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PubMedDate not supplied

Transforming care: medical practice design and information technology.

The transformation of the medical practice is possible today because of the advancement of system design knowledge coupled with innovations in information technology (IT). Examples of such transformed care are present today, and they are creating a roadmap for others. Those efforts are also elucidating critical issues in the use of IT to advance health care quality. Connectivity, electronic integration, and knowledge management are the key functionalities emerging as levers to promote this transformation.

Chronic Disease↗

PubMed2004

Integrating databases and expert systems for the analysis of brain structures: connections, similarities, and homologies.

The NeuroHomology Database system (NHDB) combines databases related to brain structures from different species with different knowledge management systems (KMSs) for systematization, evaluation and processing neurobiological data. Special attention is assessment of similarity of data from different species as a basis for exploring neural homologies. NHDB includes modules that handle brain structure and connectivity data, as well as inference engines for evaluation of the stored neurobiological information. The spatial inference engine evaluates the possible topological relations between cortical structures in different neuroanatomical atlases. The connectivity inference engine evaluates the reliability of information pertaining to fiber tracts as those are reflected in the literature. The inference engine for translation of neuroanatomical connections in different atlases evaluates the probability of existence of connections of interest in different parcellation schemes. Finally, the similarity inference engine calculates the overall degree of similarity of pairs of brain structures from different species by taking into account a set of eight criteria. We present examples of search for information in NHDB system, inferences of relations between cortical structures from equivalent neuroanatomical atlases, reconstruction of functional networks of brain structures from data collated from the literature, translation of connectivity matrices in equivalent parcellation schemes, and evaluations of similarities of brain structures from humans, macaques and rats.

Algorithms↗

PubMed2006

Neuroanatomical affiliation visualization-interface system.

A number of knowledge management systems have been developed to allow users to have access to large quantity of neuroanatomical data. The advent of three-dimensional (3D) visualization techniques allows users to interact with complex 3D object. In order to better understand the structural and functional organization of the brain, we present Neuroanatomical Affiliations Visualization-Interface System (NAVIS) as the original software to see brain structures and neuroanatomical affiliations in 3D. This version of NAVIS has made use of the fifth edition of "The Rat Brain in Stereotaxic coordinates" (Paxinos and Watson, 2005). The NAVIS development environment was based on the scripting language name Python, using visualization toolkit (VTK) as 3D-library and wxPython for the graphic user interface. The following manuscript is focused on the nucleus of the solitary tract (Sol) and the set of affiliated structures in the brain to illustrate the functionality of NAVIS. The nucleus of the Sol is the primary relay center of visceral and taste information, and consists of 14 distinct subnuclei that differ in cytoarchitecture, chemoarchitecture, connections, and function. In the present study, neuroanatomical projection data of the rat Sol were collected from selected literature in PubMed since 1975. Forty-nine identified projection data of Sol were inserted in NAVIS. The standard XML format used as an input for affiliation data allows NAVIS to update data online and/or allows users to manually change or update affiliation data. NAVIS can be extended to nuclei other than Sol.

Animals↗

PubMed2006

Technology to improve quality and accountability.

A body of evidence has been accumulated to demonstrate that current practice is not sufficiently safe for several stages of central laboratory testing. In particular, while analytical and perianalytical steps that take place within the laboratory are subjected to quality control procedures, this is not the case for several pre- and post-analytical steps. The ubiquitous application of auto-identification technology seems to represent a valuable tool for reducing error rates. A series of projects in Oxford has attempted to improve processes which support several areas of laboratory medicine, including point-of-care testing, blood transfusion, delivery and interpretation of reports, and support of decision-making by clinicians. The key tools are auto-identification, Internet communication technology, process re-engineering, and knowledge management.

Clinical Laboratory Techniques↗

PubMed2004

Chemopreventive drug treatment in subjects with genetic predisposition to cancer: prescriber liability and healthcare disparities.

Advancements in pharmacogenomics and chemoprevention promise to reduce cancer incidence and mortality, but utilization will undoubtedly be accompanied with ethical and legal issues that largely remain unexplored or discussed. As pharmacogenomic information is assessed more comprehensively and inexpensively, it will influence decisions regarding when and to whom chemoprevention therapy will be initiated. Pharmacogenomics will change the manner in which the liability system will perceive and analyse risks. Management of the risks related to chemopreventive treatment will differ from traditional disease management. Knowledge about cancer susceptibility will need to consider environmental factors as they relate to healthcare disparities.

Anticarcinogenic Agents↗

PubMed2006

Case-based reasoning, a promising tool to face solids separation problems in the activated sludge process.

Classical control has serious limitations when faced with solids separation problems in the activated sludge process. Lack of knowledge about the mechanisms involved in the imbalance within the different microbiological communities implies that a general solution to these undesirable situations has not yet been provided. However, operators have to make decisions based on their experience and intuition to solve the problem (or at least to minimise the effects). The acquisition and registration of the knowledge learnt from each new experience can be decisive when solving similar problems in the future. Case-based reasoning (CBR) is an advanced technique for knowledge management in complex systems that uses past experiences to solve brand new situations. Previous simplified proposals in this field have exposed limitations, but this paper describes a new approach to CBR, considering the dynamics and the complexity of solids separation problems.

Decision Support Techniques↗

PubMed2001

The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research.

In this review of a range of studies on the health and safety effects of precarious employment in industrialized societies published since 1984, the authors examine the overall findings and methodological issues and identify areas in need of further research. Of the 93 published journal articles and monographs/book chapters reviewed, 76 studies found precarious employment was associated with a deterioration in occupational health and safety (OHS) in terms of injury rates, disease risk, hazard exposures, or worker (and manager) knowledge of OHS and regulatory responsibilities. Of the more than 25 studies each on outsourcing and organizational restructuring/downsizing, well over 90 percent find a negative association with OHS. The evidence is fairly persuasive for temporary workers, with 14 of 24 studies finding a negative association with OHS. The evidence is less strong for small business, and a handful of studies on part-time workers found no clear association with negative OHS outcomes (in some cases the reverse). Further research is needed to more clearly link health effects to particular business practices and neoliberal policies and to explore the regulatory implications of the growth of precarious employment. The authors suggest some ways to conceptualize the association between precarious employment and occupational health.

Commerce↗

PubMed2006

Bridging the divide: the need for translational informatics.

Translational science promises to deliver real benefit to the pharmaceutical industry, reducing attrition and affording high quality, efficacious medicines. The development and use of biomarkers aims to reduce drug development risks and generate a better understanding of disease. Informatics is an essential component of the translational science toolkit; researchers must be able to work effectively with biomarker data, and the capture and reuse of knowledge is vital for long-term success. An analysis of current data and knowledge management practices in the translational science area is presented.

Humans↗

PubMedDate not supplied

Defaults, exceptions and ambiguity in a medical knowledge representation system.

Inheritance methods for general semantic networks which allow for exceptions are essential to representing medical knowledge in forms which are familiar to doctors. Such systems give rise to the possibility of ambiguity and problems of computational efficiency. Efficient computational methods using conventional hardware for inheritance and the detection of ambiguity in general semantic networks are described. These methods have been implemented in PROLOG in a knowledge management system which is being used in the development of intelligent drug information and medical decision support systems.

Algorithms↗

PubMed2003

Information technology in veterinary pharmacology instruction.

Veterinary clinical pharmacology encompasses all interactions between drugs and animals and applies basic and clinical knowledge to improve rational drug use and patient outcomes. Veterinary pharmacology instructors set educational goals and objectives that, when mastered by students, lead to improved animal health. The special needs of pharmacology instruction include establishing a functional interface between basic and clinical knowledge, managing a large quantity of information, and mastering quantitative skills essential to successful drug administration and analysis of drug action. In the present study, a survey was conducted to determine the extent to which veterinary pharmacology instructors utilize information technology (IT) in their teaching. Several IT categories were investigated, including Web-based instructional aids, stand-alone pharmacology software, interactive videoconferencing, databases, personal digital assistants (PDAs), and e-book applications. Currently IT plays a largely ancillary role in pharmacology instruction. IT use is being expanded primarily through the efforts of two veterinary professional pharmacology groups, the American College of Veterinary Clinical Pharmacology (ACVCP) and the American Academy of Veterinary Pharmacology and Therapeutics (AAVPT). The long-term outcome of improved IT use in pharmacology instruction should be to support the larger educational mission of active learning and problem solving. Creation of high-quality IT resources that promote this goal has the potential to improve veterinary pharmacology instruction within and across institutions.

Animals↗

PubMed2006

A web-based system for supporting collaboration towards resolving oncology issues.

The coordinated consideration of diverse perspectives and knowledge sources in medical decision-making contexts is undoubtedly of crucial importance, in that it augments the quality of both the overall process and decisions to be made. Towards this end, this study presents a web-based system that aims at the exploitation of personalized knowledge through a structured process of collaborative and argumentative resolution of issues raised in such settings. By using the system, a consensus emerges through the process of collaboratively considering alternative interpretations of the issue under consideration. Using an illustrative example of collaboration between a group of experts deciding on the most appropriate treatment for a particular case of breast cancer, we present the design rationale, features and functionality of the proposed system. Much attention is also paid to the associated knowledge management issues. The system can be used for distributed, asynchronous collaboration, allowing users to surpass the requirements of working at the same place and time.

Breast Neoplasms↗

PubMed1990

Managing clinical pharmacy services by integrating drug information and dispensing.

Managing clinical pharmacy services in the 1990s will remain a challenge. Planning appropriate services, matching resources to workload and needs, and meeting the rapid changes in hospital diversification requires substantial pharmacy management knowledge and expertise. A key step in meeting these challenges is integrating the pharmacist's responsibilities for drug information and drug dispensing. This step ensures the provision of the highest quality clinical and distributive pharmacy services. Patient care demands it. Pharmacists will achieve their full potential if drug dispensing and information are provided as one comprehensive service.

Drug Information Services↗

PubMedDate not supplied

Seeking the competitive advantage: it's more than cost reduction.

Most organizations focus considerable time and energy on reducing operating costs as a way to attain marketplace advantage. This strategy was not inappropriate in the past. To be competitive in the future, however, focus must be placed on other issues, not just cost reduction. The near future will be dominated by service industries, knowledge management, and virtual partnerships, with production optimization and flexibility, innovation, and strong partnerships defining those organizations that attain competitive advantage. Competitive advantage will reside in clarifying the vision and strategic plan, reviewing and redesigning work processes to optimize resources and value-added work, and creating change-ready environments and empowered workforces.

Cost Control↗

PubMed1999

Integrating case based and rule based reasoning in a decision support system: evaluation with simulated patients.

We present a Web-based knowledge management and decision support system for Type I Diabetes patients' care. The tool exploits the integration of two methodologies, Case Based Reasoning and Rule Based Reasoning, and supports physicians in the definition of therapeutic strategies. Such a work is being integrated in the EU funded T-IDDM project architecture. In this paper we report a first evaluation obtained on simulated patients.

Artificial Intelligence↗

PubMed1999

[Medical education at the dawn of the 21st century: a challenge for the French Units of Education and Investigation].

In the incoming 21st century, traditional medical schools are facing major challenges, if medical education wants to sustain educating physicians capable of answering continuous increasing health care needs of populations they should serve. Institutions should be willing to accept the necessity to modify instructional processes to favor student autonomy and to manage knowledge explosion. A new approach should guide schools in determining undergraduate program content and objectives, in favoring a learning process centered on student and oriented towards community needs, as well as in investing into faculty development in pedagogy. This approach triggers medical schools to establish with their students a new social contract intended to educate them as responsible and autonomous future medical citizens.

Curriculum↗

PubMed2000

Knowledge and change in health care organizations.

All of us realize that these are times of high change in virtually every health care system, regardless of size or location. As part of this change process, many health care systems are taking a serious look at the area that has evolved as knowledge management. While change may be mandatory, progress is definitely optional.

Delivery of Health Care↗

PubMed2000

A needs assessment of surgical residents as teachers.

OBJECTIVE: To determine the needs of surgical residents as teachers of clinical clerks. DESIGN: A needs assessment survey. SETTING: Department of Surgery, University of Toronto. PARTICIPANTS: Clinical clerks and surgical residents and staff surgeons. METHODS: Three stakeholder groups were defined: staff surgeons, surgical residents and clinical clerks. Focus-group sessions using the nominal group technique identified key issues from the perspectives of clerks and residents. Resulting information was used to develop needs assessment surveys, which were administered to 170 clinical clerks and 190 surgical residents. Faculty viewpoints were assessed with semi-structured interviews. Triangulation of these 3 data sources provided a balanced approach to identifying the needs of surgical residents as teachers. RESULTS: Response rates were 64% for clinical clerks and 66% for surgical residents. Five staff surgeons were interviewed. Consensus was noted among the stakeholder groups regarding the importance of staff surgeon role modelling and feedback, resident attitude, time management, knowledge of clerks' formal learning objectives, and appropriate times and locations for teaching. Discrepancies included a significant difference in opinion regarding the residents' capacity to address clerks' individual learning needs and to foster good team relationships. Residents indicated that they did not receive regular feedback regarding their teaching and that staff did not place an emphasis on their teaching role. CONCLUSIONS: This study has, from a multi-source perspective, assessed the needs of surgical residents as teachers. These needs include enhancing residents' education regarding how and what to teach medical students on a surgical rotation, and a need for staff surgeons to increase feedback to residents regarding their teaching.

Clinical Clerkship↗

PubMed2001

Use of webboards for distance learning: a physical therapy model.

In today's world of ever-increasing knowledge and technology, mastering the use of information is critical for success. U.S. Army physical therapists have successfully used the Knowledge Management Network as a tool to foster communication, education, and training. The model outlined in this article can serve both as a model for promoting distance learning and as a success story of how to merge today's technology with the medical community to improve productivity and communication.

Communication↗