**4.5 Analysis results**

Due to the particular characteristics of this domain and for comfortable knowledge management it was necessary to use KDSM which provided an appropriate structure for the clinical data. The structure consists of a matrix containing the patient data, a second matrix containing the baseline and post-ES serial measurements, and a third matrix containing the ECT features.

The 3 KDSM phases were carried out with the following results:


*Toward Optimization of Medical Therapies with a Little Help from Knowledge Management DOI: http://dx.doi.org/10.5772/intechopen.101987*

*a, bWhat is significant about this set of attributes is that, from the specialist's point of view, they can be modified to directly influence ECT performance.*

### **Table 8.**

*As a result of the KP phase, this table shows an array of Box plots corresponding to those attributes that are relevant to the study that the specialist is carrying out.*

reaction times and great variability of response to treatment. On the other hand, the other three classes showed a more homogeneous response throughout the treatment period and a relevant level of improvement.

3.Knowledge Production (KP): The attributes of the *Z* matrix were projected onto the six-class partition obtained in the previous phase and some valuable attributes were identified. Some of them show differences between *young* and *mature patients*. Others between those that improve or deteriorate the patients' condition. Clearly, the last group is the most crucial for the expert, as it is possible to identify a set of factors associated with the fact that an ES improves the patients' condition. This result reveals the need for further studies on ECT, since, if these attribute trends are confirmed, the efficacy of ECT could be dramatically improved.

## **4.6 Conclusions from analysis results**

The results of the previous analysis highlight some attributes of interest to the specialist in the field, in particular the reaction time of patients undergoing electroconvulsive therapy, at very specific time points and where the measurements constitute blocks relative to each patient. It should be emphasized that KDSM allows the management of patient knowledge from very short and repeated serial measurements, especially because it makes special management of management due to the presence of the blocking factor. In this respect, some interesting conclusions can be drawn:


From the psychiatric perspective, the observations on the form of the data and the use of KDSM were corroborated, especially in the management of ECT measures, provided very satisfactory results from the point of view of the field in question. It has been shown that the behavioral curves of RT in each patient are neither inherent to the patient nor to the global observation of the whole therapy. On the contrary, all patients may react differently in each *ES* session. In fact, in many studies psychiatrists, even today, continue to treat ECT (the set of all *ES* applied to the same patient during the entire treatment period) as a single entity. Therefore, they analyze the effect of the whole therapy globally, i.e. they look at the situation of the baseline patient and how the patient completes the whole therapy [15]. It is worth emphasizing, again, that the management of serial measures, under these ISD circumstances, through a summary of measures implies the loss of too much information, hiding relevant situations, which affects the patient, as he/she reacts differently after each *ES* session. To demonstrate this, **Table 9** has been constructed that illustrates how, for the same patient, the effect on RT after the application of an *ES* is often different and does not even follow a specific order. This result is very relevant because it indicates that after an *ES* session the patient's condition improves or worsens, and this change does not depend only on the patient. *ES* can change the effect on the same patient throughout ECT.

With regard to the current state of the study, the psychiatrist specializing in the ECT domain, taking into account these results, works on the identification and analysis of possible causes external or internal to the patient that may or may not be present in each *ES* session. Thus, the knowledge acquired through KDSM is added to that of the specialist and immediately modifies the way in which the specialist obtains his or her interpretations of results in order to tackle this domain.

*Toward Optimization of Medical Therapies with a Little Help from Knowledge Management DOI: http://dx.doi.org/10.5772/intechopen.101987*


*b Classes 1 to 6 resulting from the EEA phase.*

### **Table 9.**

*Sample table to demonstrate the relationship between a patient and the effect on RT of class-specific ES.*

Today, there is still no standardized practice for dealing with ISD of the kind presented in this chapter.

The direct contributions of KDSM in knowledge management for this particular psychiatric domain can be summarized in that it allows medical praxis to reconsider how to study the effects of each *ES* applied throughout ECT, as these are not monotonic. It also highlights the risk of frequent use of measure summaries, as they directly affect the communication of treatment efficacy.

## **5. Discussion**

The communication of case study results of knowledge management in Informally Structured Domains is a task that is more than a must, it is very fascinating. In this chapter, the way in which situations such as those presented in the section Knowledge Management in Informal Structure Domains were dealt with was shared. For, although management through *KDSM* is straightforward, analyzing very short and repeated serial measurements, at specific times, of an attribute of interest in these domains is not as simple as it seems.

Knowledge management of an *ISD* through *KDSM* yields the following results, it:


*KDSM*—which has never been considered before; it emphasizes that traditional management of serial measurements summarizes too much information and as a consequence loses sight of the fact that the attributes of each individual from which the measurements are derived exert an influence on the measurements after each event;


Finally, the use of *KDSM* in the medical domain has made some valuable contributions; for example, for the psychiatric field at the level of medical praxis, it reconsiders how to study the effects of each *ES* of the *ECT*, as they are not monotonous.
