Medical analysis and diagnosis by neural networks

In its first part, this contribution reviews shortly the application of neural network methods to medical problems and characterizes its advantages and problems in the context of the medical background. Successful application examples show that human diagnostic capabilities are significantly worse than the neural diagnostic systems. Then, paradigm of neural networks is shortly introduced and the main problems of medical data base and the basic approaches for training and testing a network by medical data are described. Additionally, the problem of interfacing the network and its result is given and the neuro-fuzzy approach is presented. Finally, as case study of neural rule based diagnosis septic shock diagnosis is described, on one hand by a growing neural network and on the other hand by a rule based system. Keywords: Statistical Classification, Adaptive Prediction, Neural Networks, Neurofuzzy, Medical System

Should comprehensive diagnosis include idiographic understanding?

The World Psychiatric Association has emphasised the importance of idiographic understanding as a distinct component of comprehensive assessment but in introductions to the idea it is often assimilated to the notion of narrative judgement. This paper aims to distinguish between supposed idiographic and narrative judgement. Taking the former to mean a kind of individualised judgement, I argue that it has no place in psychiatry in part because it threatens psychiatric validity. Narrative judgement, by contrast, is a genuinely distinct complement to criteriological diagnosis but it is, nevertheless, a special kind of general judgement and thus can possess validity. To argue this I first examine the origin of the distinction between idiographic and nomothetic in Windelband's 1894 rectorial address. I argue that none of three ways of understanding that distinction is tenable. Windelband's description of historical methods, as a practical example, does not articulate a genuine form of understanding. A metaphysical distinction between particulars and general kinds is guilty of subscribing to the Myth of the Given. A distinction based on an abstraction of essentially combined aspects of empirical judgement cannot underpin a distinct empirical method. Furthermore, idiographic elements understood as individualised judgements threaten the validity of psychiatric diagnosis. In the final part I briefly describe some aspects of the logic of narrative judgements and argue that in the call for comprehensive diagnosis, narrative rather than idiographic elements have an important role. Importantly, however, whilst directed towards individual subjects, narratives are framed in intrinsically general concepts and thus can aspire to validity

Problem formulation by medical students: an observation study

<p>Abstract</p> <p>Background</p> <p>Medical problems are often complex and ill-structured. In formulating the problem, one has to discriminate pertinent elements from irrelevant information in order to effectively find a solution. In this observation study, we describe how medical students formulate the problem of a complex case.</p> <p>Methods</p> <p>32 third year medical students were presented with a complex case of endocarditis. They were asked to synthesize the case and give the best formulation of the problem. They were then asked to provide a diagnosis. A subsequent group of 25 students were presented with the problem already formulated and were also asked for the diagnosis. We analyzed the student's problem formulations using the presence or absence of essential elements of the case, the use of higher-order concepts and the use of relations between concepts.</p> <p>Results</p> <p>12/32 students presented with the case made the correct diagnosis. Diagnostic accuracy was significantly associated with the use of higher-order concepts and relations between concepts. Establishing explicit relations was particularly important. Almost all students who missed the diagnosis could not elicit any relations between concepts but only reported factual observations. When presented with an already formulated problem, 19/25 students made the correct diagnosis. (p < 0.05)</p> <p>Conclusion</p> <p>When faced with a complex new case, students may not have the structured knowledge to recognize the nature of the problem. They have to build new schema or problem representation. Our observations suggest that this process involves using higher-order concepts and establishing new relations between concepts. The fact that students could recognize the disease when presented with a formulated problem but had more difficulty when presented with the original complex case indicates that knowledge of the clinical features may be necessary but not sufficient for problem formulation. Our hypothesis is that problem formulation represents a distinct ability.</p

Making intelligent systems team players: Case studies and design issues. Volume 1: Human-computer interaction design

Initial results are reported from a multi-year, interdisciplinary effort to provide guidance and assistance for designers of intelligent systems and their user interfaces. The objective is to achieve more effective human-computer interaction (HCI) for systems with real time fault management capabilities. Intelligent fault management systems within the NASA were evaluated for insight into the design of systems with complex HCI. Preliminary results include: (1) a description of real time fault management in aerospace domains; (2) recommendations and examples for improving intelligent systems design and user interface design; (3) identification of issues requiring further research; and (4) recommendations for a development methodology integrating HCI design into intelligent system design

Illness identity as an important component of candidacy: Contrasting experiences of help-seeking and access to care in cancer and heart disease

How and when we use health services or healthcare provision has dominated exploration of and debates around healthcare access. Levels of utilisation are assumed as a proxy for access. Yet, focusing on utilisation conceals an important aspect of the access conundrum: the relationships that patients and potential patients have with the healthcare system and the professionals within those systems. Candidacy has been proposed as an antidote to traditional utilisation models. The Candidacy construct offers the ability to include patient-professional aspects alongside utilisation and thus promotes a deeper understanding of access. Originally applied to healthcare access for vulnerable populations, additional socio-demographic factors, including age and ethnicity, have also been shown to influence the Candidacy process. Here we propose a further extension of the Candidacy construct and illustrate the importance of illness identities when accessing healthcare. Drawing on a secondary data analysis of three data sets of qualitative interviews from colorectal cancer and heart failure patients we found that though similar access issues are apparent pre-diagnosis, diagnosis marks a critical juncture in the experience of access. Cancer patients describe a person-centred responsive healthcare system where their patienthood requires only modest assertion. Cancer speaks for itself. In marked contrast heart failure patients, describe struggling within a seemingly impermeable system to understand their illness, its implications and their own legitimacy as patients. Our work highlights the pressing need for healthcare professionals, systems and policies to promote a person centred approach, which is responsive and timely, regardless of illness category. To achieve this, attitudes regarding the importance or priority afforded to different categories of illness need to be tackled as they directly influence ideas of Candidacy and consequently access and experiences of care

Effect of intensive instruction on inquiry patterns of registered professional nurses in making clinical judgments.

The purpose of this study is to investigate the effects of a method to modify the inquiry pattern behaviors of registered professional nurses in data gathering for clinical judgments. Forty registered professional nurses who were either students currently enrolled in an upper-division baccalaureate RN completion program or graduates of the program participated in the study. Twenty subjects were randomly assigned to Group I and received the experimental treatment, intensive instruction in cue attendance, information search, and hypothesis generation. Twenty additional subjects were assigned to Group II and received instruction in the principles of diagnostic reasoning. Measures of demographic data, level of cognitive functioning, and pre-instruction inquiry pattern behaviors were obtained prior to instruction. Analysis of variance were used to determine the effectiveness of intensive instruction. Significant near and far-transfer effects for cue attendance and information search behaviors were demonstrated. Significant effects for hypothesis generation behaviors were not demonstrated. There was insufficient evidence to support any effect of the level of cognitive functioning and accomplishments of the subjects as the result of intensive instruction. It was concluded that intensive instruction was effective for cue attendance and information search behaviors but not for hypothesis generation behaviors. Further research in the use of intensive instruction was recommended