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PubMed1997

[Decision support of clinical laboratory test by object-oriented data base].

We have constructed an object-oriented database system, using prescription, lab test result, and disease registry data, transmitted from the order entry system of Hamamatsu University Medical School Hospital. It serves not only numeric data but also semantics of laboratory results. The database system has a feature to categorize each data into structured hierarchies of attributes. By this, the user can retrieve abstract level descriptions such as "prescriptions of anti-inflammation medicines, suppository only", "any kind of gastric ulcer", etc., which is expected to be useful for researchers and students. In transferring order entry data from HIS, HL7-ASTM E1238 standard data formats using the Japan Association of Clinical Pathology lab test item code are utilized, proving this system's transferability to other hospitals. This is the first real use implementation of an object-oriented data base in a clinical setting, and results are promising in terms of providing an intelligent clinical database. Also discussed are future trends of clinical master files, hospital administrative tools, and multi vendor configurations of HIS.

Clinical Laboratory Techniques↗
PubMed2003

[Introduction to medical data mining].

Modern medicine generates a great deal of information stored in the medical database. Extracting useful knowledge and providing scientific decision-making for the diagnosis and treatment of disease from the database increasingly becomes necessary. Data mining in medicine can deal with this problem. It can also improve the management level of hospital information and promote the development of telemedicine and community medicine. Because the medical information is characteristic of redundancy, multi-attribution, incompletion and closely related with time, medical data mining differs from other one. In this paper we have discussed the key techniques of medical data mining involving pretreatment of medical data, fusion of different pattern and resource, fast and robust mining algorithms and reliability of mining results. The methods and applications of medical data mining based on computation intelligence such as artificial neural network, fuzzy system, evolutionary algorithms, rough set, and support vector machine have been introduced. The features and problems in data mining are summarized in the last section.

Algorithms↗
PubMedDate not supplied

An interactive program for the analysis of ENG tracings.

An interactive program for clinical and research evaluation of vestibular nystagmus has been developed. Because of the interactive structure of the program, the clinician can make immediate decisions on the interpretation of controversial aspects of the nystagmogram; therefore even the more irregular and noisy ENG tracings, frequently obtained from pathological subjects, can be easily processed. In this way, speed and accuracy of computer processing are coupled with intelligent activity and critical judgement of the clinical evaluation. The program can be implemented on a general purpose minicomputer and no specific technical training is required for its use. The structure of the program and the operations performed by main subsystems are discussed in detail. Examples of ENG tracings processed with the program are reported.

Computers↗
PubMed1994

A model for the assessment of medical workstations for health care support.

The development of medical workstations for the support of patient care, the assessment of care, management support, and education is just at its beginning. During the Working Conference on the Health care Professional Workstation held in Washington DC, June 1993, several aspects of such workstations were discussed, but it was also recognized that prototyping or learning by experience could be a rich source to further promote the progress in this field. Eight such prototypes or already operational medical workstations were demonstrated and a preliminary user assessment was done to obtain a first insight in the advantages and the type of criteria of such evaluations. It was concluded that such assessments were of great value to (i) give feedback to the designers of medical workstations, (ii) indicate areas of strength and for further research, and (iii) to offer criteria to potential users of such workstations for making decisions on using such systems. The assessment criteria deal with functionality, architecture, user interfaces, communications and integration, and data and knowledge management.

Artificial Intelligence↗
PubMed2005

The neuropsychological basis of competence to consent in first-episode schizophrenia: a pilot metacognitive study.

BACKGROUND: This study was designed to explore the neuropsychological basis of competence to consent to treatment in first-episode schizophrenia by evaluating its differential and joint links with cognitive versus metacognitive performance. METHODS: Twenty-one first-episode patients were assessed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback) and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "ventured" sort received a bonus of 10 cents if correct but an equal penalty if wrong. RESULTS: Compromised capacity to consent was more strongly related to deficits at the metacognitive level than to cognitive deficits per se. Moreover, prediction of competence to consent significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures but not the other way around. CONCLUSIONS: These preliminary results suggest that metacognition plays a fundamental role in capacity to consent, which might be at least equally important for decision-making competence as cognitive deficits per se.

Adult↗
PubMed2004

A greedy algorithm for supervised discretization.

We present a greedy algorithm for supervised discretization using a metric defined on the space of partitions of a set of objects. This proposed technique is useful for preparing the data for classifiers that require nominal attributes. Experimental work on decision trees and naïve Bayes classifiers confirm the efficacy of the proposed algorithm.

Algorithms↗
PubMed2000

Multivariate analysis-based prediction rule for pulmonary embolism.

The diagnosis of pulmonary embolism (PE) is still an unresolved problem. The aim of this prospective observational study was to derive and validate a prediction rule (PEscore) by which PE can be diagnosed by easily obtainable and rapidly available investigations. Included were consecutive patients with a clinical suspicion of PE admitted to a community hospital. Risk factors and clinical and instrumental investigations were registered. PE was diagnosed by angiography, scintigraphy, or autopsy. In 168 patients, PE was either diagnosed (angiography, n = 28; autopsy, n = 18) or excluded (angiography, n = 12; scintigraphy, n = 99; autopsy, n = 11). Based on the results of clinical and instrumental findings, a PEscore was derived by a multiple regression analysis, calculated as: [0.29 x proven leg vein thrombosis (0 = no, 1 = yes)] + [0.25 x ECG right heart strain (0 = no, 1 = yes)] + [0.22 x neck vein distension (0 = no, 1 = yes)] + [0.20 x dyspnoea (0 = no, 1 = yes)] + [0.13 x suspicious chest X-ray (0 = no, 1 = yes)] - [0.17 (constant)]. The PEscore was tested further in 139 subsequent cases. In these patients, the PEscore was 0.65+/-0.17 (diagnosed PE, n = 47) and 0.18+/-0.17 (excluded PE, n = 92), respectively (p = 0.0001). Depending on a given PE-score, the level of probability of PE can be assessed. Calculation of the PEscore can be helpful in clinical decisions when PE is suspected.

Adult↗
PubMed2001

A modular approach for representing and executing clinical guidelines.

In this paper, we propose an approach for managing clinical guidelines. We outline a modular architecture, allowing us to separate two conceptually distinct aspects: the representation (and acquisition) of clinical guidelines and their execution. We propose an expressive formalism, which allows one to deal with the context-dependent character of clinical guidelines and also takes into account different temporal aspects. We also describe our tool for acquiring clinical guidelines, which provides a user-friendly interface to physicians, and automatically detects many forms of syntactic and semantic inconsistencies in the guidelines being acquired. In the second part of the paper, we describe a flexible engine for executing clinical guidelines (e.g. for clinical decision support applications, for medical education, or for integrating guidelines into the clinical practice), focusing our attention on temporal issues.

Artificial Intelligence↗
PubMed2006

EEG transient event detection and classification using association rules.

In this paper, a methodology for the automated detection and classification of transient events in electroencephalographic (EEG) recordings is presented. It is based on association rule mining and classifies transient events into four categories: epileptic spikes, muscle activity, eye blinking activity, and sharp alpha activity. The methodology involves four stages: 1) transient event detection; 2) clustering of transient events and feature extraction; 3) feature discretization and feature subset selection; and 4) association rule mining and classification of transient events. The methodology is evaluated using 25 EEG recordings, and the best obtained accuracy was 87.38%. The proposed approach combines high accuracy with the ability to provide interpretation for the decisions made, since it is based on a set of association rules.

Algorithms↗
PubMed1992

An application of the elementary pragmatic model to electronic communication.

This article sets out a quantitative theory of the interaction among "subjects" which allows a description of the pragmatic aspects of communication. Within a system of interacting subjects each individual is described by means of a set of interaction parameters. In this way an interaction pattern relative to each subject can be defined. The model provides a "change law" which describes the evolution of individual patterns as a consequence of different communication events. This allows interaction deficiencies to be identified and suggests possible strategies for dealing with them. The theory was first developed in the area of clinical psychiatry and underwent two kinds of external verification: one psychometric-diagnostic, the other clinical. The theory was then applied to an economic environment in the behavioral study of decision-making processes. In this paper we suggest that it may be applied in computerized environments for cooperation support.

Artificial Intelligence↗
PubMed1988

Knowledge-based automation.

Future technologic advances in microcomputer hardware will allow us to build complex interactive information systems that go far beyond conventional laboratory management functions to address the needs of laboratorians as well as physicians in patient care activities. These systems will use a "local-area network to transmit not only text but also images to workstations throughout a hospital. Unlike current systems driven from a central computer, future systems will decentralize much of the memory and processing to individual workstations." The expansion of software tools for modeling the decision-making process coupled with the development and testing of useful systems in relatively narrow problem domains will help the laboratory construct the necessary knowledge bases for future applications. Such systems will present complex medical data in a useful, informative manner, leading to a more rapid, consistent, and, it is hoped, cost effective decision making process. Utilizing these techniques, laboratory medicine can play a crucial role in fostering the appropriate and logical use of the laboratory.

Artificial Intelligence↗
PubMed1992

A computer-based decision support system for diagnostic histopathology of the breast.

Accurate histological diagnosis of breast lesions is essential for the appropriate management of the patient. However, the technique of histological typing is problematic due to the large number of histological patterns, often of a complex and variable nature, which occur in breast disease. The introduction of the Breast Screening Programme has increased the burden on pathologists, and emphasised the need for training. Problems arise because mammographic screening detects a greater proportion of special histological types, with their attendant difficulties of identification, when compared to clinically palpable lesions. A computer-based decision support tool has been developed to assist pathologists in the histological diagnosis of breast disease. Unlike conventional expert systems, which seek to recreate the problem-solving processes of an expert, this system has been designed to act as an intelligent assistant to the pathologist. The system represents knowledge in the form of 'disease profiles', and utilises a novel inference model based upon the mathematical technique of hypergraphs. Initial trials with this system have demonstrated that a high level of diagnostic accuracy can be achieved.

Breast Diseases↗
PubMed2004

To everything there is a season and a time to every purpose: retirement and the neurosurgeon.

Neurosurgery has designed a rigid curriculum that must be followed precisely by those who wish to enter the specialty. A similar process at the other end of the practice cycle has never been formalized except for mandatory retirement from certain administrative positions at a particular age. Basic considerations for strategic decision making about voluntary retirement from neurosurgery, especially operative neurosurgery, are investigated. Statistical data from the US Census Bureau and sources in the medical literature were reviewed regarding life expectancy and retirement ages. Age-related differences in verbal and performance intelligence quotients, attention span, verbal memory recall, and visuospatial facility were surveyed. A questionnaire was sent to 29 recently retired academic neurosurgeons about their age and reasons for retirement along with postretirement activities; 22 responses were received. Analysis of the data indicates that surgeons are now retiring at the age of approximately 60 years, whereas life expectancy is approximately 80 years. An individual thus may have 15 to 20 productive years after leaving active neurosurgical practice. Reasons for retirement among the 22 responding neurosurgeons included decreasing personal satisfaction and financial rewards, a desire to pursue other activities, local ground rules mandating age-specific retirement, the general sense that enough is enough, and, overall, a strong desire to stop performing surgery while at the top of one's game. The process of age-related competence assessment of commercial airline pilots is outlined, and a similar process of assessment of practicing surgeons may be warranted, with consideration for mandatory retirement from operative neurosurgery.

Aged↗
PubMed1992

An intelligent computer-assisted instruction system designed for rural health workers in developing countries.

This paper describes an intelligent computer-assisted instruction system that was designed for rural health workers in developing countries. This system, called Consult-EAO, includes an expert module and a coaching module. The expert module, which is derived from the knowledge-based decision support system Tropicaid, covers most of medical practice in developing countries. It allows for the creation of outpatient simulations without the help of a teacher. The student may practice his knowledge by solving problems with these simulations. The system gives some initial facts and controls the simulation during the session by guiding the student toward the most efficient decisions. All student answers are analyzed and, if necessary, criticized. The messages are adapted to the situation due to the pedagogical rules of the coaching module. This system runs on PC-compatible computer.

Computer Simulation↗
PubMedDate not supplied

Predicting the phosphorylation sites using hidden Markov models and machine learning methods.

Accurately predicting phosphorylation sites in proteins is an important issue in postgenomics, for which how to efficiently extract the most predictive features from amino acid sequences for modeling is still challenging. Although both the distributed encoding method and the bio-basis function method work well, they still have some limits in use. The distributed encoding method is unable to code the biological content in sequences efficiently, whereas the bio-basis function method is a nonparametric method, which is often computationally expensive. As hidden Markov models (HMMs) can be used to generate one model for one cluster of aligned protein sequences, the aim in this study is to use HMMs to extract features from amino acid sequences, where sequence clusters are determined using available biological knowledge. In this novel method, HMMs are first constructed using functional sequences only. Both functional and nonfunctional training sequences are then inputted into the trained HMMs to generate functional and nonfunctional feature vectors. From this, a machine learning algorithm is used to construct a classifier based on these feature vectors. It is found in this work that (1) this method provides much better prediction accuracy than the use of HMMs only for prediction, and (2) the support vector machines (SVMs) algorithm outperforms decision trees and neural network algorithms when they are constructed on the features extracted using the trained HMMs.

Algorithms↗
PubMed2003

Effects of PCB exposure on neuropsychological function in children.

In the last decade advances in the analytic methods for quantification of polychlorinated biphenyls (PCBs) have resulted in widespread availability of congener-specific analysis procedures, and large amounts of data on PCB congener profiles in soil, air, water, sediments, foodstuffs, and human tissues have become available. These data have revealed that the PCB residues in environmental media and human tissues may not closely resemble any of the commercial PCB mixtures, depending on source of exposure, bioaccumulation through the food chain, and weathering of PCBs in the environment. At the same time, toxicological research has led to a growing awareness that different classes of PCB congeners have different profiles of toxicity. These advances in analytic techniques and toxicological knowledge are beginning to influence the risk assessment process. As the data from ongoing PCB studies assessing the mediators of neurobehavioral outcomes in children are published, the weight of evidence for PCB effects on neurodevelopment is growing. Studies in Taiwan, Michigan (USA), New York (USA), Holland, Germany, and the Faroe Islands have all reported negative associations between prenatal PCB exposure and measures of cognitive functioning in infancy or childhood. The German study also reported a negative association between postnatal PCB exposure and cognitive function in early childhood--a result that had not been found in previous studies. Only one published study in North Carolina (USA) has failed to find an association between PCB exposure and cognitive outcomes. Despite the fact that several more recent studies have used congener-specific analytic techniques, there have been only limited attempts to assess the role of specific PCB congeners or classes of congeners in mediating neurodevelopmental outcomes. From a statistical standpoint, attempts to determine the role of individual congeners in mediating outcomes are hampered by the fact that concentrations of most individual congeners are highly correlated with each other and with total PCBs. From a toxicological standpoint, these efforts are hampered by the fact that many of the PCB congeners present in human tissues have never been studied in the laboratory, and their relative potency to produce nervous system effects is unknown. More complete information on the health effects of various congeners or congener classes would allow more informed scientific and risk assessment decisions.

Child↗