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Biomedical subjects

M G Kahn

Publications and source records attributed to M G Kahn.

At least 37 records · Page 2Linked to original sources
PubMed1994

Construction of a literature database and its use to provide probabilities for decision-analytic models of thrombolytic therapy.

Probabilities for decision-analytic models are routinely obtained from the medical literature. This study describes development and use of a literature database to facilitate obtaining probabilities for decision-analytic models of thrombolytic therapy for acute myocardial infarction. Implementation demonstrates the concept of a literature database to be both feasible and effective. Specific difficulties encountered in the evaluation of continuous variables, the potential storage of actual probabilities, and the advantage for easy growth with the literature are discussed.

Databases, Bibliographic↗
PubMed1994

Clinical databases and critical care research.

Clinical investigators who seek to exploit electronic databases for clinical research need to be aware of the strengths and limitations of the data stored in these systems. Generic issues are examined that can arise from the use of any electronic database, as well as more specific and unique issues that need to be resolved before a comprehensive medical-record database can be realized. Specific suggestions are provided that can be employed by the critical care director who seeks to exploit the rich clinical data available in electronic form for clinical research.

Critical Care↗
PubMed1993

Objective evaluation of 3-D radiation treatment plans: a decision-analytic tool incorporating treatment preferences of radiation oncologists.

PURPOSE: Selecting the optimal radiation treatment plan from a set of competing plans involves making trade-offs among the doses delivered to the target volumes and normal tissues by the competing plans. Evaluation of 3-dimensional radiation treatment plans is difficult because it requires the review of vast amount of graphical and numerical data. We have developed an objective plan-ranking model based on the concepts of decision analysis. METHODS AND MATERIALS: Our model ranks a set of tentative radiation treatment plans from best to worst. A figure of merit is computed for each plan based on probabilities of possible clinical complications such as non-eradication of the tumor and radiation induced damage to the nearby healthy normal tissues, and weights which indicate their clinical relevance. This figure of merit is used to rank the plans. Key issues addressed by the model include the incorporation of individual treatment preferences of the radiation oncologist and clinical features of the patient. RESULTS: A methodology has been established for eliciting the treatment preferences of radiation oncologists. Results of this elicitation, and examples of several plan evaluations are presented. An interactive computer-based tool has been developed as one of a set of tools to assist in the evaluation of 3-dimensional radiation treatment plans. CONCLUSION: The paper presents a decision-analytic model incorporating radiation oncologists' treatment preferences and an interactive computer-based tool for objectively ranking competing radiation treatment plans. The tool can be used by radiation oncologists for the evaluation of competing plans, or as part of a system which tries to automatically generate optimal treatment plans using mathematical or symbolic techniques.

Decision Support Techniques↗
PubMed1993

ASTM E31.15 on health knowledge representation: the Arden Syntax.

ASTM subcommittee E31.15 on Health Knowledge Representation was formed to promote standards for defining and sharing health knowledge bases. Its first standard, the Ardan Syntax, is focused on knowledge bases that can be represented as a set of independent modules called Medical Logic Modules (MLMs). The standard is in clinical use and has generated significant interest in industry and academics. The Extensions task group plans to extend the syntax where appropriate, to expand to other types of knowledge bases. The Validation/Verification task group is approaching the enormous problem of evaluating knowledge bases and the process of sharing them.

Artificial Intelligence↗
PubMed1993

Objective evaluation of radiation treatment plans.

The evaluation of radiation treatment plans involves making trade-offs among doses delivered to the tumor volumes and nearby normal tissues. Evaluating state-of-the-art three-dimensional (3D) plans is a difficult task because of the huge amount of planning data that needs to be deciphered. Multiattribute utility theory provides a methodology for specifying trade-offs and selecting the optimal plan from many competing plans. Using multiattribute utility theory, we are developing a clinically meaningful objective plan-evaluation model for 3D radiation treatment plans. Our model incorporates three of the factors involved in radiation treatment evaluation--treatment preferences of the radiation oncologist, clinical condition of the patient, and complexity of the treatment plan.

Decision Support Techniques↗
PubMed1993

An expert system for culture-based infection control surveillance.

Hospital-acquired infections represent a significant cause of prolonged inpatient days and additional hospital charges. We describe an expert system, called GERMWATCHER, which applies the Centers for Disease Control's National Nosocomial Infection Surveillance culture-based criteria for detecting nosocomial infections. GERMWATCHER has been deployed at Barnes Hospital, a large tertiary-care teaching hospital, since February 1993. We describe the Barnes Hospital infection control environment, the expert system design, and a predeployment performance evaluation. We then compare our system to other efforts in computer-based infection control.

Cells, Cultured↗
PubMed1993

An object model for uniform access to heterogeneous databases.

The vast amount of patient information collected and maintained by hospitals is seldom stored in a single database. Much programming effort is wasted on formulating specific queries for each of several data sources, rather than focusing attention on developing the intended functionality of the application. This problem becomes more apparent as more data sources become available. The most obvious strategy for dealing with this multiplicity of data sources, namely storing all data in a single database, is impractical for reasons such as security and administrative control. This paper describes one possible solution to managing access to several database systems within applications. Using object-oriented techniques, the solution identifies the commonality among database management systems and provides a uniform method of communication between applications and databases. We describe a C(++)-based implementation which embodies these concepts.

Computer Communication Networks↗
PubMed1993

Unifying heterogeneous distributed clinical data in a relational database.

Access to clinical data which are distributed among multiple satellite information systems is crucial to delivering better care and reducing costs in many hospitals and medical centers. An integrated view of these data is needed to reduce the effort of users requiring data from multiple systems. We have addressed the issue of distributed data integration while developing both production and research decision-support applications. We describe an ideal integration solution, obstacles to realizing this solution, and our integration requirements and architecture. Our focus is a description of our specific schema and data integration techniques. We conclude with an analysis of our approach.

Computer Communication Networks↗
PubMed1992

Ranking radiotherapy treatment plans using decision-analytic and heuristic techniques.

Radiotherapy treatment optimization is done by generating a set of tentative treatment plans, evaluating them, and selecting the plan closest to achieving a set of conflicting treatment objectives. The evaluation of potential plans involves making trade-offs among competing possible outcomes. Multiattribute decision theory provides a framework for specifying such trade-offs and using them to select optimal actions. Using these concepts, we have developed a plan-ranking model which ranks a set of tentative treatment plans from best to worst. Heuristics are used to refine this model so that it reflects the clinical condition of the patient being treated and the practice preference of the physician prescribing the treatment. A figure of merit is computed for each tentative plan and is used to rank the plans. The approach described is very general and can be used for other medical domains having similar characteristics. The figure of merit can also be used as an objective function by computer programs that attempt to automatically generate an optimal treatment plan.

Decision Making, Computer-Assisted↗
PubMed1991

TQuery: a context-sensitive temporal query language.

Users of electronic medical databases request pertinent information by recasting their clinical questions into a formal database query language. Because the query language is the user's only access to the data, the query language must be powerful enough to enable users to express their data requirements. However, a competing need is for the query language to be restrictive enough so that queries can have unambiguous semantics and the query processor can generate correct answers. We describe a query language, called TQuery , that was designed specifically to formulate database queries that are dependent on temporal and contextual relationships. TQuery specifications express contextual constraints without the need to explicitly reference calendar dates. TQuery is the database query language used to retrieve patient data from an object-oriented electronic patient medical-record system called the temporal network (TNET). TNET and TQuery were developed to support the real-time temporal reasoning and representation needs of a LISP workstation-based medical expert system.

Databases, Factual↗
PubMed1991

Ranking radiotherapy treatment plans using decision-analytic and heuristic techniques.

Radiotherapy treatment optimization is done by generating a set of tentative treatment plans, evaluating them and selecting the plan closest to achieving a set of conflicting treatment objectives. The evaluation of potential plans involves making tradeoffs among competing possible outcomes. Multiattribute decision theory provides a framework for specifying such tradeoffs and using them to select optimal actions. Using these concepts, we have developed a plan-ranking model which ranks a set of tentative treatment plans from best to worst. Heuristics are used to refine this model so that it reflects the clinical condition of the patient being treated and the practice preferences of the physician prescribing the treatment. A figure of merit is computed for each tentative plan, and is used to rank the plans. The approach described is very general and can be used for other medical domains having similar characteristics. The figure of merit can also be used as an objective function by computer programs that attempt to automatically generate an optimal treatment plan.

Artificial Intelligence↗
PubMed1991

Combining physiologic models and symbolic methods to interpret time-varying patient data.

This paper describes a methodology for representing and using medical knowledge about temporal relationships to infer the presence of clinical events that evolve over time. The methodology consists of three steps: (1) the incorporation of patient observations into a generic physiologic model, (2) the conversion of model states and predictions into domain-specific temporal abstractions, and (3) the transformation of temporal abstractions into clinically meaningful descriptive text. The first step converts raw observations to underlying model concepts, the second step identifies temporal features of the fitted model that have clinical interest, and the third step replaces features represented by model parameters and predictions into concepts expressed in clinical language. We describe a program, called TOPAZ, that uses this three-step methodology. TOPAZ generates a narrative summary of the temporal events found in the electronic medical record of patients receiving cancer chemotherapy. A unique feature of TOPAZ is its use of numeric and symbolic techniques to perform different temporal reasoning tasks. Time is represented both as a continuous process and as a set of temporal intervals. These two temporal models differ in the temporal ontology they assume and in the temporal concepts they encode. Without multiple temporal models, this diversity of temporal knowledge could not be represented.

Adult↗
PubMed1991

Extensions to the time-oriented database model to support temporal reasoning in medical expert systems.

Physicians faced with diagnostic and therapeutic decisions must reason about clinical features that change over time. Database-management systems (DBMS) can increase access to patient data, but most systems are limited in their ability to store and retrieve complex temporal information. The Time-Oriented Databank (TOD) model, the most widely used data model for medical database systems, associates a single time stamp with each observation. The proper analysis of most clinical data requires accounting for multiple concurrent clinical events that may alter the interpretation of the raw data. Most medical DBMSs cannot retrieve patient data indexed by multiple clinical events. We describe two logical extensions to TOD-based databases that solve a set of temporal reasoning problems we encountered in constructing medical expert systems. A key feature of both extensions is that stored data are partitioned into groupings, such as sequential clinical visits, clinical exacerbations, or other abstract events that have clinical decision-making relevance. The temporal network (TNET) is an object-oriented database that extends the temporal reasoning capabilities of ONCOCIN, a medical expert system that provides chemotherapy advice. TNET uses persistent objects to associate observations with intervals of time during which "an event of clinical interest" occurred. A second object-oriented system called the extended temporal network (ETNET), is both an extension and a simplification of TNET. Like TNET, ETNET uses persistent objects to represent relevant intervals; unlike the first system, however, ETNET contains reasoning methods (rules) that can be executed when an event "begins", and that are withdrawn when that event "concludes". TNET and ETNET capture temporal relationships among recorded information that are not represented in TOD-based databases. Although they do not solve all temporal reasoning problems found in medical decision making, these new structures enable patient database systems to encode complex temporal relationships, to store and retrieve patient data based on multiple clinical contexts and, in ETNET, to modify the reasoning methods available to an expert system based on the onset or conclusion of specific clinical events.

Diagnosis, Computer-Assisted↗
PubMed1989

A psychophysical comparison of two methods for adaptive histogram equalization.

Adaptive histogram equalization (AHE) is a method for adaptive contrast enhancement of digital images. It is an automatic, reproducible method for the simultaneous viewing of contrast within a digital image with a large dynamic range. Recent experiments have shown that in specific cases, there is no significant difference in the ability of AHE and linear intensity windowing to display gray-scale contrast. More recently, a variant of AHE which limits the allowed contrast enhancement of the image has been proposed. This contrast-limited adaptive histogram equalization (CLAHE) produces images in which the noise content of an image is not excessively enhanced, but in which sufficient contrast is provided for the visualization of structures within the image. Images processed with CLAHE have a more natural appearance and facilitate the comparison of different areas of an image. However, the reduced contrast enhancement of CLAHE may hinder the ability of an observer to detect the presence of some significant gray-scale contrast. In this report, a psychophysical observer experiment was performed to determine if there is a significant difference in the ability of AHE and CLAHE to depict gray-scale contrast. Observers were presented with computed tomography (CT) images of the chest processed with AHE and CLAHE. Subtle artificial lesions were introduced into some images. The observers were asked to rate their confidence regarding the presence of the lesions; this rating-scale data was analyzed using receiver operating characteristic (ROC) curve techniques. These ROC curves were compared for significant differences in the observers' performances. In this report, no difference was found in the abilities of AHE and CLAHE to depict contrast information.

Contrast Media↗
PubMed1983

Morphology and function of the aqueous outflow system in monkey eyes perfused with sulfhydryl reagents.

The aqueous outflow system from anterior chamber to Schlemm's canal was examined by electron microscopy in pairs of enucleated macaque and baboon eyes, perfused via the anterior chamber with mock aqueous humor in one eye and the same fluid with added iodoacetamide (IA) or N-ethyl maleimide (NEM) in the other eye. Many details of the electron micrographs were analyzed in a masked manner using a digitizing bit pad and computer, and also using visual evaluation. Both IA and NEM increased aqueous humor outflow facility, but the morphologic changes induced by IA were quantitatively different from those induced by NEM. Intercellular junctions were not affected by IA, but were disrupted by NEM (P less than 0.01). Vacuoles in the endothelial lining of Schlemm's canal tended to increase in area, but not in number, under the influence of IA, whereas they were not so affected by NEM. No loss of extracellular material was observed in either IA- or NEM-treated eyes. The results indicate that the chemical status of cellular-SH groups may influence aqueous humor outflow facility at multiple sites in the outflow pathway.

Animals↗
PubMed1983

Glutathione in calf trabecular meshwork and its relation to aqueous humor outflow facility.

Previous studies have shown that sulfhydryl reagents can alter the facility of aqueous humor outflow but little is known about the sulfhydryl constituents of the aqueous outflow system or the effect of oxidants upon outflow facility. In the present study the concentration of glutathione (GSH) was measured in excised calf trabecular meshwork (TM) and found to be 0.40 mu mol/g wet wt (0.027 mu mol/mg protein). Oxidized glutathione was not detectable in the tissue. TM was found to have significant hexose monophosphate shunt activity as determined by measurement of the oxidation of 14C-1 and 14C-6-labeled glucose in tissue homogenates. The concentration of GSH in TM of enucleated calf eyes could be totally depleted by infusion of medium containing both diamide, which is an oxidant of GSH, and 1,3bis(2-chlorethyl)-1-nitrosourea (BCNU), which is an inhibitor of the enzyme glutathione reductase. The depletion of GSH was found to have no effect on the facility of aqueous outflow. Experiments were also done in which normal and TM GSH-depleted eyes were perfused with medium containing H202. Exposure to H202 produced no effect on outflow facility in the normal eyes but caused a 33% decrease in facility in eyes with the GSH-depleted TM. The results indicate that GSH may not participate directly in regulating aqueous humor outflow but is able to protect TM against H202-induced oxidative damage that would otherwise lead to a decrease in outflow facility.

Amino Acids↗
PubMedDate not supplied

Monitoring expert system performance using continuous user feedback.

OBJECTIVE: To evaluate the applicability of metrics collected during routine use to monitor the performance of a deployed expert system. METHODS: Two extensive formal evaluations of the GermWatcher (Washington University School of Medicine) expert system were performed approximately six months apart. Deficiencies noted during the first evaluation were corrected via a series of interim changes to the expert system rules, even though the expert system was in routine use. As part of their daily work routine, infection control nurses reviewed expert system output and changed the output results with which they disagreed. The rate of nurse disagreement with expert system output was used as an indirect or surrogate metric of expert system performance between formal evaluations. The results of the second evaluation were used to validate the disagreement rate as an indirect performance measure. Based on continued monitoring of user feedback, expert system changes incorporated after the second formal evaluation have resulted in additional improvements in performance. RESULTS: The rate of nurse disagreement with GermWatcher output decreased consistently after each change to the program. The second formal evaluation confirmed a marked improvement in the program's performance, justifying the use of the nurses' disagreement rate as an indirect performance metric. CONCLUSIONS: Metrics collected during the routine use of the GermWatcher expert system can be used to monitor the performance of the expert system. The impact of improvements to the program can be followed using continuous user feedback without requiring extensive formal evaluations after each modification. When possible, the design of an expert system should incorporate measures of system performance that can be collected and monitored during the routine use of the system.

Expert Systems↗