|
|
| Line 1: |
Line 1: |
| − | This is a review for Standridge, S., Faist, R., Pestian, J., Glauser, T., & Ittenbach, R. (2014). The reliability of an epilepsy treatment clinical decision support system. Journal of Medical Systems, 38(10), 1-6. doi:10.1007/s10916-014-0119-9
| + | #REDIRECT [[The Reliability of an Epilepsy Treatment Clinical Decision Support System]] |
| − | == Introduction ==
| + | |
| − | Epilepsy clinical decision support ([[CDS]]) is complex. Standridge et al. gives three stand-out reasons why this complexity continues to increase. Those reasons including: the lack of evidence-based treatment guidelines, the clinician’s growing deficit of current diagnostic and therapeutic knowledge, and, finally, the heterogeneity of the disease.
| + | |
| − | Standridge et al. developed a content validated computerized epilepsy treatment clinical decision support system(CDSS). The focus of the CDSS is to provide the best antiepilepsy treatments at a pediatric facility. Rigorous validation testing was required before implementation of the CDSS. Reliability was verified first. Consistency of the epilepsy treatment CDSS was measured in three areas according to Standridge et al. Consistency study areas including the preferred antiepilepsy drug choice, the top three recommended choices, and the rank order of the three choices. <ref name="Standridge et al., 2014">Standridge, S., Faist, R., Pestian, J., Glauser, T., & Ittenbach, R. (2014). The reliability of an epilepsy treatment clinical decision support system. Journal of Medical Systems, 38(10), 1-6. doi:10.1007/s10916-014-0119-9. http://link.springer.com.ezproxyhost.library.tmc.edu/article/10.1007/s10916-014-0119-9/fulltext.html</ref>
| + | |
| − | == Development ==
| + | |
| − | Standridge et al. states, when developed properly, CDSS developed for therapy management have been found to facilitate evidence-based therapeutic interventions, reduce the incidence of harmful medical errors, and improve healthcare efficiency. The developed framework, named “CHRISTINE”, stands for Children’s Hospital Resource In Selecting Therapy Individualized Expert. CHRISTINE provides an environment for developing and implementing different expert systems according to Standridge et al. One such system, the multi-expert epilepsy treatment CDS (ET-CDS), is a system designed to facilitate treatment choices and options for clinicians treating children with epilepsy. ET-CDS is made up of two applications which work together and share a database. The first application is an expert opinion collection system. The second application is where the treatment report is generated. Standridge et al. contends this ET-CDS system will provide a non-expert clinician with an expert’s knowledge in managing the exceedingly diverse disease of pediatric epilepsy. The purpose of this study was to provide preliminary evidence for the reliability of the ET-CDS system.<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | == Methods ==
| + | |
| − | The reliability of the ET-CDS system in this study was conducted and evaluated using a three-step process. Using the already developed ET-CDS system, five pediatric epilepsy syndrome profiles were created (Table 1).<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | Table 1
| + | |
| − | Five common pediatric epilepsy syndromes
| + | |
| − | 1. Childhood absence epilepsy
| + | |
| − | 2. Juvenile absence epilepsy
| + | |
| − | 3. Juvenile Myoclonic epilepsy
| + | |
| − | 4. Benign epilepsy with centrotemporal spikes
| + | |
| − | 5. Lennox-Gastaut syndrome<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | Three reliability checks were performed.
| + | |
| − | (1) 1,000 tests performed on the consistency of the ET-CDS system in providing a single preferred treatment choice.<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | (2) This step tests the consistency of the ET-CDS system in providing three appropriate treatment choices over 1,000 renditions.<ref name=" Standridge et al., 2014"></ref>.
| + | |
| − | (3) This time, however, for a given report to be considered a match with the original report, all three treatment recommendations had to match exactly; that is, the three treatment recommendations produced by the system had to appear in the same order as in the most recent original report.<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | This same three-step process was repeated for all five epilepsy syndromes. Care was taken to simulate and match five representative epilepsy syndromes often observed in clinical practice. In total, 15,000 executions were sought across five different epilepsy syndromes representing three different clinically relevant medical decision-making scenarios.<ref name=" Standridge et al., 2014"></ref>
| + | |
| − | == Results ==
| + | |
| − | Stamdrodge et al. states, the ET-CDS system demonstrated 100 % reliability whether one treatment choice was requested or three treatment choices were requested by the clinician, using a series of 1,000 independently generated treatment reports for each of five different epilepsy syndromes. The match rate of 100 % between the original treatment report and all subsequent generated treatment reports held across all 15,000 computer-based executions, irrespective of whether the choice of treatment options was allowed to vary, or remain constant. They demonstrated 100 % reliability on 15,000 executions involving a three-step process on five different common pediatric epilepsy syndromes. <ref name=" Standridge et al., 2014"></ref>
| + | |
| − | == Discussion ==
| + | |
| − | Standridge et al. states, tools can be disseminated on the worldwide web without much regulation or analysis, the scientific community must hold reliability and validity testing in high regard. A faulty clinical tool could lead to serious harm through improper recommendations on testing, diagnosis, and treatment. It is important to establish a replicable strategy to prove reliability of future updated versions as new evidence-based practices emerge. Ultimately, the reliability testing will ensure that future revisions of the ET-CDS system do not introduce unanticipated errors. <ref name=" Standridge et al., 2014"></ref>
| + | |
| − | ==Reviewer’s Comments==
| + | |
| − | === Jonzy’s Comments ===
| + | |
| − | The methodical, scientific testing of CDSS for safety is necessary before any CDSS implementation. The study is a bit simplistic and somewhat anticipatory of its own success, but required. This study is also limited to epilepsy in the pediatric environment.
| + | |
| − | Unfortunately, after writing this review, I found another had already reviewed it quit well. Please see there review as well. <ref name="OriginalArticle Review">[[The Reliability of an Epilepsy Treatment Clinical Decision Support System]]. http://clinfowiki.org/wiki/index.php/The_Reliability_of_an_Epilepsy_Treatment_Clinical_Decision_Support_System</ref>
| + | |
| − | | + | |
| − | == References ==
| + | |
| − | <references/>
| + | |
| − | | + | |
| − | | + | |
| − | [[Category:CDS]]
| + | |
| − | [[Category:Reviews]]
| + | |
