AMIA Annu Symp Proc - First-order logic theory for manipulating clinical practice guidelines applied to comorbid patients: a case study.

Tópicos

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Resumo

Clinical practice guidelines (CPGs) implement evidence-based medicine designed to help generate a therapy for a patient suffering from a single disease. When applied to a comorbid patient, the concurrent combination of treatment steps from multiple CPGs is susceptible to adverse interactions in the resulting combined therapy (i.e., a therapy established according to all considered CPGs). This inability to concurrently apply CPGs has been shown to be one of the key shortcomings of CPG uptake in a clinical setting1. Several research efforts are underway to address this issue such as the K4CARE2 and GuideLine INteraction Detection Assistant (GLINDA)3 projects and our previous research on applying constraint logic programming to developing a consistent combined therapy for a comorbid patient4. However, there is no generalized framework for mitigation that effectively captures general characteristics of the problem while handling nuances such as time and ordering requirements imposed by specific CPGs. In this paper we propose a first-order logic-based (FOL) approach for developing a generalized framework of mitigation. This approach uses a meta-algorithm and entailment properties to mitigate (i.e., identify and address) adverse interactions introduced by concurrently applied CPGs. We use an illustrative case study of a patient suffering from type 2 diabetes being treated for an onset of severe rheumatoid arthritis to show the expressiveness and robustness of our proposed FOL-based approach, and we discuss its appropriateness as the basis for the generalized theory.

Resumo Limpo

clinic practic guidelin cpgs implement evidencebas medicin design help generat therapi patient suffer singl diseas appli comorbid patient concurr combin treatment step multipl cpgs suscept advers interact result combin therapi ie therapi establish accord consid cpgs inabl concurr appli cpgs shown one key shortcom cpg uptak clinic set sever research effort underway address issu kcare guidelin interact detect assist glinda project previous research appli constraint logic program develop consist combin therapi comorbid patient howev general framework mitig effect captur general characterist problem handl nuanc time order requir impos specif cpgs paper propos firstord logicbas fol approach develop general framework mitig approach use metaalgorithm entail properti mitig ie identifi address advers interact introduc concurr appli cpgs use illustr case studi patient suffer type diabet treat onset sever rheumatoid arthriti show express robust propos folbas approach discuss appropri basi general theori

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