Selection of a Clinical Business Intelligence Solution: Validation with Clinical use cases provides early Clinical Insights
AuthorZielinski, Gail M.
MetadataShow full item record
DescriptionPresented at the University of Maryland School of Nursing, Summer Institute in Nursing Informatics, 2015.
KeywordCatholic health services
clinical and financial information integration
Clinical Business Intelligence (CBI)
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/5518
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/
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A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome PredictionFehlings, M.G.; Martin, A.R.; Tetreault, L.A. (SAGE Publications Ltd, 2017)Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI. Copyright The Author(s) 2017.
Assessing the quality of feedback during clinical learning: Development of the Feedback Assessment for Clinical Education (FACE)Onello, Rachel; Regan, Mary J.; Johantgen, Mary E. (2015)Background: During a time of increased faculty shortages, nursing programs rely heavily on adjunct instructors to facilitate clinical learning experiences essential for fostering clinical reasoning and multiple ways of thinking. A significant component of clinical learning is the reflective feedback conversation that occurs between instructor and student. Quality feedback conversations use specific techniques that explicitly encourage students to reflect, analyze, and extrapolate learning to other contexts. Comparing actual performance to desired performance through the exploration and analysis of learner thoughts and actions is an effective modality to help close learning gaps and impact future performance. However, many clinical instructors responsible for facilitating feedback conversations are inadequately prepared to do so, lacking the pedagogical training necessary to maximize learning. Current resources for clinical instructors fail to provide a clear framework that guides instructors on how to facilitate feedback conversations for quality learning. Methods: To address the need for a tool that can guide the development of feedback skills and assess feedback behaviors among clinical instructors, The Feedback Assessment for Clinical Education (FACE) was developed. The FACE was designed to assess instructor behaviors associated with facilitating quality feedback conversations across clinical settings and disciplines. Using a multiphase approach, the FACE tool, comprising a rating form and rater handbook, was developed using Mezirow's Transformative Learning Theory, multidisciplinary research, and experts from the fields of education, organizational behavior, psychology, and health sciences. An iterative comparative process using theory and research guided the identification and development of key constructs associated with effective feedback conversations. Results: Qualitative content validity testing informed the operationalization of constructs into behavioral indicators and resulted in a six element behaviorally anchored rating scale. Quantitative content validity testing using Lawshe's Content Validity Ratio and the Content Validity Index suggest strong content validity at each level of the tool. Conclusions: This work offers a theory-based, research-driven tool to assess the quality of feedback in clinical settings and presents opportunities across education, research, and practice to enhance the current state of knowledge on best practices of feedback conversations. Future psychometric testing is needed to fully appreciate the potential of the FACE tool.
Clinical experience with a novel assay measuring cytomegalovirus (CMV)-specific CD4+ and CD8+ T-cell immunity by flow cytometry and intracellular cytokine staining to predict clinically significant CMV eventsRogers, R.; Saharia, K.; Chandorkar, A. (BioMed Central Ltd., 2020)Background: Cytomegalovirus (CMV) infection is one of the most common opportunistic infections following organ transplantation, despite administration of CMV prophylaxis. CMV-specific T-cell immunity (TCI) has been associated with reduced rates of CMV infection. We describe for the first time clinical experience using the CMV T-Cell Immunity Panel (CMV-TCIP), a commercially available assay which measures CMV-specific CD4+ and CD8+ T-cell responses, to predict clinically significant CMV events. Methods: Adult (> 18-year-old) patients with CMV-TCIP results and ≥ 1 subsequent assessment for CMV DNAemia were included at Brown University and the University of Maryland Medical Center-affiliated hospitals between 4/2017 and 5/2019. A clinically significant CMV event was defined as CMV DNAemia prompting initiation of treatment. We excluded indeterminate results, mostly due to background positivity, allogeneic hematopoetic cell transplant (HCT) recipients, or patients who were continued on antiviral therapy against CMV irrespective of the CMV-TCIP result, because ongoing antiviral therapy could prevent a CMV event. Results: We analyzed 44 samples from 37 patients: 31 were solid organ transplant recipients, 4 had hematologic malignancies, 2 had autoimmune disorders. The CMV-protection receiver operating characteristic (ROC) area under the curve (AUC) was significant for %CMV-specific CD4+ (AUC: 0.78, P < 0.001) and borderline for CD8+ (AUC: 0.66, P = 0.064) T-cells. At a cut-off value of 0.22% CMV-specific CD4+ T-cells, positive predictive value (PPV) for protection against CMV was 85% (95%CI 65–96%), and negative predictive value (NPV) was 67% (95%CI 41–87%). Conclusions: The CMV-TCIP, in particular %CMV-specific CD4+ T-cells, showed good diagnostic performance to predict CMV events. The CMV-TCIP may be a useful test in clinical practice, and merits further validation in larger prospective studies. Copyright 2020 The Author(s).