Decision making and quality-of-information

Springer - Series Advances in Intelligent and Soft Computing, vol. 73In Group Decision Making based on argumentation, decisions are made considering the diverse points of view of the different partakers in order to decide which course of action a group should follow. However, knowledge and belief are normally incomplete, contradictory, or error sensitive, being desirable to use formal tools to deal with the problems that arise from the use of uncertain and even not precise information. On the other hand, qualitative models and qualitative reasoning have been around in Artificial Intelligence research for some time, in particular due the growing need to offer support in decision-making processes, a problem that in this work will be addressed in terms of an extension to the logic programming language and based on an evaluation of the Quality-of-Information (QoI) that stems out from those extended logic programs or theories. We present a computational model to address the problem of decision making, in terms of a multitude of scenarios, also defined as logic programs or theories, where the more appropriate ones stand for the higher QoIs values

Digital clinical guidelines modelling

Oliveira T., Costa A., Neves J., Novais P., Digital Clinical Guidelines Modelling, Modelling and Simulation 2011, Novais P., Machado J., Analide C., Abelha A., (Eds.) (ESM’2011 – The 2011 European Simulation and Modelling Conference, Guimarães, Portugal) EUROSIS Publisher, ISBN: 978-9077381-66-3, pp 392-398, 2011.Healthcare environments are very demanding, because practitioners are required to consult many patients in a short period of time, increasing the levels of stress which usually harms the outcome of healthcare processes. The short time practitioners have with their patients does not facilitate informed decision making and checking all possibilities. A possible solution is the use of guideline-based applications, because they have the potential of being an effective means of both changing the process of healthcare and improving its outcomes. However, current Clinical Guidelines are available in text format as long documents, which render them difficult to consult and to integrate in clinical Decision Support Systems. With this paper we present a new model for guideline interpretation, in order to facilitate de development of guideline-based Decision Support Systems and to increase the availability of Clinical Guidelines at the moment of the clinical process. This model will also provide mechanisms to comply with cases where incomplete and uncertain information is present. The development and implementation of this model will be presented in the following pages

Thrombophilia screening: An artificial neural network approach

Thrombotic disorders have severe consequences for the patients and for the society in general, being one of the main causes of death. These facts reveal that it is extremely important to be preventive; being aware of how probable is to have that kind of syndrome. Indeed, this work will focus on the development of a decision support system that will cater for an individual risk evaluation with respect to the surge of thrombotic complaints. The Knowledge Representation and Reasoning procedures used will be based on an extension to the Logic Programming language, allowing the handling of incomplete and/or default data. The computational framework in place will be centered on Artificial Neural Networks.This work is funded by National Funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within projects PEst-OE/EEI/UI0752/2014 and PEst-OE/QUI/UI0619/2012

Group decision making and quality-of-information in e-Health systems

Knowledge is central to the modern economy and society. Indeed, the knowledge society has transformed the concept of knowledge and is more and more aware of the need to overcome the lack of knowledge when has to make options or address its problems and dilemmas. One`s knowledge is less based on exact facts and more on hypotheses, perceptions or indications. Even when we use new computational artefacts and novel methodologies for problem solving, like the use of Group Decision Support Systems (GDSS), the question of incomplete information is in most of the situations marginalized. On the other hand, common sense tells us that when a decision is made it is impossible to have a perception of all the information involved and the nature of its intrinsic quality. Therefore, something has to be made in terms of the information available and the process of its evaluation. It is under this framework that a Multi-valued Extended Logic Programming language will be used for knowledge representation and reasoning, leading to a model that embodies the Quality-of-Information (QoI) and its quantification, along the several stages of the decision making process. In this way it is possible to provide a measure of the value of the QoI that supports the decision itself. This model will be here presented in the context of a GDSS for VirtualECare, a system aimed at sustaining online healthcare services

Effect of Evidence-Based Education on Nursing Students' Self-Efficacy

Background & Objective: Clinical efficacy plays an important role in clinical knowledge and skill application. One of the ways to increase self-efficacy is using experience, and results of clinical research. The aim of the present study was to evaluate the impact of evidence-based education on nursing students' self-efficacy. Methods: This experimental study was conducted on 48 nursing students in their 3rd semester in Urmia University of Medical Sciences, Iran. The study subjects were selected using convenience sampling and randomly divided into 2 groups of intervention and control (n = 24). Considering the students' training in the orthopedic ward, the intervention group participants were divided into 8 groups. Students in the intervention group were trained in evidence-based education in 2 sessions each lasting 2 hours. Self-efficacy was evaluated before and after training in the control and intervention groups using the generalized self-efficacy (GSE) scale. Data were analyzed using SPSS software, and chi-square, t-test, Mann-Whitney test, and Wilcoxon test. Data were analyzed using confidence interval of 95 ± 2%. Results: Of the students, 33.3% were female and 66.7% male. Mann-Whitney test showed the self-efficacy of the intervention group students to be significantly higher than control group students (P < 0.001). No significant differences were observed in the control group. Conclusion: Evidence-based education causes greater improvement in self-efficacy in comparison to conventional methods. Therefore, the use of this method is recommended in clinical education. Keywords Evidence-based education Efficacy Nursing student

Guias clínicas : representação e raciocínio

Dissertação de integrado em Engenharia BiomédicaOs ambientes de cuidados de saúde são extremamente exigentes para os profissionais. Nestes ambientes há uma grande exposição a situações de tensão, que se repercutem na qualidade da prática clínica. O stress ocupacional origina situações de erro médico, de variações indesejadas na prática clínica e de medicina defensiva. As Guias Clínicas (GCs), como recomendações clínicas baseadas em investigação científica sólida, podem solucionar tais problemas, fornecendo um suporte para a prática da medicina, baseado na evidência, e preenchendo eventuais vazios de conhecimento dos profissionais de saúde. Contudo, o seu formato actual não responde às exigências de um processo clínico que obriga a tomar decisões rápidas, com segurança. A solução pode passar pela implementação de formatos informáticos de GCs, as chamadas Guias Interpretáveis por Computador (Computer-Interpretable Guidelines - CIGs), em sistemas de apoio à decisão. As abordagens actuais de CIGs concentram-se sobretudo em aspectos relacionados com a modelação de tarefas, restrições temporais à execução de guiase integrações com sistemas de informação locais. No entanto, não providenciam um tratamento de casos de Informação Imperfeita, que são comuns nos processos clínicos. Há necessidade de uma representação de guias, que combine a capacidade de modelação de tarefas das abordagens actuais de CIGs, com linguagens de programação que permitam expressar casos de Informação Imperfeita e métodos que permitam quantificá-los. Para o efeito, recolheram-se as principais características das abordagens de CIGs actuais e propôs-se um modelo, utilizando a Extensão à Programação em Lógica (EPL) e o método da Qualidade da Informação (Quality of Information - QoI). A aplicabilidade deste modelo foi estudada através de um caso de estudo com uma GC para detecção e tratamento de elevados níveis de colesterol. Concluiu-se que, embora careça de melhoramentos ao nível de um suporte para o estado do paciente e ao nível da estruturação da informação, o modelo apresenta potencial para melhorar os resultados do processo clínico.Healthcare environments are very demanding. In these environments healthcare professionals are exposed to many stressful situations that affect negatively the quality of clinical practice. Occupational stress is among the causes of medical errors, undesirable variations in clinical practice and defensive medicine. The use of Clinical Guidelines may be a solution to these issues. They are evidence based recommendations that support good clinical practice and may compensate for knowledge gaps of healthcare professionals. However, their current format does not meet the requirements of real time decision support in the clinical process. Implementing Computer-Interpretable Guidelines (CIGs) in clinical decision support systems shows promises of both changing the process of healthcare delivery and improving its outcomes. The existing CIG approaches focus mainly on task modeling, temporal constraints to the execution of guidelines and integration with local information systems. Yet, they fail to address the issue of Imperfect Information, which is common in many clinical cases. There is a need for a guideline representation, which combines the task modeling capabilities of the existing CIG approaches with programing languages that enable the expression of cases of Imperfect Information and methods to quantify them. For this purpose we collected the main features of the existing approaches and proposed a model that uses the Extension to Logic Programming (ELP) and the method of Quality of Information. The applicability of this model was studied with a guideline for detection and treatment of elevated levels of cholesterol. Although the model needs improvements in the support for the patient state and the structuring of information, it has the potential to improve clinical results

Quality management in laboratories- Effciency prediction models

In recent years, the choice of quality tools by laboratories has increased significantly. This fact contributed to the growth of competitiveness, requiring a new organizational posture to adapt to the new challenges. In order to obtain competitive advantages in the respective sectors of activity, laboratories have increasingly invested in innovation. In this context, the main objective of this study aims to develop efficiency models for laboratories using tools from the Scientific Area of Artificial Intelligence. Throughout this work, different studies will be presented, carried out in water analysis laboratories, stem cell cryopreservation laboratories and dialysis care clinics, in which innovative solutions and better resource control were sought, without compromising quality and promoting greater sustainability This work can be seen as an investigation opportunity that can be applied not only in laboratories and clinics, but also in organizations from different sectors in order to seek to define prediction models, allowing the anticipation of future scenarios and the evaluation of ways of acting. The results show the feasibility of applying the models and that the normative references applied to laboratories and clinics can be a basis for structuring the systems; Gestão da Qualidade em Laboratórios Modelos de Previsão de Eficiência Resumo: Nos últimos anos, a adoção de ferramentas da qualidade por parte dos laboratórios tem aumentado significativamente. Este facto contribuiu para o crescimento da competitividade, exigindo uma nova postura organizacional de forma a se adaptarem aos novos desafios. Tendo em vista obter vantagens competitivas nos respetivos sectores de atividade, os laboratórios têm, cada vez mais, apostado em inovação. Neste contexto, o principal objetivo deste estudo visa o desenvolvimento de modelos de eficiência para laboratórios através do recurso a ferramentas da Área Científica da Inteligência Artificial. Ao longo deste trabalho irão ser apresentados diferentes estudos, realizados em laboratórios de análises de águas, laboratórios de criopreservação de células estaminais e clínicas de prestação de cuidados de diálise, nos quais se procuraram soluções inovadoras e um melhor controlo de recursos, sem comprometer a qualidade e promovendo uma maior sustentabilidade. Este trabalho pode ser encarado como uma oportunidade de investigação que pode ser aplicado não apenas em laboratórios e clínicas mas, também, em organizações de diversos sectores com o intuito de se procurar definir modelos de previsão, possibilitando a antecipação de cenários futuros e a avaliação de formas de atuação. Os resultados mostram a viabilidade da aplicação dos modelos e que os referenciais normativos aplicados aos laboratórios e às clínicas podem servir como base para estruturação dos sistemas

Inteligência Ambiente em serviços de saúde baseada em ontologias e na descoberta de conhecimento em bases de dados e/ou bases de conhecimento

Tese de doutoramento em Engenharia BiomédicaAvanços em novas Metodologias para a Resolução de Problemas e o uso de Tecnologias de Informação e Comunicação (TIC) possibilitam uma nova conceção dos processos ao nível dos Serviços de Saúde, baseados no uso e na integração de dados e conhecimentos a todos os níveis, num ambiente relacionado com Instituições de Saúde. De facto, as novas tecnologias de comunicação suportarão a transição de uma aproximação baseada na instituição, para uma abordagem baseada no utente, i.e., o Sistema de Saúde está confrontado com uma série de desafios, nomeadamente os relacionados com a qualidade da informação e o custo de tais processos. Por outro lado, o nível de saúde já atingido em Portugal não permite uma degradação do nível e qualidade de serviços já oferecidos aos cidadãos a quem constitucionalmente é garantido o direto à saúde. Importa encontrar formas de concertar a governação clínica (clinical governance) com a gestão económica dos serviços de saúde, muito particularmente para a desejada sustentabilidade do Serviço Nacional de Saúde. A prestação de cuidados de saúde a custos controlados, dotando o utente de capacidade para participar nesse processo, e a utilização e reutilização de informação, são aspetos importantes para a instituição prestadora de cuidados de saúde. O nosso principal intuito será o de encontrar formas e métodos de superação da atual dispersão de informação nos diversos serviços, departamentos e setores da saúde, muito coincidentes com a situação deficitária, por vezes desagregada, dissociada dos problemas, onde impera a desmotivação e se propiciam assimetrias nos cuidados de saúde sejam hospitalares, ou ao nível dos cuidados primários e outros. Importará garantir a acessibilidade aos cidadãos, particularmente aos doentes, disponibilizando cuidados de saúde oportunos, integradores, que respeitem as reais necessidades de saúde das pessoas e sejam administrados segundo as melhores práticas de gestão clínica e de administração. Para promover tal desiderato importa articular e integrar procedimentos, controlar metas e resultados. Importará maximizar a utilização das TIC’s, exigindo-se para tal soluções de integração e interoperabilidade de processos, criando verdadeiros sistemas de informação integrados, multidisciplinares, que considerem as necessidades e legítimos interesses dos stakeholders da saúde. As infraestruturas das TIC’s deverão, por conseguinte, refletir a visão do sistema de prestação de cuidados de saúde de forma não intrusiva, onde a informação possa fluir de forma transparente entre as instituições e os profissionais de saúde. Assim, o trabalho desenvolvido e apresentado nesta tese abordará aspetos chave que deverão estar relacionados com a utilização da tecnologia e dos sistemas de informação numa visão centrada no utente, na prestação de cuidados de saúde e na gestão e prevenção de doenças. Tratar-se-á de consolidar uma visão global da assistência hospitalar, articulada e integrada com outros setores e saberes, oferecendo aos cidadãos cuidados de saúde garantidamente adequados, sustentados em processos de integração da informação e de automação aceitáveis e oportunos, atendendo às ontologias médicas e melhores práticas profissionais, que transmitam maior proximidade aos utentes, permitindo, no limite, monitorizar e tratar os doentes no seu domicílio.Advances in new Methodologies for Problem Solving and Information Technology enable a fundamental redesign of health care processes based on the use and integration of data and/or knowledge at all levels, in a healthcare environment. Indeed, new communication technologies will support the transition from institution centric to patient-centric based applications, i.e., the health care system is faced with a series of challenges, namely those concerning quality-ofinformation and the cost-effectiveness of such processes. On the other hand, the health level achieved in Portugal does not allow anymore the degradation of the quality of services provided to citizens, to whom, constitutionally, is guaranteed the right to have health care treatments. It is important to gather clinical governance with the economic management of health care services, particularly to achieve the desired sustainability of the National Health Service (Serviço Nacional de Saúde). The distribution of cost-effective health care allowing the patient to take active part in the caring process, provision of evidence based care on all levels in the system and effective use and reuse of information are key issues for the health care organization. Our main aim will be the finding of ways and methods to overpass the actual scattering of information through the services, departments and health sectors, where personal motivation is difficult to attain, and the health care treatments are becoming disparate, at all levels. It should be guaranteed, to the citizens, mainly the sick or the needy, providing timely health care concerning the real needs of people through practices recognized as the best, from the clinical point of view. To promote such goal it is important to integrate procedures and to control results. The use of IT’s should be maximized through the application of interoperability procedures, creating truly integrated information services, considering the needs and interests of the health care stakeholders. The information and communication technology infrastructure should, therefore, reflect the view of the health care system as a seamless system where information can flow across organizational and professional borders. Thus, the work presented in this thesis, it will be address key principles that must be at the center of patient-centered use of technologies for the health care and disease management and prevention. A global vision of hospital assistance will be gathered, integrated with other sectors an know-how, providing citizens with adequate health care services, supported by information integration and automation procedures acceptable and secure, respecting clinical ontologies and the best medical practices, insuring the needed proximity to citizens, allowing, at the limit, to monitor ant to give care to patients at home