Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews?

Background: A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors. Objectives: To assess to what extent physicians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance. Methods: A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emergency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three. Results: Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians’ assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected specificity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting. Conclusion: There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physician’s preferences and contextual factors, including differences in the micro environment of each clinical setting

Automatic indexing and retrieval of encounter-specific evidence for point-of-care support

Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories

Mobile assistive technologies for the visually impaired

There are around 285 million visually impaired people worldwide, and around 370,000 people are registered as blind or partially sighted in the UK. Ongoing advances in information technology (IT) are increasing the scope for IT-based mobile assistive technologies to facilitate the independence, safety, and improved quality of life of the visually impaired. Research is being directed at making mobile phones and other handheld devices accessible via our haptic (touch) and audio sensory channels. We review research and innovation within the field of mobile assistive technology for the visually impaired and, in so doing, highlight the need for successful collaboration between clinical expertise, computer science, and domain users to realize fully the potential benefits of such technologies. We initially reflect on research that has been conducted to make mobile phones more accessible to people with vision loss. We then discuss innovative assistive applications designed for the visually impaired that are either delivered via mainstream devices and can be used while in motion (e.g., mobile phones) or are embedded within an environment that may be in motion (e.g., public transport) or within which the user may be in motion (e.g., smart homes)

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool

A Constraint Satisfaction Approach to Data-Driven Implementation of Clinical Practice Guidelines

Despite significant research efforts, the implementation of computerized clinical practice guidelines (CPG) in practice remains problematic for a number of reasons. In particular most guideline representation models do not deal adequately with incomplete or inconsistent clinical data. We present a constraint satisfaction approach to address such shortcomings by focusing on CPG data rather than CPG representation. We model a CPG as a set of data-driven constraints which are used to generate complete solutions for describing a patient state from incomplete clinical data, where the patient state is confirmed by the user. Inconsistent input data can be temporarily eliminated and final feasible solutions (permitted complete solutions from a CPG) can pinpoint inconsistencies in original input data alongside allowable guideline data. We demonstrate a sample implementation of the approach for a pediatric asthma CPG

Perspectives on computing ethics: a multi-stakeholder analysis

Purpose: Computing ethics represents a long established, yet rapidly evolving, discipline that grows in complexity and scope on a near-daily basis. Therefore, to help understand some of that scope it is essential to incorporate a range of perspectives, from a range of stakeholders, on current and emerging ethical challenges associated with computer technology. This study aims to achieve this by using, a three-pronged, stakeholder analysis of Computer Science academics, ICT industry professionals, and citizen groups was undertaken to explore what they consider to be crucial computing ethics concerns. The overlap between these stakeholder groups are explored, as well as whether their concerns are reflected in the existing literature. Design/methodology/approach: Data collection was performed using focus groups, and the data was analysed using a thematic analysis. The data was also analysed to determine if there were overlaps between the literature and the stakeholders’ concerns and attitudes towards computing ethics. Findings: The results of the focus group analysis show a mixture of overlapping concerns between the different groups, as well as some concerns that are unique to each of the specific groups. All groups stressed the importance of data as a key topic in computing ethics. This includes concerns around the accuracy, completeness and representativeness of data sets used to develop computing applications. Academics were concerned with the best ways to teach computing ethics to university students. Industry professionals believed that a lack of diversity in software teams resulted in important questions not being asked during design and development. Citizens discussed at length the negative and unexpected impacts of social media applications. These are all topics that have gained broad coverage in the literature. Social implications: In recent years, the impact of ICT on society and the environment at large has grown tremendously. From this fast-paced growth, a myriad of ethical concerns have arisen. The analysis aims to shed light on what a diverse group of stakeholders consider the most important social impacts of technology and whether these concerns are reflected in the literature on computing ethics. The outcomes of this analysis will form the basis for new teaching content that will be developed in future to help illuminate and address these concerns. Originality/value: The multi-stakeholder analysis provides individual and differing perspectives on the issues related to the rapidly evolving discipline of computing ethics