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  1. Article: Originalarbeit. EDV-gestützte Frühwarnsysteme bei akuter Nierenschädigung. Eine systematische Übersichtsarbeit. Electronic Alerts for Acute Kidney Injury - A Systematic Review

    Haase, Michael / Kribben, Andreas / Zidek, Walter / Floege, Jürgen / Albert, Christian / Isermann, Berend / Robra, Bernt-Peter / Haase-Fielitz, Anja

    Deutsches Ärzteblatt : Ausgabe A, Praxis-Ausgabe : niedergelassene Ärzte

    2016  Volume 113, Issue 1/2, Page(s) 1

    Language German
    Document type Article
    ZDB-ID 1453475-7
    ISSN 0012-1207
    Database Current Contents Medicine

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    Ua VI Zs.103/2: Show issues Location:
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  2. Article ; Online: Electronic Alerts for Acute Kidney Injury.

    Haase, Michael / Kribben, Andreas / Zidek, Walter / Floege, Jürgen / Albert, Christian / Isermann, Berend / Robra, Bernt-Peter / Haase-Fielitz, Anja

    Deutsches Arzteblatt international

    2017  Volume 114, Issue 1-02, Page(s) 1–8

    Abstract: Background: Acute kidney injury (AKI) often takes a complicated course if diagnosed late and ... undertreated. Electronic alerts that provide an early warning of AKI are intended to support treating ... randomized controlled trials of electronic alerts for AKI that were coupled with treatment recommendations have yielded ...

    Abstract Background: Acute kidney injury (AKI) often takes a complicated course if diagnosed late and undertreated. Electronic alerts that provide an early warning of AKI are intended to support treating physicians in making the diagnosis of AKI and treating it appropriately. The available evidence on the effects of such alert systems is inconsistent.
    Methods: We employed the PRISMA recommendations for systematic literature reviews to identify relevant articles in the PubMed, Scopus, and Web of Science databases. All of the studies that were retrieved were independently assessed by two of the authors with respect to the methods of computer-assisted electronic alert systems and their effects on process indicators and clinical endpoints.
    Results: 16 studies with a total of 32 842 patients were identified. 8.5% of admitted patients had community-acquired or hospital-acquired AKI, with an in-hospital mortality of 22.8%. Fifteen electronic alert systems were in use throughout the participating hospitals. In 13 of 15 studies, alarm activation was accompanied by concrete treatment recommendations. A randomized controlled trial in which no such recommendations were given did not reveal any benefit of the alert system for the patients. In controlled but non-randomized trials, however, the provision of concrete treatment recommendations when the alert was activated led to more frequent implementation of diagnostic or therapeutic measures, less loss of renal function, lower in-hospital mortality, and lower mortality after discharge compared to control groups without an electronic alert for AKI.
    Conclusion: Non-randomized controlled trials of electronic alerts for AKI that were coupled with treatment recommendations have yielded evidence of improved care processes and treatment outcomes for patients with AKI. This review is limited by the low number of randomized trials and the wide variety of endpoints used in the studies that were evaluated.
    MeSH term(s) Acute Kidney Injury/diagnostic imaging ; Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Clinical Alarms/standards ; Clinical Alarms/statistics & numerical data ; Female ; Guideline Adherence/standards ; Guideline Adherence/statistics & numerical data ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Practice Guidelines as Topic ; Prevalence ; Risk Factors ; Survival Rate ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2017-01-19
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 2406159-1
    ISSN 1866-0452 ; 1866-0452
    ISSN (online) 1866-0452
    ISSN 1866-0452
    DOI 10.3238/arztebl.2017.0001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Acute kidney injury electronic alerts in primary care - findings from a large population cohort.

    Holmes, J / Allen, N / Roberts, G / Geen, J / Williams, J D / Phillips, A O

    QJM : monthly journal of the Association of Physicians

    2017  Volume 110, Issue 9, Page(s) 577–582

    Abstract: ... demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or ... alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary ... adult CA-AKI.: Method: The study utilized the biochemistry based AKI electronic (e)-alert system ...

    Abstract Background: Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described.
    Aims: We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts.
    Design: A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI.
    Method: The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service.
    Results: 28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function.
    Conclusion: The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/mortality ; Aged ; Clinical Laboratory Information Systems/organization & administration ; Disease Progression ; Female ; Humans ; Kidney Function Tests/methods ; Male ; Medical Records Systems, Computerized/statistics & numerical data ; Middle Aged ; Monitoring, Physiologic/methods ; Primary Health Care/methods ; Primary Health Care/standards ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/physiopathology ; Telemedicine/methods ; United Kingdom
    Language English
    Publishing date 2017-03-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 1199985-8
    ISSN 1460-2393 ; 0033-5622 ; 1460-2725
    ISSN (online) 1460-2393
    ISSN 0033-5622 ; 1460-2725
    DOI 10.1093/qjmed/hcx080
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ua VI Zs.131: Show issues Location:
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  4. Article: Impact of electronic-alerting of acute kidney injury: workgroup statements from the 15(th) ADQI Consensus Conference.

    Hoste, Eric A J / Kashani, Kianoush / Gibney, Noel / Wilson, F Perry / Ronco, Claudio / Goldstein, Stuart L / Kellum, John A / Bagshaw, Sean M

    Canadian journal of kidney health and disease

    2016  Volume 3, Page(s) 10

    Abstract: Purpose of the review: Among hospitalized patients, acute kidney injury is common and associated ... of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert ... implementation.: Limitations: This paper reflects the findings of a non-systematic review and expert opinion ...

    Abstract Purpose of the review: Among hospitalized patients, acute kidney injury is common and associated with significant morbidity and risk for mortality. The use of electronic health records (EHR) for prediction and detection of this important clinical syndrome has grown in the past decade. The steering committee of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference dedicated a workgroup with the task of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert.
    Sources of information: Following an extensive, non-systematic literature search, we used a modified Delphi process to reach consensus regarding several aspects of the utilization of AKI e-alerts.
    Findings: Topics discussed in this workgroup included progress in evidence base practices, the characteristics of an optimal e-alert, the measures of efficacy and effectiveness, and finally what responses would be considered best practices following AKI e-alerts. Authors concluded that the current evidence for e-alert system efficacy, although growing, remains insufficient. Technology and human-related factors were found to be crucial elements of any future investigation or implementation of such tools. The group also concluded that implementation of such systems should not be done without a vigorous plan to evaluate the efficacy and effectiveness of e-alerts. Efficacy and effectiveness of e-alerts should be measured by context-specific process and patient outcomes. Finally, the group made several suggestions regarding the clinical decision support that should be considered following successful e-alert implementation.
    Limitations: This paper reflects the findings of a non-systematic review and expert opinion.
    Implications: We recommend implementation of the findings of this workgroup report for use of AKI e-alerts.
    Language English
    Publishing date 2016-02-26
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2765462-X
    ISSN 2054-3581
    ISSN 2054-3581
    DOI 10.1186/s40697-016-0101-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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