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A Clinical Decision Support System (CDSS) is a technology platform that uses medical knowledge with clinical data to provide customized advice for an individual patient's care. CDSSs use rules to encapsulate expert knowledge and rules engines to infer logic by evaluating rules according to a patient's specific information and related medical facts. However, CDSSs are by nature complex with a plethora of different technologies, standards and methods used to implement them and it can be difficult for practitioners to determine an appropriate solution for a specific scenario. This study's main goal is to provide a better understanding of different technical aspects of a CDSS, identify gaps in CDSS development and ultimately provide some guidelines to assist their translation into practice. We focus on issues related to knowledge representation including use of clinical ontologies, interoperability with EHRs, technology standards, CDSS architecture and mobile/cloud access. This study performs a systematic literature review of rule-based CDSSs that discuss the underlying technologies used and have evaluated clinical outcomes. From a search that yielded an initial set of 1731 papers, only 15 included an evaluation of clinical outcomes. This study has found that a large majority of papers did not include any form of evaluation and, for many that did include an evaluation, the methodology was not sufficiently rigorous to provide statistically significant results. From the 15 papers shortlisted, there were no RCT or quasi-experimental studies, only 6 used ontologies to represent domain knowledge, only 2 integrated with an EHR system, only 5 supported mobile use and only 3 used recognised healthcare technology standards (and all these were HL7 standards). Based on these findings, the paper provides some recommendations for future CDSS development that should be of interest to software developers of CDSSs and also health practitioners involved in commissioning or development.

Type 2 Diabetes Mellitus (T2DM) is the most prevalent form of diabetes in the USA, thus, the identification of biomarkers that could be used to predict the progression from prediabetes to T2DM would be greatly beneficial. Recently, circulating RNA including microRNAs (miRNAs) present in various body fluids have emerged as potential biomarkers for various health conditions, including T2DM. Whereas studies that examine the changes of miRNA spectra between healthy controls and T2DM individuals have been reported, the goal of this study is to conduct a baseline comparison of prediabetic individuals who either progress to T2DM, or remain prediabetic. Using an advanced small RNA sequencing library construction method that improves the detection of miRNA species, we identified 57 miRNAs that showed significant concentration differences between progressors (progress from prediabetes to T2DM) and non‐progressors. Among them, 26 have been previously reported to be associated with T2DM in either body fluids or tissue samples. Some of the miRNAs identified were also affected by obesity. Furthermore, we identified miRNA panels that are able to discriminate progressors from non‐progressors. These results suggest that upon further validation these miRNAs may be useful to predict the risk of conversion to T2DM from prediabetes.

Background Platelet activation is central to the pathogenesis of acute coronary syndromes. Surface expression of P ‐selectin on activated platelets induces formation of platelet–monocyte aggregates and promotes vascular inflammation and thrombosis. P ‐selectin antagonism may represent a novel therapeutic strategy in vascular disease. We aimed to investigate the effects of the novel P ‐selectin antagonist PSI ‐697 on platelet–monocyte aggregate formation in humans. Methods and Results In a double‐blind, randomized, placebo‐controlled crossover study, healthy smokers were randomized to receive either oral PSI ‐697 600 mg or matched placebo. The sequence of treatment was also randomized, with all subjects receiving both PSI ‐697 and placebo. Platelet–monocyte aggregates were measured by flow cytometry at 4 and 24 hours in the presence and absence of thrombin receptor‐activating peptide ( TRAP ; 0.1 to 1.0 μm/L). The ex vivo addition of TRAP caused a concentration‐dependent increase in platelet–monocyte aggregates from 8.2% to 94.8% ( P PSI ‐697 increased to 1906 and 83 ng/mL, respectively ( P PSI ‐697 had no demonstrable effect on either stimulated or unstimulated platelet–monocyte aggregates at 4 or 24 hours ( P >0.05). P ‐selectin‐blocking antibody ( CLB ‐Thromb6), but not PSI ‐697, inhibited both stimulated and unstimulated platelet–monocyte aggregate formation in vitro ( P Conclusions The novel small‐molecule P ‐selectin antagonist PSI ‐697 did not inhibit basal or stimulated platelet–monocyte aggregate formation in humans at the dose tested. Its clinical efficacy remains to be established. Clinical Trial Registration URL : http://EudraCT.ema.europa.eu Unique identifier: 2007‐005695‐14.