Evaluation of an expert system in resident physicians for the nutritional management of critically ill patients with intestinal insufficiency and failure.

Authors

  • Diana TREJOS GALLEGO Nutricionista
  • Diego MELO SOLARTE
  • William NARVÁEZ SOLARTE
  • Clara Helena GONZÁLEZ CORREA

DOI:

https://doi.org/10.12873/414trejos

Keywords:

tecnologías biomédicas; soporte nutricional, falla intestinal, aplicaciones móviles, sistema experto.

Abstract

Abstract: Information technology has provided medicine and nutrition with decision support tools, which have allowed a more objective and timely care to patients. An expert system is one of these tools with the potential to guide users in handling a specific problem. Adherence to clinical practice guidelines for nutritional management in patients with intestinal insufficiency and failure, through an expert system, optimizes the treatment of critically ill patients and increases their chances of survival.

Objective: To establish an expert system developed as a tool to improve the adherence of physicians to international guidelines and as support in decision-making, improves the management of nutritional support in patients with intestinal insufficiency and failure.

Methods: A questionnaire prepared by five experts through a modified three-round Delphi process was used to generate consensus on the questions that resident physicians had to answer when evaluating knowledge of international guidelines for nutritional management in these patients. Consensus was established through descriptive statistics, when agreement reached 80% or more in each of the questions. The questionnaire was applied to 26 resident physicians who rotated through the intensive care unit at a local hospital, half with support from the System and the other half without it.

Results: The use of the System was shown to be a support for the resident physicians who used it (P value = 0.044). Providing assistance for better results, fewer errors in the written test and better adherence to the recommendations of international guidelines.

Conclusions: the results found suggest that the use of the System can improve decision-making regarding the medical and nutritional approach in patients with intestinal insufficiency and failure.

References

Ricciardi R, Roberts PL, Read TE, Hall JF, Marcello PW, Schoetz DJ. Which adverse events are associated with mortality and prolonged length of stay following colorectal surgery? J Gastrointest Surg. 2013; 17:1485-93. doi: 10.1007/s11605-013-2224-3.

Karagozian R, Johannes RS, Sun X, Burakoff R. Increased mortality and length of stay among patients with inflammatory bowel disease and hospital-acquired infections. Clin Gastroenterol Hepatol. 2010; 8:961-5. doi: 10.1016/j.cgh.2010.07.017.

Enriquez-Sánchez LB, Carrillo-Gorena MJ, Granados-Aldaz LA, Balderrama-Miramontes LF, Gallegos-Portillo LG, Reza-Leal CN, et al. Intestinal failure functional classification type associated with an extended length of stay at the intestinal failure unit, Central Hospital in Chihuahua, Mexico. Cir Cir. 2019; 87:559-63. doi: 10.24875/CIRU.19000767.

Fuglsang KA, Brandt CF, Scheike T, Jeppesen PB. Hospitalizations in Patients with Non malignant Short-Bowel Syndrome Receiving Home Parenteral Support. Nutr Clin Pract. 2020; 35:894-902. doi: 10.1002/ncp.10471.

Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M. M., Casaer, M. P., Deane, A. M., et al. ESICM Working Group on Gastrointestinal Function, E. W. G. on G. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Medicine, 2017; 43:380–398. doi.10.1007/s00134-016-4665-0

Pironi, L., Corcos, O., Forbes, A., Holst, M., Joly, F., Jonkers, C., et al. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clinical Nutrition, 2018; 37:1798–1809. doi:10.1016/j.clnu.2018.07.036

Reintam Blaser A, Preiser JC, Fruhwald S, Wilmer A, Wernerman J, Benstoem C, Et al; Working Groupon Gastrointestinal Function within the Section of Metabolism, Endocrinology and Nutrition (MEN Section) of ESICM. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. CritCare. 2020; 24:224. doi: 10.1186/s13054-020-02889-4.

Badaró S, Ibañez Leonardo Javier y Agüero Martín J. Expertos: Fundamentos, Metodologías y Aplicaciones. Ciencia y Tecnología, 2013; 13:349-364 ISSN 1850-0870. Disponible en:https://www.palermo.edu/ingenieria/pdf2014/13/CyT_13_24.pdf

Trtovac D, Lee J. The Use of Technology in Identifying Hospital Malnutrition: Scoping Review. JMIR Med Inform. 2018; 6:e4. doi: 10.2196/medinform.7601.

North JC, Jordan KC, Metos J, Hurdle JF. Nutrition Informatics Applications in Clinical Practice: a Systematic Review. AMIA Annu Symp Proc. 2015; 5:963-72.

Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015; 17:e52. doi: 10.2196/jmir.3951.

Abhari S, Safdari R, Azadbakht L, et al. A Systematic Review of Nutrition Recommendation Systems: With Focus on Technical Aspects. J Biomed Phys Eng. 2019; 9:591-602. doi:10.31661/jbpe.v0i0.1248

Mahmood S, Hoffman L, Ali IA, Zhao YD, Chen A, Allen K. Smart Phone/Device Application to Improve Delivery of Enteral Nutrition in Adult Patients Admitted to the Medical Intensive Care Unit. NutrMetabInsights. 2019; 12. doi:10.1177/117863881882029

Singer, P., Reintam Blaser, A., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., et al. ESPEN Guideline ESPEN guide line on clinical nutrition in the intensive care unit. 2019; 1:48-79. doi: 10.1016/j.clnu.2018.08.037

Rosas-Flota X, Castillo-Martínez L, Reyes-Ramírez AL, Martínez-Soto Holguín MC, Serralde-Zúñiga AE. Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey. Clin Nutr ESPEN. 2020; 40:187-192. doi: 10.1016/j.clnesp.2020.09.024.

Ayres EJ, Greer-Carney JL, Fatzinger McShane PE, Miller A, Turner P. Nutrition informatics competencies a cross all levels of practice: a national Delphi study. J Acad NutrDiet. 2012; 112:2042-53. doi: 10.1016/j.jand.2012.09.025.

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians follow clinical practice guide lines? A framework for improvement. JAMA. 1999; 282:1458-65. doi: 10.1001/jama.282.15.1458.

Frantz DJ, McClave SA, Hurt RT, Miller K, Martindale RG. Cross-Sectional Study of U.S. Interns' Perceptions of Clinical Nutrition Education. JPEN J Parenter Enteral Nutr. 2016; 40:529-35. doi: 10.1177/0148607115571016.

Siebert JN, Lacroix L, Cantais A, Manzano S, Ehrler F. The Impact of a Tablet App on Adherence to American Heart AssociationGuidelinesDuringSimulatedPediatricCardiopulmonaryResuscitation: Randomized Controlled Trial. J Med Internet Res. 2020; 22:e17792. doi: 10.2196/17792.

North JC, Jordan KC, Metos J, Hurdle JF. Nutrition Informatics Applications in Clinical Practice: a Systematic Review. AMIA AnnuSympProc. 2015; 5:963-72.

Bernstam EV, Smith JW, Johnson TR. What is biomedical informatics? J Biomed Inform. 2010; 43:104-10. doi: 10.1016/j.jbi.2009.08.006.

Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA. 2013; 310:2501-2. doi: 10.1001/jama.2013.281334.

McCoy AB, Waitman LR, Lewis JB, Wright JA, Choma DP, Miller RA, et al. A framework for evaluating the appropriateness of clinical decision support alerts and responses. J Am Med Inform Assoc. 2012; 19:346-52. doi: 10.1136/amiajnl-2011-000185.

Chu LF, Erlendson MJ, Sun JS, Alva HL, Clemenson AM. Mobile computing in medical education: opportunities and challenges. Curr Opin Anaesthesiol. 2012; 25:699-718. doi: 10.1097/ACO.0b013e32835a25f1.

Published

2022-01-07

How to Cite

TREJOS GALLEGO, D., MELO SOLARTE, D., NARVÁEZ SOLARTE, W., & GONZÁLEZ CORREA, C. H. (2022). Evaluation of an expert system in resident physicians for the nutritional management of critically ill patients with intestinal insufficiency and failure. Nutrición Clínica Y Dietética Hospitalaria, 41(4). https://doi.org/10.12873/414trejos

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Research articles

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