title: Assisted knowledge discovery for the maintenance of clinical guidelines.
abstract: BACKGROUND
  Improving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used.
  
  
  OBJECTIVE
  We present the design and the evaluation of a tool (KART) that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques.
  
  
  METHODS
  KART consists of three main modules 1) a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2) a module to normalize clinical recommendations based on automatic text categorizers; and 3) a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough.
  
  
  RESULTS
  KART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users.
  
  
  CONCLUSIONS
  We have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building.
authors: Division of Medical Information Sciences, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland. emilie.pasche@unige.ch
authors: Emilie
authors: E
authors: Pasche
authors: Patrick
authors: P
authors: Ruch
authors: Douglas
authors: D
authors: Teodoro
authors: Angela
authors: A
authors: Huttner
authors: Stephan
authors: S
authors: Harbarth
authors: Julien
authors: J
authors: Gobeill
authors: Rolf
authors: R
authors: Wipfli
authors: Christian
authors: C
authors: Lovis
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000592:standards; D019317:Evidence-Based Medicine / Q000193:education / Q000592:standards; D006801:Humans; D020407:Internet; D017410:Practice Guidelines as Topic / Q000592:standards; D057386:Search Engine; D012984:Software
chemical_list: D000900:Anti-Bacterial Agents
references: J Biomed Inform. 2010 Dec;43(6):962-71
references: 20670693
references: Stud Health Technol Inform. 2009;150:569-73
references: 19745375
references: AMIA Annu Symp Proc. 2009 Nov 14;2009:537-41
references: 20351913
references: Intern Med J. 2012 Oct;42(10):1145-9
references: 22472087
references: J Am Med Inform Assoc. 2005 May-Jun;12(3):315-21
references: 15684126
references: Eur J Clin Microbiol Infect Dis. 2007 Apr;26(4):277-80
references: 17342461
references: Int J Med Inform. 2005 Aug;74(7-8):553-62
references: 16043084
references: Stud Health Technol Inform. 2004;101:172-6
references: 15537223
references: West J Med. 1999 Jun;170(6):348-51
references: 18751155
references: Stud Health Technol Inform. 2011;169:185-9
references: 21893739
references: Comput Biol Med. 2007 Oct;37(10):1511-21
references: 17374369
references: J Am Med Inform Assoc. 1998 Jul-Aug;5(4):357-72
references: 9670133
references: BMC Fam Pract. 2011 Sep 22;12:98
references: 21939542
references: J Biomed Inform. 2011 Apr;44(2):277-88
references: 21256977
references: BMC Med Inform Decis Mak. 2008 Oct 27;8 Suppl 1:S6
references: 19007443
references: Comput Methods Programs Biomed. 2010 Jul;99(1):1-24
references: 19913938
references: AMIA Annu Symp Proc. 2009 Nov 14;2009:509-13
references: 20351908
references: Proc AMIA Symp. 2000;:645-9
references: 11079963
references: Arch Pediatr. 2012 Jun;19(6):579-84
references: 22555072
references: Methods Inf Med. 2004;43(4):413-26
references: 15472756
references: Stud Health Technol Inform. 2011;169:477-81
references: 21893795
references: Brief Bioinform. 2005 Dec;6(4):344-56
references: 16420733
references: J Med Internet Res. 2012 May 29;14(3):e73
references: 22642960
references: J Hosp Infect. 2009 Feb;71(2):108-11
references: 19062133
references: Hum Genomics. 2012 Sep 01;6:17
references: 23244628
references: Stud Health Technol Inform. 2005;116:779-84
references: 16160353
references: West J Med. 2000 May;172(5):315-9
references: 18751285
references: Evid Based Med. 2013 Jun;18(3):93-7
references: 23048189
references: J Clin Monit Comput. 2008 Jun;22(3):189-98
references: 18463794
references: AMIA Annu Symp Proc. 2005;:276-80
references: 16779045
references: Bull Med Libr Assoc. 1994 Apr;82(2):140-6
references: 7772099
references: J Biomed Semantics. 2011 Oct 06;2 Suppl 5:S4
references: 22166723
references: Swiss Med Wkly. 2004 Aug 21;134(33-34):481-5
references: 15517500
references: Stud Health Technol Inform. 2009;148:50-9
references: 19745235
references: N Engl J Med. 2003 Jun 26;348(26):2635-45
references: 12826639
references: Stud Health Technol Inform. 2009;150:175-9
references: 19745292