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Towards personalized decision support in the dementia domain based on clinical practice guidelines

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Abstract

A set of evidence-based clinical practice guidelines has been synthesized and integrated in the clinical decision support system DMSS-R (Dementia Management and Support System) to support clinical routines and reasoning processes as performed by individual health professionals in daily practice. DMSS-R provides advice, tailored to individual and often exceptional patient cases, to the user while providing guidance to the next step in the assessments and support for hypothesis generation and evaluation throughout the process. This paper describes DMSS-R and the results of a case study in clinical practice where the system was used. The case study included interviews and observations of the clinical investigation process as undertaken in 41 real patient cases with suspected dementia. Two physicians participated, one of whom was considered a novice regarding dementia while the other had a moderate level of skills. Initially, both physicians were unfamiliar with DMSS-R. A group of nurses together with care personnel and relatives were also involved. The most important contribution of DMSS-R at the point of care, apart from the tailored explanatory support related to a patient case, was the educational support it provided. This was partly manifested in a change of routines in the encounter with patients. Aspects regarding the individual health care professional’s need for a personalized support system are discussed and put in relation to the team’s need for support, and in relation to the diversity of disease manifestations in this group of patients, which reinforces patient-centric assessments.

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References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd edn., DSM-III-R. American Psychiatric Association (1987)

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn., text revision (DSM-IV-TR). American Psychiatric Association (1994)

  • Arocha J.F., Wang D., Patel V.L.: Identifying reasoning strategies in medical decision making: a methodological guide. J. Biomed. Inform. 38(2), 154–171 (2005)

    Article  Google Scholar 

  • Benner P., Tanner C.: Clinical judgment: how expert nurses use intuition. Am. J. Nurs. 87, 23–31 (1987)

    Google Scholar 

  • Berg M.: Patient care information systems and health care work: a sociotechnical approach. Int. J. Med. Inform. 55, 87–101 (1999)

    Article  Google Scholar 

  • Beuscart-Zéphir M., Anceaux F., Crinquette V., Renard J.: Integrating users’ activity modeling in the design and assessment of hospital electronic patient records: the example of anesthesia. Int. J. Med. Inform. 64(2–3), 157–171 (2001)

    Article  Google Scholar 

  • Bødker S.: A human activity approach to user interfaces. Hum.-Comput. Interact. 4, 171–195 (1989)

    Article  Google Scholar 

  • Cawsey A.J., Jones R.B., Pearson J.: The evaluation of a personalised health information system for patients with cancer. User Model. User-Adapt. Interact. 10(1), 47–72 (2000)

    Article  Google Scholar 

  • Chittaro, L., Carchietti, E., De Marco, L., Zampa, A.: Personalized Emergency Medical Assistance for Disabled People. User Model. User-Adapt. Interact. 21. doi:10.1007/s11257-010-9092-2

  • Cohen T., Blatter B., Almeida C., Shortliffe E., Patel V.: A cognitive blueprint of collaboration in context: distributed cognition in the psychiatric emergency department. Artif. Intell. Med. 37(2), 73–83 (2006)

    Article  Google Scholar 

  • Cortellessa, G., Cesta, A.: Evaluating mixed-initiative systems: an experimental approach. In: ICAPS-06. Proceedings of the Sixteenth International Conference on Automated Planning and Scheduling, pp. 172–181. AAAI Press, Menlo Park, CA (2006)

  • do Amaral M., Satomura Y., Honda M., Sato T.: A psychiatric diagnostic system integrating probabilistic and categorical reasoning. Methods Inf. Med. 34, 232–243 (1996)

    Google Scholar 

  • Engeström Y.: Expansive visibilization of work: an activity-theoretical perspective. Comput. Support. Coop. Work 8, 63–93 (1999)

    Article  Google Scholar 

  • Folstein M.F., Folstein S.E., McHugh P.R.: Mini-Mental-State: a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189–198 (1975)

    Article  Google Scholar 

  • Fox J., Das S.: Safe and sound: artificial intelligence in hazardous applications. AAAI and MIT Press, Menlo Park (2000)

    Google Scholar 

  • Gartner, J., Tien, A., Damasio, L., Pereira, L.: Psychiatric diagnosis from the viewpoint of computational logic. In: Lloyd, J., et al. (eds.) Proc. of First International Conference on Computational Logic—CL2000. LNAI 1861, pp. 1362–1376. Springer Verlag (2000)

  • Herrero, B., Laita, L., Roanes-Lozano, E.R., Maojo, V., Ledesma, L., Laita, L.: A symbolic computation based expert system for Alzheimer’s disease diagnosis. In: Calmet, J., Benhamou, E., Caprotti, O., Henocque, L., Sorge, V. (eds.) Artificial Intelligence, Automated Reasoning, and Symbolic Computation—AISC 2002, LNAI 2385, pp. 39–50. Springer Verlag (2002)

  • Iliffe S., Austin T., Wilcock J., Bryans M., Turner S., Downs M.: Design and implementation of a computer decision support system for the diagnosis and management of dementia syndromes in primary care. Methods Inf. Med. 2, 98–104 (2002)

    Google Scholar 

  • Kaplan B.: Evaluating informatics application—clinical decision support systems literature review. Int. J. Med. Inform. 64, 15–37 (2001a)

    Article  Google Scholar 

  • Kaplan B.: Evaluating informatics applications—some alternative approaches: theory, social interactionism, and call for methodological pluralism. Int. J. Med. Inform. 64, 39–56 (2001b)

    Article  Google Scholar 

  • Kaptelinin V.: Activity theory: implications for human–computer interaction. In: Nardi, B. (ed.) Context and Consciousness: Activity Theory and Human–Computer Interaction, pp. 103–116. The MIT Press, Cambridge (1995)

    Google Scholar 

  • Kaptelinin V., Nardi B.: Acting with Technology: Activity Theory and Interaction Design. The MIT Press, Cambridge (2006)

    Google Scholar 

  • Karlsson, D.: Aspects of the use of medical decision-support systems—the role of context in decision support. Thesis, Institute of Technology, Linköping University (2001)

  • Kuuti K.: Activity theory as a potential framework for human–computer interaction research. In: Nardi, B. (ed.) Context and Consciousness: Activity Theory and Human–Computer Interaction, pp. 17–44. The MIT Press, Cambridge (1995)

    Google Scholar 

  • Leprohon J., Patel V.L.: Decision making strategies for telephone triage in emergency medical services. Med. Decis. Making 15, 240–253 (1995)

    Article  Google Scholar 

  • Lindgren, H.: Decision support in dementia care—developing systems for interactive reasoning. Thesis, Computer Science, Umeå University, UMINF, 07.02 (2007). http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1138. Accessed 26 Nov 2009

  • Lindgren H.: Decision support system supporting clinical reasoning process—an evaluation study in dementia care. Stud. Health Technol. Inf. 136, 315–320 (2008a)

    Google Scholar 

  • Lindgren, H.: Collaborative knowledge building for decision-support system development. In: Forbig, P, Paternó, F, Mark Pejtersen, A. (eds.) Human–Computer Interaction Symposium (HCIS2008). IFIP 272, pp. 201–206. Springer, Boston (2008b)

  • Lindgren, H.: Conceptual model of activity as tool for developing a dementia care support system. In: Ackerman, M., Dieng-Kuntz, R., Simone, C., Wulf, V. (eds.) Knowledge Management in Action (KMIA2008). IFIP 270, pp. 97–109, Springer, Boston (2008c)

  • Lindgren, H.: Towards using argumentation schemes and critical questions for supporting diagnostic reasoning in the dementia domain. In: Proc. Computational Models of Natural Arguments (CMNA’09), Pasadena, CA, pp. 10–14 (2009)

  • Lindgren H., Eklund P.: Differential diagnosis of dementia in an argumentation framework. J. Intell. Fuzzy Syst. 17(4), 387–394 (2006)

    MATH  Google Scholar 

  • Lindgren, H., Winnberg, P.: Evaluation of a semantic web application for collaborative knowledge building in the dementia domain. In: Proc. e-Health 2010—3rd International ICST Conference on Electronic Healthcare for the 21st Century, Casablanca, Morocco. Publisher: LNICST (2010a). ISBN: 978-963-9995-27-7

  • Lindgren, H., Winnberg, P.: A model for interaction design of personalised knowledge systems in the health domain. In: Proc. 5th International Workshop on Personalisation for e-Health 2010, Casablanca, Morocco (2010b) (to appear)

  • Lucas P.: Symbolic diagnosis and its formalisation. Knowl. Eng. Rev. 12(2), 109–146 (1997)

    Article  MathSciNet  Google Scholar 

  • McKeith I.G. et al.: Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65(12), 1863–1872 (2005)

    Article  Google Scholar 

  • Neary D., Snowden J.S., Gustafson L., Passant U., Stuss D., Black S., Freedman M., Kertesz A., Robert P.H., Albert M., Boone K., Miller B.L., Cummings J., Benson D.F.: Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 51, 1546–1554 (1998)

    Google Scholar 

  • Nieves, J.C., Osorio, M., Cortés, U.: Modality-based argumentation using possibilistic stable models. In: Computational Models of Natural Argument (CMNA’07), Hyderabad, India, pp. 35–41 (2007)

  • Norman D.A.: Human-centered design considered harmful. Interactions 12(4), 14–19 (2005)

    Article  MathSciNet  Google Scholar 

  • Ólafsdóttir M., Marcusson J., Skoog I.: Mental disorders among elderly people in primary care: the linköping study. Acta Psychiat. Scand. 104, 12–18 (2001)

    Article  Google Scholar 

  • Patel V.L., Kushniruk A.W., Yang S., Yale J.F.: Impact of a computerized patient record system of medical data collection, organization and reasoning. J. Am. Med. Inform. Assoc. 7, 569–585 (2000)

    Article  Google Scholar 

  • Patel V.L., Arocha J.F., Diermeier M., How J., Mottur-Pilson C.: Cognitive psychological studies of representation and use of clinical practice guidelines. Int. J. Med. Inform. 63, 147–167 (2001)

    Article  Google Scholar 

  • Patel V., Kaufman D., Arocha J.: Emerging paradigms of cognition in medical decision-making. J. Biomed. Inform. 35, 52–75 (2002)

    Article  Google Scholar 

  • Petersen R.C., Stevens J.C., Ganguli M., Tangalos E.G., Cummings J.L., DeKosky S.T.: Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 56, 1133–1142 (2001)

    Google Scholar 

  • Reisberg B.: Functional assessment staging (FAST). Psychopharmacol. Bull. 24, 653–659 (1988)

    Google Scholar 

  • Reisberg B., Auer S.R., Monteiro I.M.: Behavioural pathology in Alzheimer’s Disease (BEHAVE-AD) rating scale. Int. Psychogeriatr. 8, 301–308 (1996)

    Article  Google Scholar 

  • Shortliffe E., Buchanan B.: A model of inexact reasoning in medicine. Math. Biosci. 23, 351–379 (1975)

    Article  MathSciNet  Google Scholar 

  • Singh G., Hawkins L., Whymark G.: An integrated model of collaborative knowledge building. Interdiscipl. J. Learn. Objects 3, 85–105 (2007)

    Google Scholar 

  • Tudor R.S., Hovorka R., Cavan D.A., Meeking D., Hejlesen O.K., Andreassen S.: DIAS-NIDDM—a model-based decision support system for insulin dose adjustment in insulin treated subjects with NIDDM. Comput. Methods and Programs Biomed. 56, 175–192 (1998)

    Article  Google Scholar 

  • van Bemmel J., Musen M.: Handbook of Medical Informatics. Springer Verlag, New York (1999)

    Google Scholar 

  • Vygotsky L.: Mind in Society: The development Of Higher Psychological Processes. Harvard University Press, Cambridge (1978)

    Google Scholar 

  • Walton D., Reed C., Macagno F.: Argumentation Schemes. Cambridge University Press, Cambridge (2008)

    Google Scholar 

  • Wesnes K., McKeith I., Ferrara R., Emre M., Ser T.D., Spano P., Cicin-Sain A., Anand R., Spiegel R.: Effects of rivastigmine on cognitive function in dementia with Lewy bodies: A randomised placebo-controlled international study using the Cognitive Drug Research computerised assessment system. Dement. Geriatr. Cogn. Disord. 13(3), 183–192 (2002)

    Article  Google Scholar 

  • World Health Organisation (WHO): International classification of functioning, ability and health: ICF (2001). http://www.who.int/classifications/icf/en/. Accessed 26 Nov 2009

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  1. Department of Computing Science, Umeå University, 90187, Umeå, Sweden

    Helena Lindgren

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  1. Helena Lindgren
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Lindgren, H. Towards personalized decision support in the dementia domain based on clinical practice guidelines. User Model User-Adap Inter 21, 377–406 (2011). https://doi.org/10.1007/s11257-010-9090-4

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