Journal Article

PreJuSER-17085

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Estimations of isoprenoid emission capacity from enclosure studies: measurements, data processing, quality and standardized measurement protocols

Niinemets, U. ; Kuhn, U.FZJ* ; Harley, P. C. ; Staudt, M. ; Arneth, A. ; Cescatti, A. ; Ciccioli, P. ; Copolovici, L. ; Geron, C. ; Guenther, A. ; Kesselmeier, J. ; Lerdau, M. T. ; Monson, R. K. ; Penuelas, J.

2011
Copernicus Katlenburg-Lindau [u.a.]

This record in other databases:    

Please use a persistent id in citations: doi:10.5194/bg-8-2209-2011

Abstract: Computerized clinical decision support systems (CDSS) for intensive insulin therapy (IIT) generate recommendations using blood glucose (BG) values manually transcribed from testing devices to computers, a potential source of error. We quantified the frequency and effect of blood glucose transcription mismatches on IIT protocol performance.We examined 38 months of retrospective data for patients treated with CDSS IIT in two intensive care units at one teaching hospital. A manually transcribed BG value not equal to a corresponding device value was deemed mismatched. For mismatches we recalculated CDSS recommendations using device BG values. We compared matched and mismatched data in terms of CDSS alerts, blood glucose variability, and dosing.Of 189,499 CDSS IIT instances, 5.3% contained mismatched BG values. Mismatched data triggered 93 false alerts and failed to issue 170 alerts for nurses to notify physicians. Four of six BG variability measures differed between matched and mismatched data. Overall insulin dose was greater for matched than mismatched [matched 3.8 (1.6-6.0), median (interquartile range, IQR), versus 3.6 (1.6-5.7); p < 0.001], but recalculated and actual dose were similar. In mismatches preceding hypoglycemia, recalculated insulin dose was significantly lower than actual dose [recalculated 2.7 (0.4-5.0), median (IQR), versus 3.5 (1.4-5.6)]. In mismatches preceding hyperglycemia, recalculated insulin dose was significantly greater than actual dose [recalculated 4.7 (3.3-6.2), median (IQR), versus 3.3 (2.4-4.3); p < 0.001]. Administration of recalculated doses might have prevented blood glucose excursions.Mismatched blood glucose values can influence CDSS IIT protocol performance.

Keyword(s): Attitude of Health Personnel (MeSH) ; Critical Illness: therapy (MeSH) ; Decision Making, Organizational (MeSH) ; Decision Support Systems, Clinical: organization & administration (MeSH) ; Decision Support Systems, Clinical: statistics & numerical data (MeSH) ; Drug Therapy, Computer-Assisted (MeSH) ; Humans (MeSH) ; Hyperglycemia: drug therapy (MeSH) ; Hypoglycemic Agents: therapeutic use (MeSH) ; Insulin: therapeutic use (MeSH) ; Intensive Care Units: organization & administration (MeSH) ; Medical Errors: prevention & control (MeSH) ; Medical Errors: statistics & numerical data (MeSH) ; Medical Order Entry Systems: organization & administration (MeSH) ; Medical Order Entry Systems: statistics & numerical data (MeSH) ; Retrospective Studies (MeSH) ; Safety Management: organization & administration (MeSH) ; United States (MeSH) ; Hypoglycemic Agents ; Insulin ; J

Note: We thank the European Science Foundation (VOCBAS and INTROP programs) for travel support. The authors' studies on BVOCs have been funded by the Estonian Ministry of Science and Education (grant SF1090065s07), the Estonian Science Foundation (grant 7645), European Commission through European Regional Fund (the Center of Excellence in Environmental Adaptation), the US National Science Foundation and the US Environmental Protection Agency, the Spanish Ministry of Science (grants CGL2006-04025/BOS and Consolider-Ingenio Montes CSD2008-00040), the Catalan Department of Science (grant SGR 2009-458), and the Max Planck Society. U. N., A. A., and R. K. M. acknowledge support from the Human Frontier Science Program.

---

Contributing Institute(s):

1. Troposphäre (IEK-8)

Research Program(s):

1. Atmosphäre und Klima (P23)

Appears in the scientific report 2011

---