دورية أكاديمية
Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial.
| العنوان: | Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial. |
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| المؤلفون: | Khan AI; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Mack JA; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA., Salimuzzaman M; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh., Zion MI; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Sujon H; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh., Ball RL; Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, USA., Maples S; Geospatial Center, Stanford University Libraries, Stanford, CA, USA., Rashid MM; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Chisti MJ; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Sarker SA; Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Biswas D; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Hossin R; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Bardosh KL; Department of Anthropology, University of Florida, Gainesville, FL, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA., Begum YA; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Ahmed A; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Pieri D; Independent Technology Developer, San Francisco, CA, USA., Haque F; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh; Institute for Global Health, University College London, London, UK., Rahman M; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh., Levine AC; Department of Emergency Medicine, Brown University, Providence, RI, USA., Qadri F; Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh., Flora MS; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh., Gurka MJ; Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA., Nelson EJ; Department of Pediatrics, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA. Electronic address: USAeric.nelson@ufl.edu. |
| المصدر: | The Lancet. Digital health [Lancet Digit Health] 2020 May; Vol. 2 (5), pp. e250-e258. |
| نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101751302 Publication Model: Print Cited Medium: Internet ISSN: 2589-7500 (Electronic) Linking ISSN: 25897500 NLM ISO Abbreviation: Lancet Digit Health Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Oxford] : Elsevier Ltd., [2019]- |
| مواضيع طبية MeSH: | Decision Making, Computer-Assisted* , Decision Support Systems, Clinical* , Delivery of Health Care*/standards , Guideline Adherence*, Diarrhea/*therapy , Fluid Therapy/*methods, Administration, Intravenous ; Adolescent ; Adult ; Anti-Bacterial Agents ; Bangladesh ; Child ; Child, Preschool ; Electronics ; Female ; Hospitals ; Humans ; Infant ; Male ; Paper ; Prescriptions ; Primary Health Care ; World Health Organization ; Young Adult |
| مستخلص: | Background: Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. Methods: A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed. Findings: From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; p Interpretation: Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. Funding: US National Institutes of Health. (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0. license. Published by Elsevier Ltd.. All rights reserved.) |
| التعليقات: | Comment in: Lancet Digit Health. 2020 May;2(5):e214-e215. (PMID: 33328052) |
| References: | PLoS Negl Trop Dis. 2017 Jan 19;11(1):e0005290. (PMID: 28103233) Cochrane Database Syst Rev. 2014 Jun 19;(6):CD008625. (PMID: 24944120) Lancet. 2015 Jan 31;385(9966):430-40. (PMID: 25280870) Int J Med Inform. 2018 Jun;114:130-135. (PMID: 29330009) PLoS Negl Trop Dis. 2017 Apr 27;11(4):e0005512. (PMID: 28448489) Lancet. 2015 Nov 28;386(10009):2145-91. (PMID: 26321261) N Engl J Med. 2006 Jun 8;354(23):2452-62. (PMID: 16760445) PLoS Negl Trop Dis. 2011;5(5):e1145. (PMID: 21655350) Lancet Infect Dis. 2018 Nov;18(11):1211-1228. (PMID: 30243583) Lancet. 2017 Dec 17;388(10063):3027-3035. (PMID: 27839855) PLoS Negl Trop Dis. 2019 Jan 31;13(1):e0007124. (PMID: 30703097) Stat Med. 1995 Jul 15;14(13):1491-504. (PMID: 7481187) Clin Infect Dis. 2020 Oct 23;71(7):1635-1642. (PMID: 31891368) Am J Public Health. 2017 Jul;107(7):1078-1086. (PMID: 28520480) Stat Med. 1993 Feb;12(3-4):329-38. (PMID: 8456215) BMC Infect Dis. 2013 Nov 04;13:518. (PMID: 24188717) BMJ. 2016 Mar 17;352:i1174. (PMID: 26988021) Lancet Glob Health. 2016 Oct;4(10):e744-51. (PMID: 27567350) J Pediatr Gastroenterol Nutr. 2009 Mar;48(3):318-27. (PMID: 19274788) |
| معلومات مُعتمدة: | DP5 OD019893 United States OD NIH HHS; R21 TW010182 United States TW FIC NIH HHS; T32 HG000040 United States HG NHGRI NIH HHS |
| سلسلة جزيئية: | ClinicalTrials.gov NCT03154229 |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) |
| تواريخ الأحداث: | Date Created: 20201217 Date Completed: 20210121 Latest Revision: 20210415 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC8045011 |
| DOI: | 10.1016/S2589-7500(20)30062-5 |
| PMID: | 33328057 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 2589-7500 |
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| DOI: | 10.1016/S2589-7500(20)30062-5 |