Fuzzy rule-based system applied to risk estimation of cardiovascular patients

Cardiovascular decision support is one area of increasing research interest. On-going collaborations between clinicians and computer scientists are looking at the application of knowledge discovery in databases to the area of patient diagnosis, based on clinical records. A fuzzy rule-based system for risk estimation of cardiovascular patients is proposed. It uses a group of fuzzy rules as a knowledge representation about data pertaining to cardiovascular patients. Several algorithms for the discovery of an easily readable and understandable group of fuzzy rules are formalized and analysed. The accuracy of risk estimation and the interpretability of fuzzy rules are discussed. Our study shows, in comparison to other algorithms used in knowledge discovery, that classifcation with a group of fuzzy rules is a useful technique for risk estimation of cardiovascular patients. © 2013 Old City Publishing, Inc

Bayesian regression discontinuity designs: Incorporating clinical knowledge in the causal analysis of primary care data

The regression discontinuity (RD) design is a quasi-experimental design that estimates the causal effects of a treatment by exploiting naturally occurring treatment rules. It can be applied in any context where a particular treatment or intervention is administered according to a pre-specified rule linked to a continuous variable. Such thresholds are common in primary care drug prescription where the RD design can be used to estimate the causal effect of medication in the general population. Such results can then be contrasted to those obtained from randomised controlled trials (RCTs) and inform prescription policy and guidelines based on a more realistic and less expensive context. In this paper we focus on statins, a class of cholesterol-lowering drugs, however, the methodology can be applied to many other drugs provided these are prescribed in accordance to pre-determined guidelines. NHS guidelines state that statins should be prescribed to patients with 10 year cardiovascular disease risk scores in excess of 20%. If we consider patients whose scores are close to this threshold we find that there is an element of random variation in both the risk score itself and its measurement. We can thus consider the threshold a randomising device assigning the prescription to units just above the threshold and withholds it from those just below. Thus we are effectively replicating the conditions of an RCT in the area around the threshold, removing or at least mitigating confounding. We frame the RD design in the language of conditional independence which clarifies the assumptions necessary to apply it to data, and which makes the links with instrumental variables clear. We also have context specific knowledge about the expected sizes of the effects of statin prescription and are thus able to incorporate this into Bayesian models by formulating informative priors on our causal parameters.Comment: 21 pages, 5 figures, 2 table

Medical diagnosis of cardiovascular diseases using an interval-valued fuzzy rule-based classification system

Objective: To develop a classifier that tackles the problem of determining the risk of a patient of suffering from a cardiovascular disease within the next ten years. The system has to provide both a diagnosis and an interpretable model explaining the decision. In this way, doctors are able to analyse the usefulness of the information given by the system. Methods: Linguistic fuzzy rule-based classification systems are used, since they provide a good classification rate and a highly interpretable model. More specifically, a new methodology to combine fuzzy rule-based classification systems with interval-valued fuzzy sets is proposed, which is composed of three steps: 1) the modelling of the linguistic labels of the classifier using interval-valued fuzzy sets; 2) the use of the Kα operator in the inference process and 3) the application of a genetic tuning to find the best ignorance degree that each interval-valued fuzzy set represents as well as the best value for the parameter α of the Kα operator in each rule. Results: The suitability of the new proposal to deal with this medical diagnosis classification problem is shown by comparing its performance with respect to the one provided by two classical fuzzy classifiers and a previous interval-valued fuzzy rule-based classification system. The performance of the new method is statistically better than the ones obtained with the methods considered in the comparison. The new proposal enhances both the total number of correctly diagnosed patients, around 3% with respect the classical fuzzy classifiers and around 1% versus the previous interval-valued fuzzy classifier, and the classifier ability to correctly differentiate patients of the different risk categories. Conclusion: The proposed methodology is a suitable tool to face the medical diagnosis of cardiovascular diseases, since it obtains a good classification rate and it also provides an interpretable model that can be easily understood by the doctors.This work was partially supported by the Spanish Ministry of Science and Technology under project TIN2010-15055 and the Research Services of the Universidad Pública de Navarra

Sparse Matrix Approach in Neural Networks for Effective Medical Data Sets Classifications

In this paper, a hybrid intelligent system that consists of the sparse matrix approach incorporated in neural network learning model as a decision support tool for medical data classification is presented. The main objective of this research is to develop an effective intelligent system that can be used by medical practitioners to accelerate diagnosis and treatment processes. The sparse matrix approach incorporated in neural network learning algorithm for scalability, minimize higher memory storage capacity usage, enhancing implementation time and speed up the analysis of the medical data classification problem. The hybrid intelligent system aims to exploit the advantages of the constituent models and, at the same time, alleviate their limitations. The proposed intelligent classification system maximizes the intelligently classification of medical data and minimizes the number of trends inaccurately identified. To evaluate the effectiveness of the hybrid intelligent system, three benchmark medical data sets, viz., Hepatitis, SPECT Heart and Cleveland Heart from the UCI Repository of Machine Learning, are used for evaluation. A number of useful performance metrics in medical applications which include accuracy, sensitivity, specificity. The results were analyzed and compared with those from other methods published in the literature. The experimental outcomes positively demonstrate that the hybrid intelligent system was effective in undertaking medical data classification tasks

Early hospital mortality prediction using vital signals

Early hospital mortality prediction is critical as intensivists strive to make efficient medical decisions about the severely ill patients staying in intensive care units. As a result, various methods have been developed to address this problem based on clinical records. However, some of the laboratory test results are time-consuming and need to be processed. In this paper, we propose a novel method to predict mortality using features extracted from the heart signals of patients within the first hour of ICU admission. In order to predict the risk, quantitative features have been computed based on the heart rate signals of ICU patients. Each signal is described in terms of 12 statistical and signal-based features. The extracted features are fed into eight classifiers: decision tree, linear discriminant, logistic regression, support vector machine (SVM), random forest, boosted trees, Gaussian SVM, and K-nearest neighborhood (K-NN). To derive insight into the performance of the proposed method, several experiments have been conducted using the well-known clinical dataset named Medical Information Mart for Intensive Care III (MIMIC-III). The experimental results demonstrate the capability of the proposed method in terms of precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). The decision tree classifier satisfies both accuracy and interpretability better than the other classifiers, producing an F1-score and AUC equal to 0.91 and 0.93, respectively. It indicates that heart rate signals can be used for predicting mortality in patients in the ICU, achieving a comparable performance with existing predictions that rely on high dimensional features from clinical records which need to be processed and may contain missing information.Comment: 11 pages, 5 figures, preprint of accepted paper in IEEE&ACM CHASE 2018 and published in Smart Health journa

Monitoring and detection of agitation in dementia: towards real-time and big-data solutions

The changing demographic profile of the population has potentially challenging social, geopolitical, and financial consequences for individuals, families, the wider society, and governments globally. The demographic change will result in a rapidly growing elderly population with healthcare implications which importantly include Alzheimer type conditions (a leading cause of dementia). Dementia requires long term care to manage the negative behavioral symptoms which are primarily exhibited in terms of agitation and aggression as the condition develops. This paper considers the nature of dementia along with the issues and challenges implicit in its management. The Behavioral and Psychological Symptoms of Dementia (BPSD) are introduced with factors (precursors) to the onset of agitation and aggression. Independent living is considered, health monitoring and implementation in context-aware decision-support systems is discussed with consideration of data analytics. Implicit in health monitoring are technical and ethical constraints, we briefly consider these constraints with the ability to generalize to a range of medical conditions. We postulate that health monitoring offers exciting potential opportunities however the challenges lie in the effective realization of independent assisted living while meeting the ethical challenges, achieving this remains an open research question remains.Peer ReviewedPostprint (author's final draft

Approaches to the Estimation of the Local Average Treatment Effect in a Regression Discontinuity Design

Regression discontinuity designs (RD designs) are used as a method for causal inference from observational data, where the decision to apply an intervention is made according to a ‘decision rule’ that is linked to some continuous variable. Such designs are being increasingly developed in medicine. The local average treatment effect (LATE) has been established as an estimator of the intervention effect in an RD design, particularly where a design’s ‘decision rule’ is not adhered to strictly. Estimating the variance of the LATE is not necessarily straightforward. We consider three approaches to the estimation of the LATE: two-stage least squares, likelihood-based and a Bayesian approach. We compare these under a variety of simulated RD designs and a real example concerning the prescription of statins based on cardiovascular disease risk score

Artificial intelligence methodologies and their application to diabetes

In the past decade diabetes management has been transformed by the addition of continuous glucose monitoring and insulin pump data. More recently, a wide variety of functions and physiologic variables, such as heart rate, hours of sleep, number of steps walked and movement, have been available through wristbands or watches. New data, hydration, geolocation, and barometric pressure, among others, will be incorporated in the future. All these parameters, when analyzed, can be helpful for patients and doctors' decision support. Similar new scenarios have appeared in most medical fields, in such a way that in recent years, there has been an increased interest in the development and application of the methods of artificial intelligence (AI) to decision support and knowledge acquisition. Multidisciplinary research teams integrated by computer engineers and doctors are more and more frequent, mirroring the need of cooperation in this new topic. AI, as a science, can be defined as the ability to make computers do things that would require intelligence if done by humans. Increasingly, diabetes-related journals have been incorporating publications focused on AI tools applied to diabetes. In summary, diabetes management scenarios have suffered a deep transformation that forces diabetologists to incorporate skills from new areas. This recently needed knowledge includes AI tools, which have become part of the diabetes health care. The aim of this article is to explain in an easy and plane way the most used AI methodologies to promote the implication of health care providers?doctors and nurses?in this field