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PubMed1993

Automated decision making: the role of expert computer systems in the future of optometry.

BACKGROUND: Artificial intelligence (AI) refers to the ability of a machine, or system, or computer program to make intelligent decisions using the same methods that humans would use. By definition, and expert system (ES) is a computer program that uses knowledge and inference procedures to solve problems which would otherwise require the application of human expertise. METHODS: The role of expert systems in current and future applications in a number of fields were reviewed. RESULTS: Expert systems have and will be making an impact in many fields, including optometry in the future. CONCLUSIONS: Expert systems present an opportunity for the profession of optometry to become more efficient or accurate, provided that their development cost could be justified.

Artificial Intelligence↗
PubMed1989

Expert systems and the pancreatic cancer problem: decision support in the pre-operative diagnosis.

In this paper, after reviewing the main issue in artificial intelligence, decision support systems, medical decision-making, expert systems and some of their applications in medicine, we focus on the diagnostic aspect of pancreatic cancer. We briefly examine the most significant applications both from the oncological and from the diagnostic point of view. We discuss the medical problems mentioning incidence and mortality, aetiological factors and diagnosis, considering the roles of surgery and adjuvant therapies. Finally we justify the decision to develop an expert system in such a medical domain and discuss the SPES (Surgical Pancreatic Expert System) project, its parts dealing with the different medical phases of pancreatic cancer diagnosis and therapy: pre-operative, intra-operative and adjuvant therapies. In particular we discuss diagnostic aspects of pancreatic cancer disease, pointing out the aims of the project, methodologies, tools used and future developments.

Decision Support Techniques↗
PubMed1994

Artificial intelligence in radiology: decision support systems.

Computer-based systems that incorporate artificial intelligence techniques can help physicians make decisions about their patients' care. In radiology, systems have been developed to help physicians choose appropriate radiologic procedures and to formulate accurate diagnoses. These decision support systems use techniques such as rule-based reasoning, artificial neural networks, hypertext, Bayesian networks, and case-based reasoning. This article reviews these artificial intelligence techniques, describes their application in radiology, and discusses the role that decision support systems may play in radiology's future.

Artificial Intelligence↗
PubMedDate not supplied

Methods in informatics: using data derived from a systematic review of health care texts to develop a concept map for use in the neonatal intensive care setting.

A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 health care texts were systematically reviewed yielding 153 separate statements related to assessing premature infants' feeding readiness. Following this procedure, a pile sort method was conducted wherein an expert neonatal nurse practitioner (NNP) grouped the statements according to similarity in meaning. Ten piles of terms emerged from this process. Each pile was "named," depicting discrete components used when assessing premature infants' readiness for nipple feeding. Using these public data and the private knowledge of the NNP informant, a concept map was constructed to illustrate a framework for decision support development and to examine the map's usefulness for structuring knowledge that will provide input to an intelligent decision support system.

Computational Biology↗
PubMed1999

Better theatre management through intelligent reporting: the TIME (theatre information, management and efficiency) system.

Hospital managers, clinicians or their colleges, and the government departments of health are interested in a variety of information for understanding the performance of the health care system and making informed decisions. Intelligent reporting aims to provide the most relevant and reliable information to major stakeholders to facilitate evidence-based practice. The key element in the reporting system is its ability to identify unsatisfactory practice. The TIME (theatre information, management and efficiency) system developed at the North Queensland Clinical School and James Cook University aims to provide intelligible reports for better theatre management. It reflects an effective amalgamation of surgical expertise and systems management principles.

Data Collection↗
PubMed1992

Dentists, drugs, and decisions: introduction to Part I--Therapeutic drugs.

Numerous dental therapeutic agents or drugs are available over the counter or with prescription for patient use at home or in a professional office. Knowledge of the processes by which these agents are evaluated for safety and efficacy by the FDA and ADA is necessary for dental professionals to make intelligent decisions concerning their use. Several examples of problems with drug/cosmetic evaluations are cited.

American Dental Association↗
PubMed2004

Clinical immunology in practice, new opportunities.

While research provides new opportunities for diagnosing and treating patients with allergic and immunological disorders, there are significant challenges to putting these advances into use in clinical practice. Each new test may require clinicians in private practice to battle with a health insurer's designated clinical laboratory in an effort to get this new test and other accurate immunological laboratory studies. A new test may or may not be covered by some health care plans and may or may not be available from their designated laboratories. Many of these laboratories send time-sensitive samples across the country with risk of time delays and poor specimen handling leading to inaccurate results and/or the need to send repeat specimens. The growing role of managed care in every medical decision has led to frustrations for the patient and physician. This frequently requires a consult at a tertiary care center, where laboratory studies may be more easily accessible with fewer restrictions. Where are the new opportunities? Some are found in the enhanced ability to make intelligent decisions in the diagnosis and treatment of immunological diseases. There is now a greater selection and availability of intravenous gamma-globulin (IVIG), that can be matched to individual patient needs. The appropriate selection of these products will decrease adverse reactions and increase safety. There was a major advance in the treatment of moderate and severe asthma with the addition of omalizumab therapy. It provides allergists and immunologists with their first monoclonal humanized anti-IgE antibody.

Antibodies, Anti-Idiotypic↗
PubMedDate not supplied

New legal standards for trustee performance.

Until recently, trustees who acted "in good faith" were not held personally liable for mistakes in judgment. But in two recent cases--Smith v. Van Gorkom and Hanson Trust PLC v. MLSCM Acquisition, Inc.--the courts found directors liable for making hasty, ill-informed decisions regarding ownership issues. The rulings said that when boards make major decisions, they must be able to demonstrate that they approved a fair transaction. They can do this by consulting with senior management and corporate counsel and, if needed, with independent authorities. Boards should obtain pertinent documents to review before making a decision and should have ample time to obtain necessary data. Meeting minutes should document these precautions. In their rulings, the courts did not second-guess the boards' business judgment. Rather, they found that the unprepared directors acted so quickly that they could not have made an intelligent decision. The rulings convey a commonsense message: Trustees who exercise authority without adequate information risk damaging the corporation and its services. As trustees attempt to fulfill their legal obligation to probe and question before approving major actions, tensions with management may arise. Boards and corporate officers, however, must find ways to reach corporate consensus on important decisions while maintaining an appropriate division of authority.

Delaware↗
PubMed1973

Informed consent, a reappraisal of patients' reactions.

In response to the November 1972 ruling of the California Supreme Court requiring complete, detailed disclosure of risks for procedures and treatments, a survey was made of the reactions of one hundred patients to this decision. A fictional man was described with a clinical diagnosis of brain tumor, and then the procedure for cerebral angiography and all of that procedure's potential complications were described. The majority of the patients surveyed responded that this complete disclosure of risks helped them in making an intelligent decision about giving consent for the procedure. However, 50 percent of these patients would have withheld consent for the procedure on learning of the complications. Although physicians would have reacted differently, it is certainly the patients' right to make the choices they did.

Decision Making↗
PubMed2006

Longevity of the tooth/restoration complex: a review.

The contemporary dentist has a wide variety of materials to utilize in the restoration of defective teeth. The decision as to which restorative approach should be utilized in any given clinical situation is a joint one between the patient and the treating dentist. The dentist's primary obligations are to understand the indications and contraindications of various materials, understand how to optimally manipulate those materials, and educate the patient so that they make intelligent decisions and give proper informed consent. The ultimate decision as to which approach to use rests with the patient, and the patient must clearly understand the benefits and risks associated with different restorative options. Clearly, one of the important considerations with any treatment is the prognosis and restoration longevity. When attempting to predict the long-term prognosis of any restoration, it is important to consider both the restorative material being considered as well as the specific tooth that is being restored. Many times the amount of remaining tooth structure has a more significant bearing on long-term prognosis than what material is used for restoration. Thus, the tooth/ restoration complex must be considered as a whole when predicting potential longevity. Many clinical trials have been conducted to attempt to answer those questions, and relatively few unbiased, unambiguous answers are available. The only completely honest answer to those questions is "It depends". This is because the prognosis of all restorative therapy depends on the complex interaction of a number of variables, some of which are controlled by the dentist, and some of which are totally out of the dentist's control. This article will attempt to delineate some of the factors related to the long-term prognosis of the tooth/restoration complex, and specifically identify factors that decrease the prognosis of the tooth/restoration complex.

Bruxism↗
PubMed2005

How well can signs and symptoms predict AMI in the Malaysian population?

The aim of the study was to use data from an electronic medical record system (EMR) to look for factors that would help us diagnose acute myocardial infarction (AMI) with the ultimate aim of using these factors in a decision support system for chest pain. We extracted 887 records from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. We cleaned the data, extracted 69 possible variables and performed univariate and multivariate analysis. From the univariate analysis we find that 22 variables are significantly associated with a diagnosis of AMI. However, multiple logistic regression reveals that only 9 of these 22 variables are significantly related to a diagnosis of AMI. Race (Indian), male sex, sudden onset of persistent crushing pain, associated sweating and a history of diabetes mellitus are significant predictors of AMI. Pain that is relieved by other means and history of heart disease on treatment are important predictors of a diagnosis other than AMI. The degree of accuracy is high at 80.5%. There are 13 factors that are significant in the univariate analysis but are not among the nine significant factors in the multivariate analysis. These are location of pain, associated palpitations, nausea and vomiting; pain relieved by rest, pain aggravated by posture, cough, inspiration and exertion; age more than 40, being a smoker and abnormal chest wall and face examination. We believe that these findings can have important applications in the design of an intelligent decision support system for use in medical care as the predictive capability can be further refined with the use of intelligent computational techniques.

Adult↗
PubMed1995

Evaluation of partial classification algorithms using ROC curves.

When using computer programs for decision support in clinical routine, an assessment or a comparison of the underlying classification algorithms is essential. In classical (forced) classification, the classification rule always selects exactly one alternative. A number of proven discriminant measures are available here, e.g.sensitivity and error rate. For probabilistic classification, a series of additional measures has been developed [1]. However, for many clinical applications, there are models where an observation is classified into several classes (partial classification), e.g., models from artificial intelligence, decision analysis, or fuzzy set theory. In partial classification, the discriminatory ability (Murphy) can be adjusted a priori to any level, in most practical cases. Here the usual measures do not apply. We investigate the preconditions for assessment and comparison based on medical decision theory. We focus on problems in the medical domain and establish a methodological framework. When using partial classification procedures, a ROC analysis in the classical sense is no longer appropriate. In forced classification for two classes, the problem is to find a cutoff point on the ROC curve; while in partial classification, you have to find two of them. They characterize the elements being classified as coming from both classes. This extends to several classes. We propose measures corresponding to the usual discriminant measures for forced classification (e.g., sensitivity and error rate) and demonstrate the effects using the ROC approach. For this purpose, we extend the existing method for forced classification in a mathematically sound manner. Algorithms for the construction of thresholds can easily be adapted. Two specific measurement models, based on parametric and non-parametric approaches, will be introduced. The basic methodology is suitable for all partial classification problems, whereas the extended ROC analysis assumes a rank order of the selected alternatives. The method is based on the black box principle and makes use only of the results of the compared algorithms and some general intuitive principles. Therefore, algorithms arising from different "philosophical" approaches may also be compared according to their results. For demonstration purposes, a clinical example from cranial computed tomography is presented. Linear discriminant analysis as a reference is compared to a Bayesian and a fuzzy procedure.

Algorithms↗
PubMed1980

Cost evaluation of alternative pharmaceutical tableting processes by simulation.

A simulation model and a subsequent computer program were developed as experimentation methods for evaluating tableting processes with respect to cost. These methods also allow estimation of the various times involved in a tableting operation (e.g., the processing time). The model was programmed in FORTRAN using the GASP IV simulation language. After verification of the program, experiments were run that involved comparing different levels of specific input variables to determine which variable had an effect on the cost-time relationships of a particular processing method. Among the possible input variables chosen for evaluation were the drying method, the type of tableting machine, the batch size, the labor rate, and the operation of the equipment in the process. An analysis of variance was made, and three separate regression equations were developed that described the relationship between the input variables and the dependent variables of processing cost and time. Graphs were developed from the regression equations by manipulating them through series of different independent variables. These graphs then were used in determining minimum costs and times, breakeven points, and rates of change, as well as in simple evaluation of processes through graphic representation. By using the simulation program to run experiments and then by analyzing them, results can be obtained to help in making intelligent decisions about the cost-time relationships of a particular tableting procedure before it is implemented.

Chemistry, Pharmaceutical↗
PubMed1975

Results of pulmonary arterial banding in infancy. Survey of 5 years' experience in the New England Regional Infant Cardiac Program.

The results of pulmonary arterial banding in 238 infants, 12 percent of the infants admitted to the New England Regional Infant Cardiac Program, is reviewed. Overall survival to age 1 year was 63 percent. Survival was least likely (37 percent) in those who required banding within the 1st month of life. Additional surgery decreased the survival rate in those operated on after 1 month of age. Infants with anomalies for which no corrective surgical procedure is available (23 of 238) have only a 30 percent chance of survival. Those with lesions correctable within the 1st year (133 of 238) have a 74 percent survival rate; 52 percent (82 of 238) of those for whom a curative operation is available after the 1st year survive. These pulmonary arterial banding data coupled with results of primary correction should provide the data base required for an intelligent decision in respect to appropriate surgical treatment of infants with critical heart disease.

Heart Defects, Congenital↗
PubMed1989

Event or emergency? Two response systems in the mammalian superior colliculus.

Recent studies of the effects of stimulating the superior colliculus (SC) in rodents suggest that this structure mediates at least two classes of response to novel sensory stimuli. One class contains the familiar orienting response, together with movements resembling tracking or pursuit, and appears appropriate for undefined sensory 'events'. The second class contains defensive movements such as avoidance or flight, together with cardiovascular changes, that would be appropriate for a sudden emergency such as the appearance of a predator, or of an object on collision course. The two response systems appear to depend on separate output projections, and are probably subject to different sensory and forebrain influences. These findings (1) suggest an explanation for the complex anatomical organization of the SC, with multiple output pathways differentially accessed by a very wide variety of inputs, (2) emphasize the similarities between the SC and the optic tectum in non-mammalian species, and (3) suggest that the SC may be useful as a model for studying both the sensory control of defensive responses, and how intelligent decisions can be taken about relatively simple sensory inputs.

Animals↗
PubMed1989

Clinical neurosensory testing: practical applications.

A relatively large percentage of the practicing oral and maxillofacial surgeon's patients experience some degree of neurosensory impairment as a normal concomitant of major surgery. Additionally, some patients develop neurosensory disturbances unexpectedly following routine surgical procedures. This report describes a practical approach to evaluating these individuals, which is essential in making intelligent decisions regarding the objective nature of the nerve injury, potential for recovery, and/or possible need for secondary microneurosurgical intervention.

Humans↗
PubMed2005

A comparison study: paper-based versus web-based data collection and management.

The purpose of this pilot study was to compare the cost, accuracy, and efficiency of a web-enhanced handheld computer data collection system with those of the traditional paper-based data collection and management system and to increase awareness/knowledge of researchers on these two data collection and management methods. This is an important topic because funding resources are diminishing and high startup costs associated with automated data collection systems may give researchers pause when faced with these financial expenditures. Hence, this information will position grant writers and funders to make intelligent decisions regarding the feasibility and advantage of web-enhanced electronic data collection strategies.

Computers, Handheld↗