Medical diagnosis: Are expert systems needed?

An evaluation of the pitfalls of computer-aided diagnosis during the last ten yearns seems to show that increased emphasis on real clinical problems as well as increased use of medical knowledge are required. Since such an approach could fit into the ‘expert system’ framework, one should expect new developments in that research field to occur soon. However, expert systems can also be designed along the same concepts as previous models of diagnostic reasoning presumably with the same shortcomings.     

The tacit dimension of clinical judgment

Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered.     

Expert systems in treating substance abuse.

Computer programs can assist humans in solving complex problems that cannot be solved by traditional computational techniques using mathematic formulas. These programs, or "expert systems," are commonly used in finance, engineering, and computer design. Although not routinely used in medicine at present, medical expert systems have been developed to assist physicians in solving many kinds of medical problems that traditionally require consultation from a physician specialist. No expert systems are available specifically for drug abuse treatment, but at least one is under development. Where access to a physician specialist in substance abuse is not available for consultation, this expert system will extend specialized substance abuse treatment expertise to nonspecialists. Medical expert systems are a developing technologic tool that can assist physicians in practicing better medicine.     

Dental cone beam CT: A review

For the maxillofacial region, there are various indications that cannot be interpreted from 2D images and will benefit from multiplanar viewing. Dental cone beam CT (CBCT) utilises a cone- or pyramid-shaped X-ray beam using mostly flat-panel detectors for 3D image reconstruction with high spatial resolution. The vast increase in availability and amount of these CBCT devices offers many clinical benefits, and their ongoing development has potential to bring various new clinical applications for medical imaging. Additionally, there is also a need for high quality research and education. European guidelines promote the use of a medical physics expert for advice on radiation protection, patient dose optimisation, and equipment testing. In this review article, we perform a comparison of technical equipment based on manufacturer data, including scanner specific X-ray spectra, and describe issues concerning CBCT image reconstruction and image quality, and also address radiation dose issues, dosimetry, and optimisation. We also discuss clinical needs and what type of education users should have in order to operate CBCT systems safely. We will also take a look into the future and discuss the issues that still need to be solved.     

Expert systems in the control of animal cell culture processes: Potentials,functions, and perspectives

In recent years, the development of advanced systems for bioprocess monitoring and control has become an area of intensive research. Along with traditional techniques, there are several new approaches which are increasingly being applied to bioprocess operations. Among these, of special note is expert system technology, which provides possibilities for the design of efficient bioprocess control systems with new functional capabilities. This technology has been successfully applied to variety of microbial processes at laboratory and industrial scale. The present paper analyzes the possibility for application of expert systems to animal cell cultures processes whose high complexity is well suited to expert control. The discussion focuses on the organization and the functionality of the intelligent control systems, and covers some practical aspects of their design.     

医学研究生"高通量测序技术"应用能力的培养

高通量测序技术目前已广泛的应用于临床研究领域。与传统测序方式相比,该技术具有通量高、耗时短、成本低等特点。研究生教育中对高通量测序技术的新进展及其在疾病研究、临床诊断等方面的应用方面的介绍较少。培养医学研究生对高通量测序技术的应用能力,可以增强研究生对高通量测序技术的方法、原理、应用范围、数据分析的理解,为医学研究生应用高通量测序技术发现及解决临床问题打下一定的基础。     

Systems Approaches to Biology and Disease Enable Translational Systems Medicine

The development and application of systems strategies to biology and disease are transforming medical research and clinical practice in an unprecedented rate.In the foreseeable future,clinicians,medical researchers,and ultimately the consumers and patients will be increasingly equipped with a deluge of personal health information,e.g.,whole genome sequences,molecular profiling of diseased tissues,and periodic multi-analyte blood testing of biomarker panels for disease and wellness.The convergence of these practices will enable accurate prediction of disease susceptibility and early diagnosis for actionable preventive schema and personalized treatment regimes tailored to each individual.It will also entail proactive participation from all major stakeholders in the health care system.We are at the dawn of predictive,preventive,personalized,and participatory(P4) medicine,the fully implementation of which requires marrying basic and clinical researches through advanced systems thinking and the employment of high-throughput technologies in genomics,proteomics,nanofluidics,single-cell analysis,and computation strategies in a highly-orchestrated discipline we termed translational systems medicine.     

临床新技术评价指标体系的建立及应用研究

目的 建立科学的临床新技术评价指标体系,为临床新技术管理提供依据。方法 结合管理实践,通过文献及政策调研、专家咨询、实践验证等方法进行研究。结果 建立了临床新技术定性与定量相结合的评价指标体系,采取同行函审和集中评定相结合的办法进行了实证研究,探索了临床新技术管理的有效方法。结论 评价体系的建立和应用为临床新技术的科学管理提供了依据,推动医疗技术的进步和医院的发展。     

Medical applications of image analysis with the Magiscan 2

The previous generation of image analysis machines were capable of processing and analyzing binary, i.e., black and white images, and making measurements and decisions thereon. The Magiscan 2, one of the new generation computers, is capable of analyzing gray-level images in a variety of sophisticated ways. Its uses in the medical application of image analysis are presented, as are the techniques used to analyze images in general. The two principal current medical uses are the automatic karyotyping of chromosomes and the automatic screening of cervical smears. Other applications discussed include three-dimensional reconstruction of structures from two-dimensional sections and the possibility of developing expert systems for medical diagnostics.     

Theme C: Medical information systems and databases – results and future work

This paper presents the activities of the theme C “medical information systems and databases” in the GDR Stic Santé. Six one-day workshops have been organized during the period 2011–2012. They were devoted to 1) sharing anatomical and physiological object models for simulation of clinical medical images, 2) advantages and limitations of datawarehouse for biological data, 3) medical information engineering, 4) systems for sharing medical images for research, 5) knowledge engineering for semantic interoperability in e-health applications, and 6) using context in health. In the future, our activities will continue with a specific interest on information systems for translational medicine and the role of electronic healthcare reports in decision-making. Workshops with other research groups will be organized in particular with the e-health research group.     

Expert systems in histopathology. I. Introduction and overview

An introduction to, and overview of, expert systems is presented, along with some preliminary comments on their application in diagnostic and analytical histopathology and cytopathology. The terminology common to expert systems is defined, and the nature of expert systems is discussed. In particular, the differences between expert systems and other types of computer programs (e.g., algorithms) or means of solving problems are explored. The rationale for their use and the types of tasks for which they are appropriate are also discussed.     

大数据时代信息化管理平台在医院专科建设中的价值

大数据时代利用信息化管理平台可以优化并规范临床诊疗流程、提升诊疗服务质量与效率、提高科研质量与水平,符合医改对医院精细化管理和循证医学时代精准医疗的要求。此信息化管理平台可以自动获取临床诊疗全程结构化数据,通过顶层设计达到规范医疗文件内容,减轻临床文书工作的目的;通过一次记录同时满足临床科研、运营管理及常规临床文件的需求,对规范化诊疗、临床科研、科室运营管理意义重大,在医院专科建设中有较好的临床应用及推广价值。     

A diagnostic expert system

The introduction of new technologies in the field of electronics has influenced the development of technical equipment over the last few years. The progressive miniaturization of integrated circuits makes possible an expansion of the spectrum of functions offered by this equipment. This also applies to medical technology. These more complex units call for new methods of fault detection and diagnosis. In addition to analytical redundancy, tools developed by the artificial intelligence research community, such as expert systems, are becoming more and more important for fault diagnosis. On the basis of a realized diagnosis expert system the possibilities as well as the limits of such system are discussed. Also, possible future developments of artificial intelligence, like machine learning, are considered.     

Biomedical relevance of two-dimensional protein mapping

State-of-the-art and future perspectives are discussed for the application of two-dimensional protein maps to basic medical research and routine clinical chemistry problems. Despite the technical advances that allow effective processing of a large number of samples and the refinement of devices and procedures for image analysis, at present two-dimensional maps are mostly confined to research purposes, i.e. to the inventory of normal constituents of body fluids and tissues on the one hand, and to qualitative—quantitative alterations of some protein spots in a number of instances (genetic, degenerative, infectious or xenobiotic diseases) on the other. It is hoped that in some instances a single primarily affected component will be able to be identified and then specifically tested (for instance by immunological means) as a diagnostic marker, but complex pathological patterns would still require the analysis of a large number of peptides at the resolution level only afforded by two dimensions. Further simplification of the protocols, for example with ready-made gels, and data reduction systems might then allow the application of the technique to be extended to general clinical laboratories.     

Expert systems and the pancreatic cancer problem: decision support in the pre-operative diagnosis

In this paper, after reviewing the main issue in artificial intelligence, decision support systems, medical decision-making, expert systems and some of their applications in medicine, we focus on the diagnostic aspect of pancreatic cancer. We briefly examine the most significant applications both from the oncological and from the diagnostic point of view. We discuss the medical problems mentioning incidence and mortality, aetiological factors and diagnosis, considering the roles of surgery and adjuvant therapies. Finally we justify the decision to develop an expert system in such a medical domain and discuss the SPES (Surgical Pancreatic Expert System) project, its parts dealing with the different medical phases of pancreatic cancer diagnosis and therapy: pre-operative, intra-operative and adjuvant therapies. In particular we discuss diagnostic aspects of pancreatic cancer disease, pointing out the aims of the project, methodologies, tools used and future developments.     

SHRINE: Enabling Nationally Scalable Multi-Site Disease Studies

Results of medical research studies are often contradictory or cannot be reproduced. One reason is that there may not be enough patient subjects available for observation for a long enough time period. Another reason is that patient populations may vary considerably with respect to geographic and demographic boundaries thus limiting how broadly the results apply. Even when similar patient populations are pooled together from multiple locations, differences in medical treatment and record systems can limit which outcome measures can be commonly analyzed. In total, these differences in medical research settings can lead to differing conclusions or can even prevent some studies from starting. We thus sought to create a patient research system that could aggregate as many patient observations as possible from a large number of hospitals in a uniform way. We call this system the ‘Shared Health Research Information Network’, with the following properties: (1) reuse electronic health data from everyday clinical care for research purposes, (2) respect patient privacy and hospital autonomy, (3) aggregate patient populations across many hospitals to achieve statistically significant sample sizes that can be validated independently of a single research setting, (4) harmonize the observation facts recorded at each institution such that queries can be made across many hospitals in parallel, (5) scale to regional and national collaborations. The purpose of this report is to provide open source software for multi-site clinical studies and to report on early uses of this application. At this time SHRINE implementations have been used for multi-site studies of autism co-morbidity, juvenile idiopathic arthritis, peripartum cardiomyopathy, colorectal cancer, diabetes, and others. The wide range of study objectives and growing adoption suggest that SHRINE may be applicable beyond the research uses and participating hospitals named in this report.     

基于信息化平台的临床科室精准管理探索

精准医学时代,临床科室的“精准管理”是应用高度结构化、自动化、精准化的信息管理平台进行科室的全面监管和预警,能够通过精准预测,精准监督,精准定位来提高预测准确性和预测能力,制定合理有效的计划目标,规范医疗诊疗行为,改进医疗服务流程,提高科研效率质量以及有针对性地进行人才培养和个性化教学管理,在医院的科室管理中具有较好的临床应用性及推广价值。     

Stabilizing blood glucose with a novel medical expert system

In health, metabolism is elegantly coordinated. Failure of an underlying process (as occurs in diabetes) disrupts the coordination and impacts on the global status of the affected individual. It takes a medical expert to intervene and restore order. Chaotic processes prevail at all times in biological systems and their behaviour in sickness degenerates between medical interventions. We have explored the use of an expert system to substitute for the physician between interventions and demonstrated its ability to maintain order and thus significantly improve control of blood glucose.     

Successes in medical biophysics (on the 40th anniversary of the Medico-biological faculty of the Russian State Medical University)

On the occasion of the 40-year anniversary of the Medicobiological Faculty of the Russian State Medical University, the research activity of the biophysics department was summed up. The main result is the creation of medical biophysics as part of the medicobiological science. Scientific investigations of the biophysics department are reviewed. They are presented as follows: chemiluminescence of biological systems; effect of visible light on human and animal molecules and cells; application of luminescence methods in laboratory and clinical investigations; free radicals and their role in cell biology and pathology; medical aspects of molecular biophysics; and biological membranes and cell pathology.     

Analytical nanobiotechnology for medicine diagnostics

The review is concerned with the state-of-the-art and the prospects of development of nanotechnologies in clinical proteomics. Nanotechnology in clinical proteomics is a new medical research direction, dealing with the creation and application of nanodevices for performing proteomic analyses in the clinic. Nanotechnological progress in the field of atomic force microscopy makes it possible to perform clinical studies on the revelation, visualization and identification of protein disease markers, in particular of those with the sensitivity of 10(-17) M that surpasses by several orders the sensitivity of commonly adopted clinical methods. At the same time, implementation of nanotechnological approaches into diagnostics allows for the creation of new diagnostic systems based on the optical, electro-optical, electromechanical and electrochemical nanosensoric elements with high operating speed. The application of nanotechnological approaches to creating nanopore-based devices for express sequencing of the genome is discussed.