Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"

COMPREHENSIVE FRAMEWORKS FOR DECISION MAKING SUPPORT IN MEDICAL EQUIPMENT MANAGEMENT

Throughout medical equipment life cycle, hospitals need to take decisions on medical equipment management based upon a set of different criteria. In fact, medical equipment acquisition, preventive maintenance, and replacement are considered the most important phases, accordingly a properly planned management for these issues is considered a key decision of medical equipment management. In this thesis, a set of frameworks were developed regarding acquisition, preventive maintenance, and replacement to improve management process of medical equipment. In practice, quality function deployment was proposed as a core method around which the frameworks were developed

A fuzzy knowledge based system for clinical diagnosis of tropical fever

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Sıtma ve tifo Sahra-altı Afrika'nın en büyük tropikal ateş enfeksiyonlarıdır. Her ikisi de bölgenin hastalık, ölüm ve ekonomik kayıplarının sebebidir. Tifo ateşi sebebiyle, her 100.000 kişiden 725 tifo vakasına yakalanmakta ve bu hastalardan da 7 adedi ölümle sonuçlandığı tahmin edilmektedir ve Dünya'nın sıtma ölümlerinin %90'ı Sahra-altı Afrika'da meydana gelmektedir. Bu iki hastalığın teşhisinde önemli olan çok sayıda belirti bulunması ve birçoğunun da ortak olması dolayısıyla teşhis zorlaşmaktadır. Bulanık küme teorisine ve insan gibi sonuçlandırma üzerine dayanan bulunak mantık, insani bilimlerde yaygın olarak kullanılmakta ve birçok problemi başarılı bir şekilde çözmektedir. Sınıflandırma ve karar verme görevlerine ihtiyaç duyulan tıbbi teşhis bu cazip uygulamalardan biridir. Belirsizliklerin olduğu teşhis özelliklerindeki karmaşıklıklar bilgisayar sistemlerinde kullanılan doğal dil ile üstesinden gelinmiştir. Bu çalışmada, Sahra-altı Afrika'da sıtma ve tifo ateşinin klinik teşhisi için bilgi tabanlı teşhis sisteminin (TROPFEV) tasarımında bulanık mantık kullanımı anlatılmaktadır. Bilgiler, tıp uzmanları danışmanlığında Uganda Sağlıklı Bakanlığı tarafından hazırlanan UCG-2012'den (Uganda Klinik Klavuzu 2012) çıkarım yapılmıştır. Bu kaynaklardan edinilmiş bilgiler modellenip, bulanık kural tabanlı mantık kullanılarak tanımlanmış ve Matlab 2012a gerçeklenmiştir. Toplanan bilgilere göre, 21 adet teşhis özellikleri, ateş hastalığının durumuna ya da şiddetine göre sistemi oluşturmak için düzenlenmiştir. Kullanıcı, karmaşık-sıtma, karmaşık olmayan-sıtma, karmaşık-tifo, karmaşık olmayan-tifo veya bilinmeyen ateş cevabını sistemden beklemektedir. Test ve performansını değerlendirmek için, TROPFEV sistemin sonuçları ile doktor tarafından yapılan teşhis sonuçlarıyla karşılaştırılmıştır. Uzman teşhisleri ve sistem teşhisleri arasındaki % 86 oranında doğruluk olduğunu görülmüştür. Sonuç olarak, tıbbi teşhis için tecrübesiz hekimlerin teşhislerine daha hızlı ve verimli bir şekilde teşhis koyabilmek için yardımcı olması amacıyla bulanık mantık kullanımına ağırlık verilebilir.. Çünkü bulanık mantık belirtilerdeki kesin olmama sıkıntılarının üstesinden gelebilmek için bulanıklık kümelerini kullanır ve bir sınıflandırmaya ilişkilendirir.Malaria and typhoid fever are major tropical fever infections. Both are responsible for significant morbidity, mortality and economic loss in the region. Typhoid fever is estimated to cause 725 incident cases and 7 deaths per 100,000 people in the year and on the other side 90% of the total world malaria deaths occur in the Sub-Saharan Africa. The two diseases malaria and typhoid fever have several diagnosis features with overlapping signs and symptoms which are a task in medical diagnosis. Fuzzy logic that lies on the fuzzy set theory and similar to human reasoning is widely used for human-related sciences, and successfully solves many problems. Medical diagnosis is one of these attractive applications, which requires classification and decision making tasks. It uses natural language to represent data into computer systems where complications in diagnosis features such as vagueness are perfectly handled. This thesis describes the use of fuzzy logic to design a knowledge based system for clinical diagnosis of malaria and typhoid fever (TROPFEV) in Sub-Saharan Africa. Knowledge was extracted from the documentary of UCG-2012 (Uganda Clinical Guidelines 2012) prepared by the ministry of healthy in Uganda as well as consulting medical experts. The knowledge acquired from these resources is modelled, represented using fuzzy rule based reasoning and implemented in Matlab 2012 a. According to the collected knowledge, 21 diagnosis features have been organised with their situations or severity during fever infections to build the system. The user is expected to get the answer of complicated malaria, uncomplicated malaria, complicated typhoid, uncomplicated typhoid or unknown fever. For testing and evaluating its performance, the results of the TROPFEV system were compared with the results of diagnosis made by a real doctor The difference in results between expert diagnosis and system diagnosis showed that the expert system have similarity with the real experts with 86% accuracy. In conclusion, the use of fuzzy logic in medical diagnosis can be emphasized because it provides an efficient way to assist inexperienced physicians to arrive at the final diagnosis of fever more quickly and efficiently. This is because fuzzy logic applies fuzzy sets to handle vagueness existing in symptoms

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world