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Intensive Care Medicine

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Open Access 01-09-2009 | Review

Tight glycemic control and computerized decision-support systems: a systematic review

Authors: Saeid Eslami, Ameen Abu-Hanna, Evert de Jonge, Nicolette F. de Keizer

Published in: Intensive Care Medicine | Issue 9/2009

Abstract

Objective

To identify and summarize characteristics of computerized decision-support systems (CDSS) for tight glycemic control (TGC) and to review their effects on the quality of the TGC process in critically ill patients.

Methods

We searched Medline (1950–2008) and included studies on critically ill adult patients that reported original data from a clinical trial or observational study with a main objective of evaluating a given TGC protocol with a CDSS.

Results

Seventeen articles met the inclusion criteria. Eleven out of seventeen studies evaluated the effect of a new TGC protocol that was introduced simultaneously with a CDSS implementation. Most of the reported CDSSs were stand-alone, were not integrated in any other clinical information systems and used the “passive” mode requiring the clinician to ask for advice. Different implementation sites, target users, and time of advice were used, depending on local circumstances. All controlled studies reported on at least one quality indicator of the blood glucose regulatory process that was improved by introducing the CDSS. Nine out of ten controlled studies either did not report on the number of hypoglycemia events (one study), or reported on no change (six studies) or even a reduction in this number (two studies).

Conclusions

While most studies evaluating the effect of CDSS on the quality of the TGC process found improvement when evaluated on the basis of the quality indicators used, it is impossible to define the exact success factors, because of simultaneous implementation of the CDSS with a new or modified TGC protocol and the hybrid solutions used to integrate the CDSS into the clinical workflow.

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Title: Tight glycemic control and computerized decision-support systems: a systematic review
Authors: Saeid Eslami
Ameen Abu-Hanna
Evert de Jonge
Nicolette F. de Keizer
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1542-0

At a glance: The STEP trials

Springer Medicine

Tight glycemic control and computerized decision-support systems: a systematic review

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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