Effects of Clinical Decision Support System on Reduction of Adverse Drug Events: A Meta-Analysis / 대한의료정보학회지

The adverse drug events (ADE) is not only common but also expensive. Although it was expected that ADE could be prevented by using computer-based clinical decision support system (CDSS), it is not widely accepted in the clinical field. Therefore the purpose of this study was to verify whether CDSS can reduce ADE by meta-analysis. We searched literatures by Medline from 1975 to 2002 with key words of clinical decision support system, medication error, and adverse drug event. We also searched references of review articles as well as textbooks on medical informatics. The criteria for quality evaluation were as follows: 1) the objec t were physician, nurse, pharmacist, 2) case design for CDSS analysis was pe rformed random c linical te st of experimental-control group, 3) deal with a adverse drug event organization whether or not. Among 290 retrieved articles five studies were selected for quantitative meta-analysis. The overall effect size of the risk of adverse drug event due to CDSS was calculated by common odds ratio using MetaKorea (http://www.metakorea.or.kr). Before the integration of each effect sized into common eff ect sizes the homogene ity test were conducted. All studies were ca se control design and cases were ADEs. Homogenity of studies were conducted by Mantel-Haenszel method. The chi-square is 10.78 (p<0.05). For evaluation of odds ratio, random effec t model was used. The overall odds ratio of CDSS associated with ADE was 0.315201 (95% confidence interval = 0.191411-0.519049). Our result suggested a negative association between use of CDSS and the development of serious ADE. So we concluded that the development of serious ADE was reduced using CDSS.

A Meta-analysis of the Association between Blood Lead and Blood Pressure / 예방의학회지

OBJECTIVES: To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.