A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Using secondary knowledge to support decision tree classification of retrospective clinical data

Retrospective clinical data presents many challenges for data mining and machine learning. The transcription of patient records from paper charts and subsequent manipulation of data often results in high volumes of noise as well as a loss of other important information. In addition, such datasets often fail to represent expert medical knowledge and reasoning in any explicit manner. In this research we describe applying data mining methods to retrospective clinical data to build a prediction model for asthma exacerbation severity for pediatric patients in the emergency department. Difficulties in building such a model forced us to investigate alternative strategies for analyzing and processing retrospective data. This paper describes this process together with an approach to mining retrospective clinical data by incorporating formalized external expert knowledge (secondary knowledge sources) into the classification task. This knowledge is used to partition the data into a number of coherent sets, where each set is explicitly described in terms of the secondary knowledge source. Instances from each set are then classified in a manner appropriate for the characteristics of the particular set. We present our methodology and outline a set of experiential results that demonstrate some advantages and some limitations of our approach. © 2008 Springer-Verlag Berlin Heidelberg.

A tree-based decision model to support prediction of the severity of asthma exacerbations in children

This paper describes the development of a tree-based decision model to predict the severity of pediatric asthma exacerbations in the emergency department (ED) at 2 h following triage. The model was constructed from retrospective patient data abstracted from the ED charts. The original data was preprocessed to eliminate questionable patient records and to normalize values of age-dependent clinical attributes. The model uses attributes routinely collected in the ED and provides predictions even for incomplete observations. Its performance was verified on independent validating data (split-sample validation) where it demonstrated AUC (area under ROC curve) of 0.83, sensitivity of 84%, specificity of 71% and the Brier score of 0.18. The model is intended to supplement an asthma clinical practice guideline, however, it can be also used as a stand-alone decision tool.

Marketing responsibility in an era of economic and climatic challenge

Purpose – The purpose of this paper is to illustrate Michael Thomas's concept of civic professionalism and social trusteeship as a future alternative to the current marketing profession's code of conduct and to put this in the context of climate change and ecological sustainability as a model for firms everywhere. Design/methodology/approach – Review of the marketing profession's responsibility towards society, communities and the ecology of the planet in the twenty-first century in the light of climate change. Findings – The hypothesis for the paper emerges as: whether it is possible for Chinese firms to embrace the needs of twenty-first century global ecological sustainability in meeting their own economic requirements for development and financial prosperity. Research limitations/implications – Limited secondary research and primary research that is also limited in terms of scope. Practical implications – As we move into an era of Chinese economic supremacy, we marketers must face up to the responsibility we have towards balancing the progression of global economic development (and selling goods and services in global market systems) with our responsibility towards our cultural systems and the global ecological system (the global ecosystem), the home of all our economic wealth. Social implications – To extrapolate lessons and opportunities for firms from developing economies as they move towards global domination of world economic markets and, suggest strategies for sustainability that they can, and should, adopt. Originality/value – The paper presents a theoretical framework for a global strategy for sustainability, and provides a vision of marketing responsibility that embraces civic professionalism, social trusteeship and a strategy for sustainability.