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Abel Hinf6230 Cbr Hypo Knowledge Managmenet Health Informatics


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The widely used definition of Case Based Reasoning (CBR) is similar cases of a certain problem has related solutions. Likewise, it is widely assumed that similar differences among case descriptions imply similar differences among their solutions. In this case, CBR looks to be a best solution to many unresolved medical questions and medical knowledge based systems, like in the case of hypothyroidism treatment. The main challenge, however, in finding the best solution in treating hypothyroidism with the exact dosage of levothyroxine therapy is each case is unique and difficult to derive conclusions from the previous cases (reasons). Some researches imply that case based reasoning through adaptation has a challenge in treating hypothyroidism. Nevertheless, CBR would be successful if the adaptation issue is solved. Adaptation is one of the most problematic steps in the design and development of case-based reasoning (CBR) systems. Recently, some researches have been done and scientific discussions are emerging to solve the adaptation issue. So, in this paper, I would discuss the role of adaptation in the design and development of case-based reasoning in treating hypothyroidism as well as assess the recently emerged CBR adaptation techniques and their implication to the hypothyroid treatment.

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Abel Hinf6230 Cbr Hypo Knowledge Managmenet Health Informatics

  1. 1. Knowledge Management for Health Informatics HINF 6230 © Abel M. Gebreyesus HINF 6230 1
  2. 2. What is Hypothyroidism Biochemical and physiologic complex  when inadequate serum levels of thyroid hormone are present. • Common disorder • Synthroid one of most commonly prescribed drugs in Canada • Seven million prescriptions last year • Rising at 12% per year © Abel M. Gebreyesus HINF 6230 2
  3. 3. Incidence Congenital 1 : 5000 births   Under age 20 1 : 1500  Over age 20 1 : 150  Over age 60 1 : 50  Male / female 1:5 Basal metabolic rate can fall as low as 40 %  © Abel M. Gebreyesus HINF 6230 3
  4. 4. Differential diagnosis © Abel M. Gebreyesus HINF 6230 4
  5. 5. Signs and Symptoms  Dry skin  Weight gain with decreased appetite / weakness  Reflexes depressed  Hoarseness / hair loss / hypotension  Thick hair with loss of lateral eyebrow hair  Puffiness of face, proximal muscle weakness  Constipation  Intolerance to cold  Bradycardia Tongue enlarged – macroglossia   Menorrhagia or Amenorrhea  Obese  Hypercholesterolemia, Hyperprolactinemia © Abel M. Gebreyesus HINF 6230 5
  6. 6. Hypothyroidism and Depression Both have in common   So, this depression and other complication should be treated by:  Choice of medication  Adjustment of Therapy  Follow-up care © Abel M. Gebreyesus HINF 6230 6
  7. 7. Hormones for Treatment Maintain metabolic homeostasis by  regulating:  Intermediary metabolism  Body weight  Oxygen requirements  Body temperature control of growth, reproduction and  differentiation © Abel M. Gebreyesus HINF 6230 7
  8. 8. Some of the Problems: Actual content of thyroid hormone varies  considerably from manufacturer to manufacturer and even within product.  Patients switched from one product to another showed insignificance variations in thyroid function  Life long Treatment – Needs to be monitored continuously for better treatment results  Thus, we need to solve this treatment problem © Abel M. Gebreyesus HINF 6230 8
  9. 9. How do we solve these problems? By remembering how we solved a similar  problem in the past In other words, Case Based Reasoning  (CBR)!  memory-based problem-solving (Retrival)  re-using past experiences Experts often find it easier to relate stories  about past cases than to formulate rules © Abel M. Gebreyesus HINF 6230 9
  10. 10. CBR Solving Problems Solution Review Retain Adapt Database Retrieve Similar New Problem © Abel M. Gebreyesus HINF 6230 10
  11. 11. CBR Assumption New problem can be solved by   retrieving similar problems  adapting retrieved solutions Similar problems have similar solutions  P P P ? PP P PP P S SX S S S SS S S © Abel M. Gebreyesus HINF 6230 11
  12. 12. The Challenge of Adaptation in Medicine Cased-Based Reasoning seems to be a  suitable technique for medical knowledge based systems. However, the adaptation task is “the bottleneck” that has to be solved  Every body is unique  Which patient with how much dose and how it can be treated. © Abel M. Gebreyesus HINF 6230 12
  13. 13. One of the greatest limitations of the  CBR and its system is its close relationship with the kind of problem to be solved. This proximity to the problem found also in how information is represented in the case base.  In Medicine, solutions have to be absolutely correct  Many details and complex features (interactions, exceptions, contradictions) © Abel M. Gebreyesus HINF 6230 13
  14. 14. The Cycle of Hypothyroid CBR Problem-Solution Solution Review Retain Here we go! New solution…. What kind of Adapt patients treated with Database which does and what special prescription Similar problem to similar solution, Retrieve but take uniqueness into account New Patients who got solutions with similar problem Problem © Abel M. Gebreyesus HINF 6230 14
  15. 15. The Possible Adaptation for Hypothyroidism Abstraction and Hypothyroidism (In form  of Guidelines)  Constraints and Hypothyroidism (For Initial Therapy)  Compositional Adaptation and Hypothyroidism (Especially for dose calculations) © Abel M. Gebreyesus HINF 6230 15
  16. 16. Issue of Representation XML has become the standard for data  and document delivery on the web  Cross-platform and extensible  It is well supported and there is a large toolset of XML technologies  XML parsers, XML Schema, XML transforms, stylesheets and more © Abel M. Gebreyesus HINF 6230 16
  17. 17. CBML Document Hierarchy CBML schema Case structure Case content document (XSL) document (XML) document (XML) •The CBML (XML-based Case Mark-Up Language) Schema document An XML Schema document describing the syntax of the case structure document Static, globally available document •The Case Structure document •The Case Content document © Abel M. Gebreyesus HINF 6230 17
  18. 18. Case Representation feature-value representation   Example case problem solution extra info tablet drug filler binder lubricant disintegrant surfactant properties dose excipient excipient excipient excipient excipient amount amount amount amount amount physical chemical properties YP SRS properties 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 feature # Problem n - Extra Weight Solution n - Increase Thyroxin amount Further Patient History n - Diet - Exercise © Abel M. Gebreyesus HINF 6230 18
  19. 19. What we need:  Increased physical activity  Increased diuresis and reduced oedema  Decreased sensitivity to cold  Body temp returns to normal  Improvement in appetite and bowel activity  Weight loss  Improved mental alertness  Improved speech  Return to normal menstrual pattern  Gradual changes to hair, skin, nails  Improvement in anaemic state © Abel M. Gebreyesus HINF 6230 19
  20. 20. References: Susan Craw; Case Based Reasoning; Advanced Knowledge  Based Systems Module CM4023; The Robert Gordon University, Aberdeen Joy Ziradkar / Carl Robbins; Hypothyroidism; MUN FP Academic  Half Day (  nngbhnezojbttcry3kj3ayj5sunjnos6q4ckmuhgddmkl6nve/4%252e5 %252e38p1.pdf JOHN SLATOSKY, BENJAMIN SHIPTON, and HANEY WAHBA;  Thyroiditis: Differential Diagnosis and Management: American Family Physician: Vol. 61/No. 4 (February 15, 2000) Lorcan Coyle, Conor Hayes, Pádraig Cunningham; Representing  Cases for CBR in XML © Abel M. Gebreyesus HINF 6230 20
  21. 21. QUESTIONS???? THANK YOU!!! © Abel M. Gebreyesus HINF 6230 21