Knowledge discovery in databases para apoio à decisão em atividades vinculadas à enfermagem / Knowledge discovery in databases para apoyar la decisión en actividades relacionadas con la enfermería / Knowledge discovery in databases for the support to decision-making in nursing-related activities

RESUMO Objetivo: relatar experiências de estratégias do uso da mineração de dados em dois cenários de práticas de Enfermagem. Descrição da experiência: em ambas as experiências foi utilizado o algoritmo Apriori para descoberta de regras de associação e identificado as situações de exceção. A primeira experiência utilizou dados provenientes de óbitos infantis da região metropolitana de Curitiba - PR. Na segunda experiência utilizaram-se prontuários de pacientes atendidos por enfermeiros na classificação de risco em um hospital particular de Curitiba - PR. O primeiro estudo identificou 374 regras gerais e o segundo, 108 regras gerais, ambos com suas respectivas regras de exceção. Conclusão: a aplicação do Knowledge Discovery in Databases pode ser demonstrada e efetivada em dois cenários distintos, a fim de contribuir para a tomada de decisão pelo gestor. Espera-se que o relato reforce a importância do ensino da informática em Enfermagem como ferramenta de apoio à decisão.

RESUMEN Objetivo: reportar experiencias de estrategias de uso de minería de datos en dos escenarios de prácticas de enfermería. Descripción del experimento: en ambos experimentos se utilizó el algoritmo Apriori para descubrir reglas de asociación e identificar situaciones excepcionales. El primer experimento utilizó datos de muertes infantiles en la región metropolitana de Curitiba-PR. En el segundo experimento, se utilizaron los registros médicos de los pacientes atendidos por enfermeros en la clasificación de riesgo en un hospital privado de Curitiba-PR. El primer estudio identificó 374 reglas generales y el segundo 108 reglas generales, ambas con sus respectivas reglas de excepción. Conclusión: la aplicación del Knowledge Discovery in Databases se puede demostrar e implementar en dos escenarios diferentes, con el fin de contribuir a la toma de decisiones por parte del gerente. Se espera que el informe refuerce la importancia de la enseñanza de la informática en enfermería como herramienta de apoyo a la toma de decisiones.

ABSTRACT Objective: to report experiences of data mining use strategies in two Nursing practice settings. Description of the experience: in both experiences, the Apriori algorithm was used to discover association rules and to identify exception situations. The first experience used data from infant deaths in the metropolitan region of Curitiba, PR. In the second experience, medical records of patients assisted by nurses were used in the risk classification at a private hospital in Curitiba -PR. The first study identified 374general rules and the second, 108, both with their respective exception rules. Conclusion: the application of Knowledge Discovery in Databases can be demonstrated and carried out in two different settings, in order to contribute to decision-making by the manager. It is expected that the report reinforces the importance of teaching Nursing Informatics as a decision-making support tool.

Método para evaluar el desempeño de los recursos humanos en proyectos médicos mediante computación con palabras / Method for Evaluating the Performance of Human Resources in Medical Projects by Computing with Words

Introducción: el proceso de evaluación del desempeño de los recursos humanos en proyectos médicos está sujeto a niveles considerables de subjetividad, lo cual genera incertidumbre a la hora de tomar decisiones. Problemas de esta índole donde se incluye la evaluación y clasificación de alternativas en el proceso, pueden ser abordados a través de la Computación con palabras. Objetivo: el objetivo del presente trabajo es desarrollar un método para la evaluación del desempeño de los recursos humanos en proyectos médicos mediante computación con palabras. Materiales y métodos: se utilizan los conjuntos de datos lingüísticos para mejorar la interpretación de los resultados. Se emplea el modelo de representación de la información lingüística basado en 2-tuplas en el tratamiento de la incertidumbre. El procesamiento de la información se realizó mediante los operadores de agregación de información Promedio Ponderado Ordenado que permiten la agregación de información de acuerdo a parámetros predefinidos obteniéndose un valor representativo. Resultados: se obtiene un método de apoyo a la toma de decisiones basado en la computación con palabras. El método propuesto fue implementado para manejar la incertidumbre existente en el proceso de evaluación del desempeño de los recursos humanos en proyectos médicos a partir de la evaluación y clasificación de alternativas, basado en computación con palabras. Conclusiones: la implementación del método propuesto, permite evaluar y clasificar a los Recursos Humanos según su desempeño(AU)

Introduction: the process of evaluating the performance of human resources in medical projects is subject to considerable levels of subjectivity, which generates uncertainty when making decisions. Problems of this nature, where the evaluation and classification of alternatives is included in the process, can be addressed through Computing with Words. Objective: to develop a method for evaluating the performance of human resources in medical projects using Computing with Words. Method: linguistic data sets are used to improve the interpretation of the results. The 2-tuple-based linguistic information representation model is used in the treatment of uncertainty. The information processing was performed using the Ordered Weighted Average information aggregation operators that allow the aggregation of information according to predefined parameters obtaining a representative value. Results: a method of decision support is obtained, based on Computing with Words. The method was implemented to manage the uncertainty in the process of evaluating the performance of human resources in medical projects based on the evaluation and classification of alternatives. Conclusions: the implementation of the proposed method allows evaluating and classifying human resources according to their performance(AU)

Diseño de Sonrisa Digital / Digital Smile Desinge

Nowadays, a lot of people need in reconstruction of the teeth in connection with their loss. Before prosthetics or any other manipulations, a person wants to quickly see the aesthetic appearance of his future tooth. At the moment, many dentists use the option of verbal explanation to the patient, what will look like a smile or a front row of teeth after treatment, but the visual representation of the person remains aside. But now this can be achieved with the help of "Digital smile design", which shows the person the final result of the dentition. This technology has a number of advantages. Some of them are the rapid creation of a prototype model and high accuracy in the manufacture of work. Thanks to these technologies, communication between the specialist and the patient has been facilitated. The digital smile design has simplified the doctor's work process and reduced patient data processing time. From now on, achieving aesthetic results in the reconstruction of teeth for the dentist is not a problem.

Establishment of a rapid identification of adverse drug reaction program in R language implementation based on monitoring data / 浙江大学学报·医学版

OBJECTIVE@#To establish a clinically applicable model of rapid identification of adverse drug reaction program (RiADP) for risk management and decision-making of clinical drug use.@*METHODS@#Based on the theory of disproportion analysis, frequency method and Bayes method, a clinically applicable RiADP model in R language background was established, and the parameters of the model were interpreted by MedDRA coding. Based on the actual monitoring data of FDA, the model was validated by the assessing hepatotoxicity of lopinavir/ritonavir (LPV/r).@*RESULTS@#The established RiADP model included four parameters: standard value of adverse drug reaction signal information, empirical Bayesian geometric mean value, ratio of reporting ratio and number of adverse drug reaction cases. Through the application of R language parameter package "phViD", the model parameters could be output quickly. After being encoded by MedDRA, it was converted into clinical terms to form a clinical interpretation report of adverse drug reactions. In addition, the evaluation results of LPV/r hepatotoxicity by the model were matched with the results reported in latest literature, which also proved the reliability of the model results.@*CONCLUSIONS@#In this study, a rapid identification method of adverse reactions based on post marketing drug monitoring data was established in R language environment, which is capable of sending rapid warning of adverse reactions of target drugs in public health emergencies, and providing intuitive evidence for risk management and decision-making of clinical drugs.

Sistema informático para la gestión del conocimiento en los departamentos de anatomía patológica / Knowledge Management Computer System for Departments of Pathological Anatomy

Cuba posee uno de los índices de autopsia más elevados del mundo, sin embargo, la información generada durante este proceso no se aprovecha al máximo, debido al crecimiento acelerado de los datos. El análisis de los resultados de la autopsia genera múltiples beneficios mayormente orientados a mejorar la calidad del diagnóstico médico. En este contexto el mayor desafío es la obtención del conocimiento implícito en los datos; factible con la incorporación de las nuevas Tecnologías de la Información y las Comunicaciones. En este trabajo se presenta el sistema informático SIRCAP el cual fue desarrollado con el objetivo de gestionar el conocimiento generado en los departamentos de Anatomía Patológica pertenecientes a la red hospitalaria cubana. El sistema obtenido garantiza con su generalización, el estudio de un mayor número de casos en apoyo a la toma de decisiones. Al mismo tiempo promueve la codificación de los diagnósticos según los más recientes estándares de terminología impulsados por la Organización Mundial de la Salud. La solución desarrollada, facilita el proceso de evaluación de la calidad en la atención médica, a partir del análisis y clasificación de la correlación clinicopatológica. Posibilita la configuración y aplicación reglas de control interno sobre los diagnósticos contribuyendo a elevar la calidad de los datos almacenados. Permite la creación de un amplio conjunto de reportes estadísticos sobre los datos, los cuales podrán ser empleados como soporte para la toma de decisiones, además de contribuir con el descubrimiento y explicación de nuevas enfermedades, manifestaciones inusuales de enfermedades conocidas y complicaciones terapéuticas(AU)

Cuba has one of the highest autopsy rates in the world, however, the information generated during this process is not used to the maximum, due to the accelerated growth of the data. The analysis of the results of the autopsy generates multiple benefits mainly aimed at improving the quality of medical diagnosis. In this context, the greatest challenge is obtaining the knowledge implicit in the data; feasible with the incorporation of the new Information and Communications Technologies. This work presents the SIRCAP computer system, which was developed with the aim of managing the knowledge generated in the departments of Pathological Anatomy belonging to the Cuban hospital network. The system obtained guarantees with its generalization, the study of a greater number of cases in support of decision making. At the same time, it promotes the coding of diagnoses according to the most recent terminology standards promoted by the World Health Organization. The developed solution facilitates the process of quality assessment in medical care, based on the analysis and classification of the clinic-pathological correlation. It allows the configuration and application of internal control rules over the diagnostics contributing to raise the quality of the stored data. It allows the creation of a wide set of statistical reports on data, which can be used as support for decision making, in addition to contributing to the discovery and explanation of new diseases, unusual manifestations of known diseases and therapeutic complications(AU)

Development of an app as a tool to support research and the prevention of osteoporosis / Desenvolvimento de aplicativo como ferramenta de apoio à investigação e prevenção de osteoporose

Abstract Objective: to develop an app for the investigation and prevention of osteoporosis for use by health professionals. Method: the development of the app was performed in six steps: definition of the target audience; survey of validated osteoporosis risk assessment tools in Brazil; programming of the app through the progressive web; selection of data for the preparation of sections of the evaluation form and clinical recommendations; automated auditing and evaluation of the app by health professionals. Results: three screens were prepared for the app. These were based on the data extracted using the Osteorisk, Sapori and Frax tools for sociodemographic data (age, gender, weight, height and ethnicity), health (use of glucocorticoids, hormone replacement therapy, arthritis rheumatoid arthritis, secondary osteoporosis, previous low impact fractures, parents with a history of hip fractures) and health related behaviors (physical activity, alcohol intake and smoking). The appl followed the design pattern and functionalities of the osteoporosis adviser tool (OPAD). Regarding guidelines relating to clinical recommendations, the guidelines on osteoporosis and fall prevention in the elderly of the Ministry of Health and the Brazilian Society of Geriatrics and Gerontology, respectively, were taken as a basis. Conclusion: the app allows the early identification of patients presenting risk factors for osteoporosis and, based on these results, provides guidance on the preventive measures to be adopted, aiming at reducing complications resulting from fractures, hospitalizations, disabilities and deaths. AU

Resumo Objetivo: desenvolver um aplicativo para a investigação e prevenção de osteoporose para profissionais de saúde. Método: o desenvolvimento do aplicativo foi realizado em seis etapas: definição do público-alvo; levantamento das ferramentas de avaliação de risco para osteoporose validadas no Brasil; programação do aplicativo por meio do web progressivo; seleção de dados para elaboração das seções do formulário de avaliação e das recomendações clínicas; auditoria automatizada e avaliação do aplicativo pelos profissionais de saúde. Resultados: foram elaboradas três telas para o aplicativo. Essas telas foram criadas com base nos dados extraídos por meio das ferramentas Osteorisk, Sapori e Frax no que se referem aos dados sociodemográficos (idade, sexo, peso, estatura e raça), de saúde (uso de glicocorticoides, terapia de reposição hormonal, artrite reumatoide, osteoporose secundária, fratura prévia por baixo impacto, pais com história de fratura do quadril) e de comportamentos relacionados à saúde (prática de atividade física, ingestão de bebida alcoólica e tabagismo). O aplicativo seguiu o padrão de design e funcionalidades da ferramenta osteoporosis adviser (OPAD). Com relação às orientações pertinentes às recomendações clínicas, tomaram-se por base as diretrizes sobre osteoporose e prevenção de quedas em idosos do Ministério da Saúde e da Sociedade Brasileira de Geriatria e Gerontologia, respectivamente. Conclusão: o aplicativo possibilita a identificação precoce de pacientes que apresentam fatores de risco à osteoporose e, com base nestes resultados, fornece a orientação sobre as medidas preventivas a serem adotadas, visando à diminuição de complicações decorrentes de fraturas, reduzindo internações, incapacidades e mortes. AU

Development of an application for mobile devices to identify the frailty phenotype among the elderly / Desenvolvimento de aplicativo para dispositivos móveis voltado para identificação do fenótipo de fragilidade em idosos

Abstract Objective: to develop a mobile app to quickly and safely identify frailty syndrome features among the elderly. Method: a cross-sectional study was conducted. The application was developed for the Android platform in the Java programming language and XML markup. The study instrument was based on five frailty phenotype criteria. The tests were conducted with 20 elderly persons living in a long-term care facility. Results: the twenty elderly persons had a mean age of 76.55 (±9.5) years. Thirteen were identified as frail, five were pre-frail and two were non-frail. The comparison of the results of the instruments of analysis coincided in the general evaluation of frailty and in the individual identification of the five criteria. Conclusion: the data suggests that the use of the application for the evaluation of frailty among the elderly was performed safely, with the advantage of quick access to allow the monitoring of the clinical status and prognosis of the patient.

Resumo Objetivo: desenvolver um aplicativo para dispositivos móveis com o intuito de identificar de maneira rápida e segura as características da síndrome de fragilidade em idosos. Método: estudo transversal quantitativo. O aplicativo foi desenvolvido para a plataforma Android, em linguagem de programação Java e marcação em XML. Os fundamentos utilizados foram baseados nos cinco parâmetros para definição do fenótipo de fragilidade. Os testes foram realizados com 20 idosos residentes em uma instituição de longa permanência. Resultados: a média de idade foi de 76,55 (±9,5) anos. Dentre os 20 idosos investigados, 13 foram classificados como frágeis, cinco pré-frágeis e dois não frágeis. A comparação dos resultados entre os instrumentos de análise coincidiram na avaliação geral da fragilidade e na identificação dos cinco critérios individualmente. Conclusão: a utilização do aplicativo para avaliação da fragilidade em idosos foi feita de maneira segura, com a vantagem do acesso rápido às informações para acompanhamento do quadro clínico e prognóstico do paciente.

An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department

This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager) allocates the resources (receptionist, nurses, doctors, etc.) to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.

Componente para la toma de decisiones en salud. Un enfoque de análisis de redes sociales desde la minería de procesos / Component to decision making in health. A social network analisis approach from process mining

La mayoría de los sistemas informáticos en la actualidad generan trazas. Estas trazas revelan las acciones que son ejecutadas en estos sistemas. La Minería de Procesos tiene como objetivo descubrir, monitorear y mejorar los procesos reales de las organizaciones a través de la extracción de conocimiento de estas trazas, luego de aplicadas un conjunto de transformaciones para organizar, estructurar y limpiar la información. Sin embargo, esto no es posible si estos sistemas informáticos y sus organizaciones no tienen sus acciones con un enfoque basado en procesos. El uso de estas tecnologías permite ahorrar recursos, reducir costos, optimizar tareas, mejorar la productividad, reducir tiempos de espera, entre otras muchas acciones. En el sector de la salud es una necesidad inmediata en términos de proveer una mayor seguridad al paciente y mejorar la calidad de vida. El objetivo de esta investigación es presentar un componente para la toma de decisiones en la selección de equipos de trabajo quirúrgico en un Sistema de Información Hospitalaria que permita incrementar la efectividad de las operaciones realizadas a los pacientes. El método utilizado es el enfoque de Análisis de Redes Sociales desde la Minería de Procesos. Como resultado se espera un componente que apoye la toma de decisiones por parte de jefes de servicios de cirugía, partiendo del desempeño profesional del personal asistencial, en función de proveer un mayor confort para el paciente(AU)

Most computer systems today generate traces. These traces show the actions that are executed in those systems. Process Mining aims to discover, to monitor and to improve real processes of organizations through knowledge extraction of these traces, after applying a set of transformations to organize, to structure and to clear this information. However, this is not possible if these computer systems and its organizations do not have their actions with a process-based approach. The use of these technologies allows saving resources, to reduce costs, to optimize tasks, to improve productivity, to reduce wait times, among many other actions. In the health sector is an immediate need in terms of providing greater patient safety and to improve quality of life. The objective of this research is to present a component for decision making in selection surgical teams work in a Hospital Information System that it allows to increase the effectiveness of operations performed to the patients. The method used is a Social Network Analysis approach from the Process Mining As a result it expected a component to support decision making by managers surgical and psychological personnel starting from the professional performance of health care personnel in function of providing greater comfort to the patient(AU)

Modelos de tomada de decisão em bioética clínica: apontamentos para a abordagem computacional / Models of decision making in clinical bioethics: notes for a computational approach

A bioética tem se tornado, nas últimas décadas, um tema de importância central para a prática clínica, por fornecer ferramentas teóricas para a tomada de decisão do profissional de saúde. A questão que se propõe diz respeito a como saber se a decisão é a mais apropriada, já que uma decisão na esfera clínica - quer se esteja atuando na atenção primária, secundária ou terciária - deve, necessariamente, ser acertada tanto do ponto de vista técnico, quanto do ponto de vista ético. A literatura tem apresentado diferentes modelos para a tomada de decisão no campo de análise da bioética clínica. Com base nessas ponderações, objetiva-se, no presente ensaio, apresentar apontamentos sobre (i) a tomada de decisão na área de bioética clínica e (ii) as possibilidades de abordagem computacional das decisões bioéticas...

Bioethics has become over the recent decades a central question to clinical practice, due to the fact that it provides theoretical tools for decision making in health care. The issue that arises concerns how to know whether the decision made is the most appropriate, considering that a clinic decision - whether working in primary, secondary, or tertiary care - must be accurate from both the technical and the ethical point of views. As a result, different models for decision making in clinical bioethics have been presented in the literature. Based on these considerations, the objective of this article is to point important issues about (i) decision making in the field of clinical bioethics and (ii) the possibilities of computational approaches to assist such decisions...

La bioética se ha convertido, en las últimas décadas, en un tema de gran importancia en la práctica clínica, proporcionando herramientas teóricas para la toma de decisiones de los profesionales de la salud. La pregunta que se plantea es cómo saber si la decisión es la más apropiada, puesto que una decisión en el ámbito clínico - si se está trabajando en la atención primaria, secundaria o terciaria - debe necesariamente ser correcta desde el punto de vista técnico, como el punto de vista ético. La literatura ha presentado diferentes modelos para la toma de decisiones en el ámbito del análisis de la bioética clínica. Sobre la base de estas consideraciones, el objetivo en el siguiente texto es presentar puntos sobre (i) la toma de decisiones en el ámbito de la bioética clínica y (ii) las posibilidades de un enfoque computacional de las decisiones bioéticas...

Factors Influencing Nonabsolute Indications for Surgery in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Analysis Using Causal Bayesian Networks / 대한배뇨장애요실금학회지

PURPOSE: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lower urinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in this study. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physicians and the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR) analysis. RESULTS: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2 (+/-7.3, standard deviation) years and 47.3 (+/-25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated by physician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589 (53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladder outlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question 3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume (R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to the LR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised (0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820, P=0.063) to the LR model. CONCLUSIONS: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenced decision-making in physicians treating patients with LUTS/BPH.

Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM Project / 中西医结合学报

<p><b>BACKGROUND</b>Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy.</p><p><b>METHODS</b>We proposed the development of the SuiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management (DataTCM), simulation of cases (SimTCM), analyses and validation of datasets (SciTCM), clinical examination and pattern differentiation (DiagTCM, TongueTCM, and PulseTCM), intervention selection (AcuTCM, HerbsTCM, and DietTCM), management of medical records (ProntTCM), epidemiologic investigation of sampled data (ResearchTCM), and medical education, training, and assessment (StudentTCM).</p><p><b>DISCUSSION</b>The SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.</p>

Expert System Shells for Rapid Clinical Decision Support Module Development: An ESTA Demonstration of a Simple Rule-Based System for the Diagnosis of Vaginal Discharge / 대한의료정보학회지

OBJECTIVES: This study demonstrates the feasibility of using expert system shells for rapid clinical decision support module development. METHODS: A readily available expert system shell was used to build a simple rule-based system for the crude diagnosis of vaginal discharge. Pictures and 'canned text explanations' are extensively used throughout the program to enhance its intuitiveness and educational dimension. All the steps involved in developing the system are documented. RESULTS: The system runs under Microsoft Windows and is available as a free download at http://healthcybermap.org/vagdisch.zip (the distribution archive includes both the program's executable and the commented knowledge base source as a text document). The limitations of the demonstration system, such as the lack of provisions for assessing uncertainty or various degrees of severity of a sign or symptom, are discussed in detail. Ways of improving the system, such as porting it to the Web and packaging it as an app for smartphones and tablets, are also presented. CONCLUSIONS: An easy-to-use expert system shell enables clinicians to rapidly become their own 'knowledge engineers' and develop concise evidence-based decision support modules of simple to moderate complexity, targeting clinical practitioners, medical and nursing students, as well as patients, their lay carers and the general public (where appropriate). In the spirit of the social Web, it is hoped that an online repository can be created to peer review, share and re-use knowledge base modules covering various clinical problems and algorithms, as a service to the clinical community.

Estruturação da área de informação em saúde a partir da gerência de recursos informacionais: análise de experiência / Using information resources management to set up the area of health information: a case analysis

OBJETIVO: Relatar a experiência da Secretaria Municipal de Saúde de Belo Horizonte (SMSA/BH), no Estado de Minas Gerais, Brasil, na aplicação dos conceitos da gerência de recursos informacionais (GRI) para o desenvolvimento de um sistema de informação em saúde. MÉTODOS: Neste estudo de caso foram analisados documentos que descrevem as iniciativas na área de informação, seus mecanismos de estruturação e resultados alcançados com um sistema de gestão focado no prontuário eletrônico, no período de 2003 a 2008. Esse processo é descrito e analisado a partir do conceito de GRI. RESULTADOS: O sistema contribuiu para a mudança do modelo assistencial a partir da informatização integrada de 103 unidades básicas de saúde, nove unidades especializadas e 503 equipes de saúde da família, com ênfase nas informações relevantes para o programa saúde da família. CONCLUSÕES: Os seguintes componentes da GRI foram aplicados: estruturação de um locus único para as tecnologias de informação e a área de informação, potencial de alavancagem das tecnologias de informação e fórum estratégico de decisão quanto à informação. A limitação encontrada refere-se à utilização de informação estratégica para a tomada de decisão de longo prazo.

OBJECTIVE: To report the experience of the City Department of Health in Belo Horizonte (SMSA/BH), state of Minas Gerais, Brazil, with the use of information resources management (IRM) to develop a health information system. METHODS: In this case study we reviewed documents describing initiatives in the area of information, the mechanisms used to enable these initiatives, and the results achieved with a management system focused on the implementation of an electronic medical records system in the period from 2003 to 2008. This process is described and analyzed from the perspective of IRM. RESULTS: The system contributed to a change in the health care model, resulting from the electronic integration of 103 basic health units, 9 specialized units, and 503 family health teams, with emphasis on information that was relevant for the family health program. CONCLUSIONS: The following IRM components were effectively implemented as part of the electronic system: creation of a single locus for the areas of information technology and information, potential leveraging of information technology, and establishment of a strategic forum for information-related decision-making. One limitation refers to the use of strategic information for long-term decision-making.

Planejamento pré-operatório utilizando reconstruções 3d e endoscopia virtual para a localização do seio frontal / Preoperative planning using 3d reconstructions and virtual endoscopy for location of the frontal sinus

Introdução: Reconstruções tridimensionais (3D) geradas de tomografias computadorizadas (TCs) permitem a observação de cavidades e estruturas anatômicas de nosso corpo com riqueza de detalhes. Em nossa especialidade já houve tentativas da realização de endoscopias e laringoscopias virtuais. Entretanto, estas aplicações foram praticamente abandonadas devido à complexidade e necessidade de computadores com alto poder de processamento gráfico. Objetivo: Demonstrar a confecção de reconstruções 3D a partir de TCs de pacientes em computador pessoal, com programa específico gratuito e compará-las às imagens endoscópicas reais da cirurgia. Método: Estudo prospectivo em que os arquivos próprios das TCs de 10 pacientes foram reconstruídos com programa Intage Realia, versão 2009, 0, 0, 702 (KGT Inc, Japão). As reconstruções foram realizadas antes das cirurgias e uma endoscopia virtual foi feita para se avaliar a região do recesso e seio frontal. Após este estudo, a cirurgia foi realizada e armazenada digitalmente. As imagens endoscópicas reais da região do recesso e seio frontal foram comparadas às imagens virtuais. Resultados: A reconstrução 3D e endoscopia virtual foram realizadas nos 10 pacientes submetidos à cirurgia. As imagens virtuais apresentavam grande semelhança visual com as imagens das cirurgias reais. Conclusão: Demonstramos a possibilidade, com ferramentas relativamente simples e computador pessoal, de se gerar reconstruções 3D e endoscopias virtuais. O conhecimento pré-operatório da localização do caminho de drenagem natural do seio frontal pode vir a gerar benefícios durante a realização das cirurgias. Entretanto, mais estudos devem ser desenvolvidos para a avaliação do real papel destas reconstruções 3D e endoscopias virtuais.

Introduction: Computed tomography (TC) generated tridimensional (3D) reconstructions allow the observation of cavities and anatomic structures of our body with detail. In our specialty there have been attempts to carry out virtual endoscopies and laryngoscopies. However, such application has been practically abandoned due to its complexity and need for computers with high power of graphic processing. Objective: To demonstrate the production of 3D reconstructions from CTs of patients in personal computers, with a free specific program and compare them to the surgery actual endoscopic images. Method: Prospective study in which the CTs proper files of 10 patients were reconstructed with the program Intage Realia, version 2009, 0, 0, 702 (KGT Inc., Japan). The reconstructions were carried out before the surgeries and a virtual endoscopy was made to assess the recess and frontal sinus region. After this study, the surgery was digitally performed and stored. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images. Results: The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images. Conclusion: With relatively simple tools and personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies. The preoperative knowledge of the frontal sinus natural draining path location may generate benefits during the performance of surgeries. However, more studies must be developed for the evaluation of the real roles of such 3D reconstructions and virtual endoscopies.

Study on computer-aided diagnosis system based on multidetection / 生物医学工程学杂志

This paper, analyzes the defects and its limitations of computer-aided diagnosis system (CADS) in clinical practice in the past, proposes a new pattern CADS of designing method. We used the theory of multidetection, stored the accumulated experience in computer, established the knowledge base, and made the medical diagnosis through maximizing a posteriori (MAP) judgement rule. Statistical data revealed that the CADS had a high accuracy rate. The medical diagnosis can meet the demand for clinical treatments, and realize the clinical diagnostic application of information technology.

Telemedicina: contexto e desdobramento a partir do estudo de três casos no período de 2005 e 2006 / Telemedicine: context and deployment from the study of three cases in period 2005 to 2006

Este artigo apresenta o resultado da tese de doutorado do autor, cujo objetivo foi conhece o contexto de três projetos de Telemedicina, os respectivos desdobramentos para a sociedade. Para a realização da pesquisa, foi utilizado o modelo de estudo de caso, com uso de ferramentas de entrevista de campo e observações etnográficas. Os projetos estudados foram,nas cidades de Belo Horizonte, Recife e Porto Alegre. Os resultados alcançados são parciais, ou seja, eles reforçam a tese de que é preciso se estabelecer mecanismos de avaliação pré, durante e pós-implantação dos projetos de Telemedicina. constatamos que:Impacto no Acesso ? não há evidências de melhoria e ampliação do acesso aos serviços de saúde. Ao contrário, este acesso foi limitado há programação da realização de videoconferências; Impacto Econômico ? para os casos em que ocorreu o processo de segunda opinião, de fato, há ganhos para o paciente.; Impacto na Aceitação ? por parte dos usuários se deve ao fato do ineditismo, participação em videoconferência.

This article shows an summary of research realized to determine where they were implanted with the telemedicine projects and their consequences for society. To conduct the study, we used the model case study, with the use of interview tools and description of it, from ethnographic observations. A total of three projects in telemedicine, the cities of Belo Horizonte, Recife and Porto Alegre. The results are partial, that is, they reinforce the view that it is necessary to establish mechanisms for the pre, during and after implementation of telemedicine projects. We also found that: Impact on Access - did not find evidence of improving and expanding access to health services; Economic Impact - for cases that occurred in the process of second opinion, in fact, there are gains for the patient. ; impact on the acceptance - by among users is because of the novelty, participation in videoconferencing.

Análisis sistémico de la operación de administradoras de riesgos profesionales en Colombia / Análise sistêmica do funcionamento dos gestores de riscos profissionais na Colômbia / Systemic analysis of the operations of professional risk management organizations

Este artículo utiliza el análisis sistémico, para describir la operación de una Administradora de Riesgos Profesionales (ARP). Para este fin se estudian las características complejas que caracterizan el sistema de riesgos de profesionales y que afectan su operación. Se propone la metodología de dinámica de sistemas para la modelación en ambientes complejos, como el sistema de riesgos profesionales y sus administradoras. Se presenta la estructura básica del modelo, utilizando diagramas causales. Se concluye que la operación de una ARP cuenta con ciclos de realimentación, relaciones no lineales y retardos de tiempo, que crean dificultad en la comprensión del sistema. Se propone la modelación como alternativa para mejorar la toma de decisiones.

This paper describes the operational cycle of a workers’ compensation insurer in Colombia. Itexplains the basic characteristics of complexity wich are presented in systems like occupationalrisk, and proposes the use of system dynamics as an alternative to model those characteristics.The paper uses the causal loop diagrams to present the basic structure of the operational cyclemodel. We concluded that the operational cycle has important feedback cycles, time delays,and nonlinear relations that affect the understanding of the real system. Thus, the use of systemthinking and formal simulation models are useful tools to understand and improve decisionsin real systems.

Com este fim, estudam-se as características de complexidade que caracterizan tais sistemas e que afetam sua operação. Propõe-se a metodologia de dinâmica de sistemas para a criação de um modelo que incorpore o complexo ambiente de administradoras de riscos.Diagramas causais são utilizados para apresentar a estrutura básica do modelo. Com base nas análises conclui-se que a operação de uma administradora de riscos conta com ciclos de realimentação, relações não lineares e atraso de tempo, aspectos que dificultam a compreensão dosistema. Propõe-se a criação de modelos matemáticos de dinâmica de sistemas como alternativa para melhoria da tomada de decisões.

Esthetic perception towards different combinations of facial contours and upper incisor shape

Aim: The aim of this study was to assess the esthetic perception of adults with primary, secondary and higher education and recent dental graduates towards different combinations of facial contours and upper central incisor shapes. Methods: Photographs of 6 individuals with square, tapered and ovoid facial contours (2 per type) were modified to have the 3 different types of tooth shapes (square, tapered and ovoid) in each facial contour (total of 18 photographs). The 195 participants rated each photograph using visual analogue scales. Comparison between groups was performed using the Chi-square t-test ('alfa'=0.05). Results: No statistically significant differences (p>0.05) were found in the esthetic perception towards the frontal facial outline and upper incisor shape by participants’ educational level. In addition, the shapes of teeth perceived as the most esthetically pleasing were not always similar to the form of frontal facial outline evaluated. Conclusions: No general agreement was found in the esthetic perception towards the frontalfacial outline and upper incisor shape by educational level. Dentists tend to prefer ovoid shape tooth for almost all frontal facial outline.