisch, B. (2014). Nurses’ use of clinical decision support: A literature review. CIN: Computers, Informatics, Nursing, 32(12), 562-568

Topics covered by J-BHI include: acquisition, transmission, storage, retrieval, management, processing and analysis of biomedical and health information; applications of information and communication technologies in the practice of healthcare, public health, patient monitoring, preventive care, early diagnosis of diseases,  discovery of new therapies, and patient specific treatment protocols leading to improved outcomes; and the integration of electronic medical and health records, methods of longitudinal data analysis, data mining and discovery tools.

An integrated operations centre (IOC) is a central hub from where the day’s activity and responses are coordinated. It enables key teams to use real time information for clinical and operational decision making across the organisation.

To read the full media release from Capital and Coast DHB, go to: http://www.scoop.co.nz/stories/GE1410/S00157/integrated-operations-centre-goes-live-at-capital-coast.htm

• Evidence-based medicine
• Clinical practice guidelines
• Clinical decision making
• Clinical services organisation
• Implementation and delivery
• Health economic evaluation
• Health process
• Outcome measurement and
• New or improved methods (conceptual and statistical) for systematic inquiry into clinical practice.

"Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists".

Based on their analysis, the authors conclude that "it is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing".

Available to read in free full text at: http://dx.doi.org/10.1002/14651858.CD008165.pub3

Patterson, S.M., Cadogan, C.A., Kerse, N., Cardwell, C.R., Bradley, M.C., Ryan, C., Hughes, C. (2014). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 10, CD008165.

The book is divided into 15 sections, which include: decision support systems and clinical practice guidelines; improved healthcare through informatics; data analysis; mobile health; technology and system evaluation; and text mining. The final two sections present posters from the conference.

This e-book is open access and the content can be downloaded and read in full text at: http://ebooks.iospress.nl/volume/e-health-for-continuity-of-care-proceedings-of-mie2014

Sixty-three studies were included. The authors identify a number of research gaps, and many studies showed methodologic heterogeneity and an appreciable risk of bias. "Studies of computerized provider order entry with clinical decision support compared with studies without clinical decision support reported a 36% to 87% reduction in prescribing errors; studies of preprinted order sheets revealed a 27% to 82% reduction in prescribing errors".

The authors conclude that "pediatric medication errors can be reduced, although our understanding of optimal interventions remains hampered. Research should focus on understudied areas, use standardized definitions and outcomes, and evaluate cost-effectiveness".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1542/peds.2013-3531 or contact your DHB library, or organisational or local library for assistance.

Rinke, M.L., et al. (2014). Interventions to reduce pediatric medication errors: A systematic review. Pediatrics, 134(2), 338-360.

The authors conclude from their analysis that the decision aid had a "... high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents".

Available to read in full text at:  http://bjgp.org/content/64/625/e493.long

Tubeuf, S., et al. (2014). Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: A three-arm cluster randomised controlled trial in primary care. British Journal of General Practice, 64(625), e493-e499.

The tool's purpose was to enhance communication with nursing/care coordination and trigger earlier discharge steps for patients identified as “green” or “yellow.” Analysis of the use of the tool found that it did help facilitate earlier discharges, but accuracy depended on placement in daily work flow and experience of the user.

To read the full abstract and for information on how to access the full text, go to: http://www.ingentaconnect.com/content/jcaho/jcjqs/2014/00000040/00000006/art00001 or contact your DHB library, or local or organisational library for assistance.

Mathews, K. S., et al. (2014). Using the Red/Yellow/Green Discharge Tool to improve the timeliness of hospital discharges. Joint Commission Journal on Quality and Patient Safety, 40 (6), 243.

To read the full abstract and for information on how to access the full text, go to: http://www.publish.csiro.au/paper/AH13192.htm or contact your local, DHB or organisational library for assistance.

Clark, K. W., Moller, S., & O'Brien, L. (2014). Electronic patient journey boards a vital piece of the puzzle in patient flow. Australian Health Review, 38(3), 259-264.

The NZ Breast Cancer Foundation today launched Screen70+, an interactive online decision aid to help women over 70 – and their GPs – decide if they should continue with screening mammograms.

Screen70+ is based on the work of Dr Mara Schonberg at Harvard Medical School. It looks at a woman’s overall health and life expectancy, along with breast cancer risk and the pluses and minuses of screening.

Free screening with BreastScreen Aotearoa stops at age 69. In Australia, free mammogram screening was extended to age 74 last year, and in the UK, a large-scale trial of breast screening to age 73 is underway. The UK Public Health Office recently launched a “Don’t assume you’re past it” campaign aimed at women over 70.

To read the full media release on Scoop, go to: http://www.scoop.co.nz/stories/GE1404/S00042/interactive-tool-to-help-older-women-decide-on-mammograms.htm

To read the full abstract and for information on how to access the full text, go to: http://www.canadianjournalofdiabetes.com/article/S1499-2671%2814%2900004-5/abstract or contact your local, DHB or organsational library for assistance.

Doyle, M., et al. (2014). Using standardized insulin orders to improve patient safety in a tertiary care centre. Canadian Journal of Diabetes, 38 (2), 118-125.

The instrument consisted of 4 predictor variables: admission GCS score less than 15, nonisolated head injury, aged 65 years or older, and evidence of swelling or shift on initial cranial computed tomography scan. The decision instrument identified 114 of 116 patients requiring an acute critical care intervention if at least 1 variable was present and 192 of 484 patients who did not have an acute critical care intervention if no variables were present. Physician clinical impression was slightly less sensitive but overall similar to the clinical decision instrument. The authors conclude that their clinical decision instrument identifies a subset of patients with mild traumatic intracranial hemorrhage who are at low risk for acute critical care intervention and thus may not require ICU admission.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.annemergmed.com/article/S0196-0644%2813%2901557-6/fulltext

Nishijima, D. K., et al. (2014). Derivation of a clinical decision instrument to identify adult patients with mild traumatic intracranial hemorrhage at low risk for requiring ICU admission. Annals of Emergency Medicine, 63 (4), 448-456.

Venous thromboembolism (VTE) is a common cause of preventable harm for hospitalised patients. The authors reviewed key articles to assess the efficacy of different types of interventions to improve prescription of VTE prophylaxis for hospitalised patients.

Sixteen articles were included in this review. Two studies employed education only, four implemented paper based tools, four used computerised tools, two evaluated audit and feedback strategies, and four studies used combinations of intervention types. Individual modalities result in improved prescription of VTE prophylaxis; however, the greatest and most sustained improvements were those that combined education with computerised tools.

Studies were included if they contained quantitative economic data, including savings, spending, costs, cost effectiveness analysis, cost benefit analysis, or resource utilization. The authors excluded studies that lacked quantitative data on savings, costs, monetary value, and/or resource utilization.

The authors included seven studies with eight analyses. Of these seven studies, four analyses predicted system-wide savings, with two analyses from the same study. The predicted savings range from $8 (£5, €6) to $3068 (£1868, €2243) per patient. Larger savings accompanied reductions in treatment utilization rates. The impact on utilization rates was mixed. Authors used heterogeneous methods to allocate costs and calculate savings. Quality scores were low to moderate, and risk of bias across the studies was moderate to high, with studies predicting the most savings having the highest risk of bias. The range of issues identified in the studies included the relative absence of sensitivity analyses, the absence of incremental cost effectiveness ratios, and short time periods.

The authors conclude that, although there is evidence to show that patients choose more conservative approaches when they become better informed, there is insufficient evidence, as yet, to be confident that the implementation of patient decision support interventions leads to system-wide savings. Further work—with sensitivity analyses, longer time horizons, and more contexts—is required to avoid premature or unrealistic expectations that could jeopardize implementation and lead to the loss of already proved benefits.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1136/bmj.g188

Walsh, T., et al. (2014). Undetermined impact of patient decision support interventions on healthcare costs and savings: Systematic review BMJ, 348:g188.

Based on their analysis, the author conclude that "... there is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.

New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the choice of discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction".

This article is available to read in full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001431.pub4/full

Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 1, CD001431

Seventeen studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption.

The authors conclude that it seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘referral model’ consistently report difficulties. "We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the ‘barriers’ and ‘facilitators’ approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment".

This is an open access article that is available to read in free full text at: http://dx.doi.org/10.1186/1472-6947-13-S2-S14

This article is part of the supplement: The International Patient Decision Aid Standards (IPDAS) Collaboration’s Quality Dimensions: Theoretical Rationales, Current Evidence, and Emerging Issues

 Elwyn, G., et al. (2013). “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Medical Informatics and Decision Making, 13, (Suppl 2):S14

Forty-six comparisons (from 42 trials) were included and the authors conclude from the results of their analysis that computerised advice for drug dosage has some benefits.

"When using the computer system, healthcare professionals prescribed appropriately higher doses of the drugs initially for aminoglycoside antibiotics and the correct drug dose was reached more quickly for oral anticoagulants. It significantly decreased thromboembolism (blood clotting) events for anticoagulants and tended to reduce unwanted effects for aminoglycoside antibiotics and anti-rejection drugs (although not an important difference). It tended to reduce the length of hospital stay compared with routine care with comparable or better cost-effectiveness"

However, there were no effects on mortality or other clinical adverse events for insulin, anaesthetic agents, anti-rejection drugs and antidepressants.

The authors point to the low quality of the studies, and note that these results must be interpreted with caution.

The article is available to read in free full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002894.pub3/full

Gillaizeau F, Chan E, Trinquart L, Colombet I, Walton RT, Rège-Walther M, Burnand B, Durieux P. (2013). Computerized advice on drug dosage to improve prescribing practice. Cochrane Database of Systematic Reviews, 11, CD002894.

The authors note that the variable endpoints in studies and non-comparable study designs mean that the evidence base needs further developing. The authors discuss the potential role of simulation and clinical leadership in CIS implementation.

To read the full abstract, and for information on how to access the full text, go to: http://www.journal-surgery.net/article/S1743-9191(13)00178-7/abstract or contact your DHB library, or organisational or local library for assistance.

Kelay, T., et al. (2013). Techniques to aid the implementation of novel clinical information systems: A systematic review. International Journal of Surgery, 11(9), 783-791

University of Canterbury researchers are trialling mathematical models to help intensive care unit medical staff monitor patients’ lung conditions.

Each year up to 8000 patients with lung failure are admitted to New Zealand  hospital intensive care units  for breathing support using mechanical ventilation which is  costly, UC mechanical engineering PhD student Yeong Chiew says.

"However, patient condition and response to treatment is different for every patient. Clinicians often rely on intuition and experience to select the most suitable mechanical ventilation method for each patient leading to variable care that can expose patients to sub-optimal mechanical ventilation resulting in further risk of lung injury.

"As a result, patient care can be variable and costly, affecting the quality of patient care and clinical outcomes. In particular, ventilated patients stay 70 per cent longer in ICU and cost 140 per cent more than other patients, indicating the potential for improving care.

"Providing mechanical ventilation for New Zealand ICU patients costs an extra $15 million a year. One of the main issues is that doctors may not have appropriate tools to assess a patient’s exact lung condition at the bedside.

"Chest radiographs are not feasible and are invasive because of the radiation and the patients need to be transported out from ICU to a radiology lab every time assessment is required.

"We are using mathematical models to gauge patients’ lung conditions using already available data at the bedside. The models allow clinicians to effectively see inside the lung to gain a more accurate and exact picture of patient condition.

"Based on this mathematical modelling information, doctors can select the best individual ventilator settings in a consistent fashion every time.’’

The models have been retrospectively tested at Christchurch Hospital’s ICU, as well as on data from collaborating overseas research groups.

The UC research, supervised by Professor Geoff Chase, plans in future to implement the models in larger clinical trial at Christchurch Hospital ICU to provide more patient-specific care, to optimise treatment and to improve outcomes for critically ill patients.

Waikato DHB is implementing an internationally recognised web-based software tool to improve the patient’s journey through primary, secondary and tertiary care.

The tool, known as Map of Medicine, houses 300 clinical maps with 1100 pathways for patient care. These pathways allow clinicians from primary, secondary and tertiary care to access evidence-based local guidance and clinical decision support at the point of care.

Midland DHBs; Lakes, Taranaki, Tairawhiti and Bay of Plenty, have also agreed to implement Map of Medicine. There will be a region-wide roll-out and regionally agreed clinical pathways developed.

During a successful trial Midland Health Network has worked with Waikato DHB to develop a number of primary care pathways. Development of hospital pathways will complement the ongoing primary care pathway development.

Waikato DHB chief medical advisor Dr Tom Watson said the regionalised pathways provide significant benefits for both patients and clinicians.

“Map of Medicine informs the whole of the journey from the GP to the secondary and tertiary facility and back to the GP. Everybody will be clear about the pathway for managing patients between these,” he said.

“Our clinicians will potentially have less waste in time and scheduling, as they will have fewer patients coming in who have not had the appropriate investigations performed before a specialist sees them.

“Participating in the Map of Medicine is a great opportunity to be part of an international clinical fraternity who are using Map of Medicine to provide better outcomes for their patients and increased value across the health sector.”

International input from Map of Medicine experts

Visitors from Map of Medicine in the United Kingdom and Dubai came to Waikato Hospital yesterday (Thursday 18 July) to share their experiences how Map of Medicine is being used internationally.

UK Map of Medicine senior consultant Jennifer Dennington and Dubai Map of Medicine clinical programmes director Dr Mehmood Syed have already met with Healthshare and will meet with the Map of Medicine governance group today (Friday 19 July). The governance group includes representatives from primary and secondary care services from all five Midland DHBs; Lakes, Taranaki, Tairawhiti and Bay of Plenty.

“The map will provide Midland primary, secondary and tertiary care facilities with a tool to help with the care delivered across the community. It provides an up-to-date evidence based guide to use as a reference tool,” Dr Syed said.

“So if you’re a GP out in the community and you aren’t sure how to treat a patient, you refer to the map, which gives you evidence based guidance that has been locally tailored to you particular area. This supports your decision on how the patient ought to be treated.”
“This will lead to better health outcomes for patients, and cost savings for the health economy.”

Waikato DHB Map of Medicine project manager Graham Guy said the visit helped to cement understanding and identify further opportunities to make best use of the product as Waikato DHB and Midland DHBs look to roll it out.

Miss Dennington said it was great to see the enthusiasm from Waikato DHB.

“We look forward to the relationship that we are starting and continuing. Graham and his team have got the knowledge that they need to run the Map of Medicine programme but we will always be here for support. We will share our experiences from our own areas and create a network to reach out to for advice,” she said.

“The map will ultimately mean patients receive the right treatment at the right time and place.”

Miss Dennington and Mr Syed came to New Zealand on Sunday and have visited the Ministry of Health and other DHBs across the country. They are travelling to Australia next week.

The map has been highly successful in UK and is also launching in countries across the Middle East.

This paper reports a longitudinal qualitative interview and observation study of the development and practice of health literacy in people with long-term health conditions, living in South Wales, UK.

To read the full abstract, and for information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1111/hex.12093/abstract or contact your DHB library, or organisational or local library for assistance.

Edwards, M., et al. (2013). 'Distributed health literacy': longitudinal qualitative analysis of the roles of health literacy mediators and social networks of people living with a long-term health condition. Health Expectations, [published online 17 June 2013].

The study used a decision model that incorporated a Markov process that was developed in 2012 to estimate the net benefit and cost of PSA screening versus no screening as a function of baseline risk. The study found that the harms of screening outweighed the benefits under a number of plausible scenarios. Conclusions were sensitive to the estimated quality-of-life impacts of prostate cancer treatment as well as the incidence of cancers not detected by screening tests (poorer prognosis) and those that were detected by screening tests (better prognosis).

To read the full abstract, and for access to a free full text version of the article, go to: https://www.mja.com.au/journal/2013/198/10/risk-assessment-guide-prostate-cancer-screening-decisions-cost-effectiveness

Martin, A. J., et al. (2013). Risk assessment to guide prostate cancer screening decisions: A cost-effectiveness analysis. Medical Journal of Australia, 198(10), 546-550.

This report is about the progress OECD countries have made in the development and linkage of health and health care data and in the development and use of data from electronic health record systems for statistics and research.

The OECD Health Policy Brief summarises the key findings of this OECD study.

Access to the Health Policy Brief, as well as to the full Report are available at: http://www.oecd.org/health/health-systems/strengtheninghealthinformationinfrastructure.htm

The aims of this study were therefore to: 1. explore the type and number of perceived barriers of heart failure nurses and cardiologists to use a CDSS in the treatment of heart failure patients; 2. explore possible differences in perceived barriers between the two groups; and 3. assess the relevance and influence of knowledge management on Responsibility/Trust and Barriers/Threats.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1472-6947/13/54/abstract

de Vries, A. E., et al. (2013). Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients. BMC Medical Informatics and Decision Making, 13:54.

They develop and distribute evidence based resources which describe, facilitate and help overcome the barriers to best practice.

In the April 2013 edition of their Best Practice Journal, they discuss a new electronic notification system that has been designed for general practices to report incidents related to exposures to hazardous substances. The system has been developed by bestpractice Decision Support (BPAC Inc) and the Centre for Public Health Research, and is funded by the Ministry of Health.

This is available to read in full text at: http://www.bpac.org.nz/BPJ/2013/April/hazards-to-health.aspx

Only three trials that were identified were of satisfactory quality. PDAs were used either in recording patient information or in decision support for diagnoses or treatment. The authors found reports of increased data collection quality and improved appropriateness of diagnosis and treatment decisions.

However, evidence is limited and the authors conclude that reliable conclusions are not possible and further research is required to assess their value and ensure full benefits from their widespread use. They also note that the pace of technological development creates challenges for evaluation.

Divall, P., et al. (2103). The use of personal digital assistants in clinical decision making by health care professionals: A systematic review. Health Informatics Journal, 19(1), 16-28.

To view the full abstract and for information on how to access the full text, go to:
http://jhi.sagepub.com/content/19/1/16.abstract or contact your DHB library, or organisational or local library for assistance.

Before the Christchurch earthquakes, emergency preparedness at district health board-level in New Zealand faced challenges that they needed to overcome, suggests a University of Otago study published in the New Zealand Medical Journal today.

However, the study – the first to address the issue of strategic healthcare emergency preparedness in New Zealand - found that disaster preparedness was adequate to deal with a major emergency – as occurred in Christchurch.

The interview-based study of emergency planners at 16 District Health Boards specifically investigated healthcare disaster preparedness before the Canterbury earthquakes happened, between January and March 2010.  Five DHBs declined to be involved in the study.

Lead author, University of Otago medical and PhD student Sultan Al-Shaqsi, says emergency planners highlighted several issues that concerned them, or that they felt could improve disaster preparedness.

These included the perception that clinical personnel were disinterested in emergency planning, the need for communication backup if emergency communication systems failed and the insufficient recognition given to the likely value of volunteers who tend to turn out in big numbers following major disasters such as the Christchurch earthquakes and the 9/11 terrorist attacks in the United States.

The researchers, also including Mr Al-Shaqsi’s supervisors Associate Professor David McBride and Professor Robin Gauld of Otago’s Department of Preventive and Social Medicine, concluded that despite these challenges which existed prior to the Christchurch earthquakes, New Zealand’s healthcare preparedness was probably adequate a year out from the disaster.

Several of the challenges presented in the study were also reflected in an earlier review of the initial response to the February 2011 Canterbury earthquake, undertaken by Professor Mike Ardagh and colleagues at the University of Otago, Christchurch.

“For example, they identified that backup systems for life-line services such as water, communication and electricity were significant challenges during the initial response,” says Mr Al-Shaqsi.

“They also emphasised the need for integrated planning of hospital and community based healthcare facilities to ensure that the appropriate response to the influx of injured people is unified, and also they found that management of volunteering was a challenge during the initial response.”

The study concludes: “Prior to the Canterbury earthquakes, healthcare disaster preparedness faced multiple challenges. Despite these challenges, New Zealand’s healthcare response was adequate. Future preparedness has to take lessons learnt from the 2011 earthquakes to improve healthcare disaster planning in New Zealand.”

For more information, contact:

Associate Professor David McBride
Department of Preventive and Social Medicine
University of Otago

To view the original press release, go to: http://www.otago.ac.nz/news/news/otago043361.html

Fifteen randomised trials were included (with 14 at moderate to high risk of bias due to methodological limitations). HbA1c, quality of life and hospitalisation all favoured the computerised clinical decision support systems over the control, although none were statistically significant. Triglycerides and practitioner performance tended to favour the computerised clinical decision support systems, however the results were too heterogeneous to pool.

The authors conclude that, while the computerised systems may marginally improve clinical outcomes, confidence in the evidence is low because of risk of bias, inconsistency and imprecision.

To view the full abstract and for information on how to access the full text, go to:
http://onlinelibrary.wiley.com/doi/10.1111/dme.12087/abstract or contact your DHB library, or organisational or local library for assistance.

The authors undertook a retrospective analysis of data from a two year prospective cohort study in a paediatric emergency department.

Based on the findings of their study, the authors conclude that the NICE traffic light system failed to identify a substantial proportion of serious bacterial infections, particularly urinary tract infections. The addition of urine analysis significantly improved test sensitivity, making the traffic light system a more useful triage tool for the detection of serious bacterial infections in young febrile children.

This is an open access article and is available to read in full text at: http://www.bmj.com/content/346/bmj.f866

De, S., et al. (2013). Accuracy of the “traffic light” clinical decision rule for serious bacterial infections in young children with fever: A retrospective cohort study. BMJ, 346:f866.

Based on the results of thesir analysis, the authors conclude that there were several factors that could partially explain why some systems succeed and others fail. Presenting decision support within electronic charting or order entry systems are associated with failure compared with other ways of delivering advice. Odds of success were greater for systems that required practitioners to provide reasons when over-riding advice than for systems that did not. Odds of success were also better for systems that provided advice concurrently to patients and practitioners. Finally, most systems were evaluated by their own developers and such evaluations were more likely to show benefit than those conducted by a third party.

This is an open access article and is available to read in full text at: http://www.bmj.com/content/346/bmj.f657

Roshanov, P. S., et al. (2013). Features of effective computerised clinical decision support systems: Meta-regression of 162 randomised trials. BMJ, 346:f657

The authors used retrospective semistructured interviews and web server log analysis to assess whether clinical teams would direct patients to use web-based patient decision support interventions (DESIs) and whether patients would use them.

This is an open access article and is available to read in full text at: http://bmjopen.bmj.com/content/2/6/e001469.full

Mathers, N., et al. (2012). Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: A cluster randomised controlled trial (PANDAs) in general practice. BMJ Open, 2:e001469.

"Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12–21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients’ and physicians’ preferences, may reduce rates of elective surgery and lower costs".

This article is available to read in full text at: http://content.healthaffairs.org/content/31/9/2094.full

Arterburn, D., et al. (2012). Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Affairs, 31(9), 2094-2104.

The scope of the journal covers:

• Information systems, including national or international registration systems, hospital information systems, departmental and/or physician's office systems, document handling systems, electronic medical record systems, standardisation, systems integration etc.
• Computer-aided medical decision support systems using heuristic, algorithmic and/or statistical methods as exemplified in decision theory, protocol development, artificial intelligence, etc.
• Educational computer based programs pertaining to medical informatics or medicine in general.
• Organisational, economic, social, clinical impact, ethical and cost-benefit aspects of IT applications in health care.

The authors identified seven high-level DS system design features from the nonhealthcare literature that could be applied to CDS: providing broad, system-level perspectives; customising interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. 

This is an open access article and is available to read in free full text at: http://www.biomedcentral.com/1472-6947/12/90/abstract

Wu, H.W., et al. (2012). Advancing clinical decision support using lessons from outside of healthcare: An interdisciplinary systematic review. BMC Medical Informatics and Decision Making, 12:90 doi:10.1186/1472-6947-12-90

To view the full abstract and for information on how to access the full text, go to:
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2011.03540.x/abstract or contact your DHB library, or organisational or local library for assistance.

Nirantharakumar, K., Chen, Y. F., Marshall, T., Webber, J. and Coleman, J. J. (2012), Clinical decision support systems in the care of inpatients with diabetes in non-critical care setting: systematic review. Diabetic Medicine, 29: 698–708. 

• Computerised decision aids prove useful
• Pew internet survey
• Evaluation of a ‘perceived sensitivity to medicines’ scale
• The reassuring value of diagnostic tests
• Perception of provider time at bedside
• Walking drawings and walking ability in children with cerebral palsy
• Illness representation profiles predict use of healthcare services
• Culturally appropriate storytelling improves BP
• Helping patients simplify prescription regimens
• The role of positive contagion in golf performance

To subscribe to this research review, go to: http://www.researchreview.co.nz/

The authors identified "... a wide range of possible approaches to reduce cognitive errors in diagnosis. Not all the suggestions have been tested, and of those that have, the evaluations typically involved trainees in artificial settings, making it difficult to extrapolate the results to actual practice".

To read the full abstract and for information on how to access the full text, go to: http://qualitysafety.bmj.com/content/21/7/535.abstract or contact your local or organisational library for assistance.

Graber, M.L., et al. (2012). Cognitive interventions to reduce diagnostic error: A narrative review. BMJ Quality & Safety, 21:535-557 doi:10.1136/bmjqs-2011-000149

• Please provide a general description of the product:
• Who should I contact for more info?
• Indication of cost range and cost structure:
• Once purchased, what's the process for implementing the product in our system? Is this included in the cost?
• Is user-training available? What are the arrangements?                                                                                                                              
• What product support is available after purchase? Is there a helpdesk etc?
• Which of the main vendor products is this compatible with?

Below are responses from the vendors for each of the products.

If you need any further information, please contact the relevant vendor directly - you'll find their contact details in their responses.  

The aim of this study was to determine whether emergency physicians perceived their clinical decisions in general to be more experiential or rational and how this compared with other physicians.

A validated psychometric tool, the Rational Experiential Inventory was sent to all emergency physicians registered with the College of Physicians and Surgeons of Ontario. After analysis of these survey results the authors concluded that overall, emergency physicians favoured rational decision making rather than experiential decision making; however, female emergency physicians had higher experiential scores than male emergency physicians. This has important implications for future knowledge translation and decision support efforts among emergency physicians.

Calder, Lisa A. et al. (2011). Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions. Emergency Medicine Journal, [Epublished 7 November 2011].

To read the full abstract, and for information on how to access the full text, go to: http://emj.bmj.com/content/early/2011/11/07/emermed-2011-200468.abstract or contact your local or organisational library for assistance.

This study aimed to investigate ways in which Nurse Practitioners have incorporated the use of Information and Communication Technology (ICT) as a mechanism to support their new clinical role within Emergency Departments.

A cross-sectional qualitative study was undertaken in the Emergency Departments of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses.

The results of the study found that the role of the Emergency Nurse Practitioner was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the Nurse Practitioner role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care.

Li, J. et al. (2012). The role of ICT in supporting disruptive innovation: A multi-site qualitative study of Nurse Practitioners in Emergency Departments, BMC Medical Informatics and Decision Making, 12:27.

Access to the full text of the article is free online at, http://www.biomedcentral.com/1472-6947/12/27/abstract

http://www.nuffieldtrust.org.uk/talks/introduction-use-decision-technologies-health-care

http://www.nuffieldtrust.org.uk/talks/innovation-use-decision-technologies-health-care

Recent innovations such as CT installation in ambulances may lead to earlier start of stroke-specific treatments. However, such technically complex mobile facilities require effective methods of correctly identifying patients before deployment. This research aimed to develop and validate a new dispatcher identification algorithm for stroke emergencies. The dispatcher identification algorithm for stroke emergencies was informed by systematic qualitative analysis of the content of emergency calls to ambulance dispatchers for patients with stroke or transient ischemic attack and other neurological and nonneurological diseases. After training of dispatchers, sensitivity and predictive values were determined prospectively in patients admitted to hospital by using the discharge diagnosis as the reference standard. Analysis indicated that, using a  dispatcher identification algorithm for stroke emergencies, more than half of all patients with stroke admitted by ambulance were correctly identified by dispatchers. Most false-positive stroke codes had other neurological diagnoses.

Krebes, S., et al. (2012). Development and validation of a dispatcher identification algorithm for stroke emergencies. Stroke, 43, 776-781.

To read the full abstract, and for information on how to access the full text, go to: http://stroke.ahajournals.org/content/43/3/776.abstract or contact your local or organisational library for assistance.

Stevenson, J. E., & Nilsson, G. (2012). Nurses' perceptions of an electronic patient record from a patient safety perspective: A qualitative study. Journal of Advanced Nursing, 68 (3), 667-676.

To read the full abstract, and for information on how to access the full text, go to: http://www.ingentaconnect.com/content/bsc/jan/2012/00000068/00000003/art00018 or contact your local or organisational library for assistance.

The authors conclude that "many cardiovascular risk scores are available that can be applied to patients with type 2 diabetes. A minority of these risk scores has been validated and tested for its predictive accuracy, with only a few showing a discriminative value of ≥0.80. The impact of applying these risk scores in clinical practice is almost completely unknown, but their use is recommended in various national guidelines".

van Dieren, S., et al. (2012). Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: A systematic review. Heart, 98, 360-369.

To read the full abstract, and for information on how to access the full text, go to: http://heart.bmj.com/content/98/5/360.abstract or contact your local or organisational library for assistance.

Fifty-seven studies met inclusion criteria (40 experimental designs; 17 observational designs). Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of outcomes including HbA1c and weight. Meta-regression of adequately reported studies found that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability.

The authors note that the review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales. They conclude that few tools met their criteria for effectiveness, usefulness, sustainability, and usability. 

Yu, C., et al. (2012). Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers. Journal of the American Medical Informatics Association (JAMIA), 19:514-522.

This is an open access article and is available in full text at: http://jamia.bmj.com/content/19/4/514.full

The International Association of Diabetes and Pregnancy Study Group (IADPSG) recently recommended new criteria for diagnosing gestational diabetes mellitus (GDM). This study was undertaken to determine whether adopting the IADPSG criteria would be cost-effective, compared with the current standard of care. The authors developed a decision analysis model comparing the cost-utility of three strategies to identify GDM: 1) no screening, 2) current screening practice, or 3) screening practice proposed by the IADPSG. Assumptions included that 1) women diagnosed with GDM received additional prenatal monitoring, mitigating the risks of preeclampsia, shoulder dystocia, and birth injury; and 2) GDM women had opportunity for intensive post-delivery counseling and behaviour modification to reduce future diabetes risks. The primary outcome measure was the incremental cost-effectiveness ratio. Analysis found that the IADPSG recommendation for glucose screening in pregnancy is cost-effective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using postdelivery counseling and intervention.

• designed to promote good health and prevent ill health
• produced by the people affected by our work, including health and social care professionals, patients and the public
• based on the best evidence
• transparent in its development, consistent, reliable and based on a rigorous development process
• good value for money, weighing up the cost and benefits of treatments
• internationally recognised for its excellence.

This website lists all forthcoming NICE guidance, including guidance on breast cancer, colorectal cancer, prostate cancer, diabetes (type 2), hepatitis C, lung cancer, melanoma, lymphoma, smoking cessation, and chronic heart failure.

In total, 8864 titles were scanned, 115 full text papers considered, and 43 papers included in the final sample. These described the prospective development or validation, or both, of 145 risk prediction models and scores, 94 of which were studied in detail. The models had been tested on 6.88 million participants followed for up to 28 years. Some but not all risk models or scores had robust statistical properties and had been externally validated on a different population. Genetic markers added nothing to models over clinical and sociodemographic factors.

Most authors described their score as “simple” or “easily implemented,” although few were specific about the intended users and under what circumstances. Ten mechanisms were identified by which measuring diabetes risk might improve outcomes. Follow-on studies that applied a risk score as part of an intervention aimed at reducing actual risk in people were sparse. The authors conclude that, although much work has been done to develop diabetes risk models and scores, most are rarely used because they require tests not routinely available or they were developed without a specific user or clear use in mind. Recent research has begun to tackle usability and the impact of diabetes risk scores. Two promising areas for further research are interventions that prompt lay people to check their own diabetes risk and use of risk scores on population datasets to identify high risk “hotspots” for targeted public health interventions.

Noble, D., et al. (2011). Risk models and scores for type 2 diabetes: Systematic review. BMJ, 343, bmj.d7163.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.bmj.com/content/343/bmj.d7163?tab=full

The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results.

In one ICU, a sample of doctors and nurses (n=44, who combined to form 37 different teams) were observed during 34 morning ward rounds. Following the clinical review of each patient (n=105), team members individually recorded their anticipations for expected patient developments over 48 h. Patient-outcome data were collected to determine the accuracy of anticipations. For over half of the patients, ICU team members formed conflicting anticipations as to whether patients would deteriorate within 48 h. Senior doctors were most accurate in their predictions. Exploratory analysis found that team processes did not predict team SA. However, the involvement of junior and senior trainee doctors in the patient decision-making process predicted the extent to which those team members formed team SA with senior doctors.

Reader, T. W., et al. (2011). Team situation awareness and the anticipation of patient progress during ICU rounds. BMJ Quality and Safety, 20 (12), doi:10.1136/bmjqs.2010.048561.

To read the full abstract, and for information on how to access the full text, go to: http://qualitysafety.bmj.com/content/20/12/1035.short?rss=1 or contact your local or organisational library for assistance.

The 18 pathways currently covered include: alcohol-use disorders, anaemia management in chronic kidney disease, breast cancer, chronic heart failure, chronic kidney disease, chronic obstructive pulmonary disease, dementia, depression, diabetes, diabetes in pregnancy, diet, glaucoma, neonatal jaundice, physical activity, postnatal care, smoking, stroke, and venous thromboembolism prevention.

For futher information, go to: http://www.nice.org.uk/newsroom/pressreleases/NICEPathwaysLaunch.jsp

To read the full abstract and for access to the provisional full text PDF, go to: http://www.implementationscience.com/content/6/1/46/abstract

Tso, P., et al. (2011). Developing a decision aid to guide public sector health policy decisions: A study protocol. Implementation Science, 6 (46), doi:10.1186/1748-5908-6-46.

The clinic-randomised trial in Minnesota included 2,556 patients with diabetes. The authors concluded from the study that electronic health record-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.

O'Connor, P.J., et al. (2011). Impact of electronic health record clinical decision support on diabetes care: A randomized trial. Annals of Family Medicine, 9, 12-21.

For acess to the abstract and full-text version of this paper, go to http://www.annfammed.org/cgi/content/abstract/9/1/12