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[Multicenter evaluation of the Nutri-Expert Telematic System in diabetic patients].

Nutri-Expert is a system for self-monitoring and dietetic education, accessible through Minitel. A preliminary randomised evaluation of one hundred diabetic patients in the Midi-Pyrénées region showed that Nutri-Expert improved dietetic knowledge, dietary habits and metabolic balance. The aim of the present study was to show that the system can be successfully prescribed to patients by physicians outside the center which originated it, indicating the benefit of a wider use of Nutri-Expert, among the diabetic population. One hundred and fifty-five patients, recruited by six French centres of diabetology, used Nutri-Expert from their homes for six months. Clinical examination, tests of dietetic knowledge and biological tests, including lipid fractions, were carried out before and after six months of use. After six months, there was a significant improvement in the patients' dietetic knowledge and in some biological parameters. Nutri-Expert is thus useful even when prescribed by a centre other than the hospital which devised the system. It is an additional beneficial tool in the ambulatory management of diabetic patients.

Adolescent↗

A decision support system for hospital bed assignment.

This article presents the use of a computer-based decision support system for hospital bed assignment. The specific computer application discussed involves the development of an expert system, which mimics the decision-making process typically used by experts in a field. Expert systems are useful as consultants for problems that are best approached from the perspective of an expert. The prototype expert system presented in this article can be used to efficiently assign hospital beds to specific patients at the time of hospital admission or during the hospital stay. This assignment is based on a matching process by the expert system of patient needs and hospital bed characteristics. Data needed for this assignment are routinely collected at admission and updated during the patient's stay in the hospital. Use of this computer-based decision support system in conjunction with existing hospital information systems will result in more effective management of physical and human resources. As may be expected, any improvement in efficiency of use of resources will have an associated reduction in cost. Implications of using expert systems for future practice are also discussed.

Admitting Department, Hospital↗

Computer-aided screening for hallucinogenic and stimulant amphetamines with gas chromatography-Fourier transform infrared spectroscopy (GC-FTIR).

An expert system applied as a screening test for amphetamine analogues found in recreational-drug exhibits (tablets or powders) is described. The knowledge base defining the reference Fourier transform infrared spectroscopic (FTIR) spectral patterns has been built according to criteria encompassing toxicological, pharmacological, and neurochemical aspects. The class identity of a compound is determined within seconds using soft independent modeling of class analogy (SIMCA). The predictive value of the system, as assessed at a testing accuracy of 95%, is expressed by a total correct classification rate of 93.93% and by a 96.30% rate of true-positive amphetamines. The specificity and the selectivity of the screening test, evaluated by testing 159 toxicologically relevant compounds, are discussed, emphasizing the chemical and physical factors affecting these parameters. Medicinal amphetamines giving cross-reactions with traditional screening techniques produce a negative result. The specificity of the system characterizes the expert system as a highly sensitive, selective, fast, and user-friendly screening test that screens for amphetamines with prediction accuracy adequate for investigations in analytical toxicology.

Amphetamines↗

Heterogeneous effect of an Emergency Department Expert Charting System.

STUDY OBJECTIVE: We compare results from different modules (occupational exposure to blood and body fluids, low back pain, and fever in children) of the Emergency Department Expert Charting System. Each module of this electronic medical record provides real-time advice based on clinical guidelines embedded in the software. METHODS: We used a staggered off-on-off interrupted time-series design with an intent-to-treat analysis to implement the Emergency Department Expert Charting System in a university hospital emergency department for the treatment of fever in children, low back pain, and occupational exposure to blood and body fluids. We measured the quality of documentation as the percentage of essential items contained in the medical record and discharge instructions, the percentage of appropriate testing and treatment decisions, median charges per patient visit, physician satisfaction by pre-experiment and postexperiment questionnaires, and patient satisfaction by telephone questionnaire. RESULTS: The Emergency Department Expert Charting System improved documentation rates for all modules. The Emergency Department Expert Charting System consistently improved the appropriateness of diagnostic testing and treatment decisions for patients with occupational exposure to blood and body fluids while decreasing median charges. For the low back pain and fever in children modules, improvements in appropriateness of testing and treatment were less consistent and did not result in a decrease in charges. Although physicians were generally supportive of the intervention, the physicians' use of the Emergency Department Expert Charting System and satisfaction with the modules were greatest with occupational exposure to blood and body fluids and least with fever in children. For each presenting complaint, mean patient satisfaction was highest during the Emergency Department Expert Charting System phase. CONCLUSION: The delivery of guidelines through an electronic medical record with background decision support improved documentation, patient care, and patient satisfaction, although effects were heterogeneous across presenting complaints. The optimal guideline implementation strategy likely varies with the nature of the clinical problem and the type of health care delivery setting. For selected problems, delivering guidelines in this format through the Internet holds great promise for modifying physician behavior and improving care (see http://www.needlestick.mednet.ucla.edu ).

Adult↗

Computer aided test selection (CATS) for nuclear medicine--a prototype system for renal investigations.

An expert system for renal test selection in nuclear medicine has been developed as the first stage of a collaborative project on test selection in nuclear medicine. The stages of knowledge elicitation and knowledge representation were addressed by means of a questionnaire which was completed by five experts in the field of renal nuclear medicine. A flow chart was developed from the responses and implemented using a commercially available expert system shell (Crystal 4.5). A menu specifying clinical problems, for which renal nuclear medicine is useful, is displayed to the user who is prompted for a choice. Specific aspects of the chosen problem are then shown and again a choice is requested. Selected tests, in order of expert preference, are displayed and further information on any of these is available, if required, on selection from a menu subdivided into categories such as patient preparation, preliminary investigations, etc. The system provides cross-referencing to other areas of investigation and is currently being evaluated using a structured approach commonly employed in the assessment of user interfaces.

Decision Making, Computer-Assisted↗

Diagnostic and neural analysis of skin cancer (DANAOS). A multicentre study for collection and computer-aided analysis of data from pigmented skin lesions using digital dermoscopy.

BACKGROUND: Early detection of melanomas by means of diverse screening campaigns is an important step towards a reduction in mortality. Computer-aided analysis of digital images obtained by dermoscopy has been reported to be an accurate, practical and time-saving tool for the evaluation of pigmented skin lesions (PSLs). A prototype for the computer-aided diagnosis of PSLs using artificial neural networks (NNs) has recently been developed: diagnostic and neural analysis of skin cancer (DANAOS). OBJECTIVES: To demonstrate the accuracy of PSL diagnosis by the DANAOS expert system, a multicentre study on a diverse multinational population was conducted. METHODS: A calibrated camera system was developed and used to collect images of PSLs in a multicentre study in 13 dermatology centres in nine European countries. The dataset was used to train an NN expert system for the computer-aided diagnosis of melanoma. We analysed different aspects of the data collection and its influence on the performance of the expert system. The NN expert system was trained with a dataset of 2218 dermoscopic images of PSLs. RESULTS: The resulting expert system showed a performance similar to that of dermatologists as published in the literature. The performance depended on the size and quality of the database and its selection. CONCLUSIONS: The need for a large database, the usefulness of multicentre data collection, as well as the benefit of a representative collection of cases from clinical practice, were demonstrated in this trial. Images that were difficult to classify using the NN expert system were not identical to those found difficult to classify by clinicians. We suggest therefore that the combination of clinician and computer may potentially increase the accuracy of PSL diagnosis. This may result in improved detection of melanoma and a reduction in unnecessary excisions.

Adult↗

The prospect of expert system-based cognitive support as a by-product of image acquisition and reporting.

In order for computer-based decision-support tools to find routine use in the everyday practice of clinical radiology, further development of user interface and knowledge content are required. In an ideal interface, the interaction between the radiologist and the computer would be minimized and painlessly integrated into existing work patterns. In this article, we explore some of the ways that pre-existing computer interactions in the processes of image acquisition and reporting can be used to feed case information into an expert system and thereby allow users to acquire advice from it in an automatic fashion. We describe interface models that we have developed in the domains of mammography and obstetric ultrasound, and discuss interface and content-related questions that have arisen from informal evaluations of these systems. In particular, the need for clinical outcome-relevant decision support and training level-appropriate decision support are discussed in detail.

Expert Systems↗

AutoNR: an automated system that measures ECAP thresholds with the Nucleus Freedom cochlear implant via machine intelligence.

OBJECTIVE: AutoNRT is an automated system that measures electrically evoked compound action potential (ECAP) thresholds from the auditory nerve with the Nucleus Freedom cochlear implant. ECAP thresholds along the electrode array are useful in objectively fitting cochlear implant systems for individual use. This paper provides the first detailed description of the AutoNRT algorithm and its expert systems, and reports the clinical success of AutoNRT to date. METHODS: AutoNRT determines thresholds by visual detection, using two decision tree expert systems that automatically recognise ECAPs. The expert systems are guided by a dataset of 5393 neural response measurements. The algorithm approaches threshold from lower stimulus levels, ensuring recipient safety during postoperative measurements. Intraoperative measurements use the same algorithm but proceed faster by beginning at stimulus levels much closer to threshold. When searching for ECAPs, AutoNRT uses a highly specific expert system (specificity of 99% during training, 96% during testing; sensitivity of 91% during training, 89% during testing). Once ECAPs are established, AutoNRT uses an unbiased expert system to determine an accurate threshold. Throughout the execution of the algorithm, recording parameters (such as implant amplifier gain) are automatically optimised when needed. RESULTS: In a study that included 29 intraoperative and 29 postoperative subjects (a total of 418 electrodes), AutoNRT determined a threshold in 93% of cases where a human expert also determined a threshold. When compared to the median threshold of multiple human observers on 77 randomly selected electrodes, AutoNRT performed as accurately as the 'average' clinician. CONCLUSIONS: AutoNRT has demonstrated a high success rate and a level of performance that is comparable with human experts. It has been used in many clinics worldwide throughout the clinical trial and commercial launch of Nucleus Custom Sound Suite, significantly streamlining the clinical procedures associated with cochlear implant use.

Algorithms↗

Development and implementation of an expert information system (BRITE) used in technical support of medical diagnostics customers.

We developed BRITE (Bringing Resources and Information to Employees), an expert information retrieval system, for problem solving and retrieving technical product information. Specialists in our Technical Assistance Center (TAC) use the BRITE system on a Pentium workstation to access information in < 3 s. Manuals, technical bulletins, parts lists, and administrative tools such as word processing and network fax are available electronically. The system allows consistent troubleshooting and definition of customers' problems by TAC specialists. BRITE seamlessly integrates expert system, document retrieval, and relational database technologies; the system runs on a token ring local area network, which is part of a Ciba Corning Diagnostics wide area network. Information received over the wide area network is used to develop and update BRITE daily. BRITE is kept current by input or troubleshooting and new applications from TAC specialists.

Chemistry, Clinical↗

A knowledge-based system for the design of manual materials handling.

The purpose of this paper is to develop and test an expert system for the design of new and existing repetitive manual materials handling (RMMH) tasks. For new jobs, the expert system provides recommendations on the maximum acceptable weight to be handled under a variety of worker and task variables. For existing jobs, the expert system provides possible solutions to the design of RMMH tasks if the weight handled on the job is greater than the recommended one. The expert system was implemented on an IBM PCXT personal computer. Two examples on how to utilise the expert system in designing new and existing jobs are given.

Journal Article↗

Developing decision support systems: a change in emphasis.

Against a backdrop of many demonstrably proficient expert systems that are not routinely used, and a user community that is skeptical of the benefits of using such technology in healthcare, the AIM funded Dilemma project is attempting to introduce decision support technology into shared care environments within scenarios from the specialties of oncology and cardiology. This paper outlines the experiences of one work-package of the Dilemma project which is concerned with the development of applications with a decision support component for use in shared care of coronary artery disease patients. We suggest reasons why expert systems have failed to gain acceptance in the past, and conclude that a shift in emphasis from building expert systems to building clinically useful applications that have an expert system component may improve the chances of acceptance of this technology in the future.

Coronary Disease↗

[The application and development of artificial intelligence in medical diagnosis systems].

This paper has reviewed the development of artificial intelligence in medical practice and medical diagnostic expert systems, and has summarized the application of artificial neural network. It explains that a source of difficulty in medical diagnostic system is the co-existence of multiple diseases--the potentially inter-related diseases. However, the difficulty of image expert systems is inherent in high-level vision. And it increases the complexity of expert system in medical image. At last, the prospect for the development of artificial intelligence in medical image expert systems is made.

Artificial Intelligence↗

Comparison of methods for detecting keratoconus using videokeratography.

BACKGROUND: The detection of keratoconus patterns on videokeratography is important for screening candidates for refractive surgery and for studying the genetic basis of keratoconus. OBJECTIVE: We compared three quantitative approaches to identifying keratoconus from videokeratographic information to examine the limitations and capabilities of each test and to determine their suitability for use in the clinical setting. METHODS: Videokeratographs typical of clinically diagnosed keratoconus (n = 44) and of various non-keratoconus conditions (n = 132, including normal, with-the-rule astigmatism, contact lens-induced corneal warpage, photorefractive keratectomy, keratoplasty, and pellucid marginal degeneration) were selected. Three methods for detecting keratoconus were used: keratometry (average Simulated Keratometry [SimK] readings > 45.7 diopters [D]); the modified Rabinowitz-McDonnell test (central corneal power > 47.2 D and/or Inferosuperior Asymmetry [I-S] value > 1.4 D); and an expert system classifier (classification based on discriminant analysis and classification tree with eight topographic indexes). Sensitivity and specificity were calculated for each test. RESULTS: Sensitivities were 84% for keratometry, 96% for the modified Rabinowitz-McDonnell test, and 98% for the expert system classifier. Specificities for the three methods were 86%, 85%, and 99%, respectively. In terms of sensitivity, the expert system classifier was significantly better than keratometry (P = .04). In terms of specificity, the expert system classifier was significantly better than either of the other methods (P = .001). CONCLUSIONS: For screening candidates for refractive surgery, where high sensitivity is needed, either the modified Rabinowitz-McDonnell test or the expert system classifier is suitable. For diagnosing keratoconus, where high specificity is more useful, the expert system classifier is more appropriate than the other two methods.

Cornea↗

Creating temporal abstractions in three clinical information systems.

Modern clinical information system developers recognize the need to associate temporal information with clinical data. However, specific clinical systems capture different temporal features using a variety of data modeling techniques. Two commonly used methods to represent temporal information are point-based events and interval-based durations. We recently implemented a rule-based expert system for drug dose monitoring on three clinical information systems. The expert system requires both static drug dosing information (drug name, amount, route, frequency) and temporal dosing information (duration of therapy, renewals, restarts). Our design goal was to use the same expert system code on all three information systems by defining a common database schema to hide differences in the original systems' data models. Although we have been successful in mapping clinical data from these three source systems into a unified temporal data representation, we describe how differences in handling time within the three clinical systems made this goal difficult to achieve.

Clinical Pharmacy Information Systems↗

Concurrent validity of a rule-based system.

The purpose of this project was to test the concurrent validity of the diagnoses recommended by a rule-based expert system. Concurrent validity was determined first by comparing the expert system's computerized diagnostic recommendations with that of a Clinical Nurse Specialist (CNS Assessor) who assessed the patient, and secondly by comparing the expert system's candidate diagnoses with those of a panel of 10 clinical nurse specialists (CNS Panel). The expert system rule base for generating diagnoses was programmed for some of the most common nursing diagnoses (Metzger & Hiltunen, 1987) including: alteration in comfort, acute pain; impaired physical mobility; sleep pattern disturbance; impairment of skin integrity and self-care deficit (bathing, feeding, toileting, and dressing). Activity intolerance and potential for infection were also programmed as diagnostic possibilities in the rule base.

Aged↗

A computationally based identification algorithm for estrogen receptor ligands: part 2. Evaluation of a hERalpha binding affinity model.

The objective of this study was to evaluate the capability of an expert system described in the previous paper (S. Bradbury et al., Toxicol. Sci. 58, 253-269) to identify the potential for chemicals to act as ligands of mammalian estrogen receptors (ERs). The basis of the expert system was a structure activity relationship (SAR) model, based on relative binding affinity (RBA) values for steroidal and nonsteroidal chemicals derived from human ERalpha (hERalpha) competitive binding assays. The expert system enables categorization of chemicals into (RBA ranges of < 0.1, 0.1 to 1, 1 to 10, 10 to 100, and >150% relative to 17ss-estradiol. In the current analysis, the algorithm was evaluated with respect to predicting RBAs of chemicals assayed with ERs from MCF7 cells, and mouse and rat uterine preparations. The best correspondence between predicted and observed RBA ranges was obtained with MCF7 cells. The agreement between predictions from the expert system and data from binding assays with mouse and rat ER(s) were less reliable, especially for chemicals with RBAs less than 10%. Prediction errors often were false positives, i.e., predictions of greater than observed RBA values. While discrepancies were likely due, in part, to species-specific variations in ER structure and ligand binding affinity, a systematic bias in structural characteristics of chemicals in the hERalpha training set, compared to the rodent evaluation data sets, also contributed to prediction errors. False-positive predictions were typically associated with ligands that had shielded electronegative sites. Ligands with these structural characteristics were not well represented in the training set used to derive the expert system. Inclusion of a shielding criterion into the original expert system significantly increased the accuracy of RBA predictions. With this additional structural requirement, 38 of 46 compounds with measured RBA values greater than 10% in hERalpha, MCF7, and rodent uterine preparations were correctly categorized. Of the remaining 129 compounds in the combined data sets, RBA values for 65 compounds were correctly predicted, with 47 of the incorrect predictions being false positives. Based upon this exploratory analysis, the modeling approach, combined with a high-quality training set of RBA values derived from a diverse set of chemical structures, could provide a credible tool for prioritizing chemicals with moderate to high ER binding affinity for subsequent in vitro or in vivo assessments.

Algorithms↗

A key for freshwater invertebrates using fuzzy logic.

MOTIVATION: This paper summarizes a biological key using a fuzzy logic expert system. This approach allows the user to make some errors, be uncertain about some answers and not answer questions if unsure, but have an opportunity to identify unknown specimens correctly. This approach was adopted in order to develop a 'forgiving' key for users with little or no prior knowledge of identification. The system was implemented using a multi-media expert system builder, 'Matcher', operating in a Microsoft Windows environment. RESULTS: The paper reports the design issues for a key to identify freshwater invertebrates to family level and describes the types of questions used within the key, the fuzzy inference engine, the structure of the system and the methodology adopted for testing it. Following this, an empirical test is reported of the hypothesis that a fuzzy logic expert system can improve identification accuracy for a sample of intended users. Finally, the discussion considers the practicalities of using such a system as an aid to organism identification.

Algorithms↗

Artificial intelligence within the chemical laboratory.

Various techniques within the area of artificial intelligence such as expert systems and neural networks may play a role during the problem-solving processes within the clinical biochemical laboratory. Neural network analysis provides a non-algorithmic approach to information processing, which results in the ability of the computer to form associations and to recognize patterns or classes among data. It belongs to the machine learning techniques which also include probabilistic techniques such as discriminant function analysis and logistic regression and information theoretical techniques. These techniques may be used to extract knowledge from example patients to optimize decision limits and identify clinically important laboratory quantities. An expert system may be defined as a computer program that can give advice in a well-defined area of expertise and is able to explain its reasoning. Declarative knowledge consists of statements about logical or empirical relationships between things. Expert systems typically separate declarative knowledge residing in a knowledge base from the inference engine: an algorithm that dynamically directs and controls the system when it searches its knowledge base. A tool is an expert system without a knowledge base. The developer of an expert system uses a tool by entering knowledge into the system. Many, if not the majority of problems encountered at the laboratory level are procedural. A problem is procedural if it is possible to write up a step-by-step description of the expert's work or if it can be represented by a decision tree. To solve problems of this type only small expert system tools and/or conventional programming are required.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗