Suporte à decisão clínica no domínio da doença renal crônica / Clinical decision support in the chronic kidney disease domain

OBJETIVOS: Propor uma abordagem de Suporte à Decisão Clínica, baseada em semântica e raciocínio, utilizando uma ontologia para representar o conhecimento presente nos conjuntos de diretrizes para prática clínica no domínio da nefrologia. MÉTODOS: A metodologia foi composta pelas fases de escolha do domínio, especificação do conhecimento, aquisição de conhecimento, modelagem semântica da ontologia, definição dos métodos de avaliação e desenvolvimento do protótipo para facilitar a realização de inferência e avaliação da consistência do conhecimento representado. RESULTADOS: Este estudo possui como resultados um léxico ampliado da linguagem, contendo 79 palavras e frases mais significativas do domínio da Doença Renal Crônica (DRC), e a ontologia OntoDecideDRC, cujos conceitos de classes e propriedades forneceram subsídios para o Suporte às Decisões Clínicas relacionadas ao diagnóstico, estadiamento e encaminhamento de pacientes com DRC. CONCLUSÃO: Essa abordagem é capaz de fornecer recomendações baseadas em evidências podendo promover a qualidade no atendimento médico.

GOALS: Propose an approach of Clinical Decision Support, based on semantics and reasoning, using an ontology to represent this knowledge in sets of guidelines for clinical practice in the field of nephrology. METHODS: The methodology consisted in phases of choice domain, knowledge specification, acquisition of knowledge, semantic modeling of ontology, definition of the evaluation methods and prototype development to facilitate the achievement of inference and evaluation of the consistency of the represented knowledge. RESULTS: This study has as result an extended lexicon of language, containing 79 words and phrases more meaningful in the field of Chronic Kidney Disease (CKD), and OntoDecideCKD ontology, which concepts of classes and properties provided subsidies to the Clinical Decisions Support to related to the diagnosis, staging, and referral of patients with CKD. CONCLUSION: This approach is able toprovide evidence-based recommendations, promoting quality in medical care.

Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy-systematic review and recommendations for clinical practice.

GOALS: This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population. METHODS: A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input. MAIN RESULTS: No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed. CONCLUSIONS: The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice.

Family centered intrapartum care: revisiting an old concept.

The historic development of family centered care to the present time is traced, and future development is proposed. A family systems approach can help nurses focus on the family as a unit and on individual members. This requires nurses to develop skills in working with multiple family members, provide care and advocacy for varying and sometimes conflicting family needs, and promote family clarification of their own values and priorities. Such an approach can help intrapartum families add to their experience of coping with stress in a way that builds family cohesion and mutual support.