Modeling a Fuzzy System for Diagnosis of Syndromes with Integrated Eastern and Western Medicine Using the Importance of Symptoms

2020 ◽  
Vol 24 (5) ◽  
pp. 609-614
Author(s):  
Hoang Phuong Nguyen ◽  
Keyword(s):  
Clinical Practice ◽  
Knowledge Representation ◽  
Western Medicine ◽  
Fuzzy System ◽  
Accurate Diagnosis ◽  
Common Disease ◽  
Inference Rules ◽  
Medical Expert ◽  
Medical Expert Systems ◽  
Real Clinical Practice

In this study, we present an approach to include the importance of symptoms for the diagnosis of syndromes with integrated eastern and western medicine. We also focus on knowledge representation and inference engine of our proposed system using the importance of symptoms. The innovative point of this study is combining the degree of diagnosis of syndrome of Eastern medicine with that of disease of Western medicine when both medicines are associated to a common “disease” name to obtain more accurate diagnosis. Moreover, the importance of symptoms in the inference rules in medical expert systems still has an important role in the diagnosis of syndromes. Based on this approach, the system can adapt more with real clinical practice of integrated eastern and western medicine diagnosis. Finally, examples are provided to demonstrate the advantage of this approach.

Explanatory Power for Medical Expert Systems: Studies in the Representation of Causal Relationships for Clinical Consultations

1982 ◽  
Vol 21 (03) ◽  
pp. 127-136 ◽  
Author(s):  
J. W. Wallis ◽  
E. H. Shortliffe
Keyword(s):  
Explanatory Power ◽  
Prototype System ◽  
Inference Rules ◽  
Medical Expert ◽  
Comprehensive Knowledge ◽  
Different Types ◽  
Medical Expert Systems ◽  
Explanation System ◽  
Systems Studies

This paper reports on experiments designed to identify and implement mechanisms for enhancing the explanation capabilities of reasoning programs for medical consultation. The goals of an explanation system are discussed, as is the additional knowledge needed to meet these goals in a medical domain. We have focussed on the generation of explanations that are appropriate for different types of system users. This task requires a knowledge of what is complex and what is important; it is further strengthened by a classification of the associations or causal mechanisms inherent in the inference rules. A causal representation can also be used to aid in refining a comprehensive knowledge base so that the reasoning and explanations are more adequate. We describe a prototype system which reasons from causal inference rules and generates explanations that are appropriate for the user.

scholarly journals Evidence-based Chinese Medicine Clinical Practice Guideline for Stroke in Hong Kong

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Linda L. D. Zhong ◽  
Wai Kun ◽  
Nannan Shi ◽  
Tat Chi Ziea ◽  
Bacon F. L. Ng ◽  
...  
Keyword(s):  
Hong Kong ◽  
Clinical Practice ◽  
Chinese Medicine ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Western Medicine ◽  
Treatment Options ◽  
Target Population ◽  
Common Disease ◽  
Evidence Based

Abstract Background Stroke in Chinese Medicine (CM) includes the concepts of ischemic and hemorrhagic strokes from Western Medicine and is a common disease in Hong Kong. This clinical practice guideline (CPG) aims to evaluate and demonstrate CM treatment options for stroke, provide guideline for local CM practice, and act as a reference for decision makers on drafting CM related health policies. Methods Based on the principle of multidisciplinary integration and evidence-based medicine, a steering committee oversaw the CPG development process in accordance with a published protocol. Clinical questions and evidences were identified, appraised, and synthesised through systematic literature reviews, text mining, and two rounds of Delphi surveys with a multidisciplinary panel of experts. Results In this CPG, we defined stroke from the perspectives of both CM and Western Medicine, reported corresponding CM treatment options, and carried out evaluation based on levels of evidence and grade of recommendation. Suggested CM interventions include herbal medicine treatment based on pattern differentiation, acupuncture treatment, and nursing care. Conclusion The target population is Hong Kong stroke patients with prodrome or sequela stage. This CPG is intended to help standardizing CM clinical practice and enhancing efficiency of clinical service in Hong Kong.

In real clinical practice osteoporosis drugs are taken for a very short period: analysis of persistence in the campania region

2013 ◽  
Author(s):  
Giovanni Iolascon ◽  
Annarita Capaldo ◽  
Valentina Orlando ◽  
Enrica Menditto ◽  
Francesca Gimigliano
Keyword(s):  
Clinical Practice ◽  
Campania Region ◽  
Period Analysis ◽  
Short Period ◽  
Real Clinical Practice

PCSK9 inhibitors as an add on for the treatment of dislipemia in real clinical practice

2018 ◽  
Author(s):  
Carmen Hernandez Garcia ◽  
Cristina Maria Diaz Perdigones ◽  
Miguel Damas Fuentes ◽  
Clara Estaun Martinez ◽  
Andrea Sanchez Ramos ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pcsk9 Inhibitors ◽  
Real Clinical Practice

Comprehensive assessment of drug consumption as a basis for pharmacotherapy optimization

2019 ◽  
pp. 22-31
Author(s):  
Olga Vyacheslavovna Zhukova
Keyword(s):  
Clinical Practice ◽  
Treatment Options ◽  
Comprehensive Assessment ◽  
Drug Consumption ◽  
Treatment Standards ◽  
Disease Epidemiology ◽  
Efficacy Analysis ◽  
Epidemiological Monitoring ◽  
Guidelines Development ◽  
Real Clinical Practice

This article describes the rationale for methodology of comprehensive assessment of drug consumption in real clinical practice. The proposed methodology includes three stages: 1) epidemiological monitoring – disease epidemiology assessment; assessment of the role of factors leading to the disease; 2) pharmacoepidemiological monitoring – assessment of pharmacotherapy in real clinical practice; clinical efficacy analysis of drugs; cost-effectiveness analysis; 3) long-term clinical and economical evaluation of various treatment options. Comprehensive assessment of drug consumption should result in optimal pharmacotherapy regimens, decrease of the drug load, increasing of the therapy effectiveness and cost reduction. The scheme of comprehensive assessment of drug consumption is universal and can be used for clinical guidelines development, treatment standards, for the optimal formation of drugs lists at the federal level. Separate stages and sub-steps of an integrated assessment also can be used at the territorial and local levels, medical institution, to optimize pharmacotherapy.

Pharmacoepidemiological Analysis of Pharmacotherapy for Burn Injuries in Real Clinical Practice

2020 ◽  
pp. 70-79
Author(s):  
Olga Vyacheslavovna Zhukova ◽  
Ekaterina Sergeevna Nekaeva ◽  
Elena Sergeevna Khoroshavina ◽  
Ekaterina Alexeevna Kozlova ◽  
Yulia Alexandrovna Dudukina ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Average Cost ◽  
Burn Injury ◽  
General Structure ◽  
Burn Injuries ◽  
Antimicrobial Drugs ◽  
Positive Tendency ◽  
Defined Daily Doses ◽  
Duration Of Hospitalization ◽  
Real Clinical Practice

Objective: to conduct pharmacoepidemiological analysis and analysis of the costs of pharmacotherapy, taking into account the actual consumption of drugs in the real inpatient clinical practice at the federal center in Russia. Materials and methods. Data from the medical records of 14 patients with burn injury, who were hospitalized in 2018, was analyzed. Patients’ age was from 23 to 67 years (44,93 ± 14,66). Duration of hospitalization was from 17 to 62 days (35,93 ± 14,17). We calculated rate of prescription foe each drug and its share in general structure of all utilized drug courses (n = 460). We performed frequency analysis of prescription structure, DDD (defined daily doses) analysis, DU90% (Drug Utilization 90%) analysis, ABC-analysis and analysis of average cost of pharmacotherapy. Results. Most frequently used drugs, prescribed in 75-100% of all hospital cases, included 15 names, e.g. 2 antimicrobial drugs (vancomycin and amikacin), 19 were used commonly, including 4 antimicrobial drugs (co-trimoxazole, cefoperazone/sulbactam, tigecyclin and cefepime). Other drugs were used in less than 25% of cases. 33 drugs made 90% of all consumed NDDD, including 5 antimicrobial drugs (vancomycin, amikacin, co-trimoxazole, cefoperazone/sulbactam and tigecyclin). These drugs comprised 70,24% in the prescription structure. The cost of one DDD in DU90% segments (512,33 rubles) is 1,4 higher than in DU10% segment (649,34 rubles). Average cost of drugs included in DU90% group was 4735,89 rubles vs 4966,80 rubles for drugs from DU10% group. This finding shows positive tendency of burn injuries pharmacological treatment. Conclusion. We obtained the data, which can be used for comparison of real clinical practice costs with a current payment rates for medical care.

scholarly journals AB0564 RHEUMATOLOGISTS’ VIEWS AND EXPERIENCES IN MANAGING PsA PATIENTS BASED ON TREATING TO TARGET STRATEGY: A CROSS-SECTIONAL STUDY IN CHINA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1318.2-1319
Author(s):  
L. Xu ◽  
Z. Wang ◽  
J. Xue ◽  
M. Bai ◽  
H. Zhong ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Western Medicine ◽  
Work Experience ◽  
Tertiary Hospital ◽  
Treat To Target ◽  
Cross Sectional ◽  
Activity Assessment ◽  
High Level

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.Objectives:The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.Methods:A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.Results:(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).Conclusion:In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.References:[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.Figure 1A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.Disclosure of Interests:None declared.

scholarly journals Insulin doses requirements in patients with type 1 diabetes using glargine U300 or degludec in routine clinical practice

2021 ◽  
pp. jim-2020-001633
Author(s):  
Florentino Carral San Laureano ◽  
Mariana Tomé Fernández-Ladreda ◽  
Ana Isabel Jiménez Millán ◽  
Concepción García Calzado ◽  
María del Carmen Ayala Ortega
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Real World ◽  
Glycosylated Hemoglobin ◽  
Routine Clinical Practice ◽  
Insulin Analogs ◽  
Total P ◽  
Real Clinical Practice

There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.

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