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H R Warner

Publications and source records attributed to H R Warner.

At least 19 recordsLinked to original sources
PubMed1992

Performance of a diagnostic system (Iliad) as a tool for quality assurance.

Quality assurance improves health care through detection of quality problems and feedback to the care giver. Current review procedures employed by the Peer Review Organizations (PROs), however, appear to underdetect quality problems, particularly those arising from diagnostic errors. We studied the use of an expert diagnostic system, Iliad, to detect quality problems arising from diagnostic errors. One hundred cases were selected from among those Medicare cases reviewed by the Utah PRO (UPRO) and which contained diagnoses recognized by Iliad. Iliad flagged 28 cases out of the 100 as containing diagnostic errors, and a gold standard physician review confirmed quality problems in 17 cases (60.7%). The UPRO review found 28 cases with quality problems, mostly treatment and documentation errors. The quality problems detected by Iliad appeared to be more serious than those detected by the UPRO review. Among the six cases with quality problems detected by both the UPRO and the Iliad review, there was none for which the same quality problem was detected by the two procedures. The two review procedures were therefore complementary.

Adult↗
PubMed1992

Iliad's role in the generalization of learning across a medical domain.

Medical informatics could facilitate more effective analysis and use of clinical knowledge by means of expert systems. To be most effective, such systems should be constructed in a manner which is consistent with physicians' cognitive processes. Our past five years' work with a system called Iliad indicates that it provides effective medical training and education. The current research extends our previous work by using a wider array of training and test cases. We also evaluated whether training on specific cases could generalize to improved testing performance on related cases, which featured similar complaints and pathophysiologic mechanisms, but different final diagnoses. In their junior internal medicine clerkship, students (n = 100) completed 1300 Iliad training cases covering 48 diagnoses. The findings indicated improved problem solving on the specifically trained cases as well as the generalization cases. We discuss a possible training model for expert systems such as Iliad.

Computer-Assisted Instruction↗
PubMed1992

Comparison of different information content models by using two strategies: development of the best information algorithm for Iliad.

Iliad is a diagnostic expert system for internal medicine. Iliad's "best information" mode is used to determine the most cost-effective findings to pursue next at any stage of a work-up. The "best information" algorithm combines an information content calculation together with a cost factor. The calculations then provide a rank-ordering of the alternative patient findings according to cost-effectiveness. The authors evaluated five information content models under two different strategies. The first, the single-frame strategy, considers findings only within the context of each individual disease frame. The second, the across-frame strategy, considers the information that a single finding could provide across several diseases. The study found that (1) a version of Shannon's information model performed the best under both strategies---this finding confirms the result of a previous independent study, (2) the across-frame strategy was preferred over the single-frame strategy.

Algorithms↗
PubMed1991

Iliad training enhances medical students' diagnostic skills.

Iliad is a computerized, expert system for internal medical diagnosis. The system is designed to teach diagnostic skills by means of simulated patient case presentations. We report the results of a controlled trial in which junior students were randomly assigned to received Iliad training on one of two different simulated case mixes. Each group was subsequently tested in both their "trained" and "untrained" case domain. The testing consisted of computerized, simulated patient cases for which no training feedback was provided. Outcome variables were designed to measure the students' performance on these test cases. The results indicate that students made fewer diagnostic errors and more conclusively confirmed their diagnostic hypotheses when they were tested in their trained domain. We conclude that expert systems such as Iliad can effectively teach diagnostic skills by supplementing trainees' actual case experience with computerized simulations.

Clinical Clerkship↗
PubMed1991

An interlingua for electronic interchange of medical information: using frames to map between clinical vocabularies.

The proliferation of medical knowledge has led to the development of extensive dictionaries for electronically accessing information resources. The task of standardizing terminology used for electronic hospital records and for knowledge bases for medical expert systems and indexing the medical literature cannot easily be met by developing a single, monolithic "official" medical vocabulary. Developing a monolithic vocabulary would require a massive effort, and its existence would not guarantee its use by third-party payors, by practicing clinicians, or by developers of electronic medical information systems. Recognizing this, the National Library of Medicine (NLM) has begun to develop the Unified Medical Language System (UMLS) as a means of promoting electronic information exchange among systems with controlled vocabularies. The authors describe a frame-based system developed as an experimental approach to mapping between controlled clinical vocabularies.

Cluster Analysis↗
PubMed1991

Performance of a diagnostic system (Iliad) as a tool for quality assurance.

Quality Assurance improves health care through detection of quality problems and feedback to the care giver. Current review procedures employed by the Peer Review Organizations (PROs), however, appear to under-detect quality problems, particularly those arising from diagnostic errors. We studied the use of an expert diagnostic system, Iliad, to detect quality problems arising from diagnostic errors. 100 cases were selected from among those Medicare cases reviewed by the Utah PRO (UPRO) and which contained diagnoses recognized by Iliad. Iliad flagged 28 cases out of the 100 as containing diagnostic errors, and a gold standard physician review confirmed quality problems in 17 cases (60.7%). The UPRO review found 28 cases with quality problems, mostly treatment and documentation errors. The quality problems detected by Iliad appeared to be more serious than those detected by the UPRO review. Among the six cases with quality problems detected by both the UPRO and Iliad review, there was none for which the same quality problem was detected by the two procedures. The two review procedures were therefore complementary.

Diagnosis, Computer-Assisted↗
PubMed1991

Performance of a diagnostic system (Iliad) as a tool for quality assurance.

Quality Assurance improves health care through detection of quality problems and feedback to the care giver. Current review procedures employed by the Peer Review Organizations (PROs), however, appear to underdetect quality problems, particularly those arising from diagnostic errors. We studied the use of an expert diagnostic system, Iliad, to detect quality problems arising from diagnostic errors. 100 cases were selected from among those Medicare cases reviewed by the Utah PRO (UPRO) and which contained diagnoses recognized by Iliad. Iliad flagged 28 cases out of the 100 as containing diagnostic errors, and a gold standard physician review confirmed quality problems in 17 cases (60.7%). The UPRO review found 28 cases with quality problems, mostly treatment and documentation errors. The quality problems detected by Iliad appeared to be more serious than those detected by the UPRO review. Among the six cases with quality problems detected by both the UPRO and Iliad review, there was none for which the same quality problem was detected by the two procedures. The two review procedures were therefore complementary.

Diagnosis, Computer-Assisted↗
PubMed1991

Exploring a new best information algorithm for Iliad.

Iliad is a diagnostic expert system for internal medicine. One important feature that Iliad offers is the ability to analyze a particular patient case and to determine the most cost-effective method for pursuing the work-up. Iliad's current "best information" algorithm has not been previously validated and compared to other potential algorithms. Therefore, this paper presents a comparison of four new algorithms to the current algorithm. The basis for this comparison was eighteen "vignette" cases derived from real patient cases from the University of Utah Medical Center. The results indicated that the current algorithm can be significantly improved. More promising algorithms are suggested for future investigation.

Algorithms↗
PubMed1989

Does genotypic sex have a direct effect on longevity?

Females of the human species live longer than males, and the longevity differential is probably not entirely explained by reasons which are presently obvious. Genotypic sex has long been suspected to affect longevity to the advantage of the female. Several recent findings about the X and Y chromosomes must be reckoned with in considering determinants of longevity which derive from genotypic sex. The advantages of having two X chromosomes are apparent, notwithstanding X-chromosome inactivation. Not only can some cells compensate for biosynthetic deficiencies of others, but also cell selection according to which X chromosome is active can occur during development according to cell viability and proliferative capacity. It has recently been observed that at least some genes on inactive X chromosomes are reactivated late in life. Details of the reactivation process must be studied to determine its significance and the effects of the process on late life survival. The recent mapping of the catalytic polypeptide of DNA-polymerase-alpha to the X chromosome calls attention to a new property of the genotype which could affect the basic ability of cells to proliferate. It is likely that this enzyme, perhaps in concert with DNA-polymerase-delta, is required for DNA replication, suggesting that two alleles for this enzyme and cell selection within the female phenotypic mosaic for DNA replication may provide a sex-linked determinant of cell proliferation which could be advantageous in late life. Much remains to be learned about the Y chromosome, although there are early results consistent with a determinant of longevity on that chromosome which operates to the male disadvantage and probably does not involve sex hormones. The genotype may be a significant determinant of longevity in humans even if it does not appear to be so in non-human animals, because causes of death are different. Determinants of longevity are based on susceptibility or vulnerability to the causes and diseases of mortality, and these differ in different species.

Female↗
PubMed1989

Involvement of DNA repair in cancer and aging.

The theory of aging which proposes that DNA repair capacity declines with age and/or DNA damage accumulates with age, resulting in increasingly aberrant gene expression, is attractive but still unproven. Most results that do not support the theory are at least neutral. We propose that much of the ambiguity produced by work so far is due to (a) the difficulty of controlling all relevant variables, including particularly the proliferation state of the cells used and the location and nature of the damage being repaired, and (b) the existence of multiple and overlapping DNA repair pathways. A better knowledge of the critical, rate-limiting events in DNA repair in vivo, and the application of more sophisticated approaches for studying these events, may ultimately resolve the ambiguities. The causal relationship between DNA damage and cancer seems more secure. Declining DNA repair capacity with age would be expected to accelerate the increased incidence of cancer with age, but it is not known how important this is compared to other genetic and environmental variables. Results with genetic diseases generally support this view. Diseases characterized by DNA repair deficiencies are accompanied by phenomena that are also characteristic of normal aging, but a causal relationship has not been established. However, some of these diseases do constitute a strong risk factor for cancer. Even less convincing is a causal link between DNA repair deficiencies and aging in the so-called premature aging syndromes.

Aging↗
PubMed1989

Iliad: moving medical decision-making into new frontiers.

If the essence of clinical practice is a process of sequential problem-solving, whereby a physician works with a patient to formulate a series of decisions about diagnostic treatment, then it would naturally follow that the essence of medical education should evolve around the training of would-be clinicians in the difficult art of diagnostic decision-making. Yet this is not often the case.

Clinical Clerkship↗
PubMed1987

A decision-driven system to collect the patient history.

We have developed a computer-administered history designed to directly interview hospitalized patients with pulmonary disease. A frame-based decision system is used to direct the history and to generate a one- to five-member differential diagnostic list based on this history. This system incorporates a cognitive model of question selection and a Bayesian scoring algorithm. Structures to control the choice of questions are embedded in the diagnostic frames and in a QUERY program that makes the final choice of questions. We have compared the behavior of this decision-driven approach with a history taken using a paper questionnaire. The paper-based history presents 182 questions to every patient and captured 75% of 85 pulmonary diseases in its differential lists. The decision-driven system asks 50.7 +/- 31.0 (mean +/- standard deviation) and captured 74% of 61 pulmonary diseases. Our experience suggests that the use of a computerized diagnostic knowledge base to direct the selection of pertinent questions can substantially reduce the number of questions necessary to collect a diagnostically useful patient history.

Artificial Intelligence↗
PubMed1987

Bringing HELP to the clinical laboratory--use of an expert system to provide automatic interpretation of laboratory data.

In domains where the types of data which are to be interpreted are relatively constrained (as in the case of specific laboratory test results), our modular data-driven approach can be very productive and well received by the clinical recipient of the data. The computer rarely surpasses the knowledge of an experts result from lack of communication, imperfect memory, oversight or multiple decision-makers caring for the same patient. In such cases, most of the alerts are immediately recognized as valid, so the need for elaborate explanations is not a high priority. On the other hand, a non-specialist is alerted to the need for additional investigation, tests or collaborative support, by the fact that a reminder or diagnosis that s/he had not previously considered, appears. In other words, for the expert, a data-driven system provides unceasing oversight in high-volume low-yielded situations where a small number of mistakes may uncommonly occur for reasons which are not related to the lack of knowledge of the provider. For the non-specialist the system suggests that the patient may have problems in a domain for which the physician needs additional support. In the present state of the art, we do not think that total reliance on the computer-contained knowledge is the ultimate source of this additional support; providing the awareness of the need may be the most important contribution. Once you know that you need help, it is usually obtainable. In a discussion about how computer systems have failed, Friedman and Gustafson made the following observation.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making, Computer-Assisted↗
PubMed1986

Cell-free transcription and translation of isolated restriction fragments localize bacteriophage T5 pre-early genes.

In vitro transcription and translation of isolated restriction fragments containing all or part of the terminal redundancies of bacteriophage T5 localized virtually every pre-early gene to a small 6.3-kilobase BglI fragment. Among these genes were those encoding the A1 and A2 proteins, which are responsible for complete entry of the viral genome into its host, and the deoxynucleoside 5'-monophosphatase. A 3.9-kilobase BglI fragment containing the remainder of the pre-early region induced no proteins under these same conditions. Proteins induced by fragments including the right and left terminal redundancies were also compared and found to be identical. DNA immediately flanking the pre-early regions induced few proteins in vitro. Thus, this technique has allowed the overall gene organization of the pre-early region of T5 to be described.

Cell-Free System↗