Composite Ontology-Based Medical Diagnosis Decision Support System Framework

Current medical decision support systems have evolved from the automation of medical decision routines to improving the quality of health care services. Knowledge-based systems, compared to conventional data-driven techniques, are promising to support medical decision making. However, knowledge acquisition is usually a bottleneck in the process of developing such systemsOne possibility for acquiring medical knowledge, particularly tacit knowledge, is to use data or cases in both syntactic and semantic ways. Case-based Reasoning (CBR) methodology provides a practical way of problem solving with recalled knowledge memory of solved cases. To reduce the difficulty of knowledge acquisition, this paper proposes a design of the system framework that utilizes the simplified medical knowledge:disease-symptom ontology for prediagnosis, given patients symptoms and signs as input. In the first stage, simple pattern matching is used to gather candidate diseases in diagnosis. Following that, case-based reasoning is used to refine diagnostic decision. The case base is structured with ontological knowledge model. The case retrieval process is based on semantic similarity. The diagnostic system uses a composite knowledge base, and will allow automated diagnosis recommendation. The system framework also aims at facilitating semantic explanations to the solution derived

The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine

Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics: A Cluster Randomized Clinical Trial

Importance: Universal early screening for autism spectrum disorder (ASD) is recommended but not routinely performed. Objective: To determine whether computer-automated screening and clinical decision support can improve ASD screening rates in pediatric primary care practices. Design, Setting, and Participants: This cluster randomized clinical trial, conducted between November 16, 2010, and November 21, 2012, compared ASD screening rates among a random sample of 274 children aged 18 to 24 months in urban pediatric clinics of an inner-city county hospital system with or without an ASD screening module built into an existing decision support software system. Statistical analyses were conducted from February 6, 2017, to June 1, 2018. Interventions: Four clinics were matched in pairs based on patient volume and race/ethnicity, then randomized within pairs. Decision support with the Child Health Improvement Through Computer Automation system (CHICA) was integrated with workflow and with the electronic health record in intervention clinics. Main Outcomes and Measures: The main outcome was screening rates among children aged 18 to 24 months. Because the intervention was discontinued among children aged 18 months at the request of the participating clinics, only results for those aged 24 months were collected and analyzed. Rates of positive screening results, clinicians' response rates to screening results in the computer system, and new cases of ASD identified were also measured. Main results were controlled for race/ethnicity and intracluster correlation. Results: Two clinics were randomized to receive the intervention, and 2 served as controls. Records from 274 children (101 girls, 162 boys, and 11 missing information on sex; age range, 23-30 months) were reviewed (138 in the intervention clinics and 136 in the control clinics). Of 263 children, 242 (92.0%) were enrolled in Medicaid, 138 (52.5%) were African American, and 96 (36.5%) were Hispanic. Screening rates in the intervention clinics increased from 0% (95% CI, 0%-5.5%) at baseline to 68.4% (13 of 19) (95% CI, 43.4%-87.4%) in 6 months and to 100% (18 of 18) (95% CI, 81.5%-100%) in 24 months. Control clinics had no significant increase in screening rates (baseline, 7 of 64 children [10.9%]; 6-24 months after the intervention, 11 of 72 children [15.3%]; P = .46). Screening results were positive for 265 of 980 children (27.0%) screened by CHICA during the study period. Among the 265 patients with positive screening results, physicians indicated any response in CHICA in 151 (57.0%). Two children in the intervention group received a new diagnosis of ASD within the time frame of the study. Conclusions and Relevance: The findings suggest that computer automation, when integrated with clinical workflow and the electronic health record, increases screening of children for ASD, but follow-up by physicians is still flawed. Automation of the subsequent workup is still needed

Development of rapid, automated diagnostics for infectious disease: advances and challenges

The last 2 years has seen an exponential rise in the amount of research funding made available for the development of rapid diagnostic devices for infectious agents of medical importance. This review reports on several such projects. These highlight the development of fully automated devices for rapid diagnostics, ranging from fully automated real-time PCR-based detection methods to fully automated PCR- and array-based machines for the detection and typing of influenza. This review will also highlight the importance of refocusing work on classical immunoassay techniques, showing how biosensor-based immunoassays can greatly enhance existing assays and at a much reduced cost to molecular-based methods