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Users' Guides to the Medical Literature
XVIII. How to Use an Article Evaluating the Clinical Impact of a Computer-Based Clinical Decision Support System
Adrienne G. Randolph, MD, MSc;
R. Brian Haynes, MD, PhD;
Jeremy C. Wyatt, MD;
Deborah J. Cook, MD, MSc;
Gordon H. Guyatt, MD, MSc
JAMA. 1999;282:67-74.
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CLINICAL SCENARIO
It is 7 AM, and medical rounds are starting on university hospital ward 3B. In the past 24 hours of your residency, you have transferred 2 critically ill patients to the intensive care unit; accepted 11 patients to your medical service; examined and revised medication orders for 22 patients; placed 9 intravascular catheters; written 35 notes; and reviewed, categorized, and acted on more than 300 new pieces of laboratory and radiology data. You were planning to ask the infectious disease specialist about a patient, but he seems very busy, and the broad-spectrum antibiotic regimen you prescribed should suffice. You were just told that you ordered total parenteral nutrition for the wrong patient. While deciding which patient should receive parenteral nutrition, you realize that the calculations for . . . [Full Text of this Article]
THE SEARCH
CLINICAL COMPUTER SYSTEMS
Are the Results of the Study Valid? Was the Method of Participant Allocation Appropriate? Was the Control Group Uninfluenced by the CDSS? Aside From the CDSS, Were the Groups Treated Equally? What Are the Results? What Is the Effect of the CDSS? Can You Apply the CDSS in Your Clinical Setting? What Elements of the CDSS Are Required? Is the CDSS Exportable to a New Site? Is the CDSS Likely to Be Accepted by Clinicians in Your Setting? Do the Benefits of the CDSS Justify the Risks and Costs? Are CDSSs Beneficial?
RESOLUTION OF THE SCENARIO
Author Affiliations: Departments of Pediatrics and Anesthesia, Children's Hospital and Harvard Medical School, Boston, Mass (Dr Randolph); Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario (Drs Haynes, Cook, and Guyatt); and School of Public Policy, University College London, London, England (Dr Wyatt).
RELATED ARTICLE
July 7, 1999
JAMA. 1999;282(1):99-100.
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