| Abstract | Decision support systems (DSS) assist caregivers to make decisions that can
lead to positive health outcomes. In order to build a DSS that will be acceptable
to clinicians in their practice, it is imperative that the knowledge engineer
identifies, defines, and describes a clinical problem precisely. This precision
facilitates effective communication when modeling decisions. Clinical problems
can be subjectively identified, defined, and described by clinicians in the
practice setting and objectively defined by clinicians reviewing the scientific
literature. The present study demonstrates a method for examining the
scientific literature in a systematic way to define and delineate boundaries for
clinical problems. An instrument that extracts definitions of terminology from
the literature surrounding the concept of oral feeding in premature infants in a
neonatal intensive care unit (NICU) is presented. Premature infants are defined
as neonates regardless of birth weight, born before 37 weeks of gestation [1].
Initially, a sample of health care sources that include the relevant terminology
surrounding the concept of oral feeding in premature infants in the NICU were
systematically identified. Non-random sampling was used to choose sources
judged to be typical of the literature. Three published lists of books and journals
compiled by health science librarians [2,3,4] and four electronic databases of
key indices in the health sciences were searched. Next, a list of readings,
recommended to prospective examinees in preparation for certification, was
obtained from the board certification agencies of pediatric nurse practitioners
and neonatal nurse practitioners, respectively. After redundancy between lists
was corrected and the reference list was assessed for content validity a
non-random sample size of 43 sources was obtained. Next, a source rating
form was designed to systematically assist in the selection of appropriate
sources from the reference list. The development of this form was guided by a
review of previously used instruments for data extraction from the literature
aimed at defining nursing interventions [5]. Scoring criteria were based on
comprehensiveness and specificity. Subsequently, a coding system was
developed to extract the data from each source with a score of 2 or above.
Finally, a pilot study was conducted after stratified random sampling. The
results indicated the need for an additional step in the systematic search for
each premature infant feeding term. For example, the definition of nipple feeding
may be indexed under bottle feeding or feeding, bottle or feeding, nipple. A
template form was designed to address this problem. After completion of the
systematic scoring of each sample source, information analysis will begin. In
consultation with a methodologist, a coding system for premature infant feeding
terms will be developed and piloted. In summary, an instrument to
systematically extract data from the literature was developed to assist
researchers and practitioners to communicate effectively when building a DSS.
This novel method of information analysis can also be applied to other clinical
problems that are deemed appropriate for decision support system
development, effectively addressing an important measurement issue in
informatics research. |