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PubMed1988

Artificial intelligence: a computerized decision aid for trauma.

A computerized decision support system has been developed to advise ATLS-trained surgeons on the initial definitive management of patients with penetrating injuries of the abdomen immediately following resuscitation and stabilization. The program was developed as an "expert system," using the techniques of artificial intelligence. It is able to suggest: the need for further examination; additional tests; diagnoses; and treatments. In this study, the advice offered by the expert system was compared to that of physicians-in-training. Five actual patient care situations were presented to the system and to 13 medical students and surgical residents: four MS-III, three PGY-I, three PGY-III, and three PGY-V. The suggestions of each of the 13 trainees, the advice of the expert system, and the actual management were blinded. Five surgeons versed in trauma and otherwise not involved in the project judged whether each of the 15 purported management plans was acceptable and ranked them in order of preference. Only the actual care and the advice from the system were judged acceptable for all five problems. The rankings of the expert system were better than those of any individual trainee. The differences were statistically significant for two of the three chief residents, five of nine residents overall, and all four students. This preliminary validation of a prototype expert system is encouraging for the prospect of a computerized decision support system that can help surgeons make initial definitive management plans for patients with major trauma.

Abdominal Injuries↗

PubMed1991

Computer-assisted diagnosis of acute azotaemia: diagnostic strategy and diagnostic criteria.

This report describes the diagnostic strategy, cost-effectiveness and diagnostic accuracy of a rule-based, backward chaining diagnostic expert system designed to assist in diagnosing the cause(s) of acute azotaemia. The diagnostic strategy of the expert system seems to be cost-effective compared with that of a renal unit and the diagnostic criteria of the expert system accurately imitate the diagnoses of the renal unit. It is suggested that the expert system is diagnostically reliable and may reduce cost in the diagnostic work-up of patients with acute azotaemia.

Adolescent↗

PubMed1988

Using a symbiotic man/machine approach to evaluating visual clinical research data.

Some candidate medical expert system applications have a significant visual component. Knowledge engineers usually dismiss such task domains as potential expert systems applications. Our success in developing ESCA, a system for evaluating serial coronary angiograms, shows that such task domains should not be dismissed so quickly. We used a symbiotic approach between man and machine, where technologists provide the visual skills with an expert system imitating the conceptual skills of the expert, to produce a partially automated system that is more consistent and cost effective than one that is fully manual. The agreement between the system's conclusions and that of a panel of experts is good. The expert system actually has a slightly higher agreement rate with the expert panel than the agreement rate between two expert panel teams evaluating the same film pair.

Angiocardiography↗

PubMedDate not supplied

A probabilistic simulation model to assist the localization of nerve lesions.

I present a formal, mathematical specification of a probabilistic expert system to assist the localization of nerve lesions. The program is based on an anatomical model of the peripheral nervous system of the human upper limb. The simulation model defines a joint probability distribution over the states of nerves and clinical manifestations. A simple, general-purpose heuristic algorithm is used to approximate conditional probabilities of interest. It is shown how an upper bound on the expected approximation error can be measured experimentally; this upper bound is 0.05 for the system described here, although the bound can be made arbitrarily small by expending more computational effort. The expert system is compared with the nearest-neighbour statistical classification rule on two databases of 26 and 25 cases respectively. The expert system makes fewer errors, although the observed difference does not reach statistical significance. Possible future refinements to the model are explored, and the advantages of specifying expert systems formally are discussed.

Algorithms↗

PubMed1997

Real time monitoring and analysis via the medical information bus, Part I.

Because of the complexity of monitored data in modern intensive care units (ICUs), and the risk of information being overlooked if medical staff have to pay attention to a multiplicity of monitoring apparatuses and alarm signals, the data for each patient may well be best presented on a single bedside screen after digestion by expert system techniques. Such central units should be able to deal with data from any monitoring apparatus, not just a predefined set. Furthermore, relay of the information from each bed to a central control station (one per ICU) is desirable for the purposes of permanent storage and for in-depth analysis. The paper describes a comprehensive system for ICU monitoring management and patient data analysis that integrates multiple expert systems and computers. The basic difficulties in applying expert system techniques to monitoring are overcome with the shell OPS/83, which allows calls to sequential C routines and allows time-driven reasoning through appropriate design of the inference engine and rules. Flexibility as regards connectable monitoring apparatus is afforded by basing data acquisition mainly, though not exclusively, on the IEEE Medical Information Bus.

Computer Systems↗

PubMed1984

An expert consultation system for frontline health workers in primary eye care.

In developing countries, blindness is a major health problem whose control depends on the application of simple measures by frontline workers because, in many of these countries, specialist medical care is not readily available. To assist primary health workers in the management of common and potentially blinding eye disorders, we have developed a prototype computer program for a hand-held computer that incorporates a set of guidelines for diagnosis and treatment. This eye treatment program will help evaluate the potential of such devices for improving health care delivery in developing countries. This approach is now feasible because of recent advances in expert system and portable computer technology.

Blindness↗

PubMed1986

Application of the EXPERT consultation system to accelerated laboratory testing and interpretation.

The EXPERT consultation system-building tool, a knowledge-based artificial intelligence program developed at Rutgers University, has been applied to the development of a laboratory consultation system facilitating sequential laboratory testing and interpretation. Depending on the results of a basic panel of laboratory tests, the system requests that specific secondary tests be performed. Input of these secondary findings can result in requests for tertiary testing, to complete the database necessary for interpretation. Interpretation of all results is based upon final inferences from the collected findings through a series of rules, a hierarchical network that yields an efficient production system not easily obtained through conventional programming. The rules included in this model are based upon initial results for total protein, calcium, glucose, total bilirubin, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, thyroxin, hemoglobin, mean corpuscular volume, and the concentrations of four drugs. Pertinent clinical history items included are jaundice, diabetes, thyroid disease, medications, and ethanol. Implementing this system in a laboratory-based accelerated testing program involving outpatients maximized the effective use of laboratory resources, eliminated useless testing, and provided the patient with low-cost laboratory information.

Adolescent↗

PubMed1988

Modern pacemakers: implantable artificial intelligence?

For over twenty years computer programs have been written for applications in cardiology. Approximately one decade ago the first Expert Systems using knowledge on cardiology were built. The use of Expert System shells enabled a breakthrough. Many systems were developed, each covering a small part of cardiology. In the pacing environment Expert Systems can be used to select the optimal pacemaker therapy or to analyze complex pacemaker electrocardiograms. With the help of these artificial intelligence techniques pacemakers can be designed, that behave in an intelligent way. Finally this knowledge representation enables the reproducible simulation of the heart-pacemaker interaction.

Artificial Intelligence↗

PubMed1991

Exploring the optometric application of expert computer systems: refractive error correction.

Using the commercially available shell programs NeuroShell and EXSYS, example-based and rule-based expert computer systems were developed to explore how such systems could be applied in an optometric environment. To demonstrate such an application, the example-based NeuroShell system was taught to prescribe sphere and cylinder powers for low refractive error myopes. When the system learned with only the chief complaint, habitual prescription and acuity through the habitual, and best refraction with resulting acuity, it predicted the sphere and cylinder powers prescribed by human optometrists within 0.25 diopter 97 and 98 percent of the time, respectively, for 60 test eyes. With a set of only three rules, the rule-based EXSYS system predicted sphere powers within 0.25 diopter of the prescribed powers for 100 percent of the 60 test eyes. Results with these very simple refractive problems suggest that teaching expert computer systems to prescribe ophthalmic lens corrections is possible, and further suggest that the concept could be extended to more complex and challenging patient populations.

Eyeglasses↗

PubMed1995

Psychovegetative syndrome diagnosis: an automated psychophysiological investigation and mathematical modeling approach.

1. INTRODUCTION. The main purpose of our work was to create the informational expert system of psychovegetative syndrome diagnosis by applying clinical data and estimating the functioning of the central and peripheral part of regulatory apparatus of the human organism, taking into consideration parallel and consecutive sensory, motor, associative, emotional drive systems, and internal body state. We used automatized psychophysiological investigation and mathematical models. For this purpose the following principal tasks have been prepared: the creation of database of quantifiable estimation patient state; the definition and automation of psychophysiological investigation; mathematical modeling of vegetative functions using a non-invasive sample and its connection with real psychophysiological experiment; mathematical modeling of organisms inner medium homeostasis; and the creation of an informational-expert system of psychovegetative syndrome diagnosis. 2. DATABASE OF ESTIMATION OF PATIENTS STATE. The medical records of the DB "PATIENT" contain data on patient psychic and somatoneurological status. 3. AUTOMATED PSYCHOPHYSIOLOGICAL INVESTIGATION. Psychophysiological investigation enables estimation of the functioning of several subsystems of the human organism and establishes an interrelationship between them by means of electrophysiological data and performance parameters. The study of psychophysiological provision of behavior by psychophysiological investigation enables us to get information about adaptational mechanisms of the patient under certain environmental loads. By means of special mathematical provision, the mathematical elaboration of biosignals as performance parameters has been realized; also realized were the formation of received parameters in the database, the estimation of separated parameters in the view of informativity, and the establishment of diagnostic patterns. 4. MATHEMATICAL MODELS FOR ESTIMATION INTERNAL BODY STATE. The proposed mathematical models allow investigation of homeostatic regulation in various intensities of the metabolic processes and external load. This approach in mathematical models allows us to characterize the relations between the central and peripheral parts of the regulatory mechanisms, using non-invasive samples under psychophysiological investigation and the simulation of different surroundings for brain cells functioning. 5. INFORMATION-EXPERT SYSTEM. Proceeding from the principle of psychoneural unity, we characterized the functioning mechanisms of CNS by means of automatized EEG analysis, visually evoked potential analysis, estimated psychic status, and the characteristics of neural system biochemical processes received by mathematical modeling. By using the indices of the viscero-vegetative and somatolocomotor system (as well as parameters received by automatized analysis of ECG), the EEG respiratory signal--from mathematical models of vegetative functions decision support system applied in estimation of a peripheral block of the regulatory system--is reflected in diagnosis of certain syndromes. The informational expert system, proceeding from the functioning of the human organism's regulatory apparatus, diagnosed psychovegetative syndrome and described the mechanisms of its development. 6. CONCLUSION. The informational expert system enables estimation of the functioning of a human organism as a whole and can be introduced in the sphere of practical medicine and professional orientation as well as in laboratories of experimental psychology and neurosciences.

Brain↗

PubMed1996

Automated topographic screening for keratoconus in refractive surgery candidates.

PURPOSE: We evaluated an automated corneal topography classification system developed as an adjuvant for screening patients prior to keratorefractive surgery. We screened for patterns suspicious for keratoconus by applying the system to the analysis of a series of patients who presented for evaluation for surgical correction of myopia. METHODS: Both eyes of 53 consecutive patients who were included in a previously reported prospective study were evaluated using the Expert System classification algorithm. This quantitative classification system incorporating eight indices was applied to the videokeratoscopic data from each patient to divide the topographic patterns into keratoconus and non-keratoconus groups. The group assignment of the Expert System classifier was compared with the clinical diagnosis of keratoconus versus non-keratoconus based on the topographic pattern and objective biomicroscopy signs. RESULTS: The Expert System classified eight of the videokeratographs as keratoconus. All five corneas that had clinical evidence of keratoconus were classified as such by the Expert System (sensitivity 100%). The other three corneas that were classified as keratoconus were of patients who wore rigid contact lenses and had pseudo-keratoconus topographic patterns, without other clinical signs of keratoconus. The specificity with which the Expert System detected normal corneas was 97% (98/101). CONCLUSIONS: Evaluation of the videokeratographic data with computerized algorithms designed to detect keratoconus may aid preoperative evaluation and facilitate distinction between keratoconus and some keratoconus-like topographic patterns.

Algorithms↗

PubMed1993

To test or not to test, that is the question.

This paper describes a system that is used in Maastricht, the Netherlands, to provide general practitioners with feedback about the adequateness of their test requesting behaviour. The system has proven to be effective. Since the screening of test requests and additional patient data is work-intensive a project was started in the framework of the AIM programme OPENLABS to design a computer-based feedback system. In this system the general practitioner sends test requests to the laboratory decision support system by means of electronic data interchange (EDI). The authors were involved in the development of the EDI messages, which are now accepted standards in the Netherlands. The requests are stored in a database that is part of the laboratory decision support system. The other part of the decision support system, an expert system, obtains the request data (including patient data) from the database, screens the requests for adequateness and provides feedback when necessary.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

Data decay, significance and confidentiality: a time-oriented data-model for comprehensive care.

Long-term computer-held clinical records present new problems for data organization and for the protection of patients' privacy. To maintain clarity and to protect confidentiality, it is important that most information becomes less accessible and less prominent with time. A data-model is presented which allows the representation and manipulation of complex time-dependent relationships among data, but which imposes sufficient limits to allow efficient corrections and deletions. One useful consequence of the model is a natural analogy and potential link to the methods of production systems and 'expert systems' currently being developed by workers in artificial intelligence.

Comprehensive Health Care↗

PubMed1996

Medical informatics. The future is here.

Informatics is an indispensable discipline for leaders and managers--of patients, facilities, and organizations--because the most important assets of those organizations are their information processing technologies, and the key skills are those that help them to manage information. Managers and executives will increasingly need to anticipate trends in information management technologies that could affect their business. In health care, computer-based patient records, integration engines, online analytical processing systems, telemedicine, expert systems, and the Internet have become vital to having the competitive advantage. Those who do not understand the promise and limitations of these technologies and the need for strong leadership to establish standards for data and transaction systems will not lead their organizations well.

Computer Communication Networks↗

PubMed1999

Knowledge-mediated retrieval of laboratory observations.

Intelligent medical applications including agents, clinical decision support systems, and expert systems can benefit from components that expose the meanings of medical concepts. We have endeavored to create an ontology for laboratory observations and to make the ontology accessible in a distributed environment through a knowledge mediator offering several services. To date we have created two such services, one service to mediate the retrieval of laboratory observations and an auxiliary service to facilitate the mapping of units of measure to LOINC property-types. We report progress and insights on the development of our ontology and related knowledge mediator.

Artificial Intelligence↗

PubMed2003

[Application prospect of human-artificial intelligence system in future manned space flight].

OBJECTIVE: To make the manned space flight more efficient and safer, a concept of human-artificial (AI) system is proposed in the present paper. METHOD: The task of future manned space flight and the technique requirement with respect to the human-AI system development were analyzed. RESULT: The main points are as follows: 1)Astronaut and AI are complementary to each other functionally; 2) Both symbol AI and connectionist AI should be included in the human-AI system, but expert system and Soar-like system are used mainly inside the cabin, the COG-like robots are mainly assigned for EVA either in LEO flight or on the surface of Moon or Mars; 3) The human-AI system is hierarchical in nature with astronaut at the top level; 4) The complex interfaces between astronaut and AI are the key points for running the system reliably and efficiently. CONCLUSION: As the importance of human-AI system in future manned space flight and the complexity of related technology, it is suggested that the R/D should be planned as early as possible.

Artificial Intelligence↗

PubMed1991

Medical logic module (MLM) representation of knowledge in a ventilator treatment advisory system.

In any medical expert system it is the inherent knowledge that is the power of the system and not the particulars of its implementation. Therefore it would be valuable to use a representation that would allow: knowledge transfer between different systems, users, experts and 'importers' to be able to evaluate the logic, experts to easily input their knowledge and be guided how to use the syntax. Adren Syntax of Medical Logic Module is a proposed knowledge representation, fulfilling these criteria. The Arden Syntax has been used to represent rules and logic in a decision support system for ventilator therapy in patients with acute respiratory failure (ARF) that is under development. The medical experts involved in the project have used the Arden Syntax as a convenient way for transfer and storage of medical knowledge. The syntax is easy to learn and may be used with a minimum of training. In the present system, Medical Logical Modules have been used to represent knowledge pertinent to the initiation and maintenance phases of ventilator therapy.

Acute Disease↗

PubMed2005

Automatic analysis of pacemaker diagnostic data in the identification of atrial tachyarrhythmias in patients with no prior history of them.

AIMS: Modern pacemakers provide a large amount of diagnostic data. Given the limited time available during a pacemaker follow-up visit essential information may be overlooked. This registry was conducted to assess the utility of an expert system that analyses the diagnostic data collected by an implanted pacing device and notifies and advises the physician about suspected technical issues and arrhythmias that need further attention. METHODS: Patients with various standard indications for pacing were included in this registry and received single or dual chamber pacemakers. Data were collected and analysed by the expert system during at least two subsequent follow-up visits. The evaluation of this system focused on data obtained from patients with a dual chamber pacing device without prior history of atrial arrhythmias. RESULTS: A total number of 239 patients without prior history of atrial tachyarrhythmias were included in this analysis. Atrial tachyarrhythmias were detected in 73 (31%) of these patients. The highest incidence of newly detected arrhythmias occurred in the group of patients with high-degree AV block and VDD pacemakers. Furthermore, newly detected arrhythmias predominantly occurred in the period shortly after implantation. Device programming suggestions by the expert system were adopted in 30% of the cases. Following detection of atrial tachyarrhythmias by the expert system, pharmacological management was adjusted at 71% of the first follow-up visits and at 27% of later follow-up visits. CONCLUSION: Results of this registry show that this expert system provides a valuable tool for the detection of atrial tachyarrhythmias during pacemaker follow-up visits.

Aged↗