PubMed · 16844516
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Karl Holubar. 2006-06-05. Two patients.. https://doi.org/10.1016/j.jaad.2005.11.1069
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OBJECTIVE: Case-based reasoning has been of great importance in the development of many decision support applications. However, relatively little effort has gone into investigating how new knowledge can be validated. Knowledge validation is important in dealing with imperfect data collected over time, because inconsistencies in data do occur and adversely affect the performance of a diagnostic system. METHODS: This paper consists of two parts. First, it describes methods that enable the domain expert, who may not be familiar with machine learning, to interactively validate knowledge base of a Web-based teledermatology system. The validation techniques involve decision tree classification and formal concept analysis. Second, it describes techniques to discover unusual relationships hidden in the dataset for building and updating a comprehensive knowledge base, because the diagnostic performance of the system is highly dependent on the content thereof. Therefore, in order to classify different kinds of diseases, it is desirable to have a knowledge base that covers common as well as uncommon diagnoses. RESULTS AND CONCLUSION: Evaluation results show that the knowledge validation techniques are effective in keeping the knowledge base consistent, and that the query refinement techniques are useful in improving the comprehensiveness of the case base.
The number of tasks required of dermatologists has increased in the last decade. This article discusses potential ways to enhance the efficiency ofdermatological patient care and prevent problems of capacity. A study conducted in the UK found that, for the top 10 skin disorders, the accessibility of general practitioners with special expertise in dermatology was better than that of the dermatology clinic. Waiting times were considerably shorter with the general practitioners, but care was more expensive. Outcomes were similar for these skin disorders in terms of disease-specific quality of life. The study made no comment on the actual diagnostic ability of the specialised general practitioners. Teledermatology can reduce the number of referrals to a dermatologist by half. However, a considerable percentage of teledermatological consultations result in a different diagnosis than that obtained during a standard 'in vivo' consultation. Teledermatology can be a useful option for the follow-up of patients with ulcus cruris. The efficiency of dermatological care can be increased by working in teams. Dermatological nurses can be trained and conduct their own consultations under the supervision of a dermatologist. Dermatological care can also be organised in regional cooperative groups with general practitioners. Within these groups, teledermatology and specialised dermatology training for general practitioners can be useful innovations.
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