Decision tools in health care: focus on the problem, not the solution

BACKGROUND: Systematic reviews or randomised-controlled trials usually help to establish the effectiveness of drugs and other health technologies, but are rarely sufficient by themselves to ensure actual clinical use of the technology. The process from innovation to routine clinical use is complex. Numerous computerised decision support systems (DSS) have been developed, but many fail to be taken up into actual use. Some developers construct technologically advanced systems with little relevance to the real world. Others did not determine whether a clinical need exists. With NHS investing £5 billion in computer systems, also occurring in other countries, there is an urgent need to shift from a technology-driven approach to one that identifies and employs the most cost-effective method to manage knowledge, regardless of the technology. The generic term, 'decision tool' (DT), is therefore suggested to demonstrate that these aids, which seem different technically, are conceptually the same from a clinical viewpoint. DISCUSSION: Many computerised DSSs failed for various reasons, for example, they were not based on best available knowledge; there was insufficient emphasis on their need for high quality clinical data; their development was technology-led; or evaluation methods were misapplied. We argue that DSSs and other computer-based, paper-based and even mechanical decision aids are members of a wider family of decision tools. A DT is an active knowledge resource that uses patient data to generate case specific advice, which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them. The identification of DTs as a consistent and important category of health technology should encourage the sharing of lessons between DT developers and users and reduce the frequency of decision tool projects focusing only on technology. The focus of evaluation should become more clinical, with the impact of computer-based DTs being evaluated against other computer, paper- or mechanical tools, to identify the most cost effective tool for each clinical problem. SUMMARY: We suggested the generic term 'decision tool' to demonstrate that decision-making aids, such as computerised DSSs, paper algorithms, and reminders are conceptually the same, so the methods to evaluate them should be the same

The design and implementation of a structured backend for the MCCAT C compiler

Note:The McCAT system contains a highly optimizing, parallelizing C compiler that has been designed to support a high-level, structured intermediate representation, SIMPLE. Although the high-level abstraction enables sophisticated analyses such as pointer analysis, it limits the effective detection and exploitation of opportunities for fine-grained parallelism through low-level transformations like register allocation and instruction scheduling. This thesis presents LAST, a low-level intermediate representation that exposes important architectural details, yet retains enough abstraction to simplify retargeting of the compiler. LAST is structured, thus allowing easy access to information gathered by previous high-level analyses at SIMPLE, and also provides an elegant and simple framework for developing low-level analysis and transformation phases. To illustrate these features and their effectiveness, some example phases are presented, along with results from a small suite of benchmarks.Le système McCAT comprend un compilateur C qui optimise et parallélise, il est conçu pour permettre l'utilisation de SIMPLE, une représentation intermédiaire structurée de haut niveau. Bien que le niveau élevé d'abstraction permette des analyses sophistiquées, telle que l'analyse des pointeurs, il restreint le dépistage efficace et l'exploitation des possibilités du parallélisme à travers des transformations de bas niveau, telle que l'allocation des registres et 1' ordonnancement des instructions. Cette thèse présente LAST, une représentation intermédiaire de bas niveau qui met en évidence les détails importants de l'architecture, tout en conservant l'abstraction nécessaire pour permettre l'utilisation du compilateur en vue de plusieurs processeurs cibles. LAST est structure, permettant l'accès facile à l'information récoltée précédemment par les analyses SIMPLE de haut niveau, et fournit également une structure simple et élégante pour le développement d'analyses de bas niveau et de transformations. Les caractéristiques et leur efficacité sont illustrées par des exemples (d'analyses et de transformations) ainsi que les résultats d'une série des tests de performance

Trends in embedded systems technology: an industrial perspective

International audienceWhile there has been much talk on the necessity of a major breakthrough in design methods and advanced CAD to support the multi-million gate chips that are already a reality, there has not been a clearly identified new direction which will produce a major productivity breakthrough. This paper attempts to identify one of these productivity breakthroughs, through: an analysis of designer needs, a study of embedded systems trends in the industry, case studies in wireless communications and multi-media

HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations

This document represents expert consensus concerning the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs).The views expressed are of the international writing group consisting of seven cardiac electrophysiologists representing the Heart Rhythm Society (HRS), six from the European Heart Rhythm Association (EHRA) as well as one heart failure specialist representing the Heart Failure Society of America and another from the Heart Failure Association of the European Society of Cardiology. Members from our writing group also represented the American College of Cardiology (Kenneth A. Ellenbogen, MD), the European Society of Cardiology (Silvia G. Priori, MD, PhD), and the American Heart Association (David L. Hayes, MD). The topic covered by this document includes the monitoring of CIEDs with a description of the technology, indications for use, personnel involved in monitoring and the frequency and types of monitoring events. Also covered are issues in regard to data management, regulatory environments, reimbursement and ethical considerations in respect to device inactivation. This statement summarizes the opinion of the writing group members based on their own experience in treating patients, as well as a review of the literature, and is directed to all health care professionals, health care institutions, CIED manufacturers and governmental, reimbursement and regulatory bodies who are involved in the care of patients with CIEDs.When using or considering the guidance given in this document, it is important to remember that the ultimate judgment regarding care of a particular patient must be made by the health care provider and patient in light of all the circumstances presented by that patient