Case-Based Reasoning Applied to Medical Diagnosis and Treatment

The Case-Based Reasoning (CBR) is an appropriate methodology to apply in diagnosis and treatment. Research in CBR is growing and there are shortcomings, especially in the adaptation mechanism. In this paper, besides presenting a methodological review of the technology applied to the diagnostics and health sector published in recent years, a new proposal is presented to improve the adaptation stage. This proposal is focused on preparing the data to create association rules that help to reduce the number of cases and facilitate learning adaptation rules

Improving Retrieval Performance of Case Based Reasoning Systems by Fuzzy Clustering

Case-based reasoning (CBR), which is a classical reasoning methodology, has been put to use. Its application has allowed significant progress in resolving problems related to the diagnosis, therapy, and prediction of diseases. However, this methodology has shown some complicated problems that must be resolved, including determining a representation form for the case (complexity, uncertainty, and vagueness of medical information), preventing the case base from the infinite growth of generated medical information and selecting the best retrieval technique. These limitations have pushed researchers to think about other ways of solving problems, and we are recently witnessing the integration of CBR with other techniques such as data mining. In this article, we develop a new approach integrating clustering (Fuzzy C-Means (FCM) and K-Means) in the CBR cycle. Clustering is one of the crucial challenges and has been successfully used in many areas to develop innate structures and hidden patterns for data grouping [1]. The objective of the proposed approach is to solve the limitations of CBR and improve it, particularly in the search for similar cases (retrieval step). The approach is tested with the publicly available immunotherapy dataset. The results of the experimentations show that the integration of the FCM algorithm in the retrieval step reduces the search space (the large volume of information), resolves the problem of the vagueness of medical information, speeds up the calculation and response time, and increases the search efficiency, which further improves the performance of the retrieval step and, consequently, the CBR system

Diabetes Diagnosis by Case-Based Reasoning and Fuzzy Logic

In the medical field, experts’ knowledge is based on experience, theoretical knowledge and rules. Case-based reasoning is a problem-solving paradigm which is based on past experiences. For this purpose, a large number of decision support applications based on CBR have been developed. Cases retrieval is often considered as the most important step of case-based reasoning. In this article, we integrate fuzzy logic and data mining to improve the response time and the accuracy of the retrieval of similar cases. The proposed Fuzzy CBR is composed of two complementary parts; the part of classification by fuzzy decision tree realized by Fispro and the part of case-based reasoning realized by the platform JColibri. The use of fuzzy logic aims to reduce the complexity of calculating the degree of similarity that can exist between diabetic patients who require different monitoring plans. The results of the proposed approach are compared with earlier methods using accuracy as metrics. The experimental results indicate that the fuzzy decision tree is very effective in improving the accuracy for diabetes classification and hence improving the retrieval step of CBR reasoning

Deconstructing Orthorexia in an Age of Healthism and Social Media

Orthorexia, a pathological fixation with healthy eating, has recently emerged as a construct of interest in the field of clinical psychology. Despite its growing recognition, the origin of this construct remains unclear. This dissertation aims to contribute to the understanding of orthorexia by examining its emergence and contextual factors through a constructivist lens. The study found that the cultural, economic, and moralistic landscape of healthism and social medially have played a role in the development of orthorexia. The dominant clinical perspective of orthorexia was also deconstructed, revealing potential biases that may lead to pathologizing the experiences of those who demonstrate orthorexic behaviors. The study highlights the need for careful consideration of the risks and vulnerabilities associated with the integration of orthorexia into diagnostic and clinical models. However, it also acknowledges the reality of individuals expressing suffering in the form of orthorexic behavior and provides treatment considerations to honor their experiences and desire for relief in a clinical setting. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)

Personalised antimicrobial management in secondary care

Background: The growing threat of Antimicrobial Resistance (AMR) requires innovative methods to promote the sustainable effectiveness of antimicrobial agents. Hypothesis: This thesis aimed to explore the hypothesis that personalised decision support interventions have the utility to enhance antimicrobial management across secondary care. Methods: Different research methods were used to investigate this hypothesis. Individual physician decision making was mapped and patient experiences of engagement with decision making explored using semi-structured interviews. Cross-specialty engagement with antimicrobial management was investigated through cross-sectional analysis of conference abstracts and educational training curricula. Artificial intelligence tools were developed to explore their ability to predict the likelihood of infection and provide individualised prescribing recommendations using routine patient data. Dynamic, individualised dose optimisation was explored through: (i) development of a microneedle based, electrochemical biosensor for minimally invasive monitoring of beta-lactams; and (ii) pharmacokinetic (PK)-pharmacodynamic (PD) modelling of a new PK-PD index using C-Reactive protein (CRP) to predict the pharmacodynamics of vancomycin. Ethics approval was granted for all aspects of work explored within this thesis. Results: Mapping of individual physician decision making during infection management demonstrated several areas where personalised, technological interventions could enhance antimicrobial management. At specialty level, non-infection specialties have little engagement with antimicrobial management. The importance of engaging surgical specialties, who have relatively high rates of antimicrobial usage and healthcare associated infections, was observed. An individualised information leaflet, co-designed with patients, to provide personalised infection information to in-patients receiving antibiotics significantly improved knowledge and reported engagement with decision making. Artificial intelligence was able to enhance the prediction of infection and the prescribing of antimicrobials using routinely available clinical data. Real-time, continuous penicillin monitoring was demonstrated using a microneedle based electrochemical sensor in-vivo. A new PK-PD index, using C-Reactive Protein, was able to predict individual patient response to vancomycin therapy at 96-120 hours of therapy. Conclusion: Through co-design and the application of specific technologies it is possible to provide personalised antimicrobial management within secondary care.Open Acces