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PubMed2001

Developing an expert system for immunophenotypical diagnosis in immunodeficiency. Age-related reference values of peripheral blood lymphocyte subpopulations in Hungary.

In the process of developing a decision support system based on flow cytometric data for the diagnosis of immunodeficiency, assessment of lymphocyte subpopulations in human peripheral blood provides the key for further analysis. Samples from 273 'healthy' Hungarian subjects were measured between 1998 and 1999. Immunophenotypic data are compared here (unadjusted for gender) by different age groups: I 0-6 years (n=45); II 7-18 years (n=71); III 19-35 years (n=72); IV 36-55 years (n=48); and V 56-99 years (n=37). Two-color flow cytometric analysis was performed using the Becton Dickinson Simultest IMK Plus kit (CD45/CD14, isotype control, CD3/CD19, CD4/CD8, CD3/HLA-DR, CD3/CD16+56). All lymphocyte subpopulations were measured in all blood samples identically. The quality criteria involved at least 95% of total lymphocytes in the analysis gate, homogenous CD45+ lymphocyte population (minimum of 2000 events in the gate, CD45+ >95%). The frequency of B lymphocytes was the highest, significantly, in the youngest Hungarian subjects, but there were no significant changes with age comparing the data of other II-V age groups. On the other hand, some T subpopulations changed with aging; both CD4 and CD8 subsets varied over time including the elevation of the fraction of activated T cells as well as LGL-NK cells. Some of these changes were significant by statistical tests. Interpretation of flow cytometric data is time-consuming and requires human knowledge of an expert laboratory staff. To facilitate the diagnosis of immunodeficiency, a pilot study aiming at the development of a diagnostic algorithm has been initiated. Algorithm nodes compare the frequency of each lymphocyte subpopulations to the generated reference values. This knowledge-based system describes a short summary report as a result of the comparison, and points to some values requiring further human examination to reach a final conclusion. These reference values and the expert system appear to be a recommended basis for comparing and combining results from different laboratories.

Adolescent↗
PubMed1985

A proposed expert system for nursing practice. A springboard to nursing science.

The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.

Computers↗
PubMed1999

[RHEUMexpert: a documentation and expert system for rheumatic diseases].

A computer assisted documentation of signs and findings in rheumatic diseases is described. This documentation was developed by the Austrian Society for Rheumatology and thought to be a minimal standard for the use by general practitioners. In addition, a knowledge-based basic differential diagnosis support was developed, which differentiates between major groups of rheumatic diseases as inflammatory spine diseases, mechanical or metabolic reasons for spine disorders, inflammatory joint diseases, degenerative or metabolic joint diseases, soft tissue diseases. This presentation describes the results of an evaluation of 75 typical case histories and a second study where 252 case histories were documented retrospectively in this new system. The results of the first showed a pretty good discrimination between the described groups of different diagnoses (sensitivity between 71 and 100 percent for all groups with the exception of metabolic joint diseases, specificity between 75 and 94 percent). The second--retrospective--documentation and diagnostic support showed much weaker results (sensitivity for major groups 74-76 percent). The reasons for the different outcomes are discussed: On the one hand, signs and symptoms from case reports could not be transferred completely in the new documentation, as some findings retrospectively could not be defined sharp enough. On the other hand the study showed, that the sensitivity of well defined disorders as inflammatory joint diseases (exp. rheumatoid arthritis) reaches almost 100 percent, whereas it is as low as 50 percent in some other diseases (e.g. gout) whose characteristic findings and symptoms are suppressed by treatment (drug medication) in many cases. The results show that computer based documentation of rheumatic diseases facilitates the systematized and standardised documentation of patient data. However, a few modifications of the knowledge base as well as the knowledge representation formalisms are necessary to achieve a better performance in differential diagnostic support.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[An expert system based on the principle of brain functional asymmetry].

The generalized concept is proposed for automation of secondary data processing. Initial information is stored in the knowledge base. During processing the verbal description is generated for each object. All further operations are reduced to the transformation of the textual data. This approach makes it possible to accumulate information of diverse types and efficiently analyze it according to the universal scheme.

Brain↗