Diagnostic reference frames for seizures: a validation study

Introduction We developed structured descriptions of signs and symptoms for specific seizure types (called Diagnostic Reference Frames—DRFs—by us) that can serve as a frame of reference in the process of classifying patients with epileptic seizures. In this study the validity of the DRFs for clinical use is evaluated and described. Material and methods In this study we use a decision support system based on the DRFs and using Bayes's rule for the validation of the DRFs. Patient's manifestations are entered in the decision support system and by successively applying Bayes's rule posterior probabilities are calculated. The DRFs with the highest posterior probability gives an indication of the classification of the seizure. The validation of the DRFs was performed by comparing the seizure type with the highest posterior probability with the classification of experienced epileptologists on a series of test cases with known epileptic seizures. In this way we assessed the accuracy of the DRFs in classifying patients with epileptic seizures. Results We included sixty–six patients in this efficacy study. The patients and/or their relatives described the manifestations occurring during a seizure. Sixty cases (91%) were correctly classified using the decision support system. Discussion The accuracy of 91 % indicates that the knowledge encoded in the DRFs for the included seizure types is valid. The next step is to test the DRFs in a clinical setting to evaluate the applicability in daily practice

The efficacy of an automated feedback system for general practitioners

OBJECTIVE: An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. DESIGN: We used a randomised controlled trial with balanced block design. SETTING: Five times six participant groups of GPs in a computer laboratory setting. INTERVENTION: The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. SUBJECTS: Twenty-four randomly selected GPs participated. MAIN OUTCOME MEASURES: The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. IMPLICATIONS: Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable

The Origins Of Totalitarian Democracy

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Frequency discrimination of sinusoids as a function of duration

No abstract

Conceptual Clustering and Analysis of Data from Gynecological Database

The aim of this work is to propose a methodology for classifying, analyzing and visualizing data of patients with different symptoms from gynecological database. The application implements a variant of WITT algorithm for conceptual clustering. Pre-clustering algorithm is proposed that includes a tradeoff between overlapping of the initial clusters and displacing the center of clusters far away from the region of great density. To overcome the problem with weak correlation different coding schemes for cases are tested. Successful approach was to take square root of attribute value intervals to achieve the intervals with different sizes. Two different datasets from gynecological database are used: data related to polycystic ovary syndrome and data relevant to diagnose pre-eclampsia

The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings: a study on the clinical presentation of 1,147 patients.

The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings: a study on the clinical presentation of 1,147 patients. Adang RP, Ambergen AW, Talmon JL, Hasman A, Vismans JF, Stockbrugger RW. Department of Gastroenterology and Hepatology, University Hospital, Maastricht, The Netherlands. The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings was prospectively assessed in 1,147 patients attending for their first diagnostic endoscopy and who answered paper (n = 431) or computerized (n = 716) questionnaires. The questionnaires provided detailed information concerning present dyspeptic symptoms, with special attention to provoking and/or relieving factors, and smoking and/or drinking habits. In logistic regression models each of a number of 'specific endoscopic diagnoses' was contrasted with normal endoscopy (n = 390), and 'relevant endoscopic disease' (oesophagitis, peptic ulcers, cancers; n = 269) was contrasted with 'irrelevant' and normal endoscopic findings (n = 878). From the regression model a receiver operating characteristic (ROC) curve could be constructed, and the area under the ROC curve (AUC) was calculated to summarize the discriminative power of the regression model. The best discrimination from patients with a normal endoscopy was achieved for patients with gastric (AUC = 0.86) or duodenal (AUC = 0.85) ulcers, followed by patients with hiatus hernia (AUC = 0.78 or oesophagitis (AUC = 0.77). The discriminative performance of the regression models was somewhat less for duodenitis/bulbitis (AUC = 0.75) and endoscopic gastritis (AUC = 0.73). In an open-access endoscopy unit setting, the value of preinvestigation history-taking for the prediction of clinically relevant endoscopic disease was very limited (AUC = 0.63)

Towards a generic connection of EHR and DSS

Decision Support Systems (DSS) are typically integrated in Electronic Health Record systems (EHR). By removing this integration full reuse of a DSS system is possible. The connection between the EHR and the DSS system should be standards-based and generic. We intend to demonstrate the viability of this setup by implementing it using PropeRWeb as EHR system, Gaston as DSS system, HL7v3 messages and the SOAP protocol