54 research outputs found
An experimental study and evaluation of a new architecture for clinical decision support - integrating the openEHR specifications for the Electronic Health Record with Bayesian Networks
Healthcare informatics still lacks wide-scale adoption of intelligent decision
support methods, despite continuous increases in computing power and
methodological advances in scalable computation and machine learning, over
recent decades. The potential has long been recognised, as evidenced in the
literature of the domain, which is extensively reviewed.
The thesis identifies and explores key barriers to adoption of clinical decision
support, through computational experiments encompassing a number of technical
platforms. Building on previous research, it implements and tests a novel platform
architecture capable of processing and reasoning with clinical data. The key
components of this platform are the now widely implemented openEHR electronic
health record specifications and Bayesian Belief Networks.
Substantial software implementations are used to explore the integration of
these components, guided and supplemented by input from clinician experts and
using clinical data models derived in hospital settings at Moorfields Eye Hospital.
Data quality and quantity issues are highlighted. Insights thus gained are used to
design and build a novel graph-based representation and processing model for the
clinical data, based on the openEHR specifications. The approach can be
implemented using diverse modern database and platform technologies.
Computational experiments with the platform, using data from two clinical
domains – a preliminary study with published thyroid metabolism data and a
substantial study of cataract surgery – explore fundamental barriers that must be
overcome in intelligent healthcare systems developments for clinical settings. These
have often been neglected, or misunderstood as implementation procedures of
secondary importance. The results confirm that the methods developed have the
potential to overcome a number of these barriers.
The findings lead to proposals for improvements to the openEHR
specifications, in the context of machine learning applications, and in particular for
integrating them with Bayesian Networks. The thesis concludes with a roadmap for
future research, building on progress and findings to date
A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)
Meeting abstrac
Experience of the Izmir pediatric oncology group on neuroblastoma: IPOG-NBL-92 protocol
WOS: 000182134800004PubMed ID: 12637217This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma
High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients
Migraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients.
This case-control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18-50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry.
Mean hs-CRP level was significantly greater in migraine patients (1.94 +/- 2.03 mg/L) than control subjects (0.82 +/- 0.58 mg/L; P a parts per thousand currency signaEuro parts per thousand.0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 +/- 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 +/- 1.3; P a parts per thousand currency signaEuro parts per thousand.001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P a parts per thousand currency signaEuro parts per thousand.001).
High hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area
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