Abstract：
:Unnecessary variation in clinical care and clinical research reduces our ability to determine what healthcare interventions are effective. Reducing this unnecessary variation could lead to further healthcare quality improvement and more effective clinical research. We have developed and used electronic decision support tools (eProtocols) to reduce unnecessary variation. Our eProtocols have progressed from a locally developed mainframe computer application in one clinical site (LDS Hospital) to web-based applications available in multiple languages and used internationally. We use eProtocol-insulin as an example to illustrate this evolution. We initially developed eProtocol-insulin as a local quality improvement effort to manage stress hyperglycemia in the adult intensive care unit (ICU). We extended eProtocol-insulin use to translate our quality improvement results into usual clinical care at Intermountain Healthcare ICUs. We exported eProtocol-insulin to support research in other US and international institutions, and extended our work to the pediatric ICU. We iteratively refined eProtocol-insulin throughout these transitions, and incorporated new knowledge about managing stress hyperglycemia in the ICU. Based on our experience in the development and clinical use of eProtocols, we outline remaining challenges to eProtocol development, widespread distribution and use, and suggest a process for eProtocol development. Technical and regulatory issues, as well as standardization of protocol development, validation and maintenance, need to be addressed. Resolution of these issues should facilitate general use of eProtocols to improve patient care.
journal_name
J Clin Monit Computjournal_title
Journal of clinical monitoring and computingauthors
Blagev DP,Hirshberg EL,Sward K,Thompson BT,Brower R,Truwit J,Hite D,Steingrub J,Orme JF Jr,Clemmer TP,Weaver LK,Thomas F,Grissom CK,Sorenson D,Sittig DF,Wallace CJ,East TD,Warner HR,Morris AHdoi
10.1007/s10877-012-9356-ysubject
Has Abstractpub_date
2012-08-01 00:00:00pages
305-17issue
4eissn
1387-1307issn
1573-2614journal_volume
26pub_type
杂志文章abstract：:The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章,随机对照试验
doi：10.1007/s10877-017-0036-9
更新日期：2018-06-01 00:00:00
abstract：:Jaundice of the newborn is a common problem as a consequence of the rapid increment of blood bilirubin in the first days of live. In most cases, it is considered a physiological transient situation, but unmanaged hyperbilirubinemia can lead to death or serious injuries for the survivors. For decades, phototherapy has ...
journal_title：Journal of clinical monitoring and computing
pub_type： 临床试验,杂志文章
doi：10.1007/s10877-006-9016-1
更新日期：2006-06-01 00:00:00
abstract：OBJECTIVE:To determine if an automatic algorithm using wavelet analysis techniques can be used to reliably determine respiratory rate from the photoplethysmogram (PPG). METHODS:Photoplethysmograms were obtained from 12 spontaneously breathing healthy adult volunteers. Three related wavelet transforms were automaticall...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-005-9007-7
更新日期：2006-02-01 00:00:00
abstract：OBJECTIVE:Mixtures of helium and oxygen are regaining a place in the treatment of obstruction of the upper and lower respiratory tract. The parenchymal changes during the course of IRDS or ARDS may also benefit from the reintroduction of helium/oxygen. In order to monitor and document the effect of low-density gas mixt...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1023/a:1009978816071
更新日期：1998-08-01 00:00:00
abstract：:Recently a novel pain recognition indicator derived from electroencephalogram(EEG) signals, pain threshold index(PTI) has been developed. The aim of this study was to determine whether PTI can be used for prediction of postoperative acute pain while surgical pleth index(SPI) applied as control. Eighty patients undergo...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-020-00604-w
更新日期：2020-10-12 00:00:00
abstract：:Loss of endotracheal cuff pressure can lead to airway compromise and loss of volume delivery in mechanical ventilation requiring immediate intervention. A 40 years old male posted for bilateral interpositional arthroplasty was intubated nasally with 7.5 mm flexometallic endotracheal tube. In the intraoperative period ...
journal_title：Journal of clinical monitoring and computing
pub_type： 信件
doi：10.1007/s10877-020-00607-7
更新日期：2020-10-23 00:00:00
abstract：INTRODUCTION:Patients undergoing lung resection are vulnerable to fluid overhydration. Recently, goal-directed fluid therapy using transoesophageal Doppler monitoring (TDM) has been shown to improve postoperative clinical outcome. The aim of this study was to assess the feasibility of TDM during open-chest procedures f...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-008-9144-x
更新日期：2008-10-01 00:00:00
abstract：:The goal of this study was to evaluate the risk factors associated with positioning-related SSEP changes (PRSC). The study investigated the association between 18 plausible risk factors and the occurrence of intraoperative PRSC. Risk factors investigated included demographic variables, comorbidities, and procedure rel...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-018-0148-x
更新日期：2019-04-01 00:00:00
abstract：ABSTARCT:To investigate the use of two-site regional oxygen saturations (rSO2) and end tidal carbon dioxide (EtCO2) to assess the effectiveness of resuscitation and return of spontaneous circulation (ROSC). Eight mechanically ventilated juvenile swine underwent 28 ventricular fibrillatory arrests with open cardiac mass...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-019-00291-2
更新日期：2020-02-01 00:00:00
abstract：:To develop and validate a mathematical model for predicting intracranial pressure (ICP) noninvasively using phase-contrast cine MRI (PC-MRI). We performed a retrospective analysis of PC-MRI from patients with communicating hydrocephalus (n = 138). The patients were recruited from Shenzhen Second People's Hospital betw...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-020-00598-5
更新日期：2020-10-01 00:00:00
abstract：:With the AnaConDa™ and the MIRUS™ system, volatile anesthetics can be administered for inhalation sedation in intensive care units. Instead of a circle system, both devices use anesthetic reflectors to save on the anesthetic agent. We studied the efficiency of desflurane reflection with both devices using different ti...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-016-9902-0
更新日期：2018-08-01 00:00:00
abstract：:The American Society of Anesthesiologist recommends peripheral physiological monitoring during general anesthesia, which offers no information regarding the effects of anesthetics on the brain. Since no "gold standard" method exists for this evaluation, such a technique is needed to ensure patient comfort, procedure q...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-017-9998-x
更新日期：2018-02-01 00:00:00
abstract：:Electric energy have been in use for the treatment of various ailments, including pain, since the time of Pharaohs. The theoretical basis of electrotherapy of pain was provided by the Gate Control Theory of Melzak and Wall. In 1965, Shealey et al. first introduced electrical stimulation of spinal cord for treating pai...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章,评审
doi：10.1007/s10877-009-9201-0
更新日期：2009-10-01 00:00:00
abstract：:An ongoing issue in vascular medicine is the measure of the blood flow. Catheterization remains the gold standard measurement method, although non-invasive techniques are an area of intense research. We hereby present a computational method for real-time measurement of the blood flow from color flow Doppler data, with...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-016-9953-2
更新日期：2017-12-01 00:00:00
abstract：:Mechanically ventilated patients with ARDS due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) seem particularly susceptible to AKI. Our hypothesis was that the renal blood flow could be more compromised in SARS-CoV-2 patients than in patients with "classical" ARDS. We compared the renal resistivit...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-020-00633-5
更新日期：2021-01-01 00:00:00
abstract：:FloTrac/Vigileo™ system is based on arterial pressure waveform analysis arterial pressure-based CO (APCO). Therefore, systemic vascular resistance (SVR) can influence the accuracy of APCO. The purpose of this study is to evaluate the relationship between SVR and the accuracy of APCO. We managed 50 consecutive patients...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-013-9481-2
更新日期：2013-12-01 00:00:00
abstract：OBJECTIVE:To define the longest sampling interval which will faithfully record the time course of episodes of severe hypotension and hypoxia in anesthetised patients. METHODS:Electronic anesthetic records of 1501 patients were analyzed retrospectively for hypotension where measured systolic blood pressure fell to 60 m...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1023/a:1009978414365
更新日期：1998-07-01 00:00:00
abstract：:The use of processed electroencephalography (EEG) using a simple frontal lead system has been made available for assessing the impact of anesthetic medications during surgery. This review discusses the basic principles behind these devices. The foundations of anesthesia monitoring rest on the observations of Guedel wi...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章,评审
doi：10.1007/s10877-006-9044-x
更新日期：2006-12-01 00:00:00
abstract：:Recent progress in genomics and experimental biology has brought exponential growth of the biological information available for computational analysis in public genomics databases. However, applying the potentially enormous scientific value of this information to the understanding of biological systems requires comput...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-005-3463-y
更新日期：2005-10-01 00:00:00
abstract：OBJECTIVE:Pulse-dye densitometry (PDD) could be a suitable, low-invasive alternative to thermodilution using a pulmonary artery catheter (PAC) for monitoring cardiac output. The aim of our study was to assess the reproducibility and validity of PDD compared to PAC-thermodilution. METHODS:In 43 post-cardiac surgery pat...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-005-6865-y
更新日期：2005-12-01 00:00:00
abstract：OBJECTIVE:To develop an ergonomically designed computerized recordkeeping tool for anesthesiologists that allows the clinician to maintain visual contact with the patient while performing recordkeeping. METHODS:To simplify the human interface software, we developed two general use software components. All purpose menu...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1023/a:1009972223750
更新日期：1999-08-01 00:00:00
abstract：OBJECTIVE:To demonstrate the usefulness of rectus femoris muscle MEPs monitoring in a paraparetic neuromuscular scoliosis case. METHODS:Multiple monitoring modalities including SEPs, MEPs and EMG were performed for an anterior and posterior correction surgery for a neuromuscular scoliosis patient with no motor and sen...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-011-9325-x
更新日期：2012-02-01 00:00:00
abstract：:Recent advances in technology have led to the introduction of a variety of innovative devices, each with their own platform for data display, into the operating room (OR). While these innovative applications are expanding the traditional boundaries of the surgical space and enhancing treatment capabilities, the introd...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-006-9017-0
更新日期：2006-06-01 00:00:00
abstract：OBJECTIVE:Tracheal gas insufflation (TGI) is considered an adjunctive method to enhance carbon dioxide elimination during permissive hypercapnia in patients with acute respiratory distress syndrome. Due to increasing tidal volume and/or expiratory resistance, TGI may cause intrinsic PEEP (PEEPi), and may lessen the adv...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1023/a:1009998100819
更新日期：1998-05-01 00:00:00
abstract：:Mathematical models can be deployed to simulate physiological processes of the human organism. Exploiting these simulations, reactions of a patient to changes in the therapy regime can be predicted. Based on these predictions, medical decision support systems (MDSS) can help in optimizing medical therapy. An MDSS desi...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-013-9502-1
更新日期：2014-12-01 00:00:00
abstract：:The operating principles and methods for the continuous determination of aortic blood flow (ABF) with the Dynemo 3000 system are described in detail. The system uses a novel transesophageal ultrasonic Echo-Doppler probe simultaneously to measure aortic diameter and blood flow velocity at the same anatomic level, in re...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1023/a:1009902517388
更新日期：2000-01-01 00:00:00
abstract：:Numerous possibilities exist which may cause obstruction to ventilation under anesthesia resulting in a tight reservoir bag with low compliance. We report an interesting case where a reservoir bag twisted around its own neck and resulted in a tight bag situation. The neck portion of the reservoir bag would be hidden f...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-010-9232-6
更新日期：2010-06-01 00:00:00
abstract：OBJECTIVES:The application of sighs during baseline ventilation was found to improve alveolar recruitment and oxygenation in patients with acute respiratory distress syndrome (ARDS). The present investigation evaluates if respiratory mechanics can be modified by a sigh. METHODS:Ten consecutive patients with acute lung...
journal_title：Journal of clinical monitoring and computing
pub_type： 临床试验,杂志文章
doi：10.1007/s10877-006-9028-x
更新日期：2006-08-01 00:00:00
abstract：:Extravascular lung water (EVLW) could increase by permeability pulmonary oedema, cardiogenic oedema, or both. Transthoracic echocardiography examination of a patient allows quantifying B-lines, originating from water-thickened interlobular septa, and the E/Ea ratio, related to pulmonary capillary wedge pressure. The a...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章
doi：10.1007/s10877-014-9582-6
更新日期：2015-02-01 00:00:00
abstract：:Tissue perfusion monitoring is increasingly being employed clinically in a non-invasive fashion. In this end-of-year summary of the Journal of Clinical Monitoring and Computing, we take a closer look at the papers published recently on this subject in the journal. Most of these papers focus on monitoring cerebral perf...
journal_title：Journal of clinical monitoring and computing
pub_type： 杂志文章,评审
doi：10.1007/s10877-020-00504-z
更新日期：2020-06-01 00:00:00
