{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T05:24:28Z","timestamp":1739424268154,"version":"3.37.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Boehringer Ingelheim"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Individuals with type 2 diabetes (T2D) have a high prevalence of cardiovascular and renal comorbidities. Despite clinical practice guidelines recommending the use of cardiorenal protective medications, many people with T2D are not prescribed these medications. A clinical decision support system called Exandra was developed to provide treatment recommendations for individuals with T2D based on current clinical practice guidelines from Diabetes Canada. The current study aimed to medically validate Exandra via review by external medical experts in T2D.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Validation of Exandra took place in two phases. Test cases using simulated clinical scenarios and recommendations were generated by Exandra. In Phase 1 of the validation, reviewers evaluated whether they agreed with Exandra\u2019s recommendations with a \u201cyes,\u201d \u201cno,\u201d or \u201cnot sure\u201d response. In Phase 2, reviewers were interviewed about their \u201cno\u201d and \u201cnot sure\u201d responses to determine possible reasons and potential fixes to the Exandra system. The primary outcome was the precision rate of Exandra following the interviews and final adjudication of the cases. The target precision rate was 90%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Exandra displayed an overall precision rate of 95.5%. A large proportion of cases that were initially labeled \u201cno\u201d or \u201cnot sure\u201d by reviewers were changed to \u201cyes\u201d following the interview phase. This was largely due to the validation using a simplified user interface compared with the complexity of the actual Exandra system, and reviewers needing clarification of how the outputs would be displayed on the Exandra platform.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Exandra displayed a high level of accuracy and precision in providing guideline-directed recommendations for managing T2D and its common comorbidities. The results of this study indicate that Exandra is a promising tool for improving the management of T2D and its comorbidities.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12911-025-02881-4","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T05:34:12Z","timestamp":1739338452000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analytical validation of Exandra: a clinical decision support system for promoting guideline-directed therapy of type-2 diabetes in primary care \u2013 a collaborative study with experts from Diabetes Canada"],"prefix":"10.1186","volume":"25","author":[{"given":"Klaudia","family":"Grechuta","sequence":"first","affiliation":[]},{"given":"Pedram","family":"Shokouh","sequence":"additional","affiliation":[]},{"given":"Valentina","family":"Bayer","sequence":"additional","affiliation":[]},{"given":"Henrich","family":"Kraemer","sequence":"additional","affiliation":[]},{"given":"Jeremy","family":"Gilbert","sequence":"additional","affiliation":[]},{"given":"Susie","family":"Jin","sequence":"additional","affiliation":[]},{"given":"Ahmad","family":"Alhussein","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"2881_CR1","unstructured":"Centers for Disease Control and Prevention. 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KG, VB, HK, and AA are employees of Boehringer Ingelheim. PS is a contractor with BIX, the developer of Exandra. JG reports speaking honoraria and has served on an advisory board for Astra Zeneca, Amgen, Abbott, Dexcom, Eli Lilly, Boehringer Ingelheim, Janssen, GSK, HLS therapeutics, Novartis, Pfizer, Novo Nordisk, and Sanofi. SJ reports consulting and\/or speaking honoraria from Abbott, Boehringer Ingelheim, Dexcom, Eisai, GSK, Kenvue, Eli Lilly, Moderna, Novo Nordisk, and Pfizer.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"74"}}