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  1. Article ; Online: What's to Be Found in the Wisdom of the Crowd?

    Carr, Jason R / Peltan, Ithan D / Lanspa, Michael J

    Annals of the American Thoracic Society

    2021  Volume 18, Issue 12, Page(s) 1957–1959

    MeSH term(s) Crowding ; Humans
    Language English
    Publishing date 2021-12-01
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2717461-X
    ISSN 2325-6621 ; 1943-5665 ; 2325-6621
    ISSN (online) 2325-6621 ; 1943-5665
    ISSN 2325-6621
    DOI 10.1513/AnnalsATS.202105-574ED
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5828: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction

    Carr, Jason R. / Jones, Barbara E. / Collingridge, Dave S. / Webb, Brandon J. / Vines, Caroline / Zobell, Blake / Allen, Todd L. / Srivastava, Rajendu / Rubin, Jenna / Dean, Nathan C.

    Journal of rural health. 2022 Jan., v. 38, no. 1

    2022  

    Abstract: PURPOSE: Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed ... ...

    Abstract PURPOSE: Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited settings. METHODS: ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD‐10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction. FINDINGS: ePNa was used in 109/301 patients with pneumonia (36%, range 0%‐67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7‐4.8) on a 5‐point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs. CONCLUSIONS: ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback.
    Keywords antibiotics ; decision support systems ; guidelines ; hospitals ; mortality ; pneumonia ; rural health ; surveys ; Idaho ; Utah
    Language English
    Dates of publication 2022-01
    Size p. 262-269.
    Publishing place John Wiley & Sons, Ltd
    Document type Article
    Note JOURNAL ARTICLE
    ZDB-ID 639160-6
    ISSN 0890-765X
    ISSN 0890-765X
    DOI 10.1111/jrh.12543
    Database NAL-Catalogue (AGRICOLA)

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    Zs.B 3102: Show issues Location:
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  3. Article ; Online: Alveolar macrophages from EVALI patients and e-cigarette users: a story of shifting phenotype.

    Warren, Kristi J / Beck, Emily M / Callahan, Sean J / Helms, My N / Middleton, Elizabeth / Maddock, Sean / Carr, Jason R / Harris, Dixie / Blagev, Denitza P / Lanspa, Michael J / Brown, Samuel M / Paine, Robert

    Respiratory research

    2023  Volume 24, Issue 1, Page(s) 162

    Abstract: Exposure to e-cigarette vapors alters important biologic processes including phagocytosis, lipid metabolism, and cytokine activity in the airways and alveolar spaces. Little is known about the biologic mechanisms underpinning the conversion to e- ... ...

    Abstract Exposure to e-cigarette vapors alters important biologic processes including phagocytosis, lipid metabolism, and cytokine activity in the airways and alveolar spaces. Little is known about the biologic mechanisms underpinning the conversion to e-cigarette, or vaping, product use-associated lung injury (EVALI) from normal e-cigarette use in otherwise healthy individuals. We compared cell populations and inflammatory immune populations from bronchoalveolar lavage fluid in individuals with EVALI to e-cigarette users without respiratory disease and healthy controls and found that e-cigarette users with EVALI demonstrate a neutrophilic inflammation with alveolar macrophages skewed towards inflammatory (M1) phenotype and cytokine profile. Comparatively, e-cigarette users without EVALI demonstrate lower inflammatory cytokine production and express features associated with a reparative (M2) phenotype. These data indicate macrophage-specific changes are occurring in e-cigarette users who develop EVALI.
    MeSH term(s) Humans ; Lung Injury ; Electronic Nicotine Delivery Systems ; Macrophages, Alveolar ; Phenotype ; Biological Products ; Cytokines
    Chemical Substances Biological Products ; Cytokines
    Language English
    Publishing date 2023-06-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041675-1
    ISSN 1465-993X ; 1465-993X
    ISSN (online) 1465-993X
    ISSN 1465-993X
    DOI 10.1186/s12931-023-02455-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: ICU Utilization After Implementation of Minor Severe Pneumonia Criteria in Real-Time Electronic Clinical Decision Support.

    Carr, Jason R / Knox, Daniel B / Butler, Allison M / Lum, Marija M / Jacobs, Jason R / Jephson, Al R / Jones, Barbara E / Brown, Samuel M / Dean, Nathan C

    Critical care medicine

    2023  Volume 52, Issue 3, Page(s) e132–e141

    Abstract: Objectives: To determine if the implementation of automated clinical decision support (CDS) with embedded minor severe community-acquired pneumonia (sCAP) criteria was associated with improved ICU utilization among emergency department (ED) patients ... ...

    Abstract Objectives: To determine if the implementation of automated clinical decision support (CDS) with embedded minor severe community-acquired pneumonia (sCAP) criteria was associated with improved ICU utilization among emergency department (ED) patients with pneumonia who did not require vasopressors or positive pressure ventilation at admission.
    Design: Planned secondary analysis of a stepped-wedge, cluster-controlled CDS implementation trial.
    Setting: Sixteen hospitals in six geographic clusters from Intermountain Health; a large, integrated, nonprofit health system in Utah and Idaho.
    Patients: Adults admitted to the hospital from the ED with pneumonia identified by: 1) discharge International Classification of Diseases , 10th Revision codes for pneumonia or sepsis/respiratory failure and 2) ED chest imaging consistent with pneumonia, who did not require vasopressors or positive pressure ventilation at admission.
    Interventions: After implementation, patients were exposed to automated, open-loop, comprehensive CDS that aided disposition decision (ward vs. ICU), based on objective severity scores (sCAP).
    Measurements and main results: The analysis included 2747 patients, 1814 before and 933 after implementation. The median age was 71, median Elixhauser index was 17, 48% were female, and 95% were Caucasian. A mixed-effects regression model with cluster as the random effect estimated that implementation of CDS utilizing sCAP increased 30-day ICU-free days by 1.04 days (95% CI, 0.48-1.59; p < 0.001). Among secondary outcomes, the odds of being admitted to the ward, transferring to the ICU within 72 hours, and receiving a critical therapy decreased by 57% (odds ratio [OR], 0.43; 95% CI, 0.26-0.68; p < 0.001) post-implementation; mortality within 72 hours of admission was unchanged (OR, 1.08; 95% CI, 0.56-2.01; p = 0.82) while 30-day all-cause mortality was lower post-implementation (OR, 0.71; 95% CI, 0.52-0.96; p = 0.03).
    Conclusions: Implementation of electronic CDS using minor sCAP criteria to guide disposition of patients with pneumonia from the ED was associated with safe reduction in ICU utilization.
    MeSH term(s) Adult ; Humans ; Female ; Aged ; Male ; Decision Support Systems, Clinical ; Intensive Care Units ; Pneumonia/therapy ; Hospitalization ; Patient Discharge
    Language English
    Publishing date 2023-12-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000006163
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1261: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  5. Article ; Online: A multifaceted quality improvement intervention to improve management of alcohol withdrawal on a general medicine ward: impact on benzodiazepine use.

    Jenson, W Tyler / Carr, Jason R / Johnson, Stacy A / Yarbrough, Peter M / DeFrancisco, David / Rose, Richard S

    Journal of addictive diseases

    2021  Volume 40, Issue 2, Page(s) 179–182

    Abstract: Objective: To measure the effects of a quality improvement intervention on length of stay and benzodiazepine use among patients admitted for alcohol use disorder.: Methods: This retrospective cohort study was performed at the Salt Lake City Veterans ... ...

    Abstract Objective: To measure the effects of a quality improvement intervention on length of stay and benzodiazepine use among patients admitted for alcohol use disorder.
    Methods: This retrospective cohort study was performed at the Salt Lake City Veterans Affairs Medical Center. Patients 18 years and older admitted to a general medical ward with a diagnosis of alcohol related disorders who were treated for alcohol withdrawal were included. The baseline cohort included patients admitted over 12 months. The post-intervention cohort included patients admitted over 12 months. Primary outcomes were total benzodiazepine dose and length of stay. Secondary outcomes included episodes of delirium tremens and seizures.
    Results: Total benzodiazepine dose decreased significantly over the intervention period. Length of stay also decreased. No episodes of delirium tremens or seizures were observed.
    Conclusions: A quality improvement intervention directed at general medicine inpatients admitted for alcohol withdrawal was associated with reductions in total benzodiazepine administration and length of stay.
    MeSH term(s) Alcohol Withdrawal Delirium/complications ; Alcohol Withdrawal Delirium/drug therapy ; Alcoholism/drug therapy ; Benzodiazepines/therapeutic use ; Humans ; Quality Improvement ; Retrospective Studies ; Seizures/complications ; Seizures/drug therapy ; Substance Withdrawal Syndrome/drug therapy
    Chemical Substances Benzodiazepines (12794-10-4)
    Language English
    Publishing date 2021-08-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1077616-3
    ISSN 1545-0848 ; 1055-0887
    ISSN (online) 1545-0848
    ISSN 1055-0887
    DOI 10.1080/10550887.2021.1960121
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1696: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: A Pragmatic, Stepped-Wedge, Cluster-controlled Clinical Trial of Real-Time Pneumonia Clinical Decision Support.

    Dean, Nathan C / Vines, Caroline G / Carr, Jason R / Rubin, Jenna G / Webb, Brandon J / Jacobs, Jason R / Butler, Allison M / Lee, Jaehoon / Jephson, Al R / Jenson, Nathan / Walker, Missy / Brown, Samuel M / Irvin, Jeremy A / Lungren, Matthew P / Allen, Todd L

    American journal of respiratory and critical care medicine

    2022  Volume 205, Issue 11, Page(s) 1330–1336

    Abstract: Rationale: ...

    Abstract Rationale:
    MeSH term(s) Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Decision Support Systems, Clinical ; Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Male ; Pneumonia/diagnosis
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-03-08
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202109-2092OC
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction.

    Carr, Jason R / Jones, Barbara E / Collingridge, Dave S / Webb, Brandon J / Vines, Caroline / Zobell, Blake / Allen, Todd L / Srivastava, Rajendu / Rubin, Jenna / Dean, Nathan C

    The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

    2020  Volume 38, Issue 1, Page(s) 262–269

    Abstract: Purpose: Electronic clinical decision support (CDS) for treatment of community-acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed ...

    Abstract Purpose: Electronic clinical decision support (CDS) for treatment of community-acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource-limited settings.
    Methods: ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD-10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction.
    Findings: ePNa was used in 109/301 patients with pneumonia (36%, range 0%-67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7-4.8) on a 5-point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs.
    Conclusions: ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback.
    MeSH term(s) Decision Support Systems, Clinical ; Electronics ; Emergency Service, Hospital ; Hospitals, Urban ; Humans ; Male ; Personal Satisfaction ; Pneumonia/diagnosis ; Pneumonia/drug therapy
    Language English
    Publishing date 2020-11-26
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639160-6
    ISSN 1748-0361 ; 0890-765X
    ISSN (online) 1748-0361
    ISSN 0890-765X
    DOI 10.1111/jrh.12543
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 3102: Show issues Location:
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