Multi-Version Ontology-Based Personalization of Clinical Guidelines for Patient-Centric Healthcare

2017 ◽  
Vol 13 (1) ◽  
pp. 104-127 ◽  
Author(s):  
Fabio Grandi ◽  
Federica Mandreoli ◽  
Riccardo Martoglia
Keyword(s):  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Patient Case ◽  
Annotation Scheme ◽  
Specific Patient ◽  
Personalized Care ◽  
Care Plans ◽  
Ontology Structure ◽  
Patient Centric ◽  
Access Efficiency

When dealing with a specific patient case, physicians are often interested in retrieving a personalized version of a clinical guideline, that is a version tailored to their use needs. In a patient-centric scenario, empowered patients make up another class of users interested in retrieving personalized care plans from a guideline repository. In their previous work, the authors proposed techniques to efficiently provide ontology-based personalized access to very large collections of multi-version clinical guidelines. In this paper, they address the problem of also dealing with a multi-version ontology used to support personalized access to clinical guidelines. The authors' approach allows the semantic indexing of guideline contents with respect to multi-version ontology classes and exploits the IS-A relationship among such classes for granting personalized access. Efficiency is ensured by a newly introduced annotation scheme for guidelines and solutions to cope with the evolution of ontology structure. The tests performed on a prototype implementation confirm the goodness of the approach.

Towards Patient-Centric Healthcare

2019 ◽  
pp. 273-301 ◽  
Author(s):  
Fabio Grandi ◽  
Federica Mandreoli ◽  
Riccardo Martoglia
Keyword(s):  
Clinical Guidelines ◽  
State Of The Art ◽  
Annotation Scheme ◽  
Prototype Implementation ◽  
Related Research ◽  
Personalized Care ◽  
Care Plans ◽  
Research Themes ◽  
Ontology Structure ◽  
Patient Centric

Retrieving personalized care plans from a guideline repository is an ever-increasing need in the medical world, not only for physicians but also for empowered patients. In this chapter, we continue our long-lasting research on ontology-based personalized access to very large collections of multi-version documents by addressing a novel challenge: dealing with multi-version clinical guidelines but also with a multi-version ontology used to support personalized access to them. Efficiency is ensured by a newly introduced annotation scheme for guidelines and solutions to cope with the evolution of ontology structure. The tests performed on a prototype implementation confirm the goodness of the approach. Finally, the chapter proposes an exhaustive analysis of the state of the art in this field and, in the final part, a discussion where we expand our vision to related research themes and possible further developments of our work.

scholarly journals Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
C Bulley ◽  
C Meagher ◽  
T Street ◽  
A Adonis ◽  
C Peace ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Clinical Guidelines ◽  
Service Provision ◽  
Clinical Guideline ◽  
Service Providers ◽  
Delphi Consensus ◽  
Stakeholder Views ◽  
Key Stakeholders ◽  
The Uk

Abstract Background Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. Methods A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. Results Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. Conclusions Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

Abstract P229: Is a Multidisciplinary Approach to Hypertension Better Than Traditional Care in Female Hypertensive Patients?

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Jessica A Weber ◽  
Shital C Shah ◽  
Sara Turley ◽  
Lynne T Braun ◽  
Erica R Kent ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Multidisciplinary Approach ◽  
Smoking Status ◽  
Bivariate Analysis ◽  
Standard Practice ◽  
Personalized Care ◽  
Moderating Variables ◽  
Care Plans ◽  
Treatment Type

Background: Rush Heart Center for Women (RHCW) opened in October 2003 to provide a multidisciplinary approach (MDA) for female patients (pts). RHCW provided personalized care plans to address women’s heart health, with an emphasis on female-specific risk factors and symptoms. MDA including cardiologists, dietitians and nurse practitioners to treat female pts was compared to a similar cohort using standard practice in terms of HTN treatment. Methods: A retrospective study identified pts with HTN treated at RHCW using a MDA and compared to a cohort of pts treated by cardiologists and received a standard level of care consistent with guidelines and recommendations (standard practice). Pts seen between 2008 and 2014 with at least 2 visits between 9 and 15 months apart were studied. Demographic moderating variables were race, age, and insurance. Moderating clinical variables were baseline systolic BP, body mass index, diabetes, smoking status, history of coronary disease, stroke, and prior treatment of HTN. Bivariate and multivariate analyses were conducted to determine the effect of treatment type, with pts’ follow-up BP. Results: A total of 1486 pts were evaluated. Pts seen treated by MDA was younger by <3 years. Table shows descriptive statistics and bivariate analysis. Multivariate analysis revealed that pts treated with MDA had a significantly lower BP in their follow-up systolic BP, 3.8 mmHg less, compared to pts treated with standard practice. (p<0.002). Conclusion: The multidisciplinary approach had better BP control in female hypertensive pts. Prospective studies comparing MDA to standard practice may help to assess improved quality of life, compliance and outcomes.

Evaluating the Impact of Culturally-Specific Patient-Centric Behavioral Intervention Package versus Usual care for Tobacco Cessation among Patients attending Non- Communicable Disease Clinics in North India: A Single-Blind Trial Pilot Study Protocol (Preprint)

2020 ◽  
Author(s):  
GARIMA BHATT ◽  
SONU GOEL ◽  
RAKESH GUPTA ◽  
SANDEEP GROVER ◽  
BIKASH MEDHI
Keyword(s):  
Usual Care ◽  
Behavioral Intervention ◽  
Tobacco Cessation ◽  
Intervention Package ◽  
Culturally Specific ◽  
Specific Patient ◽  
Individual Family ◽  
The Individual ◽  
Patient Centric

BACKGROUND In a low & middle-income country (LMIC) like India, non – communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this 48% of cardiovascular diseases (CVDs), 23% of Chronic Respiratory Diseases (CRDs), 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While there are several interventions available for tobacco cessation, in resource constraint country like India, the effectiveness of low cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential which needs to be evaluated. OBJECTIVE In this study, a newly devised evidence-based tobacco cessation intervention package including a behavioral approach will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) at NCD clinics. METHODS Design: Two arm, parallel-group randomized controlled trial. Participants: Patients aged ≥ 30 years suffering from any NCD, currently using tobacco and attending NCD clinics in two districts of Punjab, India. Sample size: A total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization. Intervention: For the participants, there will be four face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language i.e, Punjabi. Follow-ups will be done at the 3rd, 6th, 9th, and 12th months. Primary outcome: Seven-day abstinence, biochemically verified by plasma cotinine levels. Secondary outcome: Quit attempts, number of sticks/number of times of SLT usage in a day, and stage of behavior change in tobacco user. RESULTS This multi-component culturally specific- patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings with a focus on the individual, family, and social environment could increase the outreach of cessation services using existing resources thereby strengthening health systems and improving the quality of life of NCD patients. CONCLUSIONS This multi-component culturally specific- patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings with a focus on the individual, family, and social environment could increase the outreach of cessation services using existing resources thereby strengthening health systems and improving the quality of life of NCD patients. CLINICALTRIAL The study protocol is registered with Clinical Trials Registry, India. The registration number is CTRI/2018/01/011643.

Promoting patient health maintenance with cancer care planning at diagnosis and during treatment: baseline data of the Coleman Supportive Oncology Collaborative (CSOC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24051-e24051
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Rosa Berardi ◽  
Al Bowen Benson ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Patient Care ◽  
Cancer Care ◽  
Online Survey ◽  
Care Plan ◽  
Care Planning ◽  
Health Maintenance ◽  
Supportive Cancer Care ◽  
Personalized Care ◽  
Care Plans ◽  
The Impact

e24051 Background: CSOC conducts quality improvements (QI) for cancer patients that facilitate delivery of appropriate health maintenance and supportive cancer care at diagnosis and during treatment. CSOC is implementing a care planning QI starting at diagnosis using the 4R oncology model (Right Info / Care / Patient / Time), which provides patients a formal personalized care plan called Patient Care Sequence. Each Care Sequence includes health maintenance, cancer treatments and supportive care. As part of CSOC, we conducted provider surveys as a pre-intervention baseline to inform QI opportunities. Methods: Online survey of cancer providers from 8 cancer centers (4 academic, 4 community) conducted July 2018 - October 2019, prior to 4R implementation. The survey focused on current care planning practices and inclusion of guideline recommended health maintenance in care plans. Results: Survey response rate: 80% (180/225); respondents were 53% physicians, 20% advanced practice, 27% nurses. Only 59% (107/180) of respondents give patients care plans at diagnosis: 61% (65/107) verbally, 22% (24/107) written, 17% (18/107) using a printed form. Providers reported considerable gaps in including guideline-based health maintenance and promotion activities in care plans given to patients (Table). Additionally, 61% of providers reported concerns that it is challenging for their patients to manage their own health maintenance activities. Providers who are concerned about patients’ challenges in managing their own health maintenance are significantly more likely to give their patients a written or printed plan (76%, 32/42) compared to those providing care plans to patients verbally or not at all (56%, 77/138), p = .02. Conclusions: Guideline based health promotion activities are not consistently included in care plans, and care planning is not sufficiently conducted at cancer diagnosis. The CSOC 4R Oncology Model, which implements Patient Care Sequences at diagnosis, will address these gaps and examine the impact of formal care planning on improving utilization of health maintenance and promotion activities. [Table: see text]

scholarly journals A layered computer-interpretable guideline model for easing the update of locally adapted clinical guidelines

2018 ◽  
Vol 26 (1) ◽  
pp. 156-171
Author(s):  
Adi Fux ◽  
Pnina Soffer ◽  
Mor Peleg
Keyword(s):  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Medical Knowledge ◽  
Single Layer ◽  
Pilot Experiment ◽  
Local Practice ◽  
Primary Layer ◽  
Layered Approach ◽  
Update Process ◽  
Java Code

Maintenance of computer-interpretable guidelines is complicated by evolving medical knowledge and by the requirement to customize content to local practice settings. We developed a framework to support knowledge engineers in customization and maintenance of computer-interpretable guidelines specified in the PROforma formalism. In our layered approach, the computer-interpretable guidelines containing the original clinical guideline serves as the primary layer and local customizations form secondary layers that adhere to its schema while augmenting it. Java code unifies the layers into a single enactable computer-interpretable guidelines. We performed a pilot experiment to verify the effectiveness of a layered framework. In this first attempt, we evaluated the hypothesis that the layered computer-interpretable guidelines framework supports knowledge engineers in maintenance of customized computer-interpretable guidelines. Participants who used the layered framework completed an update process of the primary knowledge in less time and made fewer errors as compared to those using the single-layer framework.

Comparison of European Clinical Guidelines on the Management of Alcohol Use Disorders

2020 ◽  
pp. 1-9
Author(s):  
Colin Drummond ◽  
Miriam Hillyard ◽  
Marja Leonhardt ◽  
Frieder Wurst ◽  
Geert Dom ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Literature Review ◽  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Alcohol Use Disorders ◽  
World Health ◽  
European Region ◽  
World Health Report ◽  
Standard Drink ◽  
Health Report

<b><i>Background:</i></b> Alcohol is a leading cause of morbidity and mortality in the European region, and tackling the harmful use of alcohol is a public health priority. Most countries in the region have national strategies for treating alcohol use disorders (AUD), but there is significant between-country variation. <b><i>Objectives:</i></b> This study aimed to compare clinical guidelines for the management of AUD from countries of the European region and to determine whether countries’ relative wealth or quality of their health systems had affected the guidelines. <b><i>Methods:</i></b> A survey was conducted of 24 countries. The survey encompassed how AUD clinical guidelines were researched, the range and expertise of contributors, which topics of AUD treatment were included, the definition of a “standard drink” used, and the publishing, funding, endorsement, and dissemination of the guideline. <b><i>Results:</i></b> Twenty-one of the 24 countries surveyed had a clinical guideline for AUD. All guidelines were underpinned by a literature review, and psychiatrists were the professional group most commonly involved in producing them. Most of the guidelines covered typical cornerstones of AUD care such as treatment of alcohol dependence, pharmacotherapy for relapse prevention, and detoxification. Definitions of a “standard drink” ranged from 8 to 20 grams of ethanol. Governments or governmental bodies were the main publishers and funders of guidelines, and the vast majority of guidelines were freely available online. There were no statistically significant effects of GDP, GDP per capita, or World Health Organization’s World Health Report rankings on whether countries were more likely to have an AUD clinical guideline, to have performed a systematic literature review, or to have involved service users in producing their guideline. <b><i>Conclusions:</i></b> The results of this survey reflect widespread good practice in producing AUD clinical guidelines across European countries. Regional research collaborations could offer significant time and cost savings in producing the evidence base from which guidelines are then written.

scholarly journals How to Build the Plane While Flying: VTE/PE Thromboprophylaxis Clinical Guidelines for COVID-19 Patients

2020 ◽  
Vol 14 (3) ◽  
pp. 391-405 ◽  
Author(s):  
Alessandro Costa ◽  
Eric S. Weinstein ◽  
D. Ruby Sahoo ◽  
Stanley C. Thompson ◽  
Roberto Faccincani ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Clinical Guideline ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Evidence Based ◽  
Scientific Process ◽  
Randomized Controlled ◽  
Practice Of Medicine ◽  
Novel Coronavirus ◽  
Time Required

AbstractOver the years, the practice of medicine has evolved from authority-based to experience-based to evidence-based with the introduction of the scientific process, clinical trials, and outcomes-based data analysis (Tebala GD. Int J Med Sci. 2018;15(12):1397-1405). The time required to perform the necessary randomized controlled trials, a systematic literature review, and meta-analysis of these trials to then create, accept, promulgate, and educate the practicing clinicians to use the evidence-based clinical guidelines is typically measured in years. When the severe acute respiratory syndrome novel coronavirus-2 (SARS-nCoV-2) pandemic commenced in Wuhan, China at the end of 2019, there were few available clinical guidelines to deploy, let alone adapt and adopt to treat the surge of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to first explain how clinical guidelines, on which bedside clinicians have grown accustomed, can be created in the midst of a pandemic, with an evolving scientific understanding of the pathophysiology of the hypercoagulable state. The second is to adapt and adopt current venous thromboembolism diagnostic and treatment guidelines, while relying on the limited available observational reporting of COVID-19 patients to create a comprehensive clinical guideline to treat COVID-19 patients.

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