A. Hommersom, P. Groot, P. Lucas, M. Marcos, B. Martinez-Salvador
A Constraint-based Approach to Medical Guidelines and Protocols

Abstract:

"Medical guidelines and protocols are documents aimed at improving the quality of medical care by offering support in medical decision making in the form of management recommendations based on scientific evidence. Whereas medical guidelines are intended for nationwide use, and thus omit medical management details that may differ among hospitals, medical protocols are aimed at local use within hospitals and, therefore, include detailed information. Although a medical guideline and protocol concerning the management of a particular disorder are related to each other, one question is to what extent they are different. Formal methods are applied to shed light on this issue. A Dutch medical guideline regarding the treatment of breast cancer, and a Dutch protocol based on it, are taken as an example."

   [Paper ]   [Presentation ]

J. Lahtinen, P. Myllymäki, O. Ryynänen
P-Course: Medical Applications of Bayesian Classification with Informative Priors

Abstract:

"B-Course is a web-based data analysis service for Bayesian modeling. Although already in use by researchers from many scienti.c disciplines, the current version of B-Course does not allow domain experts to incorporate prior knowledge into the system, but the models are constructed from sample data only by using machine learning techniques. P-Course is an attempt to modify BCourse so that domain knowledge can be expressed in form of priors, which are then combined with the statistical data. The current version of P-Course is designed for supervised classi.cation problems. We discuss the design principles of the P-Course system and demonstrate its usefulness by using real-world examples from the medical domain."

   [Paper ]   

Y-L. O
Model-based guideline development for symptom-based indications

Abstract:

"This work proposes a model-based guideline development method for complex diagnostic and treatment policies, for instance for symptom-based indications. An influence diagram has advantages for the development of outcome-based guidelines, because it provides an explicit link between the policies and these outcomes. A Bayesian network has a strong inference capability, suitable for complex symptom-based medical diagnostic modelling incorporating many diseases. However, neither supports temporal sequences. The modelling of symptom-based indications for guideline distillation can be supported by imposing a strict structure and a strict order. A further extension is the user interface for evaluation and ranking of the probabilities, policies, and the resulting outcomes. Instead of seeking for the best solution, the guideline is distilled by ranking these outcomes with respect to the treatment, anatomic region and pathology, and the generally expected outcome if treated properly. The proposed guideline distillation method is expected to improve the development, and therefore the quality of the guidelines."

   [Paper ]   [Presentation ]

M. Taboada, J. Des, D. Martinez, J. Mira
A study of applying knowledge modelling to evidence-based guidelines

Abstract:

"This paper reports on a case-study of applying the general purpose and widely accepted methodology CommonKADS to a clinical practice guideline. CommonKADS is focussed on obtaining a compact knowledge model. However, guidelines usually contain incomplete and ambiguous knowledge. So, the resulting knowledge model will be incomplete and we will need to detect what parts of the guideline knowledge are missing. A complementary alternative, which we propose in this work, is to reconstruct the process of knowledge model construction, proposed by CommonKADS, in order to force the knowledge engineer to keep the transformation paths during knowledge modelling. That is to say, we propose to establish explicit mappings between the original medical texts and the knowledge model, storing these correspondences in a structured way. This alternative will reduce the existing gap between natural language representation and the corresponding knowledge model."

   [Paper ]   [Presentation ]

V. Pittet, B. Burnand, J. Vader
Electronic contributions to the use of nominal group techniques in guidelines development

Abstract:

"Nominal group techniques have been used to evaluate and improve quality of care for several decades. The most [significant] of these is the RAND/UCLA appropriateness method, which seeks to combine evidence from the literature with a systematic quantification of experience of recognized multidisciplinary clinical experts. The method is finding increasing application in areas other than merely developing criteria to assess the appropriateness of healthcare indications, for which it was originally developed. This paper presents the method and various electronic enhancements and developments: the ability for experts to vote in real-time, the ability to make available detailed appropriateness criteria on the web or at point-of-care, and how to move from appropriateness criteria to clinical guidelines. Advantages and limits of the method are discussed as will prospects for applying the method to other areas of guidelines development: including defining priorities and validating specific recommendations.1"

   [Paper ]   [Presentation ]

F. Chesani, A. Ciampolini, P. Mello, M. Montali, S. Storari
Testing Guidelines Conformance by translating a Graphical Language to Computational Logic

Abstract:

"In this work we present GOSpeL, a simple graphical language for modeling guidelines in a flow-chart fashion, and an algorithm capable of translating a GOSpeL model to a formal language based on computational logic and abductive logic programming in particular. The main advantage of this formalism lies in its operational proof-theoretic counterpart, which is able to verify the conformance of a given guideline execution w.r.t. the model, both at runtime or a posteriori. The feasibility of the approach has been tested on fragments of cancer screening protocols."

   [Paper ]   

R. Sips, L. Braun, N. Roos
Applying intention-based guidelines for critiquing

Abstract:

"This paper investigates the combination of expert critiquing systems and formal medical guidelines. Medical guidelines might serve as a suitable basis for an expert critiquing system because of the ongoing acceptance of medical guidelines and the rise of both evidence-based practice and evidence-based guidelines. A prerequisite for a critiquing system based on medical guidelines is the ability to match the actions a physician performs in practice to actions prescribed by a guideline. Previous research has shown that this is quite difficult, due to the fact that computerized systems are unable to handle deviations from a guideline, which are common in the medical domain. Our solution to this problem is based on extracting the intention underlying a physician’s action and uses the intention as the basis for matching performed actions to prescribed actions. We propose an algorithm for an intention-based matching process and we evaluate the matching algorithm on 12 cases of hyperbilirubinemia in healthy term newborns."

   [Paper ]   [Presentation ]

I. Sørby, Ø. Nytrø, T. Røst
Empirical Grounding of Guideline Implementation in Cooperative Clinical Care Situations

Abstract:

"Clinical practice guidelines and protocols are designed in order to fulfill the goals of EBM and to achieve best practice in care and treatment. These idealized decision process models present a highly abstract view of actual clinical practice. In this paper, we discuss how methodical observations of clinical care situations and trajectories of care activities can be used to study and improve guideline implementation, the process of transforming a guideline into a plan for clinical work. This is a step towards an ideal empirically grounded guideline lifecycle. We present a framework and concepts for representing observable attributes of situations, actors and action trajectories. The example data that are presented in the paper are taken from an observational study at a local hospital."

   [Paper ]   [Presentation ]

J. Komulainen, I. Kunnamo, P. Nyberg, M. Kaila, T. Mäntyranta, M. Korhonen
Developing an Evidence Based Medicine Decision Support System Integrated with EPRs Utilizing Standard Data Elements

Abstract:

"We describe an evidence-based medicine decision support service currently under construction. The system will utilise data from various electronic patient records, compatible with the Finnish national EPR standards. The technological architecture is based on SOAP messages over http, and open standard interfaces. Databases for the decision support are targeted for both primary and secondary health care, and include data relevant for doctors, nurses and other health care professionals. To ensure the high quality of the decision support, the databases will be centrally managed, including the evidence-base, functional descriptions, computer-readable scripts, and their metadata."

   [Paper ]   [Presentation ]

D. Dominguez, T. Meneu, J. Mocholi, R. Serafin
Medical Guidelines for the Patient: Introducing the Life Assistance Protocols

Abstract:

"This paper introduces our preliminary results in the modeling of Life Assistance Protocols, a new vision of medical guidelines and protocols through the lenses of p-Health. In this context the patient's role in the process is emphasized, the actions to be performed less defined and not only clinical situations considered, but also healthier lifestyle promotion processes accounted for, where the person's preferences and motivations play a key role. We propose a complete framework, balancing on classical clinical guideline models and covering both the theoretical and the practical aspects of the problem, describing it from conceptualization to the execution environment."

   [Paper ]   [Presentation ]

S. Kersten, J. van den Bogert
Oncoline: an Online Database for Consultation of Cancer Clinical Practice Guidelines

Abstract:

"Oncoline is an easy-to-use online database developed to provide health professionals in cancer care with up-to-date cancer clinical practice guidelines and care practice guidelines."

   [Paper ]