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PubMed1989

Applying expert system techniques to human genetics.

Although expert systems have been developed in a variety of medical areas, there has been very little application of expert system techniques to the field of human genetics. The purpose of the research project described in this paper was (1) to experiment with different types of knowledge representation for data and knowledge structures in human genetics and (2) to explore the applicability of different inference mechanisms for various genetic problems. We present an object-oriented and a fact-based model for the representation of genealogical information and describe two prototype systems.

Algorithms↗

PubMedDate not supplied

An expert system to assist neonatal intensive care.

An expert system for neonatal intensive care (ESNIC) for the management of mechanically ventilated neonates on intermittent positive pressure ventilation (IPPV) has been developed. The system uses the rule based expert system shell XiPlus (Inference Inc.) and runs on an IBM-compatible PC. The rules have been derived from the knowledge of two consultant paediatricians. The inputs to the system are the current ventilator settings, blood gas tensions and pH. The output of the system is a set of suggested new ventilator settings. The aim of the system is to provide ventilator settings which will maintain the arterial blood gas tensions within an acceptable range, reducing pressures whenever feasible and increasing pressures only as a last resort. In addition, ESNIC provides data archiving, graphical displays of all parameters, ventilation and discharge summaries. With the 63 patients in the study ESNIC was consulted for 76% of all ventilator adjustments and the advice given was accepted on 83% of these occasions.

Expert Systems↗

PubMedDate not supplied

An expert system for the diagnosis of epilepsy: results of a clinical trial.

BACKGROUND: Artificial intelligence is an area where computer systems are used to solve real-life problems that require expert human intelligence. Expert systems serve as an effective alternative to supplement the dearth of human experts in a narrow domain of applications. We developed an expert system named SEIZ using DIAGNOS (an expert system shell for diagnostic applications) for the diagnosis and management of epilepsy. METHODS: A clinical trial was done to test the reliability of SEIZ. The clinical and demographic data from the medical records of 50 patients with epilepsy who attended an epilepsy clinic were provided to the expert system. The system-generated diagnosis was compared with the clinical diagnosis. RESULTS: The seizure types and epileptic syndromes for the 50 patients included generalized -tonic-clonic seizure (14), absence (4), complex partial seizure (18), simple partial seizure (4), juvenile myoclonic epilepsy (5) and other epileptic syndromes (3). There were two cases of hysterical conversion reaction. There was concordance in the diagnosis between the expert system and clinician in 47 cases (94%). The overall sensitivity was 94% and the specificity was 100% for absence, generalized tonic-clonic seizures, simple partial seizures and juvenile myoclonic epilepsy; 94% for complex partial seizures and 98% for hysterical conversion reaction. CONCLUSION: This expert system could generate reliable diagnoses for patients with epilepsy. Such a system may be useful for a doctor in a remote or peripheral area where an expert on epilepsy is not available.

Adult↗

PubMed1988

The expert system language GALEN.

GALEN is an expert system language based upon nonmonotonic logic and sorted higher-order quantificational logic. It is designed to permit the composition of expert systems for computerized electrocardiographic diagnosis. Using GALEN, a cardiologist will be able to supplement or replace the commercially available computer-assisted ECG diagnostic systems with diagnostic criteria of his or her own for research and clinical uses.

Diagnosis, Computer-Assisted↗

PubMed1991

[Presentation of an expert system for planning partial dentures].

An expert system for treatment planning in cast clasp partial denture cases is presented. The system may be used both to verify the construction principles of proposed clasp constructions and to develop new constructions. At first, it is intended to use this expert system for teaching in university dental schools.

Dental Clasps↗

PubMed1991

[Medical expert systems. Developmental activities in the Scandinavian countries].

Medical expert systems is a term for computer programs which represent and structure medical knowledge, and which can supplement or replace man in decisionmaking. Several research groups in Denmark, Finland, Norway and Sweden are developing such systems. Many of the projects emphasize educational aspects and also serve to qualify the participants in the project. The medical expert systems are applied to clinical chemistry, neurophysiological testing or intensive care. Within this field of medical expert systems there is much duplication of activities and too little practical application. Usually the systems are developed to be used as functional prototypes and are often not good enough or not intended to be used in daily hospital routines. There should be good prospects in this field in the near future.

Decision Making, Computer-Assisted↗

PubMed1994

Evaluation of the use of induction in the development of a medical expert system.

In an earlier study, two medical expert systems for diagnosing thyroid disorders, developed by the application of induction on a sample of previously diagnosed cases and on expert-generated rules, diagnosed a set of test cases better than an expert system developed by the more traditional method of collaboration between a knowledge engineer and an expert. In this paper, an alternative measure of the accuracy of diagnosis of each system is used to evaluate the systems. Diagnoses for every distinct case represented by a combination of indicating factors are compared with diagnoses that the expert made. The induced systems provide diagnoses for many more distinct cases, but a much higher proportion of these diagnoses are incorrect. It is argued that generalizing to unseen cases is an inappropriate use of induction algorithms. The systematic development of a decision table is a more appropriate method for devising a medical expert system.

Decision Making, Computer-Assisted↗

PubMed1994

Refinement of the HEPAR expert system: tools and techniques.

Methods and tools for the static and dynamic verification and validation of software systems are commonplace in the field of software engineering. In the field of expert systems, where it is more difficult to ensure that a system meets the specifications and expectations than in traditional software engineering, such tools are generally not available. In this paper, the need for more support of the development process by methods and tools is illustrated by the approach taken in building the HEPAR system, a rule-based expert system that can be used as a supportive tool in the diagnosis of disorders of the liver and biliary tract. At a certain stage in the development of this system an incremental development methodology has been adopted, in which implementation of parts of the expert system was followed by dynamic validation. For this purpose, a collection of software tools were implemented as extensions to a rule-based expert-system shell. These tools provide valuable information about the effects of modification of the HEPAR knowledge base, and indicate places in the knowledge base for refinement. It is believed that similar software tools may prove helpful in the development of other expert systems as well.

Artificial Intelligence↗

PubMed1991

GAMEES: a probabilistic environment for expert systems.

This paper describes GAMEES (Graphical Modelling Environment for Expert Systems), an interactive graphical environment for building and processing Belief Networks and Influence Diagrams. We review the existing systems designed for analogous purposes, and, after a brief introduction to Belief Networks and Influence Diagrams, we describe the graphical interface, discuss algorithms for probabilistic inference on these networks and illustrate the current implementation of GAMEES. The system has been designed for being integrated within wider expert systems and actually it is part of the Therapy Advisor module within an expert system for the management of anemic patients.

Algorithms↗

PubMed2000

The diagnostic headache diary--a headache expert system.

The purpose with the headache expert system was to develop a diagnostic and educational tool for the general practitioners (GP), in order to improve their management of headache disorders. This chapter describes the diagnostic headache diary, an expert system intended for education and diagnosing headache disorders. The diagnostic headache diary can be printed and used by headache patients at home to record their headache attacks and medicine consumption by a day to day basis. It can also be used by the GP at the clinic in order to provide the headache diagnoses. The diagnostic headache diary was written in the programming language Delphi and implemented as a stand-alone Windows 95 program. It was integrated as one of five modules in the headache tutorial described in another chapter of this book. The diagnostic headache diary consists of four modules: Patient data, diary, medication and diagnosis. Configured around a database, the diagnostic headache diary allows entries of several patients and search facilities. The diagnostic headache diary was tested and validated by entering expert-diagnosed data from different headache disorders which where compared to the computer generated diagnoses.

Diagnosis, Computer-Assisted↗

PubMed1997

DIAVAL, a Bayesian expert system for echocardiography.

DIAVAL is an expert system for the diagnosis of heart diseases, including several kinds of data, mainly from echocardiography. The first part of this paper is devoted to the causal probabilistic model which constitutes the knowledge base of the expert system in the form of a Bayesian network, emphasizing the importance of the OR gate. The second part deals with the process of diagnosis, which consists of computing the a posteriori probabilities, selecting the most probable and most relevant diagnoses, and generating a written report. It also describes the results of the evaluation of the program.

Artificial Intelligence↗

PubMed1993

Epileptologist's assistant: a cost effective expert system.

Epileptologist's Assistant is an expert system designed to cost effectively handle routine care in an epilepsy follow up clinic. The system guides nurses in gathering patient histories and then generates progress notes and a patient information sheet. The progress note, organized in the SOAP format, is reviewed by the physician with the patient. For difficult cases the physician may modify the Assessment or Plan sections; the Subjective and Objective sections rarely need modifications. The assertion of cost-effectiveness is based on time/motion data. Without the system a physician in our epilepsy clinic spends about 21 minutes seeing a patient. With the system the nurse spends about 14 minutes with the patient and the physician spends about 7 minutes. Two nurses and a physician handle the work load of 3 physicians. Physician time is cut by about 66%. Using the average salaries for physicians and nurses at the Department of Veterans Affairs, the cost of a clinic visit is reduced 39% by using the expert system and nurses. In addition, the progress note is more legible, it contains more information, Q/A procedures are implemented at the point of patient contact, and the data is entered into a computer system in a data field format.

Ambulatory Care Facilities↗

PubMed1997

Desiderata for product labeling of medical expert systems.

The proliferation and increasing complexity of medical expert systems raise ethical and legal concerns about the ability of practitioners to protect their patients from defective or misused software. Appropriate product labeling of expert systems can help clinical users to understand software indications and limitations. Mechanisms of action and knowledge representation schema should be explained in layperson's terminology. User qualifications and resources available for acquiring the skills necessary to understand and critique the system output should be listed. The processes used for building and maintaining the system's knowledge base are key determinants of the product's quality, and should be carefully documented. To meet these desiderata, a printed label is insufficient. The authors suggest a new, more active, model of product labeling for medical expert systems that involves embedding 'knowledge of the knowledge base', creating user-specific data, and sharing global information using the Internet.

Artificial Intelligence↗

PubMed1993

Personal computer-based expert system for quality assurance of antimicrobial therapy.

A personal computer (PC)-based expert system developed to monitor the appropriateness of antimicrobial therapy is described. Susceptibility test data and antimicrobial therapy data are downloaded daily from the microbiology department and pharmacy department computer systems. Relational database software allows for the indexing, sorting, and manipulation necessary for analysis. The expert system accomplishes its analyses using (1) databases of organisms, antimicrobial drugs, and susceptibility cutoff values, (2) programs for evaluating pathogenicity and therapy, and (3) algorithms that determine the timing and sequence of the analysis. System output consists of discrepant therapy reports that indicate that no therapy is being given despite the presence of pathogens, that the pathogens isolated are resistant to the therapy being given, that the therapy cannot be matched with susceptibility data on the isolates, or that the therapy was discontinued too quickly. The expert system has been in continuous operation at an 800-bed referral hospital since July 1991. During an 11-month period, the system generated 1538 discrepant therapy reports. The percentage of isolates resulting in reports varied substantially with the source of the isolate. Therapy was more likely to be improved when the physician was contacted about the potential problem indicated by the report than when the physician was not contacted. A PC-based expert system using data from unlinked pharmacy and microbiology computer systems automatically evaluated the appropriateness of antimicrobial drug therapy in light of susceptibility test data.

Anti-Bacterial Agents↗

PubMed1993

A probabilistic rule-based expert system.

This paper explores a medical expert system combining techniques of Bayesian network modelling with ideas of weighted inference rules. The weights of the individual rules can be estimated objectively from a training set of actual cases; and they can be used in a Monte Carlo stimulation to estimate objectively conditional probabilities of diagnosis given particular combinations of symptoms. The paper describes and evaluates a medical expert system built according to this design. The diagnostic accuracy of the program was found to be similar to that obtained through the usual application of Bayes theorem with the assumption of conditional independence of symptoms given disease, even though the Bayesian classifier has more than 70 times as many numerical parameters. The method may be promising in cases where small training sets do not permit accurate estimation of large numbers of parameters.

Abdominal Pain↗

PubMed1990

ESPRE--expert system for platelet request evaluation.

The expert system for platelet request evaluation (ESPRE) is being developed to support independent learning and decision making regarding the use of platelet transfusions while physicians are actively engaged in clinical practice. The knowledge of transfusion medicine incorporated in ESPRE has been largely gathered from blood bank physicians responsible for determining the appropriateness of blood product administration. Knowledge acquisition methods have included structured and unstructured interviews with protocol analysis using real and fabricated transfusion cases and critiques of an expert system prototype's conclusions. For knowledge representation, ESPRE uses frames with embedded production rules to provide processing efficiency and facilitate knowledge base development. ESPRE automatically acquires key laboratory findings from a laboratory information system. Systems such as ESPRE require careful evaluation and, if proven effective and accurate, present to laboratorians a new tool for delivering high-quality and individually adapted health care.

Decision Making, Computer-Assisted↗

PubMed2003

Monitoring pharmacy expert system performance using statistical process control methodology.

Automated expert systems provide a reliable and effective way to improve patient safety in a hospital environment. Their ability to analyze large amounts of data without fatigue is a decided advantage over clinicians who perform the same tasks. As dependence on expert systems increase and the systems become more complex, it is important to closely monitor their performance. Failure to generate alerts can jeopardize the health and safety of patients, while generating excessive false positive alerts can lead to valid alerts being dismissed as noise. In this study, statistical process control charts were used to monitor an expert system, and the strengths and weaknesses of this technology are presented.

Clinical Pharmacy Information Systems↗

PubMed1993

On the soundness and safety of expert systems.

The problems of developing sound and safe expert systems are discussed, with particular reference to medicine. The concepts, notations, methods, results and technologies which have emerged from the study of mathematical logic as a computational paradigm offer many benefits for improving the quality of expert systems. Logic programming offers a better discipline for design, specification and implementation than ad hoc development methodologies. When logic programming is combined with software engineering methods, such as a software development life-cycle, the probability of routinely developing large-scale yet efficient and sound applications will be increased. However, although soundness is a necessary property of any technology it is not sufficient for assuring safety. Established methods for improved software safety are discussed, and a number of approaches to improving the safety of medical expert systems is identified. The possibility of introducing an appropriately extended life-cycle, and the potential benefits of a formal theory of safety are discussed.

Artificial Intelligence↗