Guideline-based decision support in medicine : modeling guidelines for the development and application of clinical decision support systems

Guideline-based Decision Support in Medicine Modeling Guidelines for the Development and Application of Clinical Decision Support Systems The number and use of decision support systems that incorporate guidelines with the goal of improving care is rapidly increasing. Although developing systems that are both effective in supporting clinicians and accepted by them has proven to be a difficult task, of the systems that were evaluated by a controlled trial, the majority showed impact. The work, described in this thesis, aims at developing a methodology and framework that facilitates all stages in the guideline development process, ranging from the definition of models that represent guidelines to the implementation of run-time systems that provide decision support, based on the guidelines that were developed during the previous stages. The framework consists of 1) a guideline representation formalism that uses the concepts of primitives, Problem-Solving Methods (PSMs) and ontologies to represent guidelines of various complexity and granularity and different application domains, 2) a guideline authoring environment that enables guideline authors to define guidelines, based on the newly developed guideline representation formalism, and 3) a guideline execution environment that translates defined guidelines into a more efficient symbol-level representation, which can be read in and processed by an execution-time engine. The described methodology and framework were used to develop and validate a number of guidelines and decision support systems in various clinical domains such as Intensive Care, Family Practice, Psychiatry and the areas of Diabetes and Hypertension control

Knowledge-Based Clinical Decision Support Systems Continuance: An Integration of Physicians’ Identity and System Attributes

Despite the importance of sustained use of healthcare information systems, research on the continuous use of these systems is scanty, especially for clinical decision support systems. Moreover, there is an apparent gap between information systems and healthcare research approaches in studying use. We address these gaps by creating a comprehensive model based on the composite attitude-behavior model that integrates system related constructs with physicians’ professional identity constructs to explain and model physicians’ continuous use of a pain management clinical decision support system theoretically. Using a mixed methods longitudinal study design, we investigate factors influencing continuous use of automated clinical guidelines. The potential contributions of this study include enhancing our understanding of factors influencing physicians’ continuance behavior, and providing guidance on developing effective automated knowledge-based clinical decision support

Developing a Robust Computable Phenotype Definition Workflow to Describe Health and Disease in Observational Health Research

Health informatics can inform decisions that practitioners, patients, policymakers, and researchers need to make about health and disease. Health informatics is built upon patient health data leading to the need to codify patient health information. Such standardization is required to compute population statistics (such as prevalence, incidence, etc.) that are common metrics used in fields such as epidemiology. Reliable decision-making about health and disease rests on our ability to organize, analyze, and assess data repositories that contain patient health data. While standards exist to structure and analyze patient data across patient data sources such as health information exchanges, clinical data repositories, and health data marketplaces, analogous best practices for rigorously defining patient populations in health informatics contexts do not exist. Codifying best practices for developing disease definitions could support the effective development of clinical guidelines, inform algorithms used in clinical decision support systems, and additional patient guidelines. In this paper, we present a workflow for the development of phenotype definitions. This workflow presents a series of recommendations for defining health and disease. Various examples within this paper are presented to demonstrate this workflow in health informatics contexts.Comment: IEEE Computer Based Medical Systems Conferenc

Design of a goal ontology for medical decision-support

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2005.Includes bibliographical references (leaves 34-36).Objectives: There are several ongoing efforts aimed at developing formal models of medical knowledge and reasoning to design decision-support systems. Until now, these efforts have focused primarily on representing content of clinical guidelines and their logical structure. The present study aims to develop a computable representation of health-care providers' intentions to be used as part of a framework for implementing clinical decision-support systems. Our goal is to create an ontology that supports retrieval of plans based on the intentions or goals of the clinician. Methods: We developed an ontological representation of medical goals, plans, clinical scenarios and other relevant entities in medical decision-making. We used the resulting ontology along with an external ontology inference engine to simulate selection of clinical recommendations based on goals. The ontology instances used in the simulation were modeled from two clinical guidelines. Testing the design: Thirty-two clinical recommendations were encoded in the experimental model. Nine test cases were created to verify the ability of the model to retrieve the plans. For all nine cases, plans were successfully retrieved. Conclusion: The ontological design we developed supported effective reasoning over a medical knowledge base.(cont.) The immediate extension of this approach to be fully developed in medical applications may be partially limited by the lack of available editing tools. Many efforts in this area are currently aiming to the development of needed technologies.by Davide Zacacagnini [i.e. Zaccagnini].S.M

Predicting Decision-Making in Relation to Health-Risk Behavior in College Freshmen

Method/Measurements: A cross-sectional correlational design explored the relationships between decision-making, health-risk behaviors and social support systems in college freshmen. The aims of the study were: 1) to explore the relationship between decision-making and health-risk behaviors among college freshmen; 2) to determine whether or not family support and social support jointly predict decision-making among college freshmen; and 3) to ascertain whether or not the effect of family support on decision-making is different for male and female college freshmen. Measurement was collected at one time-point and participants in this study completed on-line questionnaires through a web-based online survey software application with measures of the following variables: decision-making (Adolescent Decision-Making Questionnaire); health-risk behavior (Adapted National Youth Risk Behavior Survey); and family support and social support (Multidimensional Scale of Perceived Social Support). A convenience sample of 200 freshmen aged 18 to 19 years participated from a local, private Catholic university located in Chicago. This study was approved by the institutional review board at Loyola University Chicago. Data Analysis: The primary study hypothesis was that decision-making will be associated with health-risk behaviors in college freshmen. SPSS Statistics version 24 was used to perform all statistical analyses. To test the primary hypothesis, the analysis included descriptive statistics on all study variables and correlations. Findings include positive decision-making was associated with a decrease in health risk behavior, and negative decision-making was associated with an increase in health risk behavior. The secondary and tertiary hypotheses were tested using linear regression and multiple regression analyses. Family support and social support was found to be significant predictors of positive decision-making and negative decision-making . Hence, social context played a significant role that impacted freshmen decision-making. Also, the effect of family support on positive decision-making was the same for male and female college freshmen and was statistically significant. Correspondingly, regression analysis results found that family support predicted negative decision-making in female college freshmen. Together, these findings extend the evidence that adolescence involves a period of developing decision-making processes which may help explain health-risk behavior, and more specifically, findings demonstrate a synergistic impact of social support systems on decision-making in college freshmen. Nursing and Healthcare Implications: Overall, findings from this study support the need to identify and implement interventions that may be developed to improve freshmen\u27s decision-making skills and to enhance their ability to exercise mature control over their own behavior, leading to better early college experiences. Integrated care team models, comprised of nursing professionals, especially nurse practitioners along with mental health professionals and health promotion educators have been shown to be effective in improving college students\u27 physical, psychological and emotional health. Ultimately, nurse practitioners have the unique opportunity to develop evidence-based practice guidelines to improve freshmen\u27s decision-making and coping skills while engaging in simultaneous collaborative care. The overall benefit could potentially reduce freshmen health-risk behavior thereby achieving positive health outcomes and successful educational outcomes that, in turn may result in improved undergraduate retention rates. This research, while making an important contribution to the literature, contributes to the health of college freshmen by highlighting key social support systems, hence focusing efforts on strengthening decision-making and coping skills in this subset of students

Co-management: A Synthesis of the Lessons Learned from the DFID Fisheries Management Science Programme

For the last eleven years, the UK Department for International Development (DfID) have been funding research projects to support the sustainable management of fisheries resources (both inland and marine) in developing countries through the Fisheries Management Science Programme (FMSP). A number of these projects that have been commissioned in this time have examined fisheries co-management. While these projects have, for the most part, been implemented separately, the FMSP has provided an opportunity to synthesise and draw together some of the information generated by these projects. We feel that there is value in distilling some of the important lessons and describing some of the useful tools and examples and making these available through a single, accessible resource. The wealth of information generated means that it is impossible to cover everything in detail but it is hoped that this synthesis will at least provide an overview of the co-management process together with some useful information relating to implementing co-management in a developing country context and links to the more detailed re-sources available, in particular on information systems for co-managed fisheries, participatory fish stock assessment (ParFish) and adaptive learning that have, in particular, been drawn upon for this synthesis. This synthesis is aimed at anyone interested in fisheries management in a developing country context

Synthesis of FMSP Experience and Lessons Learned for Fisheries Co-Management, Final Technical Report

In November 2012, the UK Department for International Development (DFID) set the terms of reference for a commissioned assessment of fisheries and aquaculture science. The task was to complete a "scoping review", consisting of an in-depth assessment of the existing evidence related to fisheries and aquaculture activities in developing countries and their contribution to economic growth, food security and nutrition. For this the assessment was expected to identify the existing evidence and 'evidence in the pipeline' (i.e. to be published imminently) from the existing literature, compile it, and provide an assessment of the strength (in the sense, scientific rigor) of that evidence, and identify knowledge or evidence gaps. In addition the assessment was to be complemented by a mapping of existing relevant interventions in fisheries and aquaculture. In order to conduct this assessment, the team of consultants adopted a six step methodological protocol that allowed them to assess in a consistent manner the scientific quality of the documents included in the assessment, based on quality, size and consistency of the evidence. After scanning, 202 documents were retained. The main evidences from these 202 documents were organised under two main threads: (i) Developmental outcomes, including food security; nutrition; health; economic growth and (ii) Mediating factors focusing on governance; and gender

Approaches to Improving CPR Management Performance in Developing Countries: Best Practice

The apparent and widespread lack of success over the past 50 years in attempting to manage the exploitation of Common Pool Resources in a sustainable manner is a serious concern for society. Governments recognise that they are losing out on potential benefits for development and growth, while primary stakeholders such as fishers and forest peoples recognise the threat to their livelihoods. In the specific case of fisheries, one of the major responses to the problem by scientists has been to attempt to better understand the factors affecting fisheries management performance, and in turn to develop new and alternative approaches to the challenges and opportunities presented. It is also important to review and learn from the experience of using these new approaches, and to establish 'best practice' for fisheries management across the world. In this third Key Sheet funded by the DFID Fisheries Management Science Programme, a range of new approaches which can contribute to improved fisheries management in Developing Countries will be considered, based on the findings of the FMSP

Designing Integrated Conflict Management Systems: Guidelines for Practitioners and Decision Makers in Organizations

A committee of the ADR (alternative dispute resolution) in the Workplace Initiative of the Society of Professionals in Dispute Resolution (SPIDR) prepared this document for employers, managers, labor representatives, employees, civil and human rights organizations, and others who interact with organizations. In this document we explain why organizations should consider developing integrated conflict management systems to prevent and resolve conflict, and we provide practical guidelines for designing and implementing such systems. The principles identified in this document can also be used to manage external conflict with customers, clients, and the public. Indeed, we recommend that organizations focus simultaneously on preventing and managing both internal and external conflict. SPIDR recognizes that an integrated conflict management system will work only if designed with input from users and decision makers at all levels of the organization. Each system must be tailored to fit the organization\u27s needs, circumstances, and culture. In developing these systems, experimentation is both necessary and healthy. We hope that this document will provide guidance, encourage experimentation, and contribute to the evolving understanding of how best to design and implement these systems