Value Of Clinical Information Research Articles

Tin filter compared to low kV protocols - optimizing sinonasal imaging in computed tomography.

Paranasal sinus imaging due to chronic inflammatory disease is one of the most common examinations in head and neck radiology with CT imaging considered the current gold standard. In this phantom study we analyzed different low dose CT protocols in terms of image quality, radiation exposure and subjective evaluation in order to establish an optimized scanning protocol. In a phantom study, an Alderson phantom was scanned using 12 protocols between 70-120 kV and 25-200 mAs with and without tin filtration. For all datasets, iterative reconstruction was used. Data were objectively evaluated (image noise, (dose-weighted) contrast-to-noise ratio) and for subjective evaluation an online survey using a Likert scale was performed to reach a large group of clinically experienced reader (n = 62). The protocol was considered diagnostically insufficient if the median score was 4 and above and if more than 10% of raters scored 4 and above on the Likert scale. For an interreader agreement an ICC was calculated. To compare clinical value in relation to the applied dose and the objective image parameters, we calculated a figure of merit (FOM) and ranked the protocols accordingly. There was an overall moderate agreement between the 62 readers for the 12 examined CT protocols. In this phantom study, protocols with 100 kV with spectral shaping and 50-100 mAs obtained the best results for its combination of dose, image quality and clinical information value for diagnosing sinusitis (FOM 1st- 2nd place) with the 70 kV and 50 mAs as a good alternative as well (Sinusitis: FOM shared 2nd). For preoperative planning, where a higher dose is necessary, 100 kV with spectral shaping and 100 mAs achieved the overall best results (FOM 1st place) with 70 kV and 50 mAs ranking 4th. 100-kV protocols with spectral shaping or low kV protocols (70 kV) with a similarly low dose showed the best figure of merit for imaging sinonasal disease and preoperative planning. With modern scanner technology available, spectral shaping or low KV protocols should be used for sinusitis imaging.

Value of Clinical Information on Radiology Reports in Oncological Imaging.

Radiological reporting errors have a direct negative impact on patient treatment. The purpose of this study was to investigate the contribution of clinical information (CI) in radiological reporting of oncological imaging and the dependence on the radiologists’ experience level (EL). Sixty-four patients with several types of carcinomas and twenty patients without tumors were enrolled. Computed tomography datasets acquired in primary or follow-up staging were independently analyzed by three radiologists (R) with different EL (R1: 15 years; R2: 10 years, R3: 1 year). Reading was initially performed without and 3 months later with CI. Overall, diagnostic accuracy and sensitivity for primary tumor detection increased significantly when receiving CI from 77% to 87%; p = 0.01 and 73% to 83%; p = 0.01, respectively. All radiologists benefitted from CI; R1: 85% vs. 92%, p = 0.15; R2: 77% vs. 83%, p = 0.33; R3: 70% vs. 86%, p = 0.02. Overall, diagnostic accuracy and sensitivity for detecting lymphogenous metastases increased from 80% to 85% (p = 0.13) and 42% to 56% (p = 0.13), for detection of hematogenous metastases from 85% to 86% (p = 0.61) and 46% to 60% (p = 0.15). Specificity remained stable (>90%). Thus, CI in oncological imaging seems to be essential for correct radiological reporting, especially for residents, and should be available for the radiologist whenever possible.

Comparison of procalcitonin and c-reactive protein as markers of neonatal sepsis

Objective: To compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis.Study Design: This prospective study was conducted in Neonatology unit of department of pediatrics SKIMS, Srinagar. Study was conducted on 100 patient including preterm and term both.Results: In our study Sensitivity of CRP in detecting sepsis was found to be 77.78%, specificity 78.08%. In the present study Sensitivity of Procalcitonin in detecting sepsis was found to be 96.30%, specificity 69.86%.Conclusion: PCT is a better marker of sepsis than CRP.

Assessment of informative value of effective cerebral blood flow calculation technique according to 99mTc-HMPAO polyphase scintigraphy data

Background. According to single-photon emission computed tomography (SPECT) data, the most common technique to calculate volume cerebral blood flow (VCBF) is N.A. Lassen method. Following it, VCBF in different segments of the brain is assessed in comparison with blood flow in the cerebellum, where it is considered to be constant. However, this approach does not take into account that in some pathologies, in particular, injuries, occlusions of blood vessels, VCBF of the cerebellum also does change. Therefore, an original technique of calculating regional VCBF based on polyphase scintigraphy has been developed, which will make it possible to make a more accurate assessment of the effective perfusion of the brain.
 Purpose – to evaluate the clinical informative value of the developed technique for calculating effective cerebral blood flow according to 99mTc-HMPAO (hexamethylpropyleneaminoxime) polyphase brain scintigraphy data.
 Materials and methods. The study is focused on analyzing two groups of patients: Group A represented by patients with signs of chronic cerebral ischemia and Group B enrolling patients in the interim and long term of explosive minor brain injury (n=22). Group A patients were divided into two subgroups, depending on the presence of structural and hemodynamic changes in the vertebral arteries (VA) according to ultrasound (US) of the major vessels of the brain. I-A subgroup (n=13) was made up by those patients who had structural lesions of the vertebrobasilar basin; II-A (n=27) patients had no relevant signs.
 All patients underwent a comprehensive clinical examination including neuropsychological testing, ultrasound of major vessels, magnetic resonance imaging, single-photon emission computed tomography (SPECT). Effective volume cerebral blood flow (VCBF), according to the SPECT data, was calculated based on the original technique (VCBFSB). VCBFSB values were compared with the SPECT data using N.A. Lassen (VCBFLassen) method and the ultrasound data.
 Results and discussion. Analysing the data of the groups of patients with hemodynamic impairment in the vertebro-basilar basin shows that, according to the scintigraphy of VCBF, I-A group patients differ from II-A group on average 1.82± 0.06 times the amount for CBFSB and 0.95± 0.04 for CBFLassen. The total mean blood flow in the carotid and vertebral arteries of I-A group patients was 748.19±198.42 mL/min, II-A group patients – 1112.23±63.71 mL/min. Comparing the mean values of the hemodynamic parameters of the brain of Group B patients with the data of Group II-A
 patients, VCBFSB was 1.33±0.25-fold decreased, while CBFLassen showed 1.03±0.14-fold decrease of perfusion (in total average blood flow of vertebral and carotid arteries according to US of Group B – 1760±580 ml/min).
 Conclusions. Preliminary clinical studies, using the developed technique for calculating volume cerebral blood flow according to 99mTc-HMPAO scintigraphy data with the corresponding software, showed a rather high sensitivity in assessing VCBF in case of pathological changes in the brain, especially, in occlusion of the major vessels of the brain and contusions resulting from battle trauma, whereas N.A. Lassen method was insufficiently informative. The regression analysis of US data, SPECT data and neuropsychological testing shows clear linear correlation relationships, but they do also differ in sign depending on the diagnosis and the degree of pathological changes.

Determination of Intraprostatic and Intratesticular Androgens.

Androgens represent the main hormones responsible for maintaining hormonal balance and function in the prostate and testis. As they are involved in prostate and testicular carcinogenesis, more detailed information of their active concentration at the site of action is required. Since the introduction of the term intracrinology as the local formation of active steroid hormones from inactive precursors of the adrenal gland, mainly dehydroepiandrosterone (DHEA) and DHEA-S, it is evident that blood circulating levels of sex steroid hormones need not reflect their actual concentrations in the tissue. Here, we review and critically evaluate available methods for the analysis of human intraprostatic and intratesticular steroid concentrations. Since analytical approaches have much in common in both tissues, we discuss them together. Preanalytical steps, including various techniques for separation of the analytes, are compared, followed by the end-point measurement. Advantages and disadvantages of chromatography-mass spectrometry (LC-MS, GC-MS), immunoanalytical methods (IA), and hybrid (LC-IA) are discussed. Finally, the clinical information value of the determined steroid hormones is evaluated concerning differentiating between patients with cancer or benign hyperplasia and between patients with different degrees of infertility. Adrenal-derived 11-oxygenated androgens are mentioned as perspective prognostic markers for these purposes.

Development of a clinical prediction rule for sepsis in primary care: protocol for the TeSD-IT study

BackgroundEarly recognition and treatment of sepsis is crucial to prevent detrimental outcomes. General practitioners (GPs) are often the first healthcare providers to encounter seriously ill patients. The aim of this study is to assess the value of clinical information and additional tests to develop a clinical prediction rule to support early diagnosis and management of sepsis by GPs.MethodsWe will perform a diagnostic study in the setting of out-of-hours home visits in four GP cooperatives in the Netherlands. Acutely ill adult patients suspected of a serious infection will be screened for eligibility by the GP. The following candidate predictors will be prospectively recorded: (1) age, (2) body temperature, (3) systolic blood pressure, (4) heart rate, (5) respiratory rate, (6) peripheral oxygen saturation, (7) mental status, (8) history of rigors, and (9) rate of progression. After clinical assessment by the GP, blood samples will be collected in all patients to measure C-reactive protein, lactate, and procalcitonin. All patients will receive care as usual. The primary outcome is the presence or absence of sepsis within 72 h after inclusion, according to an expert panel. The need for hospital treatment for any indication will be assessed by the expert panel as a secondary outcome. Multivariable logistic regression will be used to design an optimal prediction model first and subsequently derive a simplified clinical prediction rule that enhances feasibility of using the model in daily clinical practice. Bootstrapping will be performed for internal validation of both the optimal model and simplified prediction rule. Performance of both models will be compared to existing clinical prediction rules for sepsis.DiscussionThis study will enable us to develop a clinical prediction rule for the recognition of sepsis in a high-risk primary care setting to aid in the decision which patients have to be immediately referred to a hospital and who can be safely treated at home. As clinical signs and blood samples will be obtained prospectively, near-complete data will be available for analyses. External validation will be needed before implementation in routine care and to determine in which pre-hospital settings care can be improved using the prediction rule.Trial registrationThe study is registered in the Netherlands Trial Registry (registration number NTR7026).

Two-site evaluation of a new workflow for the detection of malignant cells on the Sysmex XN-1000 body fluid analyzer.

The presence of high fluorescent cells (HF-BF) on the Sysmex XN-1000 hematology analyzers has gained interest regarding the prediction of malignant cells in body fluids, but lacks sensitivity. We aimed to increase this sensitivity by combining HF-BF value, automated results, and clinical information. We evaluated a new workflow for the management of body fluids in the hematology laboratory, including the HF-BF criterion and clinical information. In two laboratories, 1623 serous fluids were retrospectively analyzed on the XN-1000 BF mode. All samples were morphologically screened for malignant cells. Optimal HF-BF cutoffs were determined to predict their presence. Thereafter, the added value of clinical information was evaluated. Other reflex testing rules (eosinophilic count >5% and presence of the WBC Abnormal Scattergram flag) were also used to refine our workflow. Optimal HF-BF cutoffs in the two hematology centers were 108 and 45 cells/µL, yielding a sensitivity/specificity of 66.7/93.6% and 86.8/66.6% for malignant cell detection. When adding clinical information, sensitivity/specificity evolved to 100.0/68.9% and 100.0%/not determined. Of 104 samples containing malignant cells, 97 had positive clinical information; the remainder had a HF-BF>cutoff. Combining clinical information and HF-BF reached 100% sensitivity for malignant cell detection in body fluid analysis. Lack of robustness of the optimal HF-BF cutoff deserves the use of local cutoffs. Rapid automated results reporting from the XN-1000 BF mode are also feasible in clinical practice. Prospective evaluation of the workflow is needed before its implementation in clinical practice.

How to use clinical signs and symptoms to estimate the probability of limb ischaemia in patients with a diabetic foot ulcer.

Assessment of ischaemia and interventions to improve perfusion are key elements in the management of the diabetic foot ulcer to achieve wound healing. This article will review, analyse and interpret the value of clinical information in determining the likelihood of limb ischaemia and thereby the need for referral to a vascular specialist. I conducted an historical review of the genesis of several currently recommended clinical signs and their diagnostic properties in the assessment of limb ischaemia. Changes in limb ischaemia probability based on such results were calculated using Bayes theorem, and the use of such probabilities is discussed in the context of the threshold approach to clinical decision making. Some clinical signs have negligible value in altering probability of limb ischaemia, possibly because they were advocated by Buerger for the diagnosis of thromboangiitis obliterans, an occlusive vascular disease of a different pathophysiology than atherosclerosis. Pedal pulse palpation, the most widely studied clinical sign, will marginally change a pre-test probability of ischaemia of 50% to 76% if positive (abnormal pulses) and to 36% if negative (normal pulses). Higher or lower pre-test probabilities of ischaemia will change the post-test probabilities such that these are too low or high to rule in or rule out ischaemia, respectively. Individual clinical signs convey little information regarding the presence of limb ischaemia but may have some value in combination or with pre-test probability near 50% in the assessment of ischaemia and the decision to refer for a vascular consultation.

The Contribution of Genetic Variation of Streptococcus pneumoniae to the Clinical Manifestation of Invasive Pneumococcal Disease.

Different clinical manifestations of invasive pneumococcal disease (IPD) have thus far mainly been explained by patient characteristics. Here we studied the contribution of pneumococcal genetic variation to IPD phenotype. The index cohort consisted of 349 patients admitted to 2 Dutch hospitals between 2000-2011 with pneumococcal bacteremia. We performed genome-wide association studies to identify pneumococcal lineages, genes, and allelic variants associated with 23 clinical IPD phenotypes. The identified associations were validated in a nationwide (n = 482) and a post-pneumococcal vaccination cohort (n = 121). The contribution of confirmed pneumococcal genotypes to the clinical IPD phenotype, relative to known clinical predictors, was tested by regression analysis. Among IPD patients, the presence of pneumococcal gene slaA was a nationwide confirmed independent predictor of meningitis (odds ratio [OR], 10.5; P = .001), as was sequence cluster 9 (serotype 7F: OR, 3.68; P = .057). A set of 4 pneumococcal genes co-located on a prophage was a confirmed independent predictor of 30-day mortality (OR, 3.4; P = .003). We could detect the pneumococcal variants of concern in these patients' blood samples. In this study, knowledge of pneumococcal genotypic variants improved the clinical risk assessment for detrimental manifestations of IPD. This provides us with novel opportunities to target, anticipate, or avert the pathogenic effects related to particular pneumococcal variants, and indicates that information on pneumococcal genotype is important for the diagnostic and treatment strategy in IPD. Ongoing surveillance is warranted to monitor the clinical value of information on pneumococcal variants in dynamic microbial and susceptible host populations.

First results of a new hyperspectral camera system for chemical based wound analysis

Abstract Hyperspectral imaging and near infrared spectroscopy (NIRS) for wound analysis have been used in many scientific studies with good results for the chemical analysis of wounds and have the potential to raise objective measurement and assessment of wounds to a new level with considerable higher clinical informative value. Up to now the clinical and scientific use of this technology has been hindered by the lack of a hyperspectral measurement system usable in clinical practice. We present the first hyperspectral camera for quick and robust acquisition of hyperspectral data in the combined VIS and NIR spectral range with high spectral and spatial resolution from wounds. First case studies and evaluations of chemometric parameters like the oxygenation of hemoglobin and perfusion quality are presented and exhibit the high quality and potential of this new wound measurement system.

Thrombus age is ideally measured by history or MRV prior to thrombus removal.

Many factors are known to be important in order to achieve optimal results after thrombus removal for iliofemoral DVT. Not much is published in the literature about timing the treatment, though many guidelines recommend treatment within 14 days. This time span lies within the phrase of acute DVT according to the definition given in many reporting standards. This article will highlight the value of information acquired from patients directly regarding onset of symptoms versus information acquired from imaging with the purpose of a more precise selection of patients for catheter-directed thrombolysis for iliofemoral DVT. What is the value of clinical information acquired from patients and does the information from imaging have additional value?

Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty.

To compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations in the diagnosis of periprosthetic joint infection (PJI) before revision total hip arthroplasty (THA). We conducted a prospective observational study of 71 consecutive patients (74 hips) undergoing revision THA. Procalcitonin and CRP serum concentrations and white blood cell (WBC) count were measured pre-operatively. Diagnostic accuracy was analyzed by the receiver-operating characteristic (ROC) curve and the area under the curve (AUC). The PJI incidence was 35.2% in patients with revision THA. Procalcitonin and CRP serum concentrations and WBC count were statistically higher in the PJI cohort compared with the no PJI cohort (p<0.05). The AUCs for PCT, CRP, and WBC count were 0.851 (95% confidence interval [CI] 0.773-0.929), 0.830 (95% CI 0.751-0.910), and 0.633 (95% CI 0.518-0.747), respectively. Serum PCT and CRP showed a significantly higher diagnostic ability than WBC count (p<0.05). No significant difference was found between serum PCT and CRP (p=0.367). Procalcitonin does not offer an advantage over CRP in diagnosing PJI. However, PCT and CRP proved to be more reliable than WBC count.

The 2015 guidelines for the laboratory diagnosis of rheumatic diseases by the All-Russian Public Organization «Association of Rheumatology of Russia»

The paper gives the clinical guidelines for the laboratory diagnosis of rheumatic diseases (RDs) elaborated by the Association of Rheumatologists of Russia in terms of the international requirements for methodology of a system search and assessment of the quality of evidence. The main goal of the laboratory diagnosis of RDs is to obtain objective information on the presence and pattern of immunopathological changes in a patient, which is an important tool for the early diagnosis, assessment of activity and severity of the disease, and its prediction, and efficiency of performed therapy. The clinical informative value of laboratory studies is determined by calculating their diagnostic sensitivity and specificity and the likelihood ratio for positive and negative results. Serological antibody detection tests hold a central position in the laboratory diagnosis of RDs. The main diagnostic laboratory markers of the latter are antinuclear antibodies, rheumatoid factor, anticitrullinated protein antibodies, antineutrophil cytoplasmic antibodies, and antiphospholipid antibodies. The positive results of autoantibody detection include diagnostic criteria for systemic autoimmune RDs, are used to assess the activity and prognosis of these diseases, play an important role in the diagnosis of earlystage RD, permit identification of individual clinical and laboratory RD subtypes, and serve as predictors for RDs in the absence of its symptoms. Standard autoantibody profiles were elaborated; a list of primary (screening), secondary (confirming), and additional serological tests were made out to diagnose systemic autoimmune RDs. The important laboratory markers of RDs are acutephase indicators (erythrocyte sedimentation rate, C-reactive protein, etc.) that can assess the inflammatory activity of the disease, its progression pattern, and prognosis during the chronic inflammatory process, as well as therapeutic efficiency. Other laboratory biomarkers (immunoglobulins, immune complexes, cryoglobulins, complement components, cytokines, endothelial activation markers, lymphocyte subpopulations, genetic markers, bone and cartilage tissue metabolic parameters, etc.) are of less clinical value than autoantibodies and acute inflammatory phase parameters in diagnosing RD.

Amalgamation of procalcitonin, C-reactive protein, and sequential organ failure scoring system in predicting sepsis survival.

Background:The clinical value of inflammatory biomarkers is still questionable.Aim of the Work:The aim of this study is to compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentration in the early detection of sepsis, as well as relating these biomarkers to other scoring systems.Patients and Methods:A total of 138 patients were enrolled in our study. All were subjected to PCT, CRP, and sequential organ failure assessment (SOFA) scores daily for 7 days (starting from admission day). Blood samples were collected before starting antibiotics, with 28 days follow-up and patients were assigned to three groups: Group I: SOFA 2-7, Group II: SOFA 8-10, and Group III: SOFA ≥11.Results:Underlying clinical diagnosis revealed pneumonia in 72 patients, urinary tract infections in eight, bloodstream infection in four, and other infections in 23, while infection could not be traced in 25 patients. The mean PCT was 3 ng/ml (95% confidence interval [CI]: 1-4), 12 ng/ml (95% CI: 9.1-14), and 19 ng/ml (95% CI: 16.3-22.3) in Groups I, II, and III, respectively, with a statistically significant difference in the mean PCT level among the three groups (P < 0.0001). On the other hand, CRP mean level did not significantly differentiate between the groups (147.1 mg/L in Group II, which was even higher than the level of Group III, 138.4 mg/L).Conclusion:PCT seems to do better than CRP in predicting the SOFA groups, giving its patronage display over a wide spectrum of insults.

Clinical and economic evaluation of the impact of rapid microbiological diagnostic testing

The clinical value of information provided by the Microbiology Laboratory may be reduced by the time it takes to generate results for healthcare providers. The aim of this study was to measure the clinical and economic impact associated with rapid reporting of microbiological results. 574 hospitalized patients with a bacterial clinical infection confirmed by culture were evaluated. 284 hospitalized patients were included in the historical control group (results available the day following the analysis) and 290 in the intervention group (results available the same day of the analysis). The Vitek(®) 2 system (bioMérieux) was used for identification and antimicrobial susceptibility testing in both groups. Faster reporting of microbiological results enabled the clinician to optimize the antibiotic treatment sooner (P < 0.001). This reduction in turnaround time (17.6 h) was associated with improved clinical outcome, a significant reduction in the length of hospitalization and the number of microbiological and biochemical tests performed. Intubation requirements were significantly lower in the intervention group. Mortality rates did not differ significantly between the two groups. Costs incurred for patients in the intervention group were significantly lower than those in the control group, including costs for Microbiology Laboratory testing, antibiotic costs, length of hospitalization and other patient care costs. Rapid microbiological information was associated with quality improvement seen in earlier changes in antibiotic use, an improved clinical outcome and financial benefits.

Fall risk after stroke: Do stabilometric measures add to the predictive value of clinical information?

Fall risk after stroke: Do stabilometric measures add to the predictive value of clinical information?

Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information

the prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relationship between diagnostic accuracy and years of professional experience. seven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms) were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department) completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis. forty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess): 100 vs. 80.6%, (p = 0.157); case 2 (fissure): 92.3 vs. 51.6% (p = 0.015); case 3 (thrombosed hemorrhoid): 92.3 vs. 74.2% (p = 0.321); case 4 (anal condyloma): 100 vs. 87.1% (p = 0.302); case 5 (rectal prolapse): 100 vs. 83.9% (p = 0.301); case 6 (prolapsed hemorrhoid): 92.3 vs. 29% (p = 0.001), and case 7 (fistula): 100 vs. 67.7% (p = 0.021). There were significant differences in the number of correctly diagnosed cases between groups (p < 0.001). Information about clinical symptoms significantly increased overall and specific accuracy. There was no correlation between experience and accuracy. clinical symptoms are important for diagnostic accuracy in anorectal pathology. Training in anorectal pathology in medical specialists is warranted.

Physicians' assessment of the value of clinical information: Operationalization of a theoretical model

AbstractInspired by the acquisition–cognition–application model (T. Saracevic &amp; K.B. Kantor, 1997), we developed a tool called the Information Assessment Method to more clearly understand how physicians use clinical information. In primary healthcare, we conducted a naturalistic and longitudinal study of searches for clinical information. Forty‐one family physicians received a handheld computer with the Information Assessment Method linked to one commercial electronic knowledge resource. Over an average of 320 days, 83% of 2,131 searches for clinical information were rated using the Information Assessment Method. Searches to address a clinical question, as well as the retrieval of relevant clinical information, were positively associated with the use of that information for a specific patient. Searches done out of curiosity were negatively associated with the use of clinical information. We found significant associations between specific types of cognitive impact and information use for a specific patient. For example, when the physician reported “My practice was changed and improved” as a result of this clinical information, the odds that information was used for a specific patient increased threefold. Our findings provide empirical data to support the applicability of the acquisition‐cognition‐application model, as operationalized through the Information Assessment Method, in primary healthcare. Capturing the use of research‐based information in medicine opens the door to further study of the relationships between clinical information and health outcomes.

What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering

Background The provision of relevant clinical information on pathology requests is an important part of facilitating appropriate laboratory utilization and accurate results interpretation and reporting. Purpose (1) To determine the quantity and importance of handwritten clinical information provided by physicians to the Microbiology Department of a hospital pathology service; and (2) to examine the impact of a Computerized Provider Order Entry (CPOE) system on the nature of clinical information communication to the laboratory. Methods A multi-method and multi-stage investigation which included: (a) a retrospective audit of all handwritten Microbiology requests received over a 1-month period in the Microbiology Department of a large metropolitan teaching hospital; (b) the administration of a survey to laboratory professionals to investigate the impact of different clinical information on the processing and/or interpretation of tests; (c) an expert panel consisting of medical staff and senior scientists to assess the survey findings and their impact on pathology practice and patient care; and (d) a comparison of the provision and value of clinical information before CPOE, and across 3 years after its implementation. Results The audit of handwritten requests found that 43% ( n = 4215) contained patient-related clinical information. The laboratory survey showed that 97% (84/86) of the different types of clinical information provided for wound specimens and 86% (43/50) for stool specimens were shown to have an effect on the processing or interpretation of the specimens by one or more laboratory professionals. The evaluation of the impact of CPOE revealed a significant improvement in the provision of useful clinical information from 2005 to 2008, rising from 90.1% ( n = 749) to 99.8% ( n = 915) ( p < .0001) for wound specimens and 34% ( n = 129) to 86% ( n = 422) ( p < .0001) for stool specimens. Conclusion This study showed that the CPOE system provided an integrated platform to access and exchange valuable patient-related information between physicians and the laboratory. These findings have important implications for helping to inform decisions about the design and structure of CPOE screens and what data entry fields should be designated or made voluntary.

Using electronic knowledge resources for person-centered medicine – I: An evaluation model

Rationale: Electronic knowledge resources are routinely searched by physicians for clinical information. The value of clinical information for physicians can be conceptualized in accordance with the ‘Acquisition-Cognition-Application’ model from information studies. In previous work, seven reasons for searching for information (acquisition), and 10 cognitive impacts (cognition), were proposed.Aims and objectives: In two companion papers, our objectives are: (1) to propose a person-centered model of the value of clinical information retrieved by health professionals from electronic knowledge resources, called the ‘Acquisition-Cognition-Application-Outcome’ (ACAO) model and (2) to propose a related concept, the Number Needed To Benefit From Information (NNBI), i.e., the number of patients for whom information has to be retrieved to observe health benefits for one patient. Our research questions are as follows. Part 1: What is known about patients health benefits associated with the use of information that physicians retrieve from electronic knowledge resources? Part 2: How do patients benefit when physicians use information from electronic knowledge resources?Methods: This paper (Part 1) reports a mixed studies review of the medical literature on types of information use and subsequent patient health benefits.Results: Twenty-nine papers were included in this review. These papers support four proposed types of information use and four of five types of patient health benefits.Conclusion: This review of the medical literature supports the ACAO model and paves the way toward a new concept for examining patient health benefits associated with information use, the NNBI described in Part 2.