ST-Modeler: Um Ambiente para Desenvolvimento e Verificação de Guias de Conduta Médica
Resumo
Um guia de conduta médica é um documento formado por recomendações sistematicamente desenvolvidas para auxiliar nas decisões de praticantes e pacientes sobre cuidados de saúde em circunstâncias específicas. Desde que bem elaborados, comprovadamente melhoram a qualidade média do atendimento médico. Frequentemente guias escritos em papel não são práticos para uso no local da assistência. Implementados em sistemas computacionais podem ser eficientemente usados e testados. Este trabalho está ligado ao projeto ST-Guide e apresenta o ambiente gráfico de desenvolvimento e verificação de guias do projeto. A formalização de um guia para assistência pré-natal com a ferramenta também é mostrado.
Referências
M.J. Field and K.N. Lohr. Guidelines for clinical practice: from development to use. Washington, DC: Institute of Medicine, National Academy Press, 1992.
J.M. Grimshaw and I.I. Russell. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet, 342(8883):1317–22, 1993.
L.H. Thomas, E. Mccoll, N. Cullum, N. Rousseau, and Soutter J. Clinical guidelines in nursing, midwifery and the therapies: a systematic review. Journal of Advanced Nursing, 30(1):40–50, 1999.
S.H. Woolf, R. Grol, A. Hutchinson, M. Eccles, and J. Grimshaw. Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. BMJ, 318:527–530, 1997.
A. Audet, S. Greenfield, and M. Field. Medical practice guidelines: current activities and future directions. Ann Intern Med, 113(9):709–14, 1990.
M.C. Vissers, A. Hasman, and C.J. Linden. Impact of a protocol processing system (protoview) on clinical behaviour of residents and treatment. Int J Biomed Comput, 42:143–50, 1996.
A. Hibble, D. Kanka, D. Pencheon, and F. Pooles. Guidelines in general practice: the new tower of babel? BMJ, 317(7162):862–3, 1998.
K. Kawamoto, C.A. Houlihan, E.A. Balas, and D.F. Lobach. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ, 330(7494):765, 2005.
J. Wainer, C. Billa, M.P. Dantas, A.M. Monteiro, and D. Sigulem. St-guide: A framework for the implementation of automatic clinical guidelines. SAC ’08: Proceedings of the 2008 ACM symposium on Applied computing, pages 1325–1332, 2008.
C.A. Alencar Jr. Assistência pré-natal. Projeto Diretrizes, Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, Associação Médica Brasileira e Conselho Federal de Medicina, 2001.
R. Grol, J. Dahluijsen, S. Thomas, C. Veld, G. Rutten, and H. Mokkink. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ, 317(7162):858–61, 1998.
R.N. Shiffman and R.A. Greenes. Improving clinical guidelines with logic and decision-table techniques. Medical Decision Making, 14(3):245–1101, 1994.
R.N. Shiffman. Representation of clinical practice guidelines in conventional and augmented decision tables. Journal of the American Medical Informatics Association, 4:382–393, 1997.
G. Duftschmid and S. Miksch. Knowledge-based verification of clinical guidelines by detection of anomalies. Artificial Intelligence in Medicine, 22(1):23–41, 2001.
S. Miksch, Y. Shahar, and P. Johnson. Asbru: A task-specific, intention-based, and time-oriented language for representing skeletal plans. Proceedings of the 7th Workshop on Knowledge Engineering: Methods and Languages (KEML-97), Milton Keynes, UK, 1997.
G. Duftschmid, S. Miksch, and W. Gall. Verification of temporal scheduling constraints in clinical practice guidelines. Artificial Intelligence in Medicine, 25(2):93–121, 2002.
A. ten Teije, M. Marcos, M. Balser, J. van Croonenborg, C. Duelli, F. van Harmelen, P.J.F. Lucas, S. Miksch, W. Reif, K. Rosenbrand, and A. Seyfang. Improving medical protocols by formal methods. Artificial Intelligence in Medicine, 36(3):193–209, 2006.
M. Balser, W. Reif, G. Schellhorn, K. Stenzel, and A. Thums. Formal system development with kiv. In T.Maibaum, editor, Fundamental Approaches to Software Engineering, 1783 of LNCS:219–233, 2000.
S. Bäumler, M. Balser, A. Dunets, W. Reif, and J. Schmitt. Verification of medical guidelines by model checking: a case study. Proceedings of 13th International SPIN Workshop on Model Checking of Software, 3925 of LNCS:219–233, 2006.
K.L. McMillan. Symbolic Model Checking: An Approach to the State Explosion Problem. Kluwer Academic, 1993.
J. Delgrande and T. Schaub. A consistency-based approach for belief change. Artificial Intelligence Journal, 151(1-2):1–41, 2003.
M. Versiani. Diagnóstico e tratamento de transtornos de ansiedade. Projeto Diretrizes, Associação Brasileira de Psiquiatria, Associação Médica Brasileira e Conselho Federal de Medicina, 2001.
American Academy of Pediatrics, Provisional Committee for Quality Improvement, and Subcommitte on Hyperbilirubinemia. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Pediatrics, 94(4):558–565, 1994.
Newcastle Guideline Development, Research Unit in collaboration with British Hypertension Society, and the National Collaborating Centre for Chronic Conditions. Hypertension: management of hypertension in adults in primary care. NICE clinical guideline, 34, 2006.
J.M. Grimshaw and I.I. Russell. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet, 342(8883):1317–22, 1993.
L.H. Thomas, E. Mccoll, N. Cullum, N. Rousseau, and Soutter J. Clinical guidelines in nursing, midwifery and the therapies: a systematic review. Journal of Advanced Nursing, 30(1):40–50, 1999.
S.H. Woolf, R. Grol, A. Hutchinson, M. Eccles, and J. Grimshaw. Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. BMJ, 318:527–530, 1997.
A. Audet, S. Greenfield, and M. Field. Medical practice guidelines: current activities and future directions. Ann Intern Med, 113(9):709–14, 1990.
M.C. Vissers, A. Hasman, and C.J. Linden. Impact of a protocol processing system (protoview) on clinical behaviour of residents and treatment. Int J Biomed Comput, 42:143–50, 1996.
A. Hibble, D. Kanka, D. Pencheon, and F. Pooles. Guidelines in general practice: the new tower of babel? BMJ, 317(7162):862–3, 1998.
K. Kawamoto, C.A. Houlihan, E.A. Balas, and D.F. Lobach. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ, 330(7494):765, 2005.
J. Wainer, C. Billa, M.P. Dantas, A.M. Monteiro, and D. Sigulem. St-guide: A framework for the implementation of automatic clinical guidelines. SAC ’08: Proceedings of the 2008 ACM symposium on Applied computing, pages 1325–1332, 2008.
C.A. Alencar Jr. Assistência pré-natal. Projeto Diretrizes, Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, Associação Médica Brasileira e Conselho Federal de Medicina, 2001.
R. Grol, J. Dahluijsen, S. Thomas, C. Veld, G. Rutten, and H. Mokkink. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ, 317(7162):858–61, 1998.
R.N. Shiffman and R.A. Greenes. Improving clinical guidelines with logic and decision-table techniques. Medical Decision Making, 14(3):245–1101, 1994.
R.N. Shiffman. Representation of clinical practice guidelines in conventional and augmented decision tables. Journal of the American Medical Informatics Association, 4:382–393, 1997.
G. Duftschmid and S. Miksch. Knowledge-based verification of clinical guidelines by detection of anomalies. Artificial Intelligence in Medicine, 22(1):23–41, 2001.
S. Miksch, Y. Shahar, and P. Johnson. Asbru: A task-specific, intention-based, and time-oriented language for representing skeletal plans. Proceedings of the 7th Workshop on Knowledge Engineering: Methods and Languages (KEML-97), Milton Keynes, UK, 1997.
G. Duftschmid, S. Miksch, and W. Gall. Verification of temporal scheduling constraints in clinical practice guidelines. Artificial Intelligence in Medicine, 25(2):93–121, 2002.
A. ten Teije, M. Marcos, M. Balser, J. van Croonenborg, C. Duelli, F. van Harmelen, P.J.F. Lucas, S. Miksch, W. Reif, K. Rosenbrand, and A. Seyfang. Improving medical protocols by formal methods. Artificial Intelligence in Medicine, 36(3):193–209, 2006.
M. Balser, W. Reif, G. Schellhorn, K. Stenzel, and A. Thums. Formal system development with kiv. In T.Maibaum, editor, Fundamental Approaches to Software Engineering, 1783 of LNCS:219–233, 2000.
S. Bäumler, M. Balser, A. Dunets, W. Reif, and J. Schmitt. Verification of medical guidelines by model checking: a case study. Proceedings of 13th International SPIN Workshop on Model Checking of Software, 3925 of LNCS:219–233, 2006.
K.L. McMillan. Symbolic Model Checking: An Approach to the State Explosion Problem. Kluwer Academic, 1993.
J. Delgrande and T. Schaub. A consistency-based approach for belief change. Artificial Intelligence Journal, 151(1-2):1–41, 2003.
M. Versiani. Diagnóstico e tratamento de transtornos de ansiedade. Projeto Diretrizes, Associação Brasileira de Psiquiatria, Associação Médica Brasileira e Conselho Federal de Medicina, 2001.
American Academy of Pediatrics, Provisional Committee for Quality Improvement, and Subcommitte on Hyperbilirubinemia. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Pediatrics, 94(4):558–565, 1994.
Newcastle Guideline Development, Research Unit in collaboration with British Hypertension Society, and the National Collaborating Centre for Chronic Conditions. Hypertension: management of hypertension in adults in primary care. NICE clinical guideline, 34, 2006.
Publicado
12/07/2008
Como Citar
DANTAS, Márcio Paixão; WAINER, Jacques.
ST-Modeler: Um Ambiente para Desenvolvimento e Verificação de Guias de Conduta Médica. In: SIMPÓSIO BRASILEIRO DE COMPUTAÇÃO APLICADA À SAÚDE (SBCAS), 8. , 2008, Belém/PA.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2008
.
p. 151-162.
ISSN 2763-8952.
