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Background: Nutrition support is an important aspect regarding the care of critically ill patients. Malnutrition affects the recovery process negatively. However, the impact on the clinical outcome is often underestimated in complex clinical settings due to several factors hindering optimization of nutrition. Objective: To identify the requirements for a clinical decision support system that enables the medical staff to improve its patients' nutritional status. Methods: A literature review and interviews with two senior physicians were conducted to refine the requirements for the support system as well as to determine the inclusion criteria for a subsequent intervention study. Results: The analysis resulted in: (i) the identification of 4 measurement parameters for the assessment of the nutrition status; (ii) the graphical layout in adherence to the standards-based implementation approach for the creation of multi-patient dashboards; (iii) the definition of the study group. The nutrition dashboard will be implemented and integrated based on the set requirements, followed by an intervention study evaluating the dashboard's efficacy. [ABSTRACT FROM AUTHOR]

Phenotyping, or the identification of patient cohorts, is a recurring challenge in medical informatics. While there are open source tools such as i2b2 that address this problem by providing user-friendly querying interfaces, these platforms lack semantic expressiveness to model complex phenotyping algorithms. The Arden Syntax provides procedural programming language construct, designed specifically for medical decision support and knowledge transfer. In this work, we investigate how language constructs of the Arden Syntax can be used for generic phenotyping. We implemented a prototypical tool to integrate i2b2 with an open source Arden execution environment. To demonstrate the applicability of our approach, we used the tool together with an Arden-based phenotyping algorithm to derive statistics about ICU-acquired hypernatremia. Finally, we discuss how the combination of i2b2's user-friendly cohort pre-selection and Arden's procedural expressiveness could benefit phenotyping. [ABSTRACT FROM AUTHOR]

Discharge letters are an important means of communication between physicians and nurses from intensive care units and their colleagues from normal wards. The patient data management system (PDMS) used at our local intensive care units provides an export tool to create discharge letters by inserting data items from electronic medical records into predefined templates. Local intensivists criticized the limitations of this tool regarding the identification and the further processing of clinically relevant data items for a flexible creation of discharge letters. As our PDMS supports Arden Syntax, and the demanded functionalities are well within the scope of this standard, we set out to investigate the suitability of Arden Syntax for the generation of discharge letters. To provide an easy-tounderstand facility for integrating data items into document templates, we created an Arden Syntax interface function which replaces the names of previously defined variables with their content in a way that permits arbitrary custom formatting by clinical users. Our approach facilitates the creation of flexible text sections by conditional statements, as well as the integration of arbitrary HTML code and dynamically generated graphs. The resulting prototype enables clinical users to apply the full set of Arden Syntax language constructs to identify and process relevant data items in a way that far exceeds the capabilities of the PDMS export tool. The generation of discharge letters is an uncommon area of application for Arden Syntax, considerably differing from its original purpose. However, we found our prototype well suited for this task and plan to evaluate it in clinical production after the next major release change of our PDMS. [ABSTRACT FROM AUTHOR]

This paper describes a combined evaluation approach for an information system on intensive care units. Staff self assessment of time needed for documentation activities during admission, daily treatment and discharge/transfer has been compared to a workflow analysis which demonstrated that the system eliminated process steps mainly in daily documentation activities. Interestingly, nursing staff reported major time savings rather during discharge/transfer than in daily documentation, whereas physicians noticed no time savings at all. We conclude that combining workflow analysis with either self assessment of time needed or alternatively appropriate time measurements or both increases insight into organizational changes and their implications after system implementation. [ABSTRACT FROM AUTHOR]

This paper describes a combined evaluation approach for an information system on intensive care units. Staff self assessment of time needed for documentation activities during admission, daily treatment and discharge/transfer has been compared to a workflow analysis which demonstrated that the system eliminated process steps mainly in daily documentation activities. Interestingly, nursing staff reported major time savings rather during discharge/transfer than in daily documentation, whereas physicians noticed no time savings at all. We conclude that combining workflow analysis with either self assessment of time needed or alternatively appropriate time measurements or both increases insight into organizational changes and their implications after system implementation.