Déjà Vu? How Might Lessons Learned from Electronic Health Record Implementation Apply to Artificial Intelligence?

Background: The US healthcare system is currently facing significant challenges in quality, affordability, and labor shortages. Artificial intelligence (AI) promises to transform healthcare delivery by making it safer, more effective, less wasteful, and more patient-centered. With more than $30 billion invested in healthcare AI companies in the past three years, the proliferation of AI solutions is expected to bring much-needed relief to the strained healthcare industry.

How Do Healthcare Professionals Personalize Their Software? A Pilot Exploration Based on an Electronic Health Records Search Engine.

To improve user experience, many health IT systems provide personalization options allowing end users to tailor the software to their needs and preferences. However, few studies have investigated if healthcare professionals actually make full use of this feature. As an initial step towards understanding end users' software personalization behavior in healthcare, we conducted a pilot study to examine how clinicians, staff, and researchers customized a search engine designed to facilitate information retrieval from electronic health records.

Understanding Patient Questions about their Medical Records in an Online Health Forum: Opportunity for Patient Portal Design.

There are many benefits of online patient access to their medical records through technologies such as patient portals. However, patients often have difficulties understanding the clinical data presented in portals. In response, increasingly, patients go online to make sense of this data.

Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population.

Background: Acute respiratory distress syndrome (ARDS) is a devastating condition with an estimated mortality exceeding 30%. There are data suggesting risk factors for ARDS development in high-risk populations, but few data are available in lower incidence populations. Using risk-matched analysis and a combination of clinical and research data sets, we determined the incidence and risk factors for the development of ARDS in this general surgical population.

An overview of end-of-life issues in the intensive care unit.

The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers.

A bibliometric search of citation classics in anesthesiology.

Background: Articles cited counts are catalogued and help identify landmark papers. This study provides a citation classics of anesthesiology literature using the framework of subspecialties to provide a review of well-developed areas of research in anesthesiology.

Methods: A comprehensive list of the most-cited articles in anesthesia was compiled using a bibliometric database and general search terms such as "anesthesia" as well as subspecialty-specific search terms.

A randomized trial of recombinant human granulocyte-macrophage colony stimulating factor for patients with acute lung injury.

Rationale: Despite recent advances in critical care and ventilator management, acute lung injury and acute respiratory distress syndrome continue to cause significant morbidity and mortality. Granulocyte-macrophage colony stimulating factor may be beneficial for patients with acute respiratory distress syndrome.

Objectives: To determine whether intravenous infusion of granulocyte-macrophage colony stimulating factor would improve clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome.

A description of intraoperative ventilator management in patients with acute lung injury and the use of lung protective ventilation strategies.

Background: The incidence of acute lung injury (ALI) in hypoxic patients undergoing surgery is currently unknown. Previous studies have identified lung protective ventilation strategies that are beneficial in the treatment of ALI. The authors sought to determine the incidence and examine the use of lung protective ventilation strategies in patients receiving anesthetics with a known history of ALI.

Pulse oximetry saturation to fraction inspired oxygen ratio as a measure of hypoxia under general anesthesia and the influence of positive end-expiratory pressure.

Purpose: In ICU patients with acute lung injury, the pulse oximetry saturation (Spo(2)) to fraction of inspired oxygen (Fio(2)) (S/F) ratio is a reliable surrogate measure for the P/F (Pao(2)/Fio(2)) ratio. Our goal was to determine the correlation of the S/F to the P/F in a large sample of patients undergoing general anesthesia and the influence of positive end-expiratory pressure (PEEP) on this measure.

Methods: We studied adult general anesthetics performed with arterial blood gas analysis.

A description of intraoperative ventilator management and ventilation strategies in hypoxic patients.

Background: Hypoxia is a common finding in the anesthetized patient. Although there are a variety of methods to address hypoxia, it is not well documented what strategies are used by anesthesiologists when faced with a hypoxic patient. Studies have identified that lung protective ventilation strategies have beneficial effects in both oxygenation and mortality in acute respiratory distress syndrome.

Improvement in the quality of randomized controlled trials among general anesthesiology journals 2000 to 2006: a 6-year follow-up.

Background: We previously assessed all randomized controlled trials (RCTs) from four anesthesiology journals from January 2000 to December 2000. We identified key areas for improvement in the study protocol design and implementation and in data analyses. This study was repeated for the year 2006 to determine if improvements have occurred during the 6-yr interval.

The most influential articles in critical care medicine.

Purpose: The study aimed to examine query strategies that would provide an exhaustive search method to retrieve the most referenced articles within specific categories of critical care.

Material And Methods: A comprehensive list of the most cited critical care medicine articles was generated by searching the Science Citation Index Expanded data set using general critical care terms keywords such as "critical care," critical care journal titles, and keywords for subsubjects of critical care.

Results: The final database included 1187 articles published between 1905 and 2006.

Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set.

Background: The authors sought to identify the incidence, risk factors, and mortality impact of acute kidney injury (AKI) after general surgery using a large and representative national clinical data set.

Methods: The 2005-2006 American College of Surgeons-National Surgical Quality Improvement Program participant use data file is a compilation of outcome data from general surgery procedures performed in 121 US medical centers. The primary outcome was AKI within 30 days, defined as an increase in serum creatinine of at least 2 mg/dl or acute renal failure necessitating dialysis.

Specificity improvement for network distributed physiologic alarms based on a simple deterministic reactive intelligent agent in the critical care environment.

Automated physiologic alarms are available in most commercial physiologic monitors. However, due to the variability of data coming from the physiologic sensors describing the state of patients, false positive alarms frequently occur. Each alarm requires review and documentation, which consumes clinicians' time, may reduce patient safety through 'alert fatigue' and makes automated physician paging infeasible.

Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery.

Background: The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data.

Methods: The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included.

Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort.

Objective: To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury.

Design: Secondary analysis of a prospective cohort study conducted between March 1996 and March 1999.

Setting: The study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units).

Do outcomes vary according to the source of admission to the pediatric intensive care unit?

Objective: To examine associations between mortality, length of stay, and the sources of admission to tertiary pediatric intensive care.

Design: A retrospective analysis of prospectively collected data.

Setting: A tertiary medical center with a 16-bed medical-surgical intensive care unit and a 15-bed cardiac pediatric intensive care unit (PICU).

Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function.

Background: The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function.

Methods: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days.

An open system for development of derived physiologic alarms.

Data from existing physiologic monitor alarms is frequently artifact. Hence, automated physiologic alarms are frequently ignored. Proprietary systems have shown that alarm sensitivity and specificity can be distinctly improved using advanced data processing techniques.

The quality of randomized controlled trials in major anesthesiology journals.

Increased attention has been directed at the quality of randomized controlled trials (RCTs) and how they are being reported. We examined leading anesthesiology journals to identify if there were specific areas for improvement in the design and analysis of published clinical studies. All RCTs that appeared between January 2000 and December 2000 in leading anesthesiology journals (Anesthesiology,Anesthesia & Analgesia,Anaesthesia, and Canadian Journal of Anaesthesia) were retrieved by a MEDLINE search.

Anesthetic implications for lung transplantation.

Anesthetic challenges regarding lung transplantation are related to the expanded spectrum of diseases for which lung transplantation is offered and to the interval changes in health status likely to occur as patients wait longer for an organ to become available. Particular attention to avoiding or reducing the impact of increases in pulmonary vascular resistance and right heart failure are important and may necessitate cardiopulmonary bypass. Intraoperative and postoperative ventilator management should account for differences in pulmonary compliance after the new lung is implanted.

Optimal head rotation for internal jugular vein cannulation when relying on external landmarks.

External anatomic landmarks have traditionally been used to approximate the location of the neck blood vessels to optimize central venous cannulation of the internal jugular vein (IJV) while avoiding the common carotid artery (CCA). Head rotation affects vessel orientation, but most landmark techniques do not specify its optimal degree. We simulated catheter insertion via both an anterior and central approach to the right IJV using an ultrasound probe held in the manner of a syringe and needle in 49 volunteers.

Fluid management in patients with acute respiratory distress syndrome.

In a recent review of the data for fluid strategies and ARDS, fluid restriction or diuretic use was graded as "reasonably justifiable by available scientific evidence" and as "strongly supported by expert critical care opinion". Until the ARDS Network trial is published, only general guidelines regarding fluid management with or without specific vascular filling pressures from a pulmonary artery catheter can be made. Ultimately, the rationale for restricting fluid is to reduce hydrostatic pressures as much as possible.

Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas.

Purpose: Treatment of extremity soft-tissue sarcomas yields excellent local control, but distant failure is common with large, high-grade tumors. A regimen of preoperative chemotherapy consisting of mesna, adriamycin, ifosfamide, and dacarbazine (MAID) interdigitated with radiotherapy followed by resection and postoperative chemotherapy with or without radiotherapy was designed to improve treatment outcome. We report the mature outcome data on 48 treated patients and compare them with the data of an historical matched control patient population.