A hybrid approach to clinical guideline and to basic medical knowledge conformance

Abstract. Several computer-based approaches to Clinical Guidelines have been developed in the last two decades. However, only recently the community has started to cope with the fact that Clinical Guidelines are just a part of the medical knowledge that physicians have to take into account when treating patients. The procedural knowledge in the guidelines have to be complemented by additional declarative medical knowledge. In this paper, we analyse such an interaction, by studying the conformance problem, defined as evaluating the adherence of a set of performed clinical actions w.r.t. the behaviour recommended by the guideline and by the medical knowledge

Fostering Awareness and Personalization of Learning Artificial Intelligence

This paper illustrates the activities of the projects SMAILE and AILEAP, which are devoted to foster the growth of awareness and readyness to learn artificial intelligence in the general population. The first project was mainly oriented to children and young adults, while the second is more oriented to the personalization of the learning experience also in professionals

Case-Based Decision Support in Time Dependent Medical Domains

International audienceMedical applications often require to capture the observed phenomenon dynamics, in order to properly support physicians' decision making. Case-based Reasoning (CBR), and more specifically case-based retrieval, is recently being recognized as a valuable decision support methodology in these domain. However, adopting CBR in this field is non trivial, since the need for describing the process dynamics impacts both on case representation and on the retrieval activity itself. In this work, we survey different methodologies introduced in the literature in order to implement medical CBR applications in time dependent domains, with a particular emphasis on time series representation and retrieval. Among the others, a novel approach, which relies on Temporal Abstractions, is analysed in depth

Monitoring the quality of laboraties and the prevalence of resistance to antituberculosis drugs: Italy, 1998-2000

In 1998 a network of 20 regional tuberculosis (TB) laboratories (the Italian Multicentre Study on Resistance to Antituberculosis drugs (SMIRA) network) was established in Italy to implement proficiency testing and to monitor the prevalence of drug resistance nationwide. The network managed 30% of all TB cases reported in Italy each year. The aim of the present report is to describe: 1) the accuracy of drug-susceptibility testing in the network; 2) the prevalence of drug resistance for the period 1998-2000. Data were collected from the network laboratories. Sensitivity to streptomycin and ethambutol increased from the first survey (1998-1999) to the second survey (2000) from 87.7 to 91.9%. Specificity, predictive values for resistance and susceptibility, efficiency and reproducibility were consistent in both surveys. In previously untreated cases, the prevalence of multidrug-resistance was the same in both surveys (1.2%), while a slight decrease from the first to the second survey was observed for monoresistance to rifampicin (from 0.8 to 0.4%) and isoniazid (from 2.9 to 2%,). The significant association found between isoniazid resistance and immigration is a useful indicator for both clinicians managing individual tuberculosis cases and public health services planning control strategies

Supporting physicians in the coordination of distributed execution of CIGs to treat comorbid patients

Clinical Practice Guidelines (CPGs) encode the “best” medical practices to treat patients affected by a specific disease and are widely used in the medical practice. Starting from the ‘90s', several Computer-Interpretable Guideline (CIG) systems have been devised to provide physicians with CPG-based decision support. CPGs (and CIGs) are devoted to provide evidence-based recommendations for one specific disease. In order to support the treatment of patients affected by multiple diseases (i.e., comorbid patients), challenging additional tasks have to be addressed, such as (i) the detection of the interactions between CIG actions, (ii) their management, and, finally, (iii) the “merge” or conciliation of the CIGs. Several CIG approaches have been recently extended in order to face (at least one of) such challenging problems, and one of them is GLARE. However, besides the solutions to tasks (i)-(iii) above, the “run-time” support to physicians treating a comorbid patient requires additional capabilities, to support the distribution of the management of interactions and of the execution of CIGs among different physicians. In this paper, we propose a general framework, based on GLARE and GLARE-SSCPM, to provide such additional capabilities

Supporting the distributed execution of clinical guidelines by multiple agents

Clinical guidelines (GLs) are widely adopted in order to improve the quality of patient care, and to optimize it. To achieve such goals, their application on a specific patient usually requires the interventions of different agents, with different roles (e.g., physician, nurse), abilities (e.g., specialist in the treatment of alcohol-related problems) and contexts (e.g., many chronic patients may be treated at home). Additionally, the responsibility of the application of a guideline to a patient is usually retained by a physician, but delegation of responsibility (of the whole guideline, or of a part of it) is often used equired (e.g., delegation to a specialist), as well as the possibility, for a responsible, to select the executor of an action (e.g., a physician may retain the responsibility of an action, but delegate to a nurse its execution). To manage such phenomena, proper support to agent interaction and communication must be provided, providing agents with facilities for (1) treatment continuity (2) contextualization, (3) responsibility assignment and delegation (4) check of agent “appropriateness”. In this paper we extend GLARE, a computerized GL management system, to support such needs. We illustrate our approach by means of a practical case study