Integration of the Wang & Mendel algorithm into the application of Fuzzy expert systems to intelligent clinical decision support systems

The use of intelligent systems in clinical diagnostics has evolved, integrating statistical learning and knowledge-based representation models. Two recent works propose the identification of risk factors for the diagnosis of obstructive sleep apnea (OSA). The first uses statistical learning to identify indicators associated with different levels of the apnea-hypopnea index (AHI). The second paper combines statistical and symbolic inference approaches to obtain risk indicators (Statistical Risk and Symbolic Risk) for a given AHI level. Based on this, in this paper we propose a new intelligent system that considers different AHI levels and generates risk pairs for each level. A learning-based model generates Statistical Risks based on objective patient data, while a cascade of fuzzy expert systems determines a Symbolic Risk using symptom data from patient interviews. The aggregation of risk pairs at each level involves a fuzzy expert system with automatically generated fuzzy rules using the Wang-Mendel algorithm. This aggregation produces an Apnea Risk indicator for each AHI level, allowing discrimination between OSA and non-OSA cases, along with appropriate recommendations. This approach improves variability, usefulness, and interpretability, increasing the reliability of the system. Initial tests on data from 4400 patients yielded AUC values of 0.74–0.88, demonstrating the potential benefits of the proposed intelligent system architecture.Xunta de Galicia | Ref. ED481A-2020/03

Design and conceptual development of a novel hybrid intelligent decision support system applied towards the prevention and early detection of forest fires

Forest fires have become a major problem that every year has devastating consequences at the environmental level, negatively impacting the social and economic spheres of the affected regions. Aiming to mitigate these terrible effects, intelligent prediction models focused on early fire detection are becoming common practice. Considering mainly a preventive approach, these models often use tools that indifferently apply statistical or symbolic inference techniques. However, exploring the potential for the hybrid use of both, as is already being done in other research areas, is a significant novelty with direct application to early fire detection. In this line, this work proposes the design, development, and proof of concept of a new intelligent hybrid system that aims to provide support to the decisions of the teams responsible for defining strategies for the prevention, detection, and extinction of forest fires. The system determines three risk levels: a general one called Objective Technical Fire Risk, based on machine learning algorithms, which determines the global danger of a fire in some area of the region under study, and two more specific others which indicate the risk over a limited area of the region. These last two risk levels, expressed in matrix form and called Technical Risk Matrix and Expert Risk Matrix, are calculated through a convolutional neural network and an expert system, respectively. After that, they are combined by means of another expert system to determine the Global Risk Matrix that quantifies the risk of fire in each of the study regions and generates a visual representation of these results through a color map of the region itself. The proof of concept of the system has been carried out on a set of historical data from fires that occurred in the Montesinho Natural Park (Portugal), demonstrating its potential utility as a tool for the prevention and early detection of forest fires. The intelligent hybrid system designed has demonstrated excellent predictive capabilities in such a complex environment as forest fires, which are conditioned by multiple factors. Future improvements associated with data integration and the formalization of knowledge bases will make it possible to obtain a standard tool that could be used and validated in real time in different forest areas

Proposal and definition of an intelligent clinical decision support system applied to the screening and early diagnosis of breast cancer

Breast cancer is the most frequently diagnosed tumor pathology on a global scale, being the leading cause of mortality in women. In light of this problem, screening programs have been implemented on the population at risk in the form of mammograms, starting in the 20th century. This has considerably reduced the associated deaths, as well as improved the prognosis of the patients who suffer from this disease. In spite of this, the evaluation of mammograms is not without certain variability and depends, to a large extent, on the experience and training of the medical team carrying out the assessment. With the aim of supporting the evaluation process of mammogram images and improving the diagnosis process, this work presents the design, development and proof of concept of a novel intelligent clinical decision support system, grounded on two predictive approaches that work concurrently. The first of them applies a series of expert systems based on fuzzy inferential engines, geared towards the treatment of the characteristics associated with the main findings present in mammograms. This allows the determination of a series of risk indicators, the Symbolic Risks, related to the risk of developing breast cancer according to the different findings. The second one implements a classification machine learning algorithm, which using data related to mammography findings as well as general patient information determines another metric, the Statistical Risk, also linked to the risk of developing breast cancer. These risk indicators are then combined, resulting in a new indicator, the Global Risk. This could then be corrected using a weighting factor according to the BI-RADS category, allocated to each patient by the medical team in charge. Thus, the Corrected Global Risk is obtained, which after interpretation can be used to establish the patient’s status as well as generate personalized recommendations. The proof of concept and software implementation of the system were carried out using a data set with 130 patients from a database from the School of Medicine and Public Health of the University of Wisconsin-Madison. The results obtained were encouraging, highlighting the potential use of the application, albeit pending intensive clinical validation in real environments. Moreover, its possible integration in hospital computer systems is expected to improve diagnostic processes as well as patient prognosis.Xunta de Galicia | Ref. ED481A-2020/03

Design and conceptual proposal of an intelligent clinical decision support system for the diagnosis of suspicious obstructive sleep apnea patients from health profile

Obstructive Sleep Apnea (OSA) is a chronic sleep-related pathology characterized by recurrent episodes of total or partial obstruction of the upper airways during sleep. It entails a high impact on the health and quality of life of patients, affecting more than one thousand million people worldwide, which has resulted in an important public health concern in recent years. The usual diagnosis involves performing a sleep test, cardiorespiratory polygraphy, or polysomnography, which allows characterizing the pathology and assessing its severity. However, this procedure cannot be used on a massive scale in general screening studies of the population because of its execution and implementation costs; therefore, causing an increase in waiting lists which would negatively affect the health of the affected patients. Additionally, the symptoms shown by these patients are often unspecific, as well as appealing to the general population (excessive somnolence, snoring, etc.), causing many potential cases to be referred for a sleep study when in reality are not suffering from OSA. This paper proposes a novel intelligent clinical decision support system to be applied to the diagnosis of OSA that can be used in early outpatient stages, quickly, easily, and safely, when a suspicious OSA patient attends the consultation. Starting from information related to the patient’s health profile (anthropometric data, habits, comorbidities, or medications taken), the system is capable of determining different alert levels of suffering from sleep apnea associated with different apnea-hypopnea index (AHI) levels to be studied. To that end, a series of automatic learning algorithms are deployed that, working concurrently, together with a corrective approach based on the use of an Adaptive Neuro-Based Fuzzy Inference System (ANFIS) and a specific heuristic algorithm, allow the calculation of a series of labels associated with the different levels of AHI previously indicated. For the initial software implementation, a data set with 4600 patients from the Álvaro Cunqueiro Hospital in Vigo was used. The results obtained after performing the proof tests determined ROC curves with AUC values in the range 0.8–0.9, and Matthews correlation coefficient values close to 0.6, with high success rates. This points to its potential use as a support tool for the diagnostic process, not only from the point of view of improving the quality of the services provided, but also from the best use of hospital resources and the consequent savings in terms of costs and time.Xunta de Galicia | Ref. ED481A-2020/03

Design of an intelligent decision support system applied to the diagnosis of obstructive sleep apnea

Obstructive sleep apnea (OSA), characterized by recurrent episodes of partial or total obstruction of the upper airway during sleep, is currently one of the respiratory pathologies with the highest incidence worldwide. This situation has led to an increase in the demand for medical appointments and specific diagnostic studies, resulting in long waiting lists, with all the health consequences that this entails for the affected patients. In this context, this paper proposes the design and development of a novel intelligent decision support system applied to the diagnosis of OSA, aiming to identify patients suspected of suffering from the pathology. For this purpose, two sets of heterogeneous information are considered. The first one includes objective data related to the patient’s health profile, with information usually available in electronic health records (anthropometric information, habits, diagnosed conditions and prescribed treatments). The second type includes subjective data related to the specific OSA symptomatology reported by the patient in a specific interview. For the processing of this information, a machine-learning classification algorithm and a set of fuzzy expert systems arranged in cascade are used, obtaining, as a result, two indicators related to the risk of suffering from the disease. Subsequently, by interpreting both risk indicators, it will be possible to determine the severity of the patients’ condition and to generate alerts. For the initial tests, a software artifact was built using a dataset with 4400 patients from the Álvaro Cunqueiro Hospital (Vigo, Galicia, Spain). The preliminary results obtained are promising and demonstrate the potential usefulness of this type of tool in the diagnosis of OSA.Xunta de Galicia | Ref. ED481A-2020/03

A methodology based on expert systems for the early detection and prevention of hypoxemic clinical cases

Respiratory diseases are currently considered to be amongst the most frequent causes of death and disability worldwide, and even more so during the year 2020 because of the COVID-19 global pandemic. Aiming to reduce the impact of these diseases, in this work a methodology is developed that allows the early detection and prevention of potential hypoxemic clinical cases in patients vulnerable to respiratory diseases. Starting from the methodology proposed by the authors in a previous work and grounded in the definition of a set of expert systems, the methodology can generate alerts about the patient’s hypoxemic status by means of the interpretation and combination of data coming both from physical measurements and from the considerations of health professionals. A concurrent set of Mamdani-type fuzzy-logic inference systems allows the collecting and processing of information, thus determining a final alert associated with the measurement of the global hypoxemic risk. This new methodology has been tested experimentally, producing positive results so far from the viewpoint of time reduction in the detection of a blood oxygen saturation deficit condition, thus implicitly improving the consequent treatment options and reducing the potential adverse effects on the patient’s health.Universidade de VigoXunta de Galici

Design and definition of a new decision support system aimed to the hierarchization of patients candidate to be admitted to intensive care units

The triage processes prior to the assignation of healthcare resources in hospitals are some of the decision-making processes that more severely affect patients. This effect gets even worse in health emergency situations and intensive care units (ICUs). Aiming to facilitate the decision-making process, in this work the use of vague fuzzy numbers is proposed, aiming to define a multi-attribute patient hierarchization method to be used in emergency situations at hospital ICUs. The incorporation of fuzzy models allows for modelling the vagueness and uncertainty associated with decision criteria evaluation, with which more efficient support is provided to the decision-making process. After defining the methodology, the effectiveness of this new system for patient hierarchization is shown in a case study. As a consequence of that, it is proved that the integration of decision-support systems into healthcare environments results to be efficient and productive, suggesting that if a part of the decision process is supported by these systems, then the errors associated with wrong interpretations and/or diagnoses might be reduced.Xunta de Galicia | Ref. ED481A-2020/03

Design and development of a new methodology based on expert systems applied to the prevention of indoor radon gas exposition risks

Exposure to high concentration levels of radon gas constitutes a major health hazard, being nowadays the second-leading cause of lung cancer after smoking. Facing this situation, the last years have seen a clear trend towards the search for methodologies that allow an efficient prevention of the potential risks derived from the presence of harmful radon gas concentration levels in buildings. With that, it is intended to establish preventive and corrective actions that might help to reduce the impact of radon exposure on people, especially in places where workers and external users must stay for long periods of time, as it may be the case of healthcare buildings. In this paper, a new methodology is developed and applied to the prevention of the risks derived from the exposure to radon gas in indoor spaces. Such methodology is grounded in the concurrent use of expert systems and regression trees that allows producing a diagram with recommendations associated to the exposure risk. The presented methodology has been implemented by means of a software application that supports the definition of the expert systems and the regression algorithm. Finally, after proving its applicability with a case study and discussing its contributions, it may be claimed that the benefits of the new methodology might lead on to an innovation in this field of study.Universidade de VigoXunta de Galici

Design and development of a methodology based on expert systems, applied to the treatment of pressure ulcers

The medical treatment of chronic wounds, pressure ulcers in particular, burdens healthcare systems nowadays with high expenses that result mainly from their monitoring and assessment stages. Decision support systems applied within the ‘remote medicine’ framework may be of help, not only to the process of monitoring the evolution of chronic wounds under treatment, but also to facilitate the prevention and early detection of potential risk conditions in the affected patients. In this paper, the design and definition of a new decision-support methodology to be applied to the monitoring and assessment stages of the medical treatment process for pressure ulcers is proposed. Built upon the use and development of expert systems, the methodology makes it possible to generate alerts derived from the evolution of a patient’s chronic wound, by means of the interpretation and combination of data coming from both an image of the wound, and the considerations of a healthcare professional with expertise in the subject matter. Some positive results are already shown regarding the determination of the ulcer’s status in the tests that have been carried out so far. Therefore, it is considered that the proposed methodology might lead to substantial improvements regarding both the treatment’s efficiency and cost savings

Design and development of an intelligent clinical decision support system applied to the evaluation of breast cancer risk

Breast cancer is currently one of the main causes of death and tumoral diseases in women. Even if early diagnosis processes have evolved in the last years thanks to the popularization of mammogram tests, nowadays, it is still a challenge to have available reliable diagnosis systems that are exempt of variability in their interpretation. To this end, in this work, the design and development of an intelligent clinical decision support system to be used in the preventive diagnosis of breast cancer is presented, aiming both to improve the accuracy in the evaluation and to reduce its uncertainty. Through the integration of expert systems (based on Mamdani-type fuzzy-logic inference engines) deployed in cascade, exploratory factorial analysis, data augmentation approaches, and classification algorithms such as k-neighbors and bagged trees, the system is able to learn and to interpret the patient’s medical-healthcare data, generating an alert level associated to the danger she has of suffering from cancer. For the system’s initial performance tests, a software implementation of it has been built that was used in the diagnosis of a series of patients contained into a 130-cases database provided by the School of Medicine and Public Health of the University of Wisconsin-Madison, which has been also used to create the knowledge base. The obtained results, characterized as areas under the ROC curves of 0.95–0.97 and high success rates, highlight the huge diagnosis and preventive potential of the developed system, and they allow forecasting, even when a detailed and contrasted validation is still pending, its relevance and applicability within the clinical field.Xunta de Galicia | Ref. ED481A-2020/03