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PubMed2003

Project of an expert system supporting risk stratification and therapeutic decision making in acute coronary syndromes.

The aim of the project was to create a computer program--expert system, which will support a doctor when a management for patients with acute coronary syndrome needs to be chosen. The expert system consists of four modules: knowledge base, previous cases database, inference engine and explanation module. Knowledge base was created with support of clinical experts, based on current management standards, guidelines and results of clinical trials according to evidence-based medicine rules. Data from new patient are added to the case database. Inference engine integrates two types of reasoning rule-based and case-based reasoning. Computer expert system gives unambiguous and objective answer. Recommendation given by an expert system can be reliable. At present the system is tested in clinical practice. Strategies recommended by the system are compared to the management applied in patients treated in Cardiology Clinic.

Acute Disease↗
PubMed2003

Contextualizing heterogeneous data for integration and inference.

Systems that attempt to integrate and analyze data from multiple data sources are greatly aided by the addition of specific semantic and metadata "context" that explicitly describes what a data value means. In this paper, we describe a systematic approach to constructing models of data and their context. Our approach provides a generic "template" for constructing such models. For each data source, a developer creates a customized model by filling in the tem-plate with predefined attributes and value. This approach facilitates model construction and provides consistent syntax and semantics among models created with the template. Systems that can process the template structure and attribute values can reason about any model so described. We used the template to create a detailed knowledge base for syndromic surveillance data integration and analysis. The knowledge base provided support for data integration, translation, and analysis methods.

Database Management Systems↗
PubMed1991

Iliad training effects: a cognitive model and empirical findings.

Iliad is a diagnostic expert system consisting of an "inference engine" (collection of rules and procedures for making decisions) and a "knowledge base" (collection of medical facts). Iliad's internal medicine knowledge base recognizes 5000 medical findings and covers 1150 diagnostic conditions in 10 subspecialty fields. We used Iliad's simulator mode to train diagnostic skills in junior-year medical students. The results corroborate previous findings documenting Iliad's teaching efficacy. Recent developments in cognitive psychology provide a framework for explaining Iliad's training effects.

Clinical Clerkship↗
PubMed1996

Automatic knowledge acquisition from medical texts.

An approach to knowledge-based understanding of realistic texts from the medical domain (viz. findings of gastro-intestinal diseases) is presented. We survey major methodological features of an object-oriented, fully lexicalized, dependency-based grammar model which is tightly linked to domain knowledge representations based on description logics. The parser adheres to the principles of robustness, incrementality and concurrency. The substrate of automatic knowledge acquisition are text knowledge bases generated by the parser from medical narratives, which represent major portions of the content of these documents.

Artificial Intelligence↗
PubMed2002

Computable decision modules for patient safety in child health care.

OBJECTIVE: To identify controlled evidence from the child health literature on patient conditions and clinical procedures that resulted in unacceptable adverse outcomes. METHODS: Systematic searches of MEDLINE (1966 to 2001), and Cochrane Database of Systematic Reviews (2001) were done. Studies that met the eligibility criteria, were verified for quality of methodology and lack of conflicting studies. A knowledge base of Child Health Safety Modules was then developed. The knowledge base could be used to transfer controlled evidence on potentially harmful interventions into clinical decision support systems conforming with Arden Syntax, a widely applied computer standard. RESULTS: The searches identified knowledge to create 41 Child Health Safety Modules for medications and procedures in child health care, from 29 randomized controlled trials and 12 non-randomized controlled studies. The modules are focused on 28 medication interventions and 13 other clinical procedures. Eighty five percent of the studies were published between 1997-2001. CONCLUSION: An increasing amount of controlled evidence on risks of adverse outcomes in child health is available to alert clinicians when potential planning errors are about to be overlooked.

Artificial Intelligence↗
PubMedDate not supplied

Guidelines for reporting innovations in computer-based information systems for nursing.

Inconsistent, incomplete reporting of computer applications in nursing is a barrier to building a knowledge base in the field. Progress in building this knowledge base might be accelerated if system developers could use the available literature to build upon work previously done and to profit from lessons already learned. This article presents guidelines for developing articles and reports on computer applications in nursing. Important topics include statement of the problem, proposed solution, description of the system, system impact, relationship to previous work, problems encountered, lessons learned, professional issues, transferability, and future plans. A checklist is provided. The authors welcome comments on these guidelines.

Communication↗
PubMedDate not supplied

An expert system for performance-based direct delivery of published clinical evidence.

OBJECTIVE: To develop a system for clinical performance improvement through rule-based analysis of medical practice patterns and individualized distribution of published scientific evidence. METHODS: The Quality Feedback Expert System (QFES) was developed by applying a Level-5 expert system shell to generate clinical direct reports for performance improvement. The system comprises three data and knowledge bases: 1) a knowledge base of measurable clinical practice parameters; 2) a practice pattern database of provider-specific numbers of patients and clinical activities; and 3) a management rule base comprising "redline rules" that identify providers whose practice styles vary significantly. Clinical direct reports consist of a table of practice data highlighting individual utilization vs recommendation and selected pertinent statements from medical literature. RESULTS: The QFES supports integration of recommendations from several guidelines into a comprehensive and measurable quality improvement plan, analysis of actual practice patterns and comparison with accepted recommendations, and generation of a confidential individualized direct report to those who significantly deviate from clinical recommendations. The feasibility of the practice pattern analysis by the QFES was demonstrated in a sample of 182 urinary tract infection cases from a primary care clinic. In a set of clinical activities, four questions/procedures were associated with significant (p < 0.001) and unexplained variation. CONCLUSION: The QFES provides a flexible tool for the implementation of clinical practice guidelines in diverse and changing clinical areas without the need for special program development. Preliminary studies indicate utility in the analysis of clinical practice variation and deviations. Using data obtained through a retrospective chart audit, the QFES was able to detect overutilization, and to identify nonrandom differences in practice patterns.

Databases, Factual↗
PubMed1994

Integration of data driven decision support into the HELIOS environment.

The development of large-scale, clinically accepted decision support systems (DSS) calls for powerful and commonly available methods and tools for knowledge acquisition, system realisation, and knowledge base maintenance. The paper addresses problems associated with the integration of knowledge-based systems within the clinical setting with special reference to (i) data driven decision support, (ii) the Arden Syntax as a knowledge representation format and, (iii) the HELIOS software engineering environment. Architecture of a DSS based on Arden Syntax and its integration in the HELIOS environment are presented. Realisation of the DSS is discussed in relation to client-server architecture and object-oriented databases, which are essential concepts of the HELIOS environment. Sharability and reusability of the knowledge, together with commonality of used software tools are also discussed.

Database Management Systems↗
PubMed1997

[Scientific role of German ophthalmology in the European telecommunication project OPHTEL].

BACKGROUND: In Denmark, France, Germany, Great Britain and Italy, the OPHTEL project combines clinical centers of ophthalmology and internal medicine, an institute for medical informatics and health services research, a publishing company and different industrial partners in the EDP market. AIMS: With the aid of visual telecommunication and rapid data transfer, methods and conditions will be developed and proved so that any physician can very easily obtain sufficient information for treating his patient. Thus, the regional differences in the quality of structured health service (e.g., urban/ rural) will be overcome throughout Europe. SCIENTIFIC TASKS: A multilingual diagnostic and therapeutic thesaurus has to be worked out in order to create standards for communication and quality control. Based on literature, images and image analysis in a knowledge-based data bank, a monitoring system (containing watch-dog functions) and the basic aspects of an ophthalmological patient/disease register will be investigated. (In parallel, a technical development of synchronous and asynchronous telecommunication between eye physicians is taking place in close cooperation with the regional Bavarian project Teleopathalmology in Bavaria on-line). RESULTS: State of the art 6 months after starting the project:the knowledge-based image data bank has been founded and also an ophthalmological 8 language thesaurus and definition standard. All data transfer lines are installed. DISCUSSION: The project is taking place amid diverging sections of medicine: ophthalmology and internal medicine, health politics and data protection, individual treatment and common interest (health care), product management and office organization. Thus, the scientific quality of the transferred ophthalmological content must undergo sophisticated controls. FUTURE STEPS: Intense cooperation with the big German associations for ophthalmology (DOG, BVA) and the European ophthalmological societies concerning EDP, classification and quality control.

Computer Communication Networks↗
PubMed2002

Distilling the essential features of a protein surface for improving protein-ligand docking, scoring, and virtual screening.

For the successful identification and docking of new ligands to a protein target by virtual screening, the essential features of the protein and ligand surfaces must be captured and distilled in an efficient representation. Since the running time for docking increases exponentially with the number of points representing the protein and each ligand candidate, it is important to place these points where the best interactions can be made between the protein and the ligand. This definition of favorable points of interaction can also guide protein structure-based ligand design, which typically focuses on which chemical groups provide the most energetically favorable contacts. In this paper, we present an alternative method of protein template and ligand interaction point design that identifies the most favorable points for making hydrophobic and hydrogen-bond interactions by using a knowledge base. The knowledge-based protein and ligand representations have been incorporated in version 2.0 of SLIDE and resulted in dockings closer to the crystal structure orientations when screening a set of 57 known thrombin and glutathione S-transferase (GST) ligands against the apo structures of these proteins. There was also improved scoring enrichment of the dockings, meaning better differentiation between the chemically diverse known ligands and a approximately 15,000-molecule dataset of randomly-chosen small organic molecules. This approach for identifying the most important points of interaction between proteins and their ligands can equally well be used in other docking and design techniques. While much recent effort has focused on improving scoring functions for protein-ligand docking, our results indicate that improving the representation of the chemistry of proteins and their ligands is another avenue that can lead to significant improvements in the identification, docking, and scoring of ligands.

Algorithms↗
PubMed2005

Read, Think, Do!: a method for fitting research evidence into practice.

AIM: This paper discusses a process for research utilization that overcomes well-known barriers in order to influence clinical decision-making and practice change. Read, Think, Do! is a problem-solving approach to research utilization and practice development which has the potential to overcome barriers to research utilization. BACKGROUND: Any process for research utilization at the practice level needs to overcome numerous barriers in order to influence clinical decision-making and practice change. Access to research-based knowledge is an obvious first step in the evidence-based approach to care delivery, but is clearly inadequate alone in influencing the improvement of practice. DISCUSSION: Read, Think, Do! acknowledges the complexity of problem-solving processes from the outset by looking for (1) the evidence, (2) assessing the value to practice, and (3) addressing the social and cultural milieu of the practice setting to ascertain the best strategies for initiating and sustaining practice change. This approach draws distal forms of empirical knowledge that have the capacity to improve patient outcomes into the proximal knowledge base of the clinical nurse. This is achieved by collaboration, planning and evaluation involving all levels of staff and a specialist facilitator, the Clinical Nurse Consultant in evidence-based practice. CONCLUSION: Read, Think, Do! is a method of research utilization and practice development that has the potential to overcome barriers to research utilization and avoid the "misplaced concreteness" that can occur when trying to fit empiricism into practice. By addressing the breadth and diversity of issues surrounding research utilization in a systematic manner it presents a sustainable method for practice change informed by evidence.

Decision Making↗
PubMed1993

Development of intelligent design associates: a case study.

A number of human factors data sets provides guidelines and recommendations for the system design process. Much of this information is available to the human factors engineer in design handbooks, textbooks, and periodicals. While human factors design information is both available and abundant, it is not necessarily readily accessible or in a format that is easily assimilated into a particular design scenario. This paper discusses the feasibility of incorporating human factors design data into intelligent, knowledge-based systems referred to as design associates. Successful implementation of any design associate is dependent upon two key issues: conversion of human factors data into a valid knowledge base, and overcoming the knowledge representation constraints imposed by an intelligent software tool. Detailed results of a recent effort to address these issues, and subsequently implement a design associate on a commercially available intelligent software tool, are presented. This particular associate, implemented in a rule-based tool environment, aids in the selection of visual display technologies.

Journal Article↗
PubMedDate not supplied

DIABETEX--a decision support system for therapy of type I diabetic patients.

DIABETEX is a knowledge-based, computer-supported consultation system for the therapy of type I diabetic out-patients. Three knowledge bases contain the medical and technical knowledge for treating either adults, adolescents or children by means of injections or by pumps. For the evaluation of the quality of the decision proposals three groups of patients were studied. The results obtained in test phase 1, i.e. the retrospective evaluation of DIABETEX decision proposals by the experts, and in test phase 2, i.e. the parallel work of DIABETEX and of an expert and the subsequent evaluation by experts, provide the basis for the further development and application of the system by non-expert diabetologists.

Adolescent↗
PubMed2000

Updating geographical knowledge: principles of coherence and inertia.

In 2 experiments, the authors investigated how representations of global geography are updated when people learn new location information about individual cities. Participants estimated the latitude of cities in North America (Experiment 1) and in the Old and New Worlds (Experiment 2). After making their first estimates, participants were given information about the latitudes of 2 cities and asked to make a second set of estimates. Both the first and second estimates revealed evidence for psychologically distinct geographical subregions that were coordinated, in an ordinal sense, across the Atlantic Ocean. Further, the second estimates were affected by the nature of the physical adjacency between regions (e.g., the southern U.S. and Mexico) and by accurate location information about distant, but coordinated, subregions (e.g., the southern U.S. and Mediterranean Europe). The data provide support for a framework for making geographical estimates in which people strike a balance between 2 principles: the need to keep their knowledge base coherent, and the inertial tendency to resist changing the knowledge base unless it is necessary to maintain coherence.

Cognition↗
PubMed2001

The social ecology of the co-occurrence of substance use and early coitus among poor, urban black female adolescents.

Currently, the profession of social work has proclaimed the need for an empirical research agenda to broaden its knowledge base. The profession's positivists rightly argue that a sound knowledge base is derived from rigorous scientific empirical methods. Unquestionably, the profession's unique contribution to the study of human development has been its emphasis on environmental effects and individual adaptation. Presently, social scientists embrace an ecological perspective when studying how social environmental effects are mediated. As researchers shift to a social ecological perspective, an empirical contextual model will allow the study of racial/ethnic differences in the incidence of adolescent problem behaviors (Stevens, 1998). An examination of the social ecology of poor, urban black female adolescents was undertaken to examine claims of the co-occurrence of early coitus and substance use, behaviors evident in black adolescents. An ecological framework operationalized by the constructs structural strain, kinscriptions, and community bridging is used to explicate how coital behavior among black females may not co-occur with drug use. The article's exegesis is directed by four postulates that help clarify the relationship of social ecology to the linkage of early coital behavior and substance use. The article concludes with adolescent narratives that illumine the cogency of the ecological analysis.

Adolescent↗
PubMed1995

Nursing informatics: state of the science.

The phenomena of interest in nursing informatics are nursing data, nursing information and nursing knowledge. The current state of knowledge related to these phenomena suggests four implications for the development of systems to support nursing. First, research has provided evidence that knowledge and experience is related to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task-specific. Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to increase the level of knowledge of the nurse decision-maker. Second, structured patient assessment forms with linkages to knowledge bases of diagnoses have the potential to improve the quality of the patient assessment and the accuracy of the diagnosis or clinical inference. Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate. Model-based decision support applications such as decision analysis and multi-attribute utility theory can assist the clinicians and patients to analyse and compare the treatment alternatives in a systematic manner. Fourth, there is modest support for demonstrating the relationship between the process and outcomes of clinical decision making. Large databases built upon nursing data are needed to further examine this relationship.

Expert Systems↗
PubMed1988

Primary knowledge, medical education and consultant expertise.

We have studied the knowledge of students and clinicians that they actually used to follow up four problems in general medicine. Some unexpected similarities and differences in their readily accessible or primary knowledge were found in groups from first-year clinical medical students to consultants. There is no linear increase in the quantity of primary knowledge with experience, but qualitative changes are very much more important. At all levels individuals show a remarkable dissimilarity in the knowledge they use to solve clinical problems, so that the bulk of personal knowledge used is individual. Comparatively rarely do people use the same knowledge to solve any one clinical problem. However, there is evidence of a general tendency towards increasing uniformity in knowledge as a result of the medical school years. After houseman level, individuality increases again. These changes result in consultants achieving an identical profile to first-year clinical medical students in terms of the extent to which their primary knowledge bases are held individually or in common. These findings suggest that consultant expertise is actually based on individual experience rather than a common core of knowledge. The influence of medical school in providing such a common knowledge base is (1) limited and (2) reversed by clinical practice. The results suggest the necessity for increased vocational and practice-oriented components in medical education, particularly in postgraduate education.

Clinical Competence↗
PubMed2004

Automatic annotation of protein motif function with Gene Ontology terms.

BACKGROUND: Conserved protein sequence motifs are short stretches of amino acid sequence patterns that potentially encode the function of proteins. Several sequence pattern searching algorithms and programs exist foridentifying candidate protein motifs at the whole genome level. However, a much needed and important task is to determine the functions of the newly identified protein motifs. The Gene Ontology (GO) project is an endeavor to annotate the function of genes or protein sequences with terms from a dynamic, controlled vocabulary and these annotations serve well as a knowledge base. RESULTS: This paper presents methods to mine the GO knowledge base and use the association between the GO terms assigned to a sequence and the motifs matched by the same sequence as evidence for predicting the functions of novel protein motifs automatically. The task of assigning GO terms to protein motifs is viewed as both a binary classification and information retrieval problem, where PROSITE motifs are used as samples for mode training and functional prediction. The mutual information of a motif and aGO term association is found to be a very useful feature. We take advantage of the known motifs to train a logistic regression classifier, which allows us to combine mutual information with other frequency-based features and obtain a probability of correct association. The trained logistic regression model has intuitively meaningful and logically plausible parameter values, and performs very well empirically according to our evaluation criteria. CONCLUSIONS: In this research, different methods for automatic annotation of protein motifs have been investigated. Empirical result demonstrated that the methods have a great potential for detecting and augmenting information about the functions of newly discovered candidate protein motifs.

Amino Acid Motifs↗