Knowledge-Based Support to the Treatment of Exceptions in Computer Interpretable Clinical Guidelines

2016 ◽  
Vol 6 (3) ◽  
pp. 1-27
Author(s):  
Alessio Bottrighi ◽  
Giorgio Leonardi ◽  
Luca Piovesan ◽  
Paolo Terenziani
Keyword(s):  
Clinical Guidelines ◽  
Medical Knowledge ◽  
Healthcare Services ◽  
Severe Trauma ◽  
Treatment Modalities ◽  
Software Systems ◽  
Evidence Based ◽  
Knowledge Based ◽  
Different Types ◽  
Healthcare Processes

Clinical guidelines are one of the major tools that have been introduced to increase the rationalization of healthcare processes, granting both the quality and the standardization of healthcare services, and the minimization of costs. Computer interpretable clinical guidelines (CIGs) are widely adopted in order to assist practitioners in decision making, providing them evidence-based recommendations based on the best available medical knowledge. However, a main problem in CIG adoption is the fact that, in the medical context, some degree of uncertainty is often present. Thus, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exceptions is mandatory, but most of the current software systems coping with CIGs do not support it. In this paper, the authors describe how the GLARE system has been extended to deal with this purpose. They identify different types of exceptions, considering their “pre-locability” and “pre-plannability”. On the basis of such parameters, the authors propose different treatment modalities, consisting of both data structures to model the different types of exceptions, and the algorithms to treat them. The resulting methodology is an innovative one, integrating different Artificial Intelligence techniques (ranging from planning to ontology-based reasoning). Finally, they also discuss how they implemented their system-independent methodology on top of GLARE, and describe its application in the ROPHS project, considering the management of the severe trauma guideline.

Knowledge-Based Support to the Treatment of Exceptions in Computer Interpretable Clinical Guidelines

2020 ◽  
pp. 658-687
Author(s):  
Alessio Bottrighi ◽  
Giorgio Leonardi ◽  
Luca Piovesan ◽  
Paolo Terenziani
Keyword(s):  
Data Structures ◽  
Clinical Guidelines ◽  
Medical Knowledge ◽  
Healthcare Services ◽  
Severe Trauma ◽  
Treatment Modalities ◽  
Software Systems ◽  
Knowledge Based ◽  
Different Types ◽  
Healthcare Processes

Clinical guidelines are one of the major tools that have been introduced to increase the rationalization of healthcare processes, granting both the quality and the standardization of healthcare services, and the minimization of costs. Computer interpretable clinical guidelines (CIGs) are widely adopted in order to assist practitioners in decision making, providing them evidence-based recommendations based on the best available medical knowledge. However, a main problem in CIG adoption is the fact that, in the medical context, some degree of uncertainty is often present. Thus, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exceptions is mandatory, but most of the current software systems coping with CIGs do not support it. In this paper, the authors describe how the GLARE system has been extended to deal with this purpose. They identify different types of exceptions, considering their “pre-locability” and “pre-plannability”. On the basis of such parameters, the authors propose different treatment modalities, consisting of both data structures to model the different types of exceptions, and the algorithms to treat them. The resulting methodology is an innovative one, integrating different Artificial Intelligence techniques (ranging from planning to ontology-based reasoning). Finally, they also discuss how they implemented their system-independent methodology on top of GLARE, and describe its application in the ROPHS project, considering the management of the severe trauma guideline.

scholarly journals Missing Diagnoses during the COVID-19 Pandemic: A Year in Review

2021 ◽  
Vol 18 (10) ◽  
pp. 5335
Author(s):  
Héctor Pifarré i Arolas ◽  
Josep Vidal-Alaball ◽  
Joan Gil ◽  
Francesc López ◽  
Catia Nicodemo ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Services ◽  
Evidence Based ◽  
Administrative Records ◽  
The Public ◽  
Primary Health ◽  
Health Authorities ◽  
Different Types ◽  
Icd 10 ◽  
The Impact

The COVID-19 pandemic has had major impacts on population health not only through COVID-positive cases, but also via the disruption of healthcare services, which in turn has impacted the diagnosis and treatment of all other diseases during this time. We study changes in all new registered diagnoses in ICD-10 groups during 2020 with respect to a 2019 baseline. We compare new diagnoses in 2019 and 2020 based on administrative records of the public primary health system in Central Catalonia, Spain, which cover over 400,000 patients and 3 million patient visits. We study the ratio of new diagnoses between 2019 and 2020 and find an average decline of 31.1% in new diagnoses, with substantial drops in April (61.1%), May (55.6%), and November (52%). Neoplasms experience the largest decline (49.7%), with heterogeneity in the magnitudes of the declines across different types of cancer diagnoses. While we find evidence of temporal variation in new diagnoses, reductions in diagnoses early in the year are not recouped by the year end. The observed decline in new diagnoses across all diagnosis groups suggest a large number of untreated and undetected cases across conditions. Our findings provide a year-end summary of the impact of the pandemic on healthcare activities and can help guide health authorities to design evidence-based plans to target under-diagnosed conditions in 2021.

scholarly journals Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

2021 ◽  
Vol 7 ◽  
pp. 237796082110290
Author(s):  
Jing Xu ◽  
Kristen Hicks-Roof ◽  
Chloe E. Bailey ◽  
Hanadi Y. Hamadi
Keyword(s):  
Health Professionals ◽  
Online Survey ◽  
Evidence Based Practice ◽  
Core Competencies ◽  
Healthcare Services ◽  
Interdisciplinary Teams ◽  
Evidence Based ◽  
Health Providers ◽  
Cross Sectional ◽  
The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

scholarly journals What is that’s going on here? A multidimensional time concept is foundational to framing for decision making in situations of uncertainty

2021 ◽  
Author(s):  
Federica Raia ◽  
Lezel Legados ◽  
Irina Silacheva ◽  
Jennifer B. Plotkin ◽  
Srikanth Krishnan ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Knowledge ◽  
High Tech ◽  
Evidence Based ◽  
Dominant Culture ◽  
Cultural Changes ◽  
Cultural Paradigm ◽  
Life Saving ◽  
Cultural Dominance ◽  
K 12

AbstractSTEM disciplines are the dominant culture in K-12 education. With its study of organs and diseases that afflict patients’ bodies, Western evidence-based medicine is seen and understood in the modern cultural paradigm as a science and as the practice in which a subject, the doctor, acts on an object; the patient’s body—a dominant culture in the patient’s journey. However, with the continually evolving high-technological and medical knowledge, life-saving therapeutic options are life-changing. They can range from changes in the diet, requiring structural and cultural changes in family life, to changes related to the experiences of learning to live tethered to a machine that is partly inside and partly outside one’s body or with somebody else’s heart. In this article, we show how competing needs to personalize care for the patient as a person forcefully emerge in response to evidence-based medicine’s global cultural dominance. We highlight two fundamental issues emerging in decision-making processes: (1) Framing evidence-based knowledge, uncertainties of the course of the disease and options, and (2) working with different, equally important, and often at odds conceptions of time in the care for the Other. Through the longitudinal analysis of moment-to-moment interactions in high-tech medicine encounters of a patient, his family, and the team caring for them, we show how framing and different conceptions of time emerge as issues, are profoundly interconnected, and are addressed by participants to care for a patient confronting existential decisions.

scholarly journals Carer Empowerment Is Key to Reduce Dementia Care Inequalities in the Middle East

2021 ◽  
Vol 18 (8) ◽  
pp. 4378
Author(s):  
Syed Fahad Javaid ◽  
Aishah Al-Zahmi ◽  
Munir Abbas
Keyword(s):  
Middle East ◽  
Social Care ◽  
Evidence Based ◽  
Political Factors ◽  
Knowledge Based ◽  
Care And Support ◽  
Health And Social Care ◽  
Care Systems ◽  
Spiritual Perspectives ◽  
Do So

Dementia represents a significant problem in the Middle East. Sociocultural and political factors that shape conceptions of health and care tend to stifle research and the dissemination of knowledge throughout the Middle East. These socio-political challenges concerning engagement with individuals living with dementia and their carers include language barriers, stigmatization, logistical constraints, lack of informal support outside of hospitals, and over-dependence on clinicians for dementia information. There is an urgent need in the Middle East to increase care and support for adults with dementia and their carers, enhance research efforts and improve the dissemination of information related to dementia in the region. One possible way to do so is to begin to promote a knowledge-based culture throughout the Middle East. This can be achieved by aligning traditional deterministic and spiritual perspectives of mental health with more Western, scientific, and evidence-based models. We suggest employing practical, multidimensional approaches to deal with the stated challenges, both at individual and societal levels. Doing so will improve knowledge of dementia and allow health and social care systems in the Middle East to begin to address a growing problem.

scholarly journals What is the content of virtually delivered pain management programmes for people with persistent musculoskeletal pain? A systematic review

2021 ◽  
pp. 204946372110230
Author(s):  
Gregory Booth ◽  
Deborah Williams ◽  
Hasina Patel ◽  
Anthony W Gilbert
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Musculoskeletal Pain ◽  
Clinical Guidelines ◽  
Reporting Quality ◽  
Skills Training ◽  
Evidence Based ◽  
Core Element ◽  
Multidisciplinary Pain Management ◽  
Pain Services

Introduction: Virtual consultations (VC) have been embraced by healthcare organisations during the COVID-19 pandemic. VC allows continuation of patient care while adhering to government advised restrictions and social distancing measures. Multidisciplinary pain management programmes (PMPs) are a core element of many pain services and utilising virtual methods to deliver PMPs has allowed them to continue to provide care. This systematic review aimed to explore the content of existing virtually delivered PMPs and discuss if and how these findings can be used to guide clinical delivery. Methods: Eligible studies included adults (aged ⩾18 years) with persistent musculoskeletal pain and any virtually delivered intervention that was described as a PMP or that had components of PMPs. Databases were searched from inception until July 2020. We performed a content analysis comparing existing interventions with established evidence-based clinical guidelines published by the British Pain Society (BPS). Intervention reporting quality was assessed using the Template for Intervention Description and Replication (TIDieR) checklist: an established checklist developed to improve the completeness of the reporting of interventions. Results: Eight studies were included. One intervention included six of the seven components recommended by the BPS; none included all seven. ‘Skills training and activity management’ was present in all eight interventions; ‘education’ and ‘cognitive therapy methods’ were present in six interventions; ‘graded activation’ and ‘methods to enhance acceptance, mindfulness and psychological flexibility’ were present in four interventions; ‘physical exercise’ was present in two interventions and ‘graded exposure’ was present in one intervention. None of the studies described all 12 items of the TIDieR checklist adequately enough for replication. Conclusion: Published virtual PMPs partially meet established clinical guidelines. Future virtual PMPs should be based on evidence-based clinical guidelines, and more research is needed to explore the effectiveness of virtually delivered PMPs and each recommended component.

Optimising chronic wound care: a human and financial necessity

2021 ◽  
Vol 27 (11) ◽  
pp. 269-271
Author(s):  
Julie Penfold
Keyword(s):  
Chronic Wound ◽  
Evidence Based Practice ◽  
Wound Care ◽  
Healthcare Services ◽  
Evidence Based

Julie Penfold highlights the importance of evidence-based practice in wound care to reduce the burden on patients and healthcare services.

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