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J Dudeck

Publications and source records attributed to J Dudeck.

121 records · Page 7Linked to original sources
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Computer based nursing documentation means to achieve the goal.

New functions have been integrated in the Giessen Hospital Information System WING to support the classification of all intensive care patients into the Therapeutic Intervention Scoring System (TISS). The use of those functions has been pushed when health insurance bodies demanded evidence for the correct classification of ICU beds. This article presents an overview on this development from the start in just one intensive care unit to the complete coverage of six intensive care units and three intensive monitoring units with a total of 109 beds. For those units complete TISS data has been documented for more than a year now at a detailed level. On average 14 interventions have been recorded per patient and day, accumulating to a database with more than a million entries. We describe the experiences made during introduction and the different front-end applications we used to achieve the goal. Results gained from the huge database and their implications for our future work are discussed. TISS documentation is now an established routine on every intensive care unit of our University hospital. It has been implemented without major financial or manpower investments and no specific intensive care information system has been needed. Establishing this type of basic care documentation made nurses aware of their activities, so that now they consider electronic care documentation to be in their very own interest. The next goal has been set by nurses themselves, they want to establish intervention based care documentation on normal wards as well. We think that step by step we will thus be able to achieve a more complete electronic patient record.

Attitude of Health Personnel↗
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Confronting actual practice with practice guidelines in oncology.

Improving health care quality requires the availability of data to identify and eliminate unnecessary variations in the care process. Variations can be caused by an ineffective implementation of research findings or by obstacles to the translation of research into clinical practice. The analysis of current patterns of care by the use of routine data from electronic patient records or clinical registries may help highlight these deficiencies in actual care. The growing infrastructure of information technologies and the knowledge about clinically relevant variations of routine practice may help us understand the mechanisms that are impeding the translation of research into practice. There is a need to scrutinize these variations of practice and the barriers to guideline implementation. We think that an understanding and open discussion of such reasons may help, to continuously improve the quality of patient care. This process facilitates efforts and strategies to implement evidence-based medicine in the daily routine.

Data Collection↗
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DTDs go XML schema--a tools perspective.

Document Type Definitions (DTDs) are widely used to describe the structure of XML documents. The Clinical Document Architecture (CDA) and the Guideline Element Model (GEM) are examples from the healthcare domain. XML schemas provide another way to describe types of XML documents. In this paper we aim to advocate XML schemas from the perspective of an ANSI standard, the XML based CDA from HL7 (ANSI/HL7 CDA R1.0-2000). It turned out that existing tools do not fully exploit the knowledge contained in DTDs and XML schemas. The result of this study is a set of tools (DTD to XML Schema translator, DTD and XML schema browser, XML editor), which can be downloaded from the official W3C site and which work with any DTD and XML schema.

Ambulatory Care Information Systems↗
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Evaluating the implications of clinical practice guidelines for patient care.

Patient care evaluation studies have been developed by the Commission on Cancer of the American College of Surgeons. The studies were primarily designed to monitor trends in diagnosis, therapy, and outcome of specific oncologic diseases in hospitals and cancer centers. As they reflect the current standards of patient care, patient care evaluation studies have become valid tools of quality management in medicine. In an international pilot project that began in 1996, this approach was redefined to evaluate the impact of current clinical practice guidelines in oncology. Close cooperation between medical societies in the United States and Germany under the coordination of the Commission on Cancer and the Institute of Medical Informatics at the Justus-Liebig-University of Giessen was established. This infrastructure for data collection, data management, analysis, and interpretation of results allows for the recognition of international differences in patient care. Our results indicate discrepancies between current state-of-the-art patient care represented by clinical practice guidelines and the diagnostic and therapeutic procedures in the clinical routine. Patient care evaluation studies are designed as exploratory, not confirmatory, trials. In contrast with confirmatory trials, their aims may not always lead to predefined hypotheses. They reflect routine practice and are not the basis of the formal proof of efficacy, although they may contribute to the total body of relevant evidence. Without this comprehensive approach to evaluation, the potential of clinical practice guidelines to improve patient care remains unknown.

Germany↗
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Temporal propositions in a HIS-oriented expert system shell.

This paper describes one of the most important aspects in our recent research on building a HIS-oriented expert system shell: representation and processing of temporal propositions about time-series. With respect to time attribute, medical objects have been classified into three categories: time-independent objects, pointwise time-dependent objects and durationwise time-dependent objects. Temporal propositions can be applied only to time-dependent objects. Through implementation of fuzzy relational operators and their uses, the representation and processing of such propositions become more reasonable and more natural.

Algorithms↗
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Certainty factor theory and its implementation in a medical expert system shell.

In this article some topics related to the MYCIN-model for uncertainty handling are discussed. First, it is pointed out that one of the problems identified by Adams should be considered as evidence supporting the point of view that the probabilistic interpretations of measures of belief and measures of disbelief given by Shortliffe are inappropriate. In this context some results achieved by Heckerman are reviewed, and it is shown that similar problems can be identified in the interpretation given by him. It is also pointed out that Heckerman's argument that the original probabilistic interpretation of certainty factors implies non-commutative evidence-updating is not correct. Then, in the context of the result achieved by Horvitz and Heckerman, in which it was proven that there is an isomorphic mapping from the evidence combination scheme for the likelihood ratio to the evidence combination function in EMYCIN and its successors, it is pointed out that the evidence combination scheme for the likelihood ratio suffers from a great restriction on its applicability in expert systems. Subsequently, some short remarks are made with respect to the complaint that sometimes the MYCIN model cannot work as well as expected. Lastly implementation of the certainty factor mechanism in a HIS-oriented expert system shell with some substantial changes is described.

Databases, Factual↗
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Discovering objects in a blood recipient information system.

Application of object-oriented (OO) methodologies has been generally considered as a solution to the problem of improving the software development process and managing the so-called software crisis. Among them, object-oriented analysis (OOA) is the most essential and is a vital prerequisite for the successful use of other OO methodologies. Though there are already a good deal of OOA methods published, the most important aspect common to all these methods: discovering objects classes truly relevant to the given problem domain, has remained a subject to be intensively researched. In this paper, using the successful development of a blood recipient information system as an example, we present our approach which is based on the conceptual framework of responsibility-driven OOA. In the discussion, we also suggest that it may be inadequate to simply attribute the software crisis to the waterfall model of the software development life-cycle. We are convinced that the real causes for the failure of some software and information systems should be sought in the methodologies used in some crucial phases of the software development process. Furthermore, a software system can also fail if object classes essential to the problem domain are not discovered, implemented and visualized, so that the real-world situation cannot be faithfully traced by it.

Blood Banks↗
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Value of XML in the implementation of clinical practice guidelines--the issue of content retrieval and presentation.

The purpose of guidelines in clinical practice is to improve the effectiveness and efficiency of clinical care. It is known that nationally or internationally produced guidelines which, in particular, do not involve medical processes at the time of consultation, do not take local factors into account, and have no consistent implementation strategy, have limited impact in changing either the behaviour of physicians, or patterns of care. The literature provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most effective concepts are knowledge-based functions for decision support or monitoring that are integrated in clinical information systems. This approach is mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical rules. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published guidelines have little impact on the behaviour of physicians. It can be difficult and time-consuming to browse the internet to find (a) the correct guidelines to an existing diagnosis and (b) and adequate recommendation for a specific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and returns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge letters, reports, forms, etc. The same applies for facilities containing medical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining information from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution that preserves the original cohesiveness. The lack of structure limits the automatic identification and extraction of the information contained in these resources. For this reason, we have chosen a document-based approach using eXtensible Markup Language (XML) with its schema definition and related technologies. XML empowers the applications for in-context searching. In addition it allows the same content to be represented in different ways. Our XML reference clinical data model for guidelines has been realized with the XML schema definition. The schema is used for structuring new text-based guidelines and updating existing documents. It is also used to establish search strategies on the document base. We hypothesize that enabling the physicians to query the available CPGs easily, and to get access to selected and specific information at the point of care will foster increased use. Based on current evidence we are confident that it will have substantial impact on the care provided, and will improve health outcomes.

Computer Systems↗