Desarrollo y Validación de una herramienta telemática de ayuda al diagnóstico de la litiasis renal

- Introducció La intel·ligència artificial aplicada a la medicina es una branca de les ciències informàtiques, capaç d’analitzar dades mèdiques complexes. La litiasi renal es classifica en diferents tipus, cada un dels quals presenta factors etiològics específics, el maneig dels quals requereix una gran dedicació de temps. Considerant aquests fets, s’ha desenvolupat i validat un programa informàtic d’ajuda al diagnòstic de la litiasi renal. - Contingut de la investigació El desenvolupament del programa de diagnòstic està basat en els coneixements actuals sobre els factors etiològics dels diferents tipus de càlculs renals. La validació del programa de diagnòstic s’ha fet emprant dades reals de pacients del Servei d’Urologia de l’Hospital de Manacor (Mallorca) i comprovant que el diagnòstic donat pel programa es correcte i es correspon amb les dades introduïdes. - Conclusió El programa desenvolupat i validat a aquesta Tesi Doctoral permetrà una gran millora en l’atenció assistencial, ja que els uròlegs podran fer el diagnòstic del pacient litiàsic de forma més àgil i indiviualitzada- Introducción La inteligencia artificial aplicada a la medicina es una rama de las ciencias informáticas, capaz de analizar complejos datos médicos. La litiasis renal se clasifica en distintos tipos, cada uno de los cuales presenta factores etiológicos específicos, cuyo manejo requiere una gran dedicación de tiempo. Considerando estos hechos, se ha desarrollado y validado un programa informático de ayuda al diagnóstico de la litiasis renal. - Contenido de la investigación El desarrollo del programa de diagnóstico está basado en los conocimientos actuales sobre los factores etiológicos de los distintos tipos de cálculos renales. La validación del programa de diagnóstico se ha realizado con datos reales de pacientes del Servicio de Urología del Hospital de Manacor (Mallorca) y comprobando el correcto diagnóstico proporcionado por el programa a partir de los datos introducidos. - Conclusión El programa desarrollado y validado en esta Tesis Doctoral permitirá una gran mejora en la atención asistencial, ya que los urólogos podrán realizar el diagnóstico del paciente litiásico de forma más ágil e individualizada.- Introduction Artificial intelligence applied to medicine is a branch of computer science capable of analyzing complex medical data. Renal lithiasis is classified into various types, each of which has specific etiological factors, whose handling requires a large time dedication. Considering these facts, a computer program for the diagnosis of renal lithiasis have been developed and validated. - Content of the research The development of the diagnostic program is based on current knowledge about the etiological factors of the different types of renal stones. The diagnostic program validation was performed with real patient data from the Department of Urology, Hospital de Manacor (Mallorca) and checking the correct diagnosis provided by the program from the data entered. - Conclusion The program developed and validated in this thesis will allow a great improvement in health care, since urologists will be able to diagnose renal stone patients in a more agile and individualized way

Evaluating Evaluations of Clinical Decision Support Systems: Case Studies From NHS Clinical Settings

The NHS is under increasing pressure to cut costs while delivering high quality care. At the same time, the demand for healthcare services has grown, driven in part by the increasing number of older people in the population. NHS Trusts are adopting clinical decision support systems (CDSSs) to help decision making at the point of care. CDSSs are said to bring benefits such as improvements in guideline adherence, clinical processes and user performance but evidence of these benefits is not always available and their effectiveness in terms of improving patient outcomes is often open to question. This thesis presents research that was carried out in a large teaching NHS Trust looking at the evaluations of three CDSSs. Semi structured interviews were carried out with key informants who were involved in their adoption, use and evaluations. Documentary analysis and observations were also used to augment the interviews. Most evaluations were carried out informally by the developers and were primarily driven by external regulatory pressures rather than patient outcomes and organisational needs. Evaluation documentation was inadequate or missing, thus making it difficult to systematically assess these evaluations. This thesis contends that evaluations are important to provide decision makers in NHS Trusts with adequate information to make decisions about CDSSs and computerised healthcare information technologies in general. NHS Trusts need to build organisational capacity and readiness to enable them to effectively carry out evaluations that will provide meaningful information to gain better understanding of CDSSs and to inform their successful adoption, implementation, usage and to justify the resource allocation. This research shows that CDSS evaluations investigated took a predominantly narrow view. It thus provides evidence for the need for a more systemic approach to evaluation