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PubMed1996

Programs, databases, and expert systems for human geneticists--a survey.

We present an overview of the variety of databases and programs that offer substantial aid to medical and molecular geneticists. Databases and expert systems for genetic diseases and birth defects, programs for segregation and linkage analysis, certain DNA and protein sequence databases, and information resources in general for molecular biology are addressed. These systems cannot be used effectively without the newly developed techniques of information exchange based on international computer networks. A short introduction is given to the Internet and to European institutions and organizations that offer help with the acquisition and use of bioinformatic resources.

Computer Communication Networks↗
PubMedDate not supplied

Knowledge acquisition and knowledge representation in a rule-based expert system.

It is important to understand and describe how nurses make diagnostic decisions. This article describes the process by which knowledge is acquired and represented in a rule-based expert system for nursing diagnosis. Knowledge acquisition was obtained by tapping the expertise of clinical nurse specialists who were able to articulate the elements present in their diagnostic decisions. Knowledge representation was achieved using a commercially-available software package. VP Expert (Berkeley, CA). The clinical nurse specialists contributed many of the heuristics in the determination of self-care deficit as a nursing diagnosis. Three models of rules for the determination of self-care deficit, bathing are provided. These models represent a method for discriminating between levels of patient dependence. A description of rules that define specific causes, such as immobility are also included. They will be tested in the clinical setting.

Artificial Intelligence↗
PubMed1996

If there are expert systems and dose checks, why do we still need the clinical pharmacist?

Trends in patient care, along with escalating health care costs, and the demand for medication safety may provide a breadth of opportunities for clinical pharmacists. Service and drug use guidelines development, medication error prevention, quality assurance, and pharmacoeconomic assessment are areas in which skills of the oncology pharmacist may be used. Although expert systems may aid the pharmacist in these areas, such systems cannot replace the professional.

Antineoplastic Agents↗
PubMed1994

Managing provider networks through expert systems: use of patterns of treatment to address overutilization.

Among the most important contributors to rising health care costs is excess utilization of services. Sophisticated clinical criteria, encoded as an expert system in software, allow identification of probable excess utilization in large claims data sets. These systems can be used to adjudicate claims, resulting in direct cost savings, or to profile physicians and other providers, facilitating creation and maintenance of networks. These systems are used by traditional payers to promote quality, control costs, and enhance competitiveness and are beginning to be used by nontraditional payers, such as physician groups and hospital-based networks.

Ambulatory Care↗
PubMed1997

[Choice of therapeutic tactics in treatment of endogenous depression by means of statusmetric expert system].

There was elaborated expert models based on computer data base including 42 formalized signs (anamnesis, state of the patients, medical measures and indices of expert estimation of the response to therapy, based on the reduction of scores of Hamilton's scale). The study was carried out in 104 in-patients whose clinical states corresponded according to ICD-10 to category "depressive episode" and "recurrent depressive disorder". The patients were divided into 2 groups: in the first one the treatment was performed by serotoninergic antidepressants (SA)-fluoxetine (20 patients), fluvoxamine (20), sertraline (30). Tricyclic antidepressant (TAD) amitryptiline was administered to 34 patients of the second group. Two data bases were formed: responders to TAD and responders to SA. Natural pair model of classification (error of the model--12.5%) including 9 informative signs, was constructed, that gave chance to define probability sensitivity to TAD and SA. Check-up of computer model revealed that 3 patients of SA group didn't submit to decisive rule, while there were found 2 such patients in TAD application. Application of computer experiment permitted to turn from group prognosis to individual one.

1-Naphthylamine↗
PubMed1997

Misunderstanding between knowledge engineers and domain experts: a re-evaluation of the use of induction for medical expert systems.

The effectiveness of an induction algorithm for making decisions was investigated using a complete set of diagnoses and corresponding outcomes for all possible distinct cases of thyroid disorders. Investigation of both diagnoses and outcomes followed a late discovery of a misunderstanding between the knowledge engineers and the expert. The knowledge engineers had erroneously equated the expert's terms 'diagnosis' and 'outcome'. Following this discovery, two previously reported induced expert systems were re-evaluated using the more appropriate 'outcomes' and were found to be correct for 79 and 70% of all cases.

Algorithms↗
PubMed1993

Data explorer: a prototype expert system for statistical analysis.

The inadequate analysis of medical research data, due mainly to the unavailability of local statistical expertise, seriously jeopardizes the quality of new medical knowledge. Data Explorer is a prototype Expert System that builds on the versatility and power of existing statistical software, to provide automatic analyses and interpretation of medical data. The system draws much of its power by using belief network methods in place of more traditional, but difficult to automate, classical multivariate statistical techniques. Data Explorer identifies statistically significant relationships among variables, and using power-size analysis, belief network inference/learning and various explanatory techniques helps the user understand the importance of the findings. Finally the system can be used as a tool for the automatic development of predictive/diagnostic models from patient databases.

Artificial Intelligence↗
PubMed1995

[Use of expert systems in internal medicine. Analysis of performance and reliability of the Quick Medical Reference].

Here are reported the results of an analysis on the performance and the reliability of an expert system as a diagnostic aid in internal medicine, the Quick Medical Reference (QMR). The QMR is able to suggest a list of differential diagnoses elaborated on the basis of the clinical data available from patient's study cases. The study was performed on 27 clinicopathological cases published by the N Engl J Med in a consecutive series starting from 1993 until 1994. Each case was analyzed in three different phases in the attempt to simulate real life diagnostic procedure. In phase I only anamnestic and physical examination data were used, in phase II laboratory routine data, in phase III all the remaining clinical data. The QMR performance was evaluated by determining the frequency in which the "correct diagnosis" was given as highly probable by QMR in each of the three phases. At the end of phase III, the program suggested the correct diagnosis as the only one possible in 1 case. In 25 out of the 27 cases studied, the correct diagnosis was ranked within the first 5 positions, 14 out of 27 cases were listed as the most probable hypothesis. In 48% of the cases the program was able to give a diagnostic indication only on the basis of anamnestic and physical examination data. The program gave a poor performance only in those cases that were not well represented or the method used for the diagnostic procedure was not accurate.

Diagnosis, Computer-Assisted↗
PubMed2004

Mental Status Expert: an expert system for scoring and reporting the mental status examination.

For neurology clerks and residents, the mental status examination is often the most difficult part of the neurological examination. We have developed the Mental Status Expert (MSE), a structured mental status examination designed for use by neurology student clerks and neurology residents. The MSE assesses seven areas of cognitive function: orientation and concentration, language, right parietal functions, left parietal functions, occipital lobe functions, frontal lobe functions, and memory. Norms for the test have been created based on administration to 281 subjects referred to the Neurology Clinic. The MSE uses production rules and other expert system features to assist in the scoring and reporting of test results.

Aged↗
PubMed1987

[Development of an expert system as a teaching aid in the serological diagnosis of acute viral hepatitis].

The serological diagnosis of acute viral hepatitis is complex for both practitioners and students. We have developed an expert system to teach the serological diagnosis of acute viral hepatitis in order to help non-specialists in deciding on the diagnosis. Three levels of increasing difficulty have been devised. The procedure consists of the following steps: choice of first-line examinations; discontinuation of the examinations in cases where the diagnosis is ascertained; choice of the most discriminant examination in cases where the diagnosis is doubtful. The value of this computer-assisted teaching must be confirmed by randomized studies involving a group of students trained by "classical" methods and a group of students trained by a computer-assisted method.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

[Perspectives on the application of expert systems in medicine].

Attention is drawn to the relationship between informatics and biological models in the study of problems of human physiology and physiopathology. The biomathematical principles, to which reference must be made for the elaboration of the expert systems, necessary in evaluating biological feed-back in particular, are analyzed.

Biofeedback, Psychology↗
PubMed2002

An expert system for monitoring and diagnosis of anaerobic wastewater treatment plants.

In this paper, an expert system (ES) developed for the monitoring and diagnosis of anaerobic wastewater treatment plants (AWT), is presented. The system was evaluated in a hybrid pilot plant of 1.1 m3 located in an industrial environment for the treatment of wastewaters from a fibreboard production factory. The reactor is a hybrid USBF, combining an upflow anaerobic sludge blanket (UASB) in the lower part and an upflow anaerobic filter (UAF) at the top.

Bacteria, Anaerobic↗
PubMedDate not supplied

Evaluation of user acceptance of a clinical expert system.

OBJECTIVE: To measure the attitudes of physicians and nurses who use the Health Evaluation through Logical Processing (HELP) clinical information system. DESIGN: Questionnaire survey of 360 attending physicians and 960 staff nurses practicing at the LDS Hospital. The physicians' responses were signed, permitting follow-up for nonresponse and use of demographic data from staff files. The nurses' responses were anonymous and their demographic data were obtained from the questionnaires. MEASUREMENTS: Fixed-choice questions with a Likert-type scale, supplemented by free-text comments. Question categories included: computer experience; general attitudes about impact of the system on practice; ranking of available functions; and desired future capabilities. RESULTS: The response rate was 68% for the physicians and 39% for the nurses. Age, specialty, and general computer experience did not correlate with attitudes. Access to patient data and clinical alerts were rated highly. Respondents did not feel that expert computer systems would lead to external monitoring, or that these systems might compromise patient privacy. The physicians and nurses did not feel that computerized decision support decreased their decision-making power. CONCLUSION: The responses to the questionnaire and "free-text comments" provided encouragement for future development and deployment of medical expert systems at LDS Hospital and sister hospitals. Although there has been some fear on the part of medical expert system developers that physicians would not adapt to or appreciate recommendations given by these systems, the results presented here are promising and may be of help to other system developers and evaluators.

Adult↗
PubMed1991

Foetos: an expert system for fetal assessment.

Assessment of the fetus in a high-risk pregnancy uses a variety of tests for screening and continued detection of in utero compromise. This paper describes Foetos, an expert system designed to help clinical personnel to interpret several fetal assessment tests: fetal biophysical profile, contraction stress test, and nonstress tests. Foetos has been built using the knowledge engineering tool Genie, which adopts a mixed frame- and rule-based approach to represent the clinical knowledge in the field. Foetos includes diagnostic, prognostic, and therapeutic structures, based on heuristic interpretation of such tests and contextual structures which relate interpretation to the overall clinical picture. The results of initial retrospective and prospective program validation are included in the report. These results show a substantial level of agreement between Foetos' recommendations and clinical management. Interpretation of the results indicates that the obstetrical field could be an area of interest for the application of AI techniques.

Diagnosis, Computer-Assisted↗
PubMed2003

FINEX: a Probabilistic Expert System for forensic identification.

A series of recent papers have shown how to formulate complex problems of forensic DNA identification inference, such as occur in disputed paternity or criminal identification cases, in terms of Probabilistic Expert Systems (PESs). However, at the present time, general purpose PES software is not particularly well suited to the repetitive tasks of: specifying an appropriate set of marker networks for a specific problem; for editing the many local conditional probability tables; and combining evidence from several genetic markers to evaluate likelihoods. Here, I describe a user-friendly prototype software tool called FINEX developed both to automate such tasks and also to evaluate likelihoods of interest. Ease of use is achieved by a graphical specification language that enables a user to quickly specify a range of forensic DNA problems. I describe the algorithms by which FINEX converts the user input in the graphical specification language and data on observed markers to the Bayesian networks used in PES.

Algorithms↗
PubMed1991

Thomas: building Bayesian statistical expert systems to aid in clinical decision making.

Knowledge-based system for classical statistical analysis must separate the task of analyzing data from that of using the results of the analysis. In contrast, a Bayesian framework for building biostatistical expert system allows for the integration of the data-analytic and decision-making tasks. The architecture of such a framework entails enabling the system (1) to make its recommendations on decision-analytic grounds; (2) to construct statistical models dynamically; (3) to update a statistical model based on the user's prior beliefs and on data from, the methodological concerns evinced by, the study. This architecture permits the knowledge engineer to represent a variety of types of statistical and domain knowledge. Construction of such systems requires that the knowledge engineer reinterpret traditional statistical concerns, such as by replacing the notion of statistical significance with that of a pragmatic clinical threshold. The clinical user of such a system can interact with the system at a semantic level appropriate to her fund of methodological knowledge, rather than at the level of statistical details. We demonstrate these issues with a prototype system called THOMAS which helps a physician decision maker interpret the results of a published randomized clinical trial.

Artificial Intelligence↗