Department of Surgery, Campus Innenstadt, Ludwig-Maximilians University, Nußbaumstr. 20, 80336, Munich, Germany.
Langenbecks Arch Surg. 2011 Jan;396(1):31-40. doi: 10.1007/s00423-010-0713-3. Epub 2010 Nov 2.
Clinical algorithms contribute to the problem- and priority-orientated management of patients and their disease in healthcare. Algorithms are of particular importance in all aspects of emergency medicine where the fast completion of a complex problem according to a hierarchy is required. The advantages and success of this priority- and problem-orientated concept led to its expansion to other subspecialties in medicine in recent years. However, in spite of algorithms being created based on defined norms, they are frequently violated in the literature, which renders the algorithm useless in a particular case.
The present debate addresses these issues and provides the formal criteria and their necessary modification for creating sufficient clinical algorithms. In this context, we also clarify the misunderstandings between step-by-step schemes, decision trees, and algorithms, which are often used synonymously, and discuss their implications in clinical medicine and quality management.
A clinical algorithm can easily be created with the present derivation of the algorithm by its formal mathematical function using the corresponding norms describing specific symbols for a single criterion. Some symbol modifications as well as the usage of checklists to focus on the major criteria led to a rigorous reduction of the algorithm length and results in a clearer arrangement for routine clinical use. In clinical medicine, algorithms cannot only provide a fast access for solving complex problems but must also assure a transparent protocol and democratic treatment such that every patient receives the same quality of treatment. Thus, a treatment by chance can be excluded by standardization, which might impact the overall work needed to guide patients though diagnostics and therapy and may ultimately reduce cost. Algorithms are useful not only for quality in healthcare but also for undergraduate and continuous medical education. From a more philosophical point of view, we can raise the question of whether medical pathways and thereby the medical art should be disclosed to the general public by algorithms. Hippocrates form Kos held the view in the so-called Hippocratic Oath that medical art should only be revealed to medical scholars.
The present derivation and nomination of the formal requirements may lead to a better understanding of algorithms themselves as well as their development and generation.
临床算法有助于在医疗保健中对患者及其疾病进行问题导向和优先级导向的管理。算法在急诊医学的各个方面都非常重要，在这些方面需要根据层次结构快速完成复杂问题。这种优先级和问题导向概念的优势和成功促使其在近年来扩展到医学的其他亚专业。然而，尽管算法是根据既定规范创建的，但在文献中经常违反这些规范，这使得算法在特定情况下变得毫无用处。
本辩论解决了这些问题，并提供了创建足够临床算法的正式标准及其必要修改。在这方面，我们还澄清了在临床实践和质量管理中经常同义使用的逐步方案、决策树和算法之间的误解，并讨论了它们的含义。
通过使用描述特定标准的相应符号的正式数学函数，可以很容易地使用现有的算法推导来创建临床算法。对一些符号进行修改，并使用清单来关注主要标准，可以严格缩短算法的长度，并使常规临床使用的安排更加清晰。在临床医学中，算法不仅可以提供解决复杂问题的快速途径，还必须确保透明的协议和民主的治疗，以便每个患者都能获得相同的治疗质量。因此，可以通过标准化排除偶然治疗，这可能会影响指导患者进行诊断和治疗所需的整体工作，并最终降低成本。算法不仅对医疗保健质量有用，而且对本科和继续医学教育也有用。从更哲学的角度来看，我们可以提出这样一个问题，即是否应该通过算法向公众公开医学途径，从而公开医学艺术。来自科斯的希波克拉底在所谓的希波克拉底誓言中认为，医学艺术只应向医学学者揭示。
目前对形式要求的推导和命名可能会导致对算法本身及其开发和生成的更好理解。
