No abstract

The rationalization of the healthcare processes and organizations is a task of fundamental importance to grant both the quality and the standardization of healthcare services, and the minimization of costs. Clinical Practice Guidelines (CPGs) are one of the major tools that have been introduced to achieve such a challenging task. CPGs are widely used to provide decision support to physicians, supplying them with evidence-based predictive and prescriptive information about patients' status and treatments, but usually on individual pathologies. This sets up the urgent need for developing decision support methodologies to assist physicians and healthcare managers in the detection of interactions between guidelines, to help them to devise appropriate patterns of treatment for comorbid patients (i.e., patients affected by multiple diseases). We identify different levels of abstractions in the analysis of interactions, based on both the hierarchical organization of clinical guidelines (in which composite actions are refined into their components) and the hierarchy of drug categories. We then propose a general methodology (data/knowledge structures and reasoning algorithms operating on them) supporting user-driven and flexible interaction detection over the multiple levels of abstraction. Finally, we discuss the impact of the adoption of computerized clinical guidelines in general, and of our methodology in particular, for patients (quality of the received healthcare services), physicians (decision support and quality of provided services), and healthcare managers and organizations (quality and optimization of provided services).

We propose an innovative approach to the detection and analysis of interactions between CPGs considering different sources of temporal information (CPGs, ontological knowledge and execution logs), which is the first one in the literature that takes into account the temporal issues, and accounts for different application scenarios.

Temporal representation and temporal reasoning is a central in Artificial Intelligence. The literature is moving to the treatment of "non-crisp" temporal constraints, in which also preferences or probabilities are considered. However, most approaches only support numeric preferences, while, in many domain applications, users naturally operate on "layered" scales of values (e.g., Low, Medium, High), which are domain-and task-dependent. For many tasks, including decision support, the evaluation of the minimal network of the constraints (i.e., the tightest constraints) is of primary importance. We propose the first approach in the literature coping with layered preferences on quantitative temporal constraints. We extend the widely used simple temporal problem (STP) framework to consider layered user-defined preferences, proposing (i) a formal representation of quantitative constraints with layered preferences, and (ii) a temporal reasoning algorithm, based on the general algorithm Compute-Summaries, for the propagation of such temporal constraints. We also prove that our temporal reasoning algorithm evaluates the minimal network.

Exposure to SO2 and CO seems to postpone delivery: a longer gestation could compensate for maternal hypoxemic-hypoxic damage.