Biomedical subjects

Dominique Fieschi

Publications and source records attributed to Dominique Fieschi.

4 recordsLinked to original sources

PubMed2005

Applicability of textual clinical practice guidelines: impact of physician interpretation.

OBJECTIVES: 1) Determine whether textual Clinical Practice Guidelines (CPGs) are interpreted accurately and unequivocally by targeted physicians. 2) Specify audience and perception of the CPGs. METHOD: Comparative analysis of answers given by a panel of general practitioners to a series of questions and clinical case studies related to three textual CPGs produced and published by the French National Agency for Accreditation and Evaluation in Health (ANAES). RESULTS: 68 to 96% of physicians are aware of the existence of the CPGs studied. Less than 50% state having read them. On average, 38% of physician interpretations of CPGs are incorrect (i.e., not in agreement with expert interpretation). Furthermore, there is disagreement among physicians responses. CONCLUSION: This study credits the argument of disparities in practice which derive from inaccurate and discordant CPGs' interpretations. The results should prompt those responsible for producing such decision-making support to design documents that are better structured, less ambiguous, and more precise. In a model which facilitates their computerisation the expression of CPGs provides a solution that should be included upstream in the publication process.

Awareness↗

PubMed2004

Coupling computer-interpretable guidelines with a drug-database through a web-based system--The PRESGUID project.

BACKGROUND: Clinical Practice Guidelines (CPGs) available today are not extensively used due to lack of proper integration into clinical settings, knowledge-related information resources, and lack of decision support at the point of care in a particular clinical context. OBJECTIVE: The PRESGUID project (PREScription and GUIDelines) aims to improve the assistance provided by guidelines. The project proposes an online service enabling physicians to consult computerized CPGs linked to drug databases for easier integration into the healthcare process. METHODS: Computable CPGs are structured as decision trees and coded in XML format. Recommendations related to drug classes are tagged with ATC codes. We use a mapping module to enhance computerized guidelines coupling with a drug database, which contains detailed information about each usable specific medication. In this way, therapeutic recommendations are backed up with current and up-to-date information from the database. RESULTS: Two authoritative CPGs, originally diffused as static textual documents, have been implemented to validate the computerization process and to illustrate the usefulness of the resulting automated CPGs and their coupling with a drug database. We discuss the advantages of this approach for practitioners and the implications for both guideline developers and drug database providers. Other CPGs will be implemented and evaluated in real conditions by clinicians working in different health institutions.

Computer Graphics↗

PubMed2003

A platform to develop and to improve effectiveness of online computable guidelines.

The quality criteria of guidelines are identified. Taking these criteria into account we have built a platform to improve computable guideline effectiveness and facilitate their production. Our implementation is based on the GLIF Model (GuideLine Interchange Format). We have designed software components to edit, test, index, perform and present guidelines in a user-friendly Web architecture. These components are based on XML specifications in order to preserve their shareability and their re-usability. Several guidelines have been developed using our approach. We discuss the advantages of such an implementation and future evolutions so as to improve guideline integration within the clinician's workflow.

Decision Support Systems, Clinical↗

PubMed2002

Experimenting with new paradigms for medical education and the emergence of a distance learning degree using the internet: teaching evidence-based medicine.

This paper is focused on designing and developing a teaching environment associated with an introductory course in evidence-based medicine designed for undergraduates. Attempting to break away from the traditional educational model based on acquisition of factual knowledge, we developed a software tool centred on content management, student assessment and feedback. We ran this course on an educational website, using chat rooms and electronic mail for trainer-trainee communication over one academic year. The website served as a repository for knowledge and information and presented freestanding web-based interactive study modules and a non-interactive degree course. Trainers and trainees responded favourably to the computer applications and the Internet. This project demonstrated the feasibility of computer-aided learning and the advantages of distance teaching over the Internet.

Computer-Assisted Instruction↗