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David Franklin Lobach

David Franklin Lobach

Medical Associate Professor in the Department of Family Medicine and Community Health
Family Medicine and Community Health
david.lobach@duke.edu
Duke Box 3886, Durham, NC 27710
2100 Erwin Road, Durham, NC 27710

Selected Publications

A qualitative analysis of algorithm-based decision support usability testing for symptom management across the trajectory of cancer care: one size does not fit all.

Journal Article BMC Med Inform Decis Mak · March 5, 2024 BACKGROUND: Adults with cancer experience symptoms that change across the disease trajectory. Due to the distress and cost associated with uncontrolled symptoms, improving symptom management is an important component of quality cancer care. Clinical decisi ... Full text Link to item Cite

Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.

Journal Article JAMIA Open · December 2023 Remote monitoring of women experiencing hypertensive disorders of pregnancy (HDP) can provide timely life-saving data, particularly if these data are integrated into existing patient and clinical workflows. This pilot intervention of a smartphone applicati ... Full text Link to item Cite

Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards.

Journal Article Appl Clin Inform · October 2022 BACKGROUND: Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperabili ... Full text Link to item Cite

Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.

Journal Article J Am Med Inform Assoc · June 14, 2022 OBJECTIVE: We conducted a horizon scan to (1) identify challenges in patient-centered clinical decision support (PC CDS) and (2) identify future directions for PC CDS. MATERIALS AND METHODS: We engaged a technical expert panel, conducted a scoping literatu ... Full text Link to item Cite

The Technology Landscape of Patient-Centered Clinical Decision Support - Where Are We and What Is Needed?

Journal Article Stud Health Technol Inform · June 6, 2022 Patient Centered Outcomes Research (PCOR) and health care delivery system transformation require investments in development of tools and techniques for rapid dissemination of clinical and operational best practices. This paper explores the current technolo ... Full text Link to item Cite

The technical landscape for patient-centered CDS: progress, gaps, and challenges.

Journal Article J Am Med Inform Assoc · May 11, 2022 Supporting healthcare decision-making that is patient-centered and evidence-based requires investments in the development of tools and techniques for dissemination of patient-centered outcomes research findings via methods such as clinical decision support ... Full text Link to item Cite

Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT.

Journal Article J Pain Symptom Manage · April 2022 CONTEXT: Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve t ... Full text Link to item Cite

Algorithm-based decision support for symptom self-management among adults with Cancer: results of usability testing.

Journal Article BMC Med Inform Decis Mak · May 29, 2018 BACKGROUND: It is essential that cancer patients understand anticipated symptoms, how to self-manage these symptoms, and when to call their clinicians. However, patients are often ill-prepared to manage symptoms at home. Clinical decision support (CDS) is ... Full text Link to item Cite

Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.

Journal Article Stud Health Technol Inform · 2017 Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging ... Link to item Cite

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention.

Journal Article JMIR Med Inform · November 8, 2016 BACKGROUND: Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision supp ... Full text Link to item Cite

Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model.

Journal Article AMIA Annu Symp Proc · 2016 The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated th ... Open Access Link to item Cite

Feasibility of using algorithm-based clinical decision support for symptom assessment and management in lung cancer.

Journal Article J Pain Symptom Manage · January 2015 CONTEXT: Distressing symptoms interfere with the quality of life in patients with lung cancer. Algorithm-based clinical decision support (CDS) to improve evidence-based management of isolated symptoms seems promising, but no reports yet address multiple sy ... Full text Link to item Cite

Making it local: Beacon Communities use health information technology to optimize care management.

Journal Article Popul Health Manag · June 2014 Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technolo ... Full text Link to item Cite

Creating computable algorithms for symptom management in an outpatient thoracic oncology setting.

Journal Article J Pain Symptom Manage · December 2013 CONTEXT: Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. OBJECTIVES: This a ... Full text Link to item Cite

Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors' maintenance of dietary practices and physical activity.

Journal Article Psychooncology · April 2013 BACKGROUND: This study examined whether changes in self-efficacy explain the effects of a mailed print intervention on long-term dietary practices of breast and prostate cancer survivors. The relationship between change in self-efficacy and long-term physi ... Full text Link to item Cite

DECISION SUPPORT FOR SYMPTOM AND QUALITY OF LIFE MANAGEMENT

Conference ANNALS OF BEHAVIORAL MEDICINE · March 1, 2013 Link to item Cite

A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.

Journal Article J Med Syst · February 2013 To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services. Randomized clinical trial of three clinical decision support delivery modalities: email messages to care managers (emai ... Full text Link to item Cite

Decision support for evidence-based pharmacotherapy detects adherence problems but does not impact medication use.

Journal Article Stud Health Technol Inform · 2013 Although evidence-based pharmacotherapies are a principal component of patient care, 30-50% of patients do not take their medications as prescribed. We conducted a randomized trial of two clinical decision support (CDS) interventions in 2219 patients: pati ... Link to item Cite

Effect of clinical decision-support systems: a systematic review.

Journal Article Ann Intern Med · July 3, 2012 BACKGROUND: Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking. PURPOSE: To evaluate the effect of CDSSs on clinical outcomes, health car ... Full text Link to item Cite

Enabling health care decisionmaking through clinical decision support and knowledge management.

Journal Article Evid Rep Technol Assess (Full Rep) · April 2012 OBJECTIVES: To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be in ... Link to item Cite

Population-based clinical decision support: a clinical and economic evaluation.

Journal Article Stud Health Technol Inform · 2012 Governments are investing in health information technologies (HIT) to improve care quality and reduce medical costs. However, evidence of these benefits is limited. We conducted a randomized trial of three clinical decision support (CDS) interventions in 2 ... Link to item Cite

Long-term dietary outcomes of the FRESH START intervention for breast and prostate cancer survivors.

Journal Article J Am Diet Assoc · December 2011 BACKGROUND: Cancer survivors are at increased risk for secondary cancers and other diseases. Healthy dietary practices may improve cancer survivors' health and well-being. OBJECTIVE: The durability of the effects of the FRESH START intervention, a program ... Full text Link to item Cite

Clinical and economic results from a randomized trial of clinical decision support in a rural health network.

Journal Article Stud Health Technol Inform · 2011 BACKGROUND: Replication studies evaluate technologies in usual use settings. METHODS: We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subje ... Link to item Cite

Improving Medication Adherence in a Regional Healthcare Information Exchange using a Scalable, Claims-Driven, and Service-Oriented Approach.

Journal Article AMIA Annu Symp Proc · November 13, 2010 Evidence-based pharmacotherapy is a central aspect of optimal patient care for many chronic conditions. However, medication non-adherence frequently inhibits the attainment of optimal pharmacotherapy regimens. In this study, we designed, developed, and imp ... Link to item Cite

Integrating direct electronic collection of data from patients into the process of care for eye care professionals.

Journal Article AMIA Annu Symp Proc · November 13, 2010 Enabling collection of clinical data directly from patients has the potential to increase data accuracy and augment patient engagement in the care process. Most patient data entry systems have been created independent of electronic health records, and few ... Link to item Cite

Factors influencing uptake of pharmacogenetic testing in a diverse patient population.

Journal Article Public Health Genomics · 2010 BACKGROUND: The successful integration of pharmacogenetic (PGx) testing into clinical care will require attention to patient attitudes. In this study, we aimed to identify the major reasons why patients would or would not consider PGx testing and whether t ... Full text Link to item Cite

Implementation of a clinical decision support system using a service model: results of a feasibility study.

Journal Article Stud Health Technol Inform · 2010 Numerous studies have shown that the quality of health care is inadequate, and healthcare organizations are increasingly turning to clinical decision support systems (CDSS) to address this problem. In implementing CDSS, a highly promising architectural app ... Link to item Cite

Standards for scalable clinical decision support: need, current and emerging standards, gaps, and proposal for progress.

Journal Article Open Med Inform J · 2010 Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-s ... Full text Link to item Cite

System-agnostic clinical decision support services: benefits and challenges for scalable decision support.

Journal Article Open Med Inform J · 2010 System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating ... Full text Link to item Cite

Implementation of a clinical decision support system using a service model: Results of a feasibility study

Conference Studies in Health Technology and Informatics · January 1, 2010 Numerous studies have shown that the quality of health care is inadequate, and healthcare organizations are increasingly turning to clinical decision support systems (CDSS) to address this problem. In implementing CDSS, a highly promising architectural app ... Full text Cite

Evaluation of the PharmGKB knowledge base as a resource for efficiently assessing the clinical validity and utility of pharmacogenetic assays.

Journal Article AMIA Annu Symp Proc · November 14, 2009 Prior to clinical use, pharmacogenetic tests should be systematically evaluated for their clinical validity and utility. Here, we evaluated whether the publicly available, online Pharmacogenomics Knowledge Base (PharmGKB) could facilitate such assessments ... Link to item Cite

Facilitating consumer clinical information seeking by maintaining referential context: evaluation of a prototypic approach.

Journal Article AMIA Annu Symp Proc · November 14, 2009 Millions of consumers seek health information on the Internet. Unfortunately, this searching often falls short because of design limitations of many consumer-oriented Web sites. In this paper, we describe an approach that addresses several known barriers t ... Link to item Cite

Comparing the 7-day physical activity recall with a triaxial accelerometer for measuring time in exercise.

Journal Article Med Sci Sports Exerc · June 2009 PURPOSE: The primary study aim was to evaluate associations of estimated weekly minutes of moderate-to-vigorous-intensity exercise from self-reports of the telephone-administered 7-Day Physical Activity Recall (7-Day PAR) with data captured by the RT3 tria ... Full text Link to item Cite

A national clinical decision support infrastructure to enable the widespread and consistent practice of genomic and personalized medicine.

Journal Article BMC Med Inform Decis Mak · March 23, 2009 BACKGROUND: In recent years, the completion of the Human Genome Project and other rapid advances in genomics have led to increasing anticipation of an era of genomic and personalized medicine, in which an individual's health is optimized through the use of ... Full text Link to item Cite

Recommendations for a clinical decision support for the management of individuals with chronic kidney disease.

Journal Article Clin J Am Soc Nephrol · February 2009 BACKGROUND AND OBJECTIVES: Care for advanced CKD patients is suboptimal. CKD practice guidelines aim to close gaps in care, but making providers aware of guidelines is an ineffective implementation strategy. The Institute of Medicine has endorsed the use o ... Full text Link to item Cite

A randomized clinical trial of clinical decision support in a rural community health network serving lower income individuals: study design and baseline characteristics.

Journal Article Stud Health Technol Inform · 2009 Lower income individuals in the US frequently experience difficulties in obtaining access to needed health care services. We describe a randomized clinical trial that seeks to improve the quality of, and access to healthcare services for medically underser ... Link to item Cite

Health information technology economic evaluation

Journal Article · December 1, 2008 This chapter describes a framework for conducting economic analyses of health information technologies (HIT). It explains the basic principles of healthcare economic analyses and the relationships between the costs and effectiveness of a health interventio ... Full text Cite

Coupling direct collection of health risk information from patients through kiosks with decision support for proactive care management.

Journal Article AMIA Annu Symp Proc · November 6, 2008 Data collection from patients for use in clinical decision making is foundational for medical practice. Increasingly, kiosks are being used to facilitate direct data collection from patients. However, kiosk-collected data are generally not integrated into ... Link to item Cite

Deployment of health information kiosks in diverse community settings: experience and lessons learned.

Journal Article AMIA Annu Symp Proc · November 6, 2008 The use of kiosks in healthcare by patients to collect and deliver health information is growing rapidly. When planning kiosk deployment many factors such as proper location, presentation, access, and support need to be considered to foster usage. This pos ... Link to item Cite

Change in self-efficacy partially mediates the effects of the FRESH START intervention on cancer survivors' dietary outcomes.

Journal Article Psychooncology · October 2008 OBJECTIVE: This study examined change in self-efficacy as a mediator of the effects of a mailed print intervention on the dietary and exercise practices of newly diagnosed breast and prostate cancer survivors. METHOD: A total of 543 breast and prostate can ... Full text Link to item Cite

Differences in baseline characteristics and outcomes at 1- and 2-year follow-up of cancer survivors accrued via self-referral versus cancer registry in the FRESH START Diet and exercise trial.

Journal Article Cancer Epidemiol Biomarkers Prev · May 2008 Participant accrual to research studies is a challenge; oftentimes, advertisements are used to supplement cases ascertained through clinic caseloads and cancer registries. It is unknown, however, if cases ascertained through these two sources differ. In th ... Full text Link to item Cite

Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard

Journal Article Studies in Health Technology and Informatics · December 1, 2007 Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, th ... Cite

Development and evaluation of an improved methodology for assessing adherence to evidence-based drug therapy guidelines using claims data.

Journal Article AMIA Annu Symp Proc · October 11, 2007 Non-adherence to evidence-based pharmacotherapy is associated with increased morbidity and mortality. Claims data can be used to detect and intervene on such non-adherence, but existing claims-based approaches for measuring adherence to pharmacotherapy gui ... Link to item Cite

Evaluating implementation fidelity in health information technology interventions.

Journal Article AMIA Annu Symp Proc · October 11, 2007 Health information technology evaluators need to distinguish between intervention efficacy as assessed in the ideal circumstances of clinical trials and intervention effectiveness as assessed in the real world circumstances of actual practice. Because curr ... Link to item Cite

Proactive population health management in the context of a regional health information exchange using standards-based decision support.

Journal Article AMIA Annu Symp Proc · October 11, 2007 Featured Publication The clinic-based healthcare model does not deliver high quality, cost-effective care to populations of patients. Despite public perception that aggressive investment in information technology will lead to improvements in the safety and quality of healthcar ... Link to item Cite

Determining user preferences between touch and pen data entry methods in the Tablet PC computing environment.

Journal Article AMIA Annu Symp Proc · October 11, 2007 Tablet personal computers (PCs) are becoming common in the clinical environment. In a recent survey comparing mobile devices, the Tablet PC was perceived to have made the most significant difference in the delivery of healthcare. As the use of Tablet PC te ... Link to item Cite

Implementation fidelity: a framework for evaluation in the health information technology field.

Journal Article AMIA Annu Symp Proc · October 11, 2007 Health information technology evaluators need to distinguish between intervention efficacy as assessed in the ideal circumstances of clinical trials and intervention effectiveness as assessed in the real world circumstances of actual practice. We have deve ... Link to item Cite

Providing contextually relevant health literature for at-risk patients using free-standing touchscreen computer kiosks in community settings.

Journal Article AMIA Annu Symp Proc · October 11, 2007 In this project we describe the successful implementation of a computer kiosk system that collects health risk information directly from patients and provides both contextually relevant and patient-tailored health information. We include usage statistics f ... Link to item Cite

Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors.

Journal Article J Clin Oncol · July 1, 2007 PURPOSE: Cancer survivors are at increased risk for cardiovascular disease, diabetes, osteoporosis, and second primary tumors. Healthful lifestyle practices may improve the health and well-being of survivors. The FRESH START trial tested the efficacy of se ... Full text Link to item Cite

Research challenges for electronic health records.

Journal Article Am J Prev Med · May 2007 Featured Publication The availability and use of electronic health records (EHRs) are likely to increase markedly over the next 10 years. This promulgation of EHRs will change dramatically the delivery of healthcare in the United States. Researchers seeking to maximize the imp ... Full text Link to item Cite

Proposal for fulfilling strategic objectives of the U.S. Roadmap for national action on clinical decision support through a service-oriented architecture leveraging HL7 services.

Journal Article J Am Med Inform Assoc · 2007 Featured Publication Despite their demonstrated effectiveness, clinical decision support (CDS) systems are not widely used within the U.S. The Roadmap for National Action on Clinical Decision Support, published in June 2006 by the American Medical Informatics Association, iden ... Full text Link to item Cite

Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

Journal Article Stud Health Technol Inform · 2007 Featured Publication Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, th ... Link to item Cite

The teachable moment following cancer diagnosis: the FRESH START trial.

Journal Article American Journal of Oncology Review · January 2006 no abstract available ... Cite

Assessing the quality of medical information technology economic evaluations: room for improvement.

Journal Article AMIA Annu Symp Proc · 2006 Medical information systems are being recognized for their ability to improve patient outcomes. While standards for the economic evaluation of medical technologies were instituted in the mid-1990s, little is known about their application in medical informa ... Link to item Cite

Perceptions of Medicaid beneficiaries regarding the usefulness of accessing personal health information and services through a patient Internet portal.

Journal Article AMIA Annu Symp Proc · 2006 Increasing emphasis is being placed on the importance of information technology to improve the safety and quality of healthcare. However, concern is growing that these potential benefits will not be equally distributed across the population because of a wi ... Link to item Cite

Economic evaluation in medical information technology: why the numbers don't add up.

Journal Article AMIA Annu Symp Proc · 2006 Standards for the economic evaluation of medical technologies were instituted in the mid-1990s, yet little is known about their application in medical information technology studies. In a review of evaluation studies published between 1982 and 2002, we fou ... Link to item Cite

Perceptions about use of a patient Internet portal among Medicaid beneficiaries.

Journal Article AMIA Annu Symp Proc · 2006 Patient Internet portals that allow patients to access their personal health information are an emerging form of enabling technology. The purported benefits from increasing use of information technology in healthcare, however, may not be universal because ... Link to item Cite

User interface considerations for collecting data at the point of care in the tablet PC computing environment.

Journal Article AMIA Annu Symp Proc · 2006 Collecting clinical data directly from clinicians is a challenge. Many standard development environments designed to expedite the creation of user interfaces for electronic healthcare applications do not provide acceptable components for satisfying the req ... Link to item Cite

Design, implementation, use, and preliminary evaluation of an UMLS-enabled terminology Web service for clinical decision support.

Journal Article AMIA Annu Symp Proc · 2006 To facilitate the provision of clinical decision support (CDS), the Unified Medical Language System (UMLS) was leveraged to implement a terminology Web service. Supported functions include inter-vocabulary translation and the identification of concepts sub ... Link to item Cite

Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.

Journal Article BMJ · April 2, 2005 Featured Publication OBJECTIVE: To identify features of clinical decision support systems critical for improving clinical practice. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Literature searches via Medline, CINAHL, and the Cochrane Controlled Tri ... Full text Link to item Cite

Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy.

Journal Article J Gen Intern Med · April 2005 The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a sin ... Full text Link to item Cite

A simple, flexible and scalable approach for generating tailored questionnaires and health education messages.

Journal Article Comput Inform Nurs · 2005 Tailored health information is important for generating patient-specific recommendations in clinical decision support systems and for crafting health education materials that are specifically customized to a patient. Many previous attempts to generate tail ... Full text Link to item Cite

Assessing the potential economic value of health information technology interventions in a community-based health network.

Journal Article AMIA Annu Symp Proc · 2005 Health information professionals recognize the need to demonstrate that the benefits of health information technological (HIT) interventions outweigh their costs. However, such cost-benefit analyses are rarely conducted for HIT interventions, due in part t ... Link to item Cite

Developing a framework for conducting economic evaluations of community-based health information technology interventions.

Journal Article AMIA Annu Symp Proc · 2005 This study describes a framework for conducting economic analyses for health information technology (HIT) interventions, in the context of three interventions that are currently being implemented in a community-based health network caring for 17,779 Medica ... Link to item Cite

Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based Web service for clinical decision support.

Journal Article AMIA Annu Symp Proc · 2005 Despite their demonstrated ability to improve care quality, clinical decision support systems are not widely used. In part, this limited use is due to the difficulty of sharing medical knowledge in a machine-executable format. To address this problem, we d ... Link to item Cite

Identifying and overcoming obstacles to point-of-care data collection for eye care professionals.

Journal Article AMIA Annu Symp Proc · 2005 Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to ... Link to item Cite

Direct comparison of a tablet computer and a personal digital assistant for point-of-care documentation in eye care.

Journal Article AMIA Annu Symp Proc · 2005 New mobile computing devices including personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. Unfortunately, little research has been reported regarding which device is optimal for a given c ... Link to item Cite

Assessment of relative importance of tablet computer features in supporting direct electronic documentation of encounters by eye care professionals.

Journal Article AMIA Annu Symp Proc · 2005 Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Compu ... Link to item Cite

Creation and use of a survey instrument for comparing mobile computing devices.

Journal Article AMIA Annu Symp Proc · 2005 Both personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. However, little research has been reported comparing these mobile computing devices in specific care settings. In this study we pr ... Link to item Cite

Overcoming obstacles to collecting narrative data from eye care professionals at the point-of-care.

Journal Article AMIA Annu Symp Proc · 2005 Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to po ... Link to item Cite

Agreement between a brief mailed screener and an in-depth telephone survey: observations from the Fresh Start study.

Journal Article J Am Diet Assoc · October 2004 Brief screening instruments can roughly characterize individual behavior and target those most in need of change. However, the level of agreement between abbreviated and full-scale instruments is often unknown. We determined agreement between a brief scree ... Full text Link to item Cite

Computerized knowledge management in diabetes care.

Journal Article Med Care · June 2004 INTRODUCTION: Many scientific achievements become part of usual diabetes care only after long delays. The purpose of this article is to identify the impact of automated information interventions on diabetes care and patient outcomes and to enable this know ... Full text Link to item Cite

Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

Journal Article Studies in health technology and informatics · January 2004 Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized informa ... Cite

Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

Journal Article Stud Health Technol Inform · 2004 Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized informa ... Link to item Cite

Evaluation of an infrared/radiofrequency equipment-tracking system in a tertiary care hospital.

Journal Article J Med Syst · August 2003 Optimal management of assets in large hospitals is important to both cost control and patient care. A prospective controlled evaluation was conducted to determine whether an asset-tracking system using combined radiofrequency and infrared signals could inc ... Full text Link to item Cite

Not blowing smoke [2]

Journal Article InTech · July 1, 2003 Cite

The social context of gastrointestinal cancer pain: a preliminary study examining the relation of patient pain catastrophizing to patient perceptions of social support and caregiver stress and negative responses.

Journal Article Pain · May 2003 A number of studies have shown that catastrophizing is an important predictor of pain and disability in persons having persistent pain conditions. The newly developed communal model of catastrophizing maintains that catastrophizing is a part of broader, in ... Full text Link to item Cite

Design of FRESH START: a randomized trial of exercise and diet among cancer survivors.

Journal Article Med Sci Sports Exerc · March 2003 PURPOSE: FRESH START is a randomized controlled trial that will test whether a personally tailored, distance-medicine-based program will increase exercise and fruit and vegetable consumption, and decrease fat intake of individuals recently diagnosed with b ... Full text Link to item Cite

Evaluation of a tool to categorize patients by reading literacy and computer skill to facilitate the computer-administered patient interview.

Journal Article AMIA Annu Symp Proc · 2003 Featured Publication Past efforts to collect clinical information directly from patients using computers have had limited utility because these efforts required users to be literate and facile with the computerized information collecting system. In this paper we describe the c ... Link to item Cite

Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

Journal Article AMIA Annu Symp Proc · 2003 Featured Publication Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) ... Link to item Cite

Factors associated with patient-recalled smoking cessation advice in a low-income clinic.

Journal Article J Natl Med Assoc · May 2002 It is recommended that providers advise cessation to their patients who smoke. However, patients' reports of cessation advice indicate disparities based on patients' race, gender, age, and smoking level. Providers' reports do not corroborate these disparit ... Link to item Cite

Development of an adaptive multimedia program to collect patient health data.

Journal Article Am J Prev Med · November 2001 BACKGROUND: Direct entry of personal health survey information into a computer by patients could streamline clinical data collection, improve completeness and accuracy of health information available to providers, and provide data for tailoring health educ ... Full text Link to item Cite

Defining and supporting the diverse information needs of community-based care using the web and hand-held devices.

Journal Article Proc AMIA Symp · 2001 Featured Publication Community-based healthcare focused on maintaining wellness is becoming increasingly prevalent in the United States in an effort to eliminate healthcare disparities and reduce healthcare costs. These community-oriented initiatives, however, often require pa ... Link to item Cite

Delivering interactive clinical practice guidelines to the point of care using handheld devices

Journal Article JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION · January 1, 2001 Link to item Cite

Feasibility of a tailored intervention to improve preventive care use in women.

Journal Article Prev Med · October 2000 BACKGROUND: Women age 50 years and older are in need of multiple preventive health care services. Despite recent improvements in rates of delivery of preventive care services, especially within managed care organizations, substantial numbers of women are s ... Full text Link to item Cite

A systematic process for converting text-based guidelines into a linear algorithm for electronic implementation.

Journal Article Proc AMIA Symp · 2000 Featured Publication Clinical practice guidelines are increasingly important for improving the quality and the process of healthcare delivery. Unfortunately, most guidelines are available only in a text-based format, which is difficult to integrate into clinical practice. Comp ... Link to item Cite

Integration of clinical decision support with on-line encounter documentation for well child care at the point of care.

Journal Article Proc AMIA Symp · 1999 Electronic medical record systems and clinical practice guideline (CPG) support applications are emerging in the clinical environment to document and support care. Applications which integrate online documentation with CPG are often complex systems bound t ... Link to item Cite

A Web link management tool for optimizing utilization of distributed knowledge in health care applications.

Journal Article Proc AMIA Symp · 1999 The number of health-related Web sites on the Internet is increasing. Incorporating these sites into clinical decision support systems and other health care applications can significantly enhance the educational and instructional value of such systems. Whi ... Link to item Cite

Siegfried: System for interactive electronic guidelines with feedback and resources for instructional and educational development

Conference Studies in Health Technology and Informatics · January 1, 1998 The proliferation of clinical practice guidelines (CPGs) has necessitated computerized solutions for guideline distribution and implementation. In this paper we describe a Web-based system that interactively presents CPGs at the point of care. Our system, ... Full text Cite

Siegfried: System for Interactive Electronic Guidelines with Feedback and Resources for Instructional and Educational Development.

Journal Article Stud Health Technol Inform · 1998 Featured Publication The proliferation of clinical practice guidelines (CPGs) has necessitated computerized solutions for guideline distribution and implementation. In this paper we describe a Web-based system that interactively presents CPGs at the point of care. Our system, ... Link to item Cite

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

Journal Article Proc AMIA Symp · 1998 Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design feature ... Link to item Cite

Exploratory Data Analysis to Detect Preterm Risk Factors

Journal Article Journal of the American Medical Informatics Association · December 1, 1997 Cite

Integration of a computer-based patient record system into the primary care setting.

Journal Article Comput Nurs · 1997 The use of computer-based patient record systems (CPRS) in the primary care setting will increase significantly over the next few years. Real-time, point-of-care use of such systems must provide adequate payback to justify the intrusion into the provider/p ... Link to item Cite

Computerized decision support based on a clinical practice guideline improves compliance with care standards.

Journal Article Am J Med · January 1997 Featured Publication PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of an clinical practice guid ... Full text Link to item Cite

Medical data mining: knowledge discovery in a clinical data warehouse.

Journal Article Proc AMIA Annu Fall Symp · 1997 Clinical databases have accumulated large quantities of information about patients and their medical conditions. Relationships and patterns within this data could provide new medical knowledge. Unfortunately, few methodologies have been developed and appli ... Link to item Cite

Structuring clinical practice guidelines in a relational database model for decision support on the Internet.

Journal Article Proc AMIA Annu Fall Symp · 1997 Featured Publication The rapid proliferation of clinical practice guidelines (CPGs) has made computerization increasingly useful to clinicians. Computerization, however, requires transformation of the content and logic of each guideline into a computer-accessible form. In this ... Link to item Cite

Development and use of a Guideline Entry Wizard to convert text clinical practice guidelines to a relational format.

Journal Article Proc AMIA Annu Fall Symp · 1997 Computerization of clinical practice guidelines (CPGs) has been proposed as one solution to enhance the use of guidelines in influencing standard clinical care. However, the conversion of text guidelines to the format required by a computer program is a ma ... Link to item Cite

Medical Data Mining: Knowledge Discovery in a Clinical Data Warehouse

Journal Article Journal of the American Medical Informatics Association · January 1, 1997 Clinical databases have accumulated large quantities of information about patients and their medical conditions. Relationships and patterns within this data could provide new medical knowledge. Unfortunately, few methodologies have been developed and appli ... Cite

Structuring Clinical Practice Guidelines in a Relational Database Model for Decision Support on the Internet

Journal Article Journal of the American Medical Informatics Association · January 1, 1997 The rapid proliferation of clinical practice guidelines (CPGs) has made computerization increasingly useful to clinicians. Computerization, however, requires transformation of the content and logic of each guideline into a computer-accessible form. In this ... Cite

Development and Use of a Guideline Entry Wizard to Convert Text Clinical Practice Guidelines to a Relational Format

Journal Article Journal of the American Medical Informatics Association · January 1, 1997 Computerization of clinical practice guidelines (CPGs) has been proposed as one solution to enhance the use of guidelines in influencing standard clinical care. However, the conversion of text guidelines to the format required by a computer program is a ma ... Cite

Electronically distributed, computer-generated, individualized feedback enhances the use of a computerized practice guideline.

Journal Article Proc AMIA Annu Fall Symp · 1996 Featured Publication Clinical guidelines have been developed to assist with the management of patient care; however, these guidelines are frequently neglected in clinical practice. Computer-generated reminders enhance guideline use, but these systems often fail to achieve high ... Link to item Cite

Documenting data delivery: design, deployment, and decision.

Journal Article Proc AMIA Annu Fall Symp · 1996 Developing and deploying informatics solutions which are useful and acceptable to busy physicians are challenging tasks. We describe the design, deployment, and evaluation process by which the delivery of routine clinical laboratory reports is automated us ... Link to item Cite

Converting a legacy system database into relational format to enhance query efficiency.

Journal Article Proc Annu Symp Comput Appl Med Care · 1995 The analysis of clinical data collected over time can provide important insight into the health care process. Unfortunately, much of the electronic clinical data that exists today is stored in legacy systems, making it difficult to access and share the inf ... Link to item Cite

A model for adapting clinical guidelines for electronic implementation in primary care.

Journal Article Proc Annu Symp Comput Appl Med Care · 1995 Featured Publication Medical informaticians who seek to implement clinical guidelines by computer must be aware of a significant gap that exists between guideline development and utilization. In order to be effective, guideline recommendations must be followed by clinicians; i ... Link to item Cite

Development and evaluation of a Computer-Assisted Management Protocol (CAMP): improved compliance with care guidelines for diabetes mellitus.

Journal Article Proc Annu Symp Comput Appl Med Care · 1994 Disease-specific standards for directing patient management are becoming increasingly important. These standards, however, are often not followed because they are not sufficiently integrated into the clinical care setting. In this study we describe the dev ... Link to item Cite

Nucleotide sequence, expression, and chromosomal mapping of Mrp and mapping of five related sequences.

Journal Article Genomics · July 1993 We isolated and characterized a genomic clone for the mouse MARCKS-related protein, or MRP, also known as F52 and MacMARCKS. A 3699-bp plasmid contained 407 bp of 5'-flanking region, 186 bp of 5'-untranslated region, 600 bp of protein coding region, 784 bp ... Full text Link to item Cite

The thymic microenvironment. Characterization of in vitro differentiation of the IT26R21 rat thymic epithelial cell line.

Journal Article Differentiation · 1987 We have previously postulated an in vivo pathway of thymic epithelial (TE) cell maturation in pre- and postnatal thymus, whereby endocrine medullary TE cells terminally differentiate to form Hassall's bodies. Epithelial-cell differentiation has been well d ... Full text Link to item Cite

Human thymocytes bind to autologous and allogeneic thymic epithelial cells in vitro.

Journal Article Proc Natl Acad Sci U S A · September 1986 The thymus plays a critical role in the generation of immunocompetent T lymphocytes. In the thymus, lymphocytes are in close contact with epithelial cells, and this contact is necessary for T-cell maturation. Using cultured human thymic epithelial (TE) cel ... Full text Link to item Cite

DEMONSTRATION OF THYMIC EPITHELIAL-CELL DIFFERENTIATION INVITRO

Journal Article CLINICAL RESEARCH · April 1, 1986 Link to item Cite

Human T cell antigen expression during the early stages of fetal thymic maturation.

Journal Article J Immunol · September 1985 Human thymus tissue was examined from 7 wk of gestation through birth for the expression of antigens reacting with a panel of anti-T cell monoclonal antibodies. Additionally, the reactivities of reagents against the transferrin receptor, against leukocytes ... Link to item Cite

In vitro growth and phenotypic characterization of mesodermal-derived and epithelial components of normal and abnormal human thymus.

Journal Article Hum Immunol · July 1985 Long-term in vitro cultures of human thymic tissue were established and phenotypically characterized using monoclonal reagents that define distinct components of the human thymic microenvironment. The epithelial component of the thymus, defined by monoclon ... Full text Link to item Cite

Expression of antigens by cultured epithelial cells: comparison of epidermis and thymic epithelium.

Journal Article J Invest Dermatol · July 1985 We have established long term in vitro cultures of human thymic epithelium and human epidermis free of contaminating fibroblasts. The cultured cells were examined using a panel of monoclonal antibodies which were raised against human thymic stroma and reco ... Full text Link to item Cite

The human thymic microenvironment. Phenotypic characterization of Hassall's bodies with the use of monoclonal antibodies.

Journal Article J Immunol · January 1985 The human thymic microenvironment is important in promotion of T cell maturation, particularly during early stages of thymic ontogeny. Hassall's bodies (HB) are epithelial swirls in the human thymic medulla that are thought to be derived from endocrine med ... Link to item Cite

ONTOGENY OF HUMAN T-CELL ANTIGENS

Journal Article CLINICAL RESEARCH · January 1, 1985 Link to item Cite

Phenotypic characterization and ontogeny of mesodermal-derived and endocrine epithelial components of the human thymic microenvironment.

Journal Article J Exp Med · April 1, 1984 Using murine monoclonal antibodies TE-4 and TE-7 raised against human thymic stroma, we identified two distinct and mutually exclusive thymic microenvironment components: the thymic endocrine epithelium (TE-4+) and mesodermal-derived fibrous stroma (TE-7+) ... Full text Link to item Cite

In vivo study of microvascular wall characteristics and resting control in young and mature spontaneously hypertensive rats.

Journal Article Blood Vessels · 1978 This study was designed to determine if vessel wall hypertrophy and increased expression of sympathetic activity occur in the microcirculation during the development of hypertension. The cremaster muscle microvasculature of normal Wistar-Kyoto (WKY) and sp ... Full text Link to item Cite