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E L Kinney

Publications and source records attributed to E L Kinney.

At least 37 records · Page 2Linked to original sources
PubMed1988

An expert system on the diagnosis of ascites.

We constructed an expert system on the diagnosis of ascites, using a combination of case reports and unpublished patient data. Rule production was by induction from examples, and the program operated on an algorithm which was a modification of Quinlan's ID3. The result was a small, but formally complete expert system. When tested against a new data set of patients, our expert system predicted the clinical diagnosis 82% of the time.

Ascites↗
PubMed1988

Should echocardiography be used to screen dizzy patients?

The value of echocardiography in the evaluation of dizziness was studied in 151 consecutive patients. Twenty-two patients, on further review, were found to have related complaints, seizures and syncope mainly, but not dizziness. Twenty-four patients had vertigo, 67 had nonvertiginous dizziness, and in 38 patients, there was insufficient information to categorize the dizziness as being vertigo or nonvertiginous dizziness. When the 22 nondizzy patients were compared with the 129 dizzy patients, the only statistically significant differences were that there were more blacks in the nondizzy group and that the aortic root dimension was, on average, 0.4 cm larger in the nondizzy group. These findings, although statistically significant, appeared to be clinically insignificant. There was, however, a high prevalence of valvular heart disease in both the nondizzy and two of the three dizzy subgroups. In most cases, the valvular abnormality had not been suspected clinically. But in no case was significant information added by echocardiography that helped in patient management. Thus, in the dizzy patient, echocardiography should be reserved for specific cardiac indications and not used as a routine screening test.

Adult↗
PubMed1988

Accuracy of self-reported weight in a non-normal population.

Although prior studies have concluded that self-reported weight was accurate enough that it could readily be substituted for measured weight, the populations in these prior studies were either not well-defined or lacked generalizability. The present study was done in a well-defined group of 167 consecutive, male Veterans Administration (VA) patients. The relationship between actual weight (AW) and self-reported weight (RW) was found to be: AW = 0.96* RW + 16.3, and the standard error of estimate was 11.6 lbs, roughly twice as great as reported previously. The factors most closely associated with self-reporting error were obesity, race, and a history of congestive heart failure.

Aged↗
PubMed1987

Cardiac size and motion during water immersion: implications for volume homeostasis.

Prior work has shown that head-out water immersion (WI) produces a prompt central hypervolemia, a natriuresis, and a diuresis. To assess if cardiac chamber enlargement modulates these effects, we measured cardiac size, shape, wall motion, and cardiac displacement via serial underwater two-dimensional echocardiography. Six normal volunteers underwent 2.5 hours of WI to the neck, seated, at 34.5 degrees C. Recovery was 30 minutes. The size of both atria increased significantly but transiently during the study (p less than 0.0001 for left atrium, and p = 0.0020 for right atrium). Both atria returned to baseline size during WI. Moreover, for left atrium there was a small overshoot in recovery. Neither left ventricular nor right ventricular dimensions nor ejection fraction changed significantly. Also, no shape changes were detected, although WI was associated with upward and lateral displacement of the acoustic windows. Correlation coefficients (r) for left atrial, or right atrial size vs urinary excretion of sodium or urine volume size ranged from 0.05 to 0.36. These results, in sum, suggest that strong compensatory mechanisms are counteracting the effect of WI on distended cardiac receptors, and that cardiac receptor activation alone does not constitute the afferent limb of the reflex mediating the renal effects of head-out WI.

Adolescent↗
PubMed1987

Comparison of the ID3 algorithm versus discriminant analysis for performing feature selection.

Having obtained disappointing results in a small medical data set despite the fact that our data seemed to be well suited for induction via ID3, we decided to compare the performance of ID3 to discriminant analysis. Performance was gauged by the percentage of correct classification in a second, independent data set. Examples were obtained from a cardiology project on the accuracy of auscultation. There were 107 examples in the first data set and 67 cases in the second. We found that ID3 and discriminant analysis performed equally poorly, with ID3 classifying only 60% of the second set correctly and discriminant analysis classifying 66% of the second set correctly. Also, the ID3 probability statistic for estimating the accuracy of ID3 for classifying further cases was markedly optimistic compared to our actual second data set results. Moreover, with an increase in sample size, ID3 seemed to break down, producing a large, complex decision tree of dubious generality, whereas discriminant analysis, with a larger sample size, used more independent variables but maintained its first set accuracy. These data suggest that there is a need for more sophisticated algorithms than ID3, even at the risk of giving up some computational efficiency.

Adult↗
PubMed1986

Expert system detection of drug interactions: results in consecutive inpatients.

Although drug interactions (DI) are a common cause of morbidity, their large number precludes remembering them. To address this problem, we constructed a microcomputer-based expert system and assessed its efficacy in 90 consecutive inpatients. It was found that, without the expert system, a knowledge of the patient's medication list did not affect the frequency of occurrence of DI. Also, without the expert system, no DI were predicted, clinically, whereas the expert system predicted 27 DI of which, in retrospect, 10 actually occurred. Unsuspected DI were most likely if: a drug was not within the specialty of the clinician, DI host factors were present, or the DI involved a commonly prescribed drug pair. Although none of the drug interactions were life-threatening, in two cases, the DI was the cause for admission. Since the offending medications could usually be adjusted in dose, drug interactions were easily corrected once clinicians were made aware of them.

Aged↗
PubMed1985

Value of two-dimensional echocardiographic detection of incomplete mitral leaflet closure.

The echocardiographic pattern of incomplete mitral leaflet closure (IMLC) is reported to be present in about 90% of patients with acute myocardial infarction and new onset of mitral regurgitation. To determine the significance of this echocardiographic sign, we retrieved all echocardiograms containing this abnormality from a file of 1200 consecutive echocardiograms. Seventy-three echocardiograms manifested IMLC. We also studied a control group consisting of 52 patients without IMLC, but who were matched with the IMLC group with respect to a range of left ventricular (LV) diameters at end diastole and fractional shortening. The following was found in the control group: fewer wall motion abnormalities per patient, less frequent mitral "B bumps," and a smaller LV end-diastolic dimension (LVEDD) (p less than 0.05 for each comparison). By logistic regression, the variable most important to the probability of having IMLC was the presence of mitral valve "B bumps." We conclude that: (1) elevated left ventricular filling pressure is associated with IMLC and (2) IMLC is not specific for the subset of patients with papillary muscle dysfunction due to acute myocardial infarction. Rather, IMLC is commonly seen in association with dilated, usually ischemic cardiomyopathy.

Aged↗