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Assignment: Literature Review: The Use of Clinical Systems to Improve

Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

· Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.

· Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”

· Identify and select 4 peer-reviewed research articles from your research.

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

· Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.

· Include an introduction explaining the purpose of the paper.

· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

· In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.

· Use APA format and include a title page.

Assignment must include

My field of practice is ENT (Ear, Nose and Throat and the assignment must be related with the allergy field. Please see attachments for the articles to be use related to my current nursing field

Please see the example attached on how to complete and do this assignment.

Original Paper

Adherence to Prescribed E-Diary Recording by Patients With
Seasonal Allergic Rhinitis: Observational Study

Marco Di Fraia1,2, MD; Salvatore Tripodi3,4,5, MD; Stefania Arasi1,6, MD, PhD; Stephanie Dramburg1, MD; Sveva

Castelli1, MD; Danilo Villalta7, MD; Francesca Buzzulini7, MD; Ifigenia Sfika3, MD; Valeria Villella3, MD; Ekaterina

Potapova1, MSc; Serena Perna1, MSc; Maria Antonia Brighetti8, PhD; Alessandro Travaglini8, MA; Pierluigi Verardo9,

MA; Simone Pelosi5, MA; Anna Maria Zicari2, MD; Paolo Maria Matricardi1, MD
1Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
2Department of Pediatrics, Sapienza University of Rome, Rome, Italy
3Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
4Allergology Service, Policlinico Casilino, Rome, Italy
5TPS Production, Rome, Italy
6Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children’s Research Hospital, Rome, Italy
7Department of Immunology-Allergy, Santa Maria degli Angeli Hospital, Pordenone, Italy
8Department of Biology, University of Rome Tor Vergata, Rome, Italy
9Center of Aerobiology, Agenzia Regionale per la Protezione Ambientale, Pordenone, Italy

Corresponding Author:
Paolo Maria Matricardi, MD
Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine
Charité University Medicine
Augustenburger Platz 1
Berlin, 13353
Phone: 49 30 450 566 406
Email: [email protected]


Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the
sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure,
can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to
their recording.

Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording
via e-diary explicitly prescribed by an allergist within a blended care approach.

Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients
with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone,
Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily
through a mobile app (Allergy.Monitor) during the relevant pollen season.

Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence
to device use slowly declined during

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Full Text | Scholarly Journal

Identifying Risk of Future Asthma Attacks Using UK Medical Record Data: A Respiratory Effectiveness Group Initiative

Blakey, John D; Price, David B; Pizzichini, Emilio; Popov, Todor A; Dimitrov, Borislav D; et al.
Journal of Allergy and Clinical Immunology. In Practice; Amsterdam Vol. 5, Iss. 4, (Jul 1, 2017): 1015-1024. DOI:10.1016/j.jaip.2016.11.007



Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors.


We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent attacks.


We analyzed anonymized, longitudinal medical records of 118,981 patients with actively treated asthma (ages 12-80 years) and 3 or more years of data. Potential risk factors
during 1 baseline year were evaluated using univariable (simple) logistic regression for outcomes of 2 or more and 4 or more attacks during the following 2-year period.
Predictors with significant univariable association (P< .05) were entered into multiple logistic regression analysis with backward stepwise selection of the model including all
significant independent predictors. The predictive accuracy of the multivariable models was assessed.


Independent predictors associated with future attacks included baseline-year markers of attacks (acute oral corticosteroid courses, emergency visits), more frequent reliever
use and health care utilization, worse lung function, current smoking, blood eosinophilia, rhinitis, nasal polyps, eczema, gastroesophageal reflux disease, obesity, older age, and
being female. The number of oral corticosteroid courses had the strongest association. The final cross-validated models incorporated 19 and 16 risk factors for 2 or more and 4
or more attacks over 2 years, respectively, with areas under the curve of 0.785 (95% CI, 0.780-0.789) and 0.867 (95% CI, 0.860-0.873), respectively.


Routinely collected data could be used proactively via automated searches to identify individuals at risk of recurrent asthma attacks. Further re

Implementation and Effect of a Novel

Electronic Medical Record Format for

Patient Allergy Information

Masaharu NAKAYAMA, MD, PhD
a, b, 1

and Ryusuke INOUE, MD, PhD

Medical Informatics, Tohoku University Graduate School of Medicine, Miyagi, Japan.

b Medical IT Center, Tohoku University Hospital, Miyagi, Japan

Abstract. Adverse drug events (ADEs) are critical. Approximately 10% of fatal
ADEs are believed to be allergic reactions. Therefore, sharing patient allergy
information is beneficial to medical staff members in avoiding potentially lethal
complications. We previously performed a nationwide study of patient allergy
information in Japanese hospitals. The report showed that most of the responding
hospitals needed a standard format for reporting the information. To establish this,
we implemented a novel format for recording patient allergy information into the
hospital information system at Tohoku University Hospital; this format was created
through vigorous discussion among medical staff members with a variety of
specialties, including doctors, nurses, pharmacists, nutritionists, and medical safety
managers. In this study, we followed the amount of inputted allergy information and
the number of incidents involving medication after implementation. The amount of
allergy information inputted increased slightly. Although incidents involving
medication also increased slightly, ADEs due to allergy significantly decreased. We
believe that our findings will be useful in helping to determine the optimal
characteristics of drug allergy information and to improve the dissemination of
information regarding potential allergens and subsequent ADEs.

Keywords. Allergy, Patient profile, Adverse drug event, Medical Safety

1. Introduction

The prevention of adverse drug events (ADEs) is important for patient safety.


previously performed a questionnaire-based study to describe the current status of data

collection for allergy information in the Electronic Medical Record (EMR) and

Computerized Physician Order Entry system (CPOE) in 76 large Japanese hospitals. The

report demonstrated that most of the responding hospitals claimed that they are either

preparing their own versions or still in the discussion phase. A patient profile standard

for correctly handling allergy information should be determined. We then implemented

a novel format for inputting patient allergy information into the hospital information

system at Tohoku University Hospital. This occurred after vigorous discussion among

medical staff members with a variety of specialties, including doctors, nurses,

pharmacists, and medical safety managers. In this study, we aim to test a new standard

format for recording such information.

REVIEW Open Access

Digital technologies for an improved
management of respiratory allergic
diseases: 10 years of clinical studies using
an online platform for patients and
Salvatore Tripodi1,2,3*† , Andrea Giannone4†, Ifigenia Sfika3, Simone Pelosi2, Stephanie Dramburg4,
Annamaria Bianchi5, Antonio Pizzulli6, Jakob Florack4, Valeria Villella3, Ekaterina Potapova4 and
Paolo Maria Matricardi4


Background: Digital health technologies carry the great potential of assisting physicians in making well-informed
diagnostic and therapeutic decisions. In allergy care, electronic clinical diaries have been recently used to
prospectively collect patient data and improve diagnostic precision.

Objective: This review summarizes the clinical and scientific experience we gathered over 10 years of using a
digital platform for patients suffering from seasonal allergic rhinitis.

Methods: The mobile application and back-office of AllergyMonitor (TPS software production, Rome, Italy) enable
patients to record their daily allergy symptoms as well as drug and immunotherapy intake plus possible side effects
in a customizable way. The results can be accessed by the patient and attending physician as concise reports via a
smartphone or computer. This technology has been used in several clinical studies and routine practice since 2009.

Results: Our studies showed that A) the etiological diagnosis of SAR may be supported by matching prospectively
registered symptoms with pollen counts; B) it is possible to perform a short-term prediction of SAR-symptoms at
individual level; C) the adherence to daily symptom monitoring can remain high (> 80%) throughout several weeks
when prescribed and thoroughly explained by the treating doctor; D) the use of mobile technology can improve
adherence to symptomatic drugs as well as allergen-specific immunotherapy and E) the choice of the correct
symptom-severity-score is critical at patient level, but not at group level.

Conclusion: The studies and clinical practice based on the use of AllergyMonitor have proven the reliability and
positive impact of a digital platform including an electronic diary (eDiary) on the diagnostic precision of SAR in
poly-sensitized patients as well as patient adherence to both, drug therapy and allergen immunotherapy.

Keywords: Mobile health, E-diary, Pollen, Precision medicine, Digital

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