Browsing by Subject "Practice guideline"

Now showing 1 - 3 of 3
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    Enhancing narrative clinical guidance with computer-readable artifacts: Authoring FHIR implementation guides based on WHO recommendations
    (Elsevier, 2021) Shivers, Jennifer; Amlung, Joseph; Ratanaprayul, Natschja; Rhodes, Bryn; Biondich, Paul; Herron School of Art and Design
    Introduction: Narrative clinical guidelines often contain assumptions, knowledge gaps, and ambiguities that make translation into an electronic computable format difficult. This can lead to divergence in electronic implementations, reducing the usefulness of collected data outside of that implementation setting. This work set out to evolve guidelines-based data dictionaries by mapping to HL7 Fast Health Interoperability Resources (FHIR) and semantic terminology, thus progressing toward machine-readable guidelines that define the minimum data set required to support family planning and sexually transmitted infections. Material and methods: The data dictionaries were first structured to facilitate mapping to FHIR and semantic terminologies, including ICD-10, SNOMED-CT, LOINC, and RxNorm. FHIR resources and codes were assigned to data dictionary terms. The data dictionary and mappings were used as inputs for a newly developed tool to generate FHIR implementation guides. Results: Implementation guides for core data requirements for family planning and sexually transmitted infections were created. These implementation guides display data dictionary content as FHIR resources and semantic terminology codes. Challenges included the use of a two-dimensional spreadsheet to facilitate mapping, the need to create FHIR profiles and resource extensions, and applying FHIR to a data dictionary that was created with a user interface in mind. Conclusions: Authoring FHIR implementation guides is a complex and evolving practice, and there are limited examples for this groundbreaking work. Moving toward machine-readable guidelines by mapping to FHIR and semantic terminologies requires a thorough understanding of the context and use of terminology, an applied information model, and other strategies for optimizing the creation and long-term management of implementation guides. Next steps for this work include validation and, eventually, real-world application. The process for creating the data dictionary and for generating implementation guides should also be improved to prepare for this expanding work.
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    Insecure messaging: how clinicians approach potentially problematic messages from patients
    (Oxford University Press, 2020-12-05) Lee, Joy L.; Matthias, Marianne S.; Huffman, Monica; Frankel, Richard M.; Weiner, Michael; Medicine, School of Medicine
    Objective: Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients. Methods: In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes. Results: Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content. Conclusion: Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice. Practical implications: We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients.
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    The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section
    (Elsevier, 2021-10) Alhazzani, Waleed; Alshahrani, Mohammed; Alshamsi, Fayez; Aljuhani, Ohoud; Eljaaly, Khalid; Hashim, Samaher; Alqahtani, Rakan; Alsaleh, Doaa; Al Duhailib, Zainab; Algethamy, Haifa; Al-Musawi, Tariq; Alshammari, Thamir; Alqarni, Abdullah; Khoujah, Danya; Tashkandi, Wail; Dahhan, Talal; Almutairi, Najla; Alserehi, Haleema A.; Al-Yahya, Maytha; Al-Judaibi, Bandar; Arabi, Yaseen M.; Abualenain, Jameel; Alotaibi, Jawaher M.; Al Bshabshe, Ali; Alharbi, Reham; Al-Hameed, Fahad; Elhazmi, Alyaa; Almaghrabi, Reem S.; Almaghlouth, Fatma; Abedalthagafi, Malak; Al Khathlan, Noor; Al-Suwaidan, Faisal A.; Bunyan, Reem F.; Baw, Bandar; Alghamdi, Ghassan; Al Hazmi, Manal; Mandourah, Yasser; Assiri, Abdullah; Enani, Mushira; Alawi, Maha; Aljindan, Reem; Aljabbary, Ahmed; Alrbiaan, Abdullah; Algurashi, Fahd; Alsaawi, Abdulmohsen; Alenazi, Thamer H.; Alsultan, Mohammed A.; Alqahtani, Saleh A.; Memish, Ziad; Al-Tawfiq, Jaffar A.; Al-Jedai, Ahmed; Medicine, School of Medicine
    BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.