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Explainable machine learning for breast cancer diagnosis from mammography and ultrasound images: a systematic review 从乳房 X 射线照相术和超声波图像诊断乳腺癌的可解释机器学习:系统综述
IF 4.1 Q2 Computer Science Pub Date : 2024-02-01 DOI: 10.1136/bmjhci-2023-100954
Daraje kaba Gurmessa, Worku Jimma
Background Breast cancer is the most common disease in women. Recently, explainable artificial intelligence (XAI) approaches have been dedicated to investigate breast cancer. An overwhelming study has been done on XAI for breast cancer. Therefore, this study aims to review an XAI for breast cancer diagnosis from mammography and ultrasound (US) images. We investigated how XAI methods for breast cancer diagnosis have been evaluated, the existing ethical challenges, research gaps, the XAI used and the relation between the accuracy and explainability of algorithms. Methods In this work, Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and diagram were used. Peer-reviewed articles and conference proceedings from PubMed, IEEE Explore, ScienceDirect, Scopus and Google Scholar databases were searched. There is no stated date limit to filter the papers. The papers were searched on 19 September 2023, using various combinations of the search terms ‘breast cancer’, ‘explainable’, ‘interpretable’, ‘machine learning’, ‘artificial intelligence’ and ‘XAI’. Rayyan online platform detected duplicates, inclusion and exclusion of papers. Results This study identified 14 primary studies employing XAI for breast cancer diagnosis from mammography and US images. Out of the selected 14 studies, only 1 research evaluated humans’ confidence in using the XAI system—additionally, 92.86% of identified papers identified dataset and dataset-related issues as research gaps and future direction. The result showed that further research and evaluation are needed to determine the most effective XAI method for breast cancer. Conclusion XAI is not conceded to increase users’ and doctors’ trust in the system. For the real-world application, effective and systematic evaluation of its trustworthiness in this scenario is lacking. PROSPERO registration number CRD42023458665. Data are available upon reasonable request.
背景 乳腺癌是女性最常见的疾病。最近,可解释人工智能(XAI)方法被用于研究乳腺癌。目前,针对乳腺癌的 XAI 研究还很少。因此,本研究旨在回顾一种用于从乳房 X 射线照相术和超声波(US)图像诊断乳腺癌的 XAI。我们调查了用于乳腺癌诊断的 XAI 方法是如何被评估的、现有的伦理挑战、研究差距、所使用的 XAI 以及算法的准确性和可解释性之间的关系。方法 在这项工作中,使用了《系统综述和元分析首选报告项目》清单和图表。从 PubMed、IEEE Explore、ScienceDirect、Scopus 和 Google Scholar 数据库中搜索了同行评审文章和会议论文集。论文筛选没有明确的日期限制。论文搜索日期为 2023 年 9 月 19 日,使用了 "乳腺癌"、"可解释"、"可解释"、"机器学习"、"人工智能 "和 "XAI "等搜索词的不同组合。Rayyan 在线平台检测了重复、纳入和排除的论文。结果 本研究共发现了 14 项利用 XAI 从乳房 X 射线照相术和 US 图像诊断乳腺癌的主要研究。在所选的 14 项研究中,只有 1 项研究对人类使用 XAI 系统的信心进行了评估,此外,92.86% 的已识别论文将数据集和数据集相关问题确定为研究差距和未来方向。结果表明,要确定最有效的乳腺癌 XAI 方法,还需要进一步的研究和评估。结论 XAI 并不能增加用户和医生对系统的信任。在实际应用中,还缺乏对其可信度的有效和系统评估。PROSPERO 注册号为 CRD42023458665。如有合理要求,可提供相关数据。
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引用次数: 0
Seamless EMR data access: Integrated governance, digital health and the OMOP-CDM 无缝的 EMR 数据访问:综合治理、数字医疗和 OMOP-CDM
IF 4.1 Q2 Computer Science Pub Date : 2024-02-01 DOI: 10.1136/bmjhci-2023-100953
Christine Mary Hallinan, Roger Ward, Graeme K Hart, Clair Sullivan, Nicole Pratt, Ashley P Ng, Daniel Capurro, Anton Van Der Vegt, Siaw-Teng Liaw, Oliver Daly, Blanca Gallego Luxan, David Bunker, Douglas Boyle
Objectives In this overview, we describe theObservational Medical Outcomes Partnership Common Data Model (OMOP-CDM), the established governance processes employed in EMR data repositories, and demonstrate how OMOP transformed data provides a lever for more efficient and secure access to electronic medical record (EMR) data by health service providers and researchers. Methods Through pseudonymisation and common data quality assessments, the OMOP-CDM provides a robust framework for converting complex EMR data into a standardised format. This allows for the creation of shared end-to-end analysis packages without the need for direct data exchange, thereby enhancing data security and privacy. By securely sharing de-identified and aggregated data and conducting analyses across multiple OMOP-converted databases, patient-level data is securely firewalled within its respective local site. Results By simplifying data management processes and governance, and through the promotion of interoperability, the OMOP-CDM supports a wide range of clinical, epidemiological, and translational research projects, as well as health service operational reporting. Discussion Adoption of the OMOP-CDM internationally and locally enables conversion of vast amounts of complex, and heterogeneous EMR data into a standardised structured data model, simplifies governance processes, and facilitates rapid repeatable cross-institution analysis through shared end-to-end analysis packages, without the sharing of data. Conclusion The adoption of the OMOP-CDM has the potential to transform health data analytics by providing a common platform for analysing EMR data across diverse healthcare settings. Data sharing not applicable as no datasets generated.
目的 在本综述中,我们将介绍观察性医疗结果合作组织通用数据模型(OMOP-CDM)、EMR 数据存储库所采用的既定管理流程,并展示 OMOP 转换后的数据如何为医疗服务提供者和研究人员更高效、更安全地访问电子病历(EMR)数据提供杠杆作用。方法 通过化名和通用数据质量评估,OMOP-CDM 为将复杂的 EMR 数据转换为标准化格式提供了一个强大的框架。这样就可以创建共享的端到端分析包,而无需直接交换数据,从而提高了数据的安全性和隐私性。通过安全共享去标识化和汇总数据,并在多个 OMOP 转换数据库中进行分析,患者级数据在各自的本地站点内被安全防火墙隔离。结果 通过简化数据管理流程和治理,并通过促进互操作性,OMOP-CDM 支持了广泛的临床、流行病学和转化研究项目,以及医疗服务运营报告。讨论 在国际和本地采用 OMOP-CDM 能够将大量复杂、异构的 EMR 数据转换为标准化的结构化数据模型,简化管理流程,并通过共享端到端分析包,在不共享数据的情况下,促进快速、可重复的跨机构分析。结论 采用 OMOP-CDM 有可能改变健康数据分析,为分析不同医疗机构的 EMR 数据提供一个通用平台。由于未生成数据集,数据共享不适用。
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引用次数: 0
Performance of large language models on advocating the management of meningitis: a comparative qualitative stud 大语言模型在脑膜炎管理宣传方面的表现:一项定性比较研究
IF 4.1 Q2 Computer Science Pub Date : 2024-02-01 DOI: 10.1136/bmjhci-2023-100978
Urs Fisch, Paulina Kliem, Pascale Grzonka, Raoul Sutter
Objectives We aimed to examine the adherence of large language models (LLMs) to bacterial meningitis guidelines using a hypothetical medical case, highlighting their utility and limitations in healthcare. Methods A simulated clinical scenario of a patient with bacterial meningitis secondary to mastoiditis was presented in three independent sessions to seven publicly accessible LLMs (Bard, Bing, Claude-2, GTP-3.5, GTP-4, Llama, PaLM). Responses were evaluated for adherence to good clinical practice and two international meningitis guidelines. Results A central nervous system infection was identified in 90% of LLM sessions. All recommended imaging, while 81% suggested lumbar puncture. Blood cultures and specific mastoiditis work-up were proposed in only 62% and 38% sessions, respectively. Only 38% of sessions provided the correct empirical antibiotic treatment, while antiviral treatment and dexamethasone were advised in 33% and 24%, respectively. Misleading statements were generated in 52%. No significant correlation was found between LLMs’ text length and performance (r=0.29, p=0.20). Among all LLMs, GTP-4 demonstrated the best performance. Discussion Latest LLMs provide valuable advice on differential diagnosis and diagnostic procedures but significantly vary in treatment-specific information for bacterial meningitis when introduced to a realistic clinical scenario. Misleading statements were common, with performance differences attributed to each LLM’s unique algorithm rather than output length. Conclusions Users must be aware of such limitations and performance variability when considering LLMs as a support tool for medical decision-making. Further research is needed to refine these models' comprehension of complex medical scenarios and their ability to provide reliable information. Data are available upon reasonable request.
目的 我们旨在通过一个假设的医疗案例来检验大型语言模型(LLMs)对细菌性脑膜炎指南的遵从情况,从而突出其在医疗保健领域的实用性和局限性。方法 将一个继发于乳突炎的细菌性脑膜炎患者的模拟临床情景分三次展示给七个可公开访问的大型语言模型(Bard、Bing、Claude-2、GTP-3.5、GTP-4、Llama、PaLM)。根据良好临床实践和两份国际脑膜炎指南,对回复进行了评估。结果 90% 的 LLM 会议确定了中枢神经系统感染。所有人都建议进行影像学检查,81%的人建议进行腰椎穿刺。分别只有 62% 和 38% 的会议建议进行血液培养和特定乳突炎检查。只有 38% 的会议提供了正确的经验性抗生素治疗,而分别有 33% 和 24% 的会议建议进行抗病毒治疗和地塞米松治疗。有 52% 的陈述具有误导性。结果表明,语言学习者的文字长度与学习成绩之间没有明显的相关性(r=0.29,p=0.20)。在所有 LLM 中,GTP-4 的性能最佳。讨论 最新的 LLM 在鉴别诊断和诊断程序方面提供了有价值的建议,但在引入真实的临床场景时,在细菌性脑膜炎的治疗特异性信息方面存在显著差异。误导性陈述很常见,性能差异归因于每个 LLM 的独特算法而非输出长度。结论 用户在考虑将 LLM 作为医疗决策支持工具时,必须意识到这些局限性和性能差异。还需要进一步的研究来完善这些模型对复杂医疗场景的理解能力以及提供可靠信息的能力。如有合理要求,可提供相关数据。
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引用次数: 0
Rapidly scalable and low-cost public health surveillance reporting system for COVID-19. 针对 COVID-19 的可快速扩展的低成本公共卫生监测报告系统。
IF 4.1 Q2 Computer Science Pub Date : 2024-01-18 DOI: 10.1136/bmjhci-2023-100759
Vivek Jason Jayaraj, Chiu-Wan Ng, Victor Chee-Wai Hoe, Diane Woei-Quan Chong, Sanjay Rampal

Objective: Data-driven innovations are essential in strengthening disease control. We developed a low-cost, open-source system for robust epidemiological intelligence in response to the COVID-19 crisis, prioritising scalability, reproducibility and dynamic reporting.

Methods: A five-tiered workflow of data acquisition; processing; databasing, sharing, version control; visualisation; and monitoring was used. COVID-19 data were initially collated from press releases and then transitioned to official sources.

Results: Key COVID-19 indicators were tabulated and visualised, deployed using open-source hosting in October 2022. The system demonstrated high performance, handling extensive data volumes, with a 92.5% user conversion rate, evidencing its value and adaptability.

Conclusion: This cost-effective, scalable solution aids health specialists and authorities in tracking disease burden, particularly in low-resource settings. Such innovations are critical in health crises like COVID-19 and adaptable to diverse health scenarios.

目标:数据驱动的创新对加强疾病控制至关重要。为应对 COVID-19 危机,我们开发了一个低成本、开源的流行病学情报系统,优先考虑可扩展性、可重复性和动态报告:方法:采用五层工作流程:数据采集、处理、数据库、共享、版本控制、可视化和监测。COVID-19 数据最初从新闻稿中收集,然后过渡到官方来源:COVID-19 的关键指标已制成表格并实现可视化,于 2022 年 10 月使用开源主机进行部署。该系统性能卓越,可处理大量数据,用户转换率达 92.5%,证明了其价值和适应性:这一成本效益高、可扩展的解决方案有助于卫生专家和当局跟踪疾病负担,尤其是在资源匮乏的环境中。这种创新在 COVID-19 等健康危机中至关重要,并可适应各种健康情景。
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引用次数: 0
Regulating AI for health. 规范人工智能,促进健康。
IF 4.1 Q2 Computer Science Pub Date : 2023-12-21 DOI: 10.1136/bmjhci-2023-100931
Ian Oppermann
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引用次数: 0
Call for the responsible artificial intelligence in the healthcare. 呼吁在医疗保健领域使用负责任的人工智能。
IF 4.1 Q2 Computer Science Pub Date : 2023-12-21 DOI: 10.1136/bmjhci-2023-100920
Umashankar Upadhyay, Anton Gradisek, Usman Iqbal, Eshita Dhar, Yu-Chuan Li, Shabbir Syed-Abdul

The integration of artificial intelligence (AI) into healthcare is progressively becoming pivotal, especially with its potential to enhance patient care and operational workflows. This paper navigates through the complexities and potentials of AI in healthcare, emphasising the necessity of explainability, trustworthiness, usability, transparency and fairness in developing and implementing AI models. It underscores the 'black box' challenge, highlighting the gap between algorithmic outputs and human interpretability, and articulates the pivotal role of explainable AI in enhancing the transparency and accountability of AI applications in healthcare. The discourse extends to ethical considerations, exploring the potential biases and ethical dilemmas that may arise in AI application, with a keen focus on ensuring equitable and ethical AI use across diverse global regions. Furthermore, the paper explores the concept of responsible AI in healthcare, advocating for a balanced approach that leverages AI's capabilities for enhanced healthcare delivery and ensures ethical, transparent and accountable use of technology, particularly in clinical decision-making and patient care.

人工智能(AI)与医疗保健的结合正逐渐变得举足轻重,尤其是其在加强患者护理和业务工作流程方面的潜力。本文探讨了人工智能在医疗保健领域的复杂性和潜力,强调了在开发和实施人工智能模型过程中可解释性、可信性、可用性、透明度和公平性的必要性。它强调了 "黑箱 "挑战,突出了算法输出与人类可解释性之间的差距,并阐明了可解释的人工智能在提高医疗保健领域人工智能应用的透明度和问责制方面的关键作用。论述延伸到伦理方面的考虑,探讨了人工智能应用中可能出现的潜在偏见和伦理困境,重点关注如何确保在全球不同地区公平、合乎伦理地使用人工智能。此外,本文还探讨了负责任的人工智能在医疗保健中的应用这一概念,主张采用一种平衡的方法,利用人工智能的能力来加强医疗保健服务,并确保技术的使用,尤其是在临床决策和患者护理方面的使用,做到合乎道德、透明和负责任。
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引用次数: 0
Call to digital health leaders: test and leverage this guideline to support health information technology implementation in practice. 呼吁数字卫生领导者:测试和利用本指南,以支持卫生信息技术在实践中的实施。
IF 4.1 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-02 DOI: 10.1136/bmjhci-2023-100829
Samantha Erin Harding, Karen Day, Peter Carswell

Background: Health information technology (HIT) is increasingly used to enable health service/system transformation. Most HIT implementations fail to some degree; very few demonstrate sustainable success. No guidelines exist for health service leaders to leverage factors associated with success. The purpose of this paper is to present an evidence-based guideline for leaders to test and leverage in practice.

Methods: This guideline was developed from a literature review and refined by a set of eight interviews with people in senior HIT roles, which were thematically analysed. It was refined in the consultancy work of the first author and confirmed after minor refinements.

Results: Five key actions were identified: relationships, vision, HIT system attributes, constant evaluation and learning culture.

Conclusions: This guideline presents a significant opportunity for health system leaders to systematically check relevant success factors during the implementation process of single projects and regional/national programmes.

背景:卫生信息技术(HIT)越来越多地用于实现卫生服务/系统转型。大多数HIT实现在某种程度上都失败了;很少有持续的成功。目前还没有指导卫生服务领导者如何利用与成功相关的因素。本文的目的是为领导者在实践中测试和利用提供一个基于证据的指导方针。方法:本指南从文献综述中发展而来,并通过对HIT高级角色的八组访谈进行了改进,并对其进行了主题分析。这是在第一作者的咨询工作中完善的,经过小的修改后得到了确认。结果:确定了五个关键行动:关系、愿景、HIT系统属性、持续评估和学习文化。结论:本指南为卫生系统领导人在单个项目和区域/国家规划实施过程中系统检查相关成功因素提供了重要机会。
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引用次数: 0
ChatGPT in Iranian medical licensing examination: evaluating the diagnostic accuracy and decision-making capabilities of an AI-based model 伊朗医学执照考试中的 ChatGPT:评估基于人工智能模型的诊断准确性和决策能力
IF 4.1 Q2 Computer Science Pub Date : 2023-12-01 DOI: 10.1136/bmjhci-2023-100815
Manoochehr Ebrahimian, Behdad Behnam, Negin Ghayebi, Elham Sobhrakhshankhah
Introduction Large language models such as ChatGPT have gained popularity for their ability to generate comprehensive responses to human queries. In the field of medicine, ChatGPT has shown promise in applications ranging from diagnostics to decision-making. However, its performance in medical examinations and its comparison to random guessing have not been extensively studied. Methods This study aimed to evaluate the performance of ChatGPT in the preinternship examination, a comprehensive medical assessment for students in Iran. The examination consisted of 200 multiple-choice questions categorised into basic science evaluation, diagnosis and decision-making. GPT-4 was used, and the questions were translated to English. A statistical analysis was conducted to assess the performance of ChatGPT and also compare it with a random test group. Results The results showed that ChatGPT performed exceptionally well, with 68.5% of the questions answered correctly, significantly surpassing the pass mark of 45%. It exhibited superior performance in decision-making and successfully passed all specialties. Comparing ChatGPT to the random test group, ChatGPT’s performance was significantly higher, demonstrating its ability to provide more accurate responses and reasoning. Conclusion This study highlights the potential of ChatGPT in medical licensing examinations and its advantage over random guessing. However, it is important to note that ChatGPT still falls short of human physicians in terms of diagnostic accuracy and decision-making capabilities. Caution should be exercised when using ChatGPT, and its results should be verified by human experts to ensure patient safety and avoid potential errors in the medical field. Data are available on reasonable request.
引言 大型语言模型(如 ChatGPT)因其能够生成对人类查询的全面回复而广受欢迎。在医学领域,从诊断到决策,ChatGPT 都显示出良好的应用前景。然而,它在医学检查中的表现以及与随机猜测的比较尚未得到广泛研究。方法 本研究旨在评估 ChatGPT 在实习前考试中的表现,这是一项针对伊朗学生的综合医学评估。考试包括 200 道选择题,分为基础科学评估、诊断和决策。使用的是 GPT-4,试题被翻译成英语。为了评估 ChatGPT 的性能,并将其与随机测试组进行比较,我们进行了统计分析。结果 结果显示,ChatGPT 的表现非常出色,68.5% 的问题回答正确,大大超过了 45% 的及格线。它在决策方面表现出色,并成功通过了所有专业测试。将 ChatGPT 与随机测试组相比,ChatGPT 的成绩明显更高,这表明它有能力提供更准确的回答和推理。结论 本研究凸显了 ChatGPT 在医学执业资格考试中的潜力及其相对于随机猜测的优势。不过,需要注意的是,就诊断准确性和决策能力而言,ChatGPT 仍与人类医生存在差距。使用 ChatGPT 时应谨慎,其结果应由人类专家验证,以确保患者安全,避免医疗领域潜在的错误。如有合理要求,可提供相关数据。
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引用次数: 0
Exploring the reliability of inpatient EMR algorithms for diabetes identification 探索住院病人 EMR 算法在糖尿病识别方面的可靠性
IF 4.1 Q2 Computer Science Pub Date : 2023-12-01 DOI: 10.1136/bmjhci-2023-100894
Seungwon Lee, Elliot A Martin, Jie Pan, Cathy A Eastwood, Danielle A Southern, David J T Campbell, Abdel Aziz Shaheen, Hude Quan, Sonia Butalia
Introduction Accurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms. Materials and methods A chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms used or statements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV). Results The algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99. Discussion Free-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery. Data may be obtained from a third party and are not publicly available. Restrictions apply to the availability of these data. Data were obtained from Alberta Health Services and are available with the permission of Alberta Health Services.
导言 在实时住院环境中准确识别医疗状况对医疗系统至关重要。目前的住院病人合并症算法依赖于整合各种来源的管理数据,但有时在获取和连接这些数据方面存在相当大的滞后性。我们的研究目标是开发基于电子病历(EMR)数据的住院病人糖尿病表型算法。材料和方法 完成了对 3040 人的病历审查,其中 583 人患有糖尿病。我们将这些患者的电子病历数据与国际疾病分类(ICD)管理数据库进行了链接。我们开发了以下基于 EMR 数据的糖尿病算法:(1) 实验室数据;(2) 药物数据;(3) 实验室和药物数据;(4) 糖尿病概念关键词;(5) 糖尿病自由文本算法。使用的组合算法或上述算法之间的语句。使用病历审查作为金标准来衡量算法性能。我们将灵敏度(SN)和阳性预测值(PPV)表现较高的算法确定为表现最佳的算法。结果 测试的算法普遍表现良好:ICD编码数据,SN为0.84,特异性(SP)为0.98,PPV为0.93,阴性预测值(NPV)为0.96;药物和实验室算法,SN为0.90,SP为0.95,PPV为0.80,NPV为0.97;所有文件类型算法,SN为0.95,SP为0.98,PPV为0.94,NPV为0.99。讨论 基于自由文本数据的糖尿病算法可产生与常用的 ICD 编码算法相当或更高的性能,可作为现有方法的补充。这类基于住院病人 EMR 的病例识别算法可能成为及时规划资源和提供护理的关键方法。数据可能来自第三方,不对外公开。这些数据的可用性受到限制。数据来自艾伯塔省卫生服务机构,经艾伯塔省卫生服务机构许可后提供。
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引用次数: 0
Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study 电子健康记录干预增加住院病人使用非甾体抗炎药镇痛:分组随机对照研究
IF 4.1 Q2 Computer Science Pub Date : 2023-12-01 DOI: 10.1136/bmjhci-2023-100842
Tasce Bongiovanni, Mark J Pletcher, Andrew Robinson, Elizabeth Lancaster, Li Zhang, Matthias Behrends, Elizabeth Wick, Andrew Auerbach
Background Prescribing non-opioid pain medications, such as non-steroidal anti-inflammatory (NSAIDs) medications, has been shown to reduce pain and decrease opioid use, but it is unclear how to effectively encourage multimodal pain medication prescribing for hospitalised patients. Therefore, the aim of this study is to evaluate the effect of prechecking non-opioid pain medication orders on clinician prescribing of NSAIDs among hospitalised adults. Methods This was a cluster randomised controlled trial of adult (≥18 years) hospitalised patients admitted to three hospital sites under one quaternary hospital system in the USA from 2 March 2022 to 3 March 2023. A multimodal pain order panel was embedded in the admission order set, with NSAIDs prechecked in the intervention group. The intervention group could uncheck the NSAID order. The control group had access to the same NSAID order. The primary outcome was an increase in NSAID ordering. Secondary outcomes include NSAID administration, inpatient pain scores and opioid use and prescribing and relevant clinical harms including acute kidney injury, new gastrointestinal bleed and in-hospital death. Results Overall, 1049 clinicians were randomised. The study included 6239 patients for a total of 9595 encounters. Both NSAID ordering (36 vs 43%, p<0.001) and administering (30 vs 34%, p=0.001) by the end of the first full hospital day were higher in the intervention (prechecked) group. There was no statistically significant difference in opioid outcomes during the hospitalisation and at discharge. There was a statistically but perhaps not clinically significant difference in pain scores during both the first and last full hospital day. Conclusions This cluster randomised controlled trial showed that prechecking an order for NSAIDs to promote multimodal pain management in the admission order set increased NSAID ordering and administration, although there were no changes to pain scores or opioid use. While prechecking orders is an important way to increase adoption, safety checks should be in place. Data are available in a public, open access repository. Data is publicly available from the Centers of Medicare and Medicaid Services from the US Government.
背景开具非阿片类止痛药(如非甾体类抗炎药)已被证明可以减轻疼痛并减少阿片类药物的使用,但如何有效鼓励为住院患者开具多模式止痛药尚不清楚。因此,本研究旨在评估预先检查非阿片类止痛药医嘱对临床医生为住院成年人开具非甾体抗炎药处方的影响。方法 这是一项分组随机对照试验,研究对象是 2022 年 3 月 2 日至 2023 年 3 月 3 日期间在美国一家四级医院系统下的三家医院住院的成人(≥18 岁)住院患者。入院医嘱中嵌入了一个多模式疼痛医嘱面板,干预组预先勾选了非甾体抗炎药。干预组可以取消对非甾体抗炎药单的勾选。对照组可使用相同的非甾体抗炎药单。主要结果是增加了非甾体抗炎药的订购量。次要结果包括非甾体抗炎药的使用、住院患者疼痛评分、阿片类药物的使用和处方,以及相关的临床危害,包括急性肾损伤、新发消化道出血和院内死亡。结果 共有 1049 名临床医生接受了随机治疗。研究共涉及 6239 名患者,共计 9595 次就诊。干预(预先检查)组的非甾体抗炎药订购率(36% 对 43%,P<0.001)和住院第一天结束时的用药率(30% 对 34%,P=0.001)均高于干预(预先检查)组。住院期间和出院时的阿片类药物治疗效果在统计学上没有明显差异。住院第一天和最后一天的疼痛评分在统计学上有显著差异,但临床意义不大。结论 这项分组随机对照试验表明,在入院医嘱中预先核对非甾体抗炎药的医嘱以促进多模式疼痛管理,可以增加非甾体抗炎药的医嘱和用药量,但疼痛评分或阿片类药物的使用没有变化。虽然预先检查医嘱是提高采用率的重要方法,但安全检查也应到位。数据可在公开、开放的资料库中获取。数据由美国政府医疗保险和医疗补助服务中心公开提供。
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BMJ Health & Care Informatics
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