Expert Systems and Decision Support in Medicine: 33rd Annual Meeting of the GMDS EFMI Special Topic Meeting Peter L. Reichertz Memorial Conference Hannover, September 26–29, 1988 Proceedings

583 Pages·1988·16.551 MB·English-German

by  Jan H. van Bemmel (auth.), O. Rienhoff, U. Piccolo, B. Schneider (eds.)

Lecture Notes in Medical Informatics
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Lecture Notes in
Medical Informatics
Edited by P. L. Reichertz and D. A. B. Lindberg
36
O. Rienhoff U. Piccolo
B. Schneider (Eds.)
Expert Systems and
Decision Support in Medicine
33rd Annual Meeting of the GMDS
EFMI Special Topic Meeting
Peter L. Reichertz Memorial Conference
Hannover, September 26-29, 1988
Proceedings
Springer-Verlag
Berlin Heidelberg New York London Paris Tokyo
Editorial Board
J.Anderson J.H. van Bemmel M.F.Collen F.Gremy S.Kaihara A. Levy
O.A.B. Lindberg (Managing Editor) H. Peterson A. Pratt
P. L. Reichertzt E. H. Shortliffe W Spencer K. Uberla C. Val bona
Editors
O. Rienhoff
Institut fUr Medizinische Informatik, Philipps-Universitiit Marburg
BunsenstraBe 3, 0-3550 Marburg
U. Piccolo
B. Schneider
Institut fur Medizinische Informatik, Medizinische Hochschule Hannover
Konstanty-Gutschow-StraBe 8, 0-3000 Hannover 61
ISBN 978-3-540-50317-0 ISBN 978-3-642-48706-4 (eBook)
DOI 10.1007/978-3-642-48706-4
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© Springer-Verlag Berlin Heidelberg 1988
2127/3140-543210 - Printed on acid-free paper
FOREWORD
The 33rd Annual Meeting of the German Association for Medical Documentation, Informatics
and Statistics was combined with a Special Topic Conference of the European Federation for
Medical Informatics and takes place at Hannover, F.R. of Germany, from September 26 to 29,
1988. It was planned and initililly prepared by the late Prof. P.L Reichertz, who headed the
Hannover institute from 1969 to 1987. To commemorate his contribution to the development of
medicine the conference was devoted to him
"Peter Reichertz Memorial Conference
on Expert Systems and Decision Support in Medicine"
Since computers in the early Fifties were first applied to support medical reasoning, various
phases of euphoria and resi~ation have .followed. Every new methodology which became
technically possible was and will be applied to the old questlon of how to diagnose diseases more
reliably. Artificial Intelligence is just one new approach to the old challenge.
Over the years some· authors have been very optimistic and put forward opinions which
motivated the common press to coin the phrase 'Dr.med.computer'. Papers printed under this
heading rebuffed the majority of physiCians for many years. Today we know that medical
decision making is a most complex buman performance. And 30 years of research on decision
support have given us only limited insight into the underlying processes.
Most of the principal methodological questions were already asked very early on. After many
field tests of prototype systems we have a solid body of knowledge on what does not work and
why. It is therefore an invaluable experience for all of us to read the literature and to relate our
own research to the many papers already published on the topic.
In reviewing the contributions for this book we tried to motivate the authors to analyze this
literature and to scientifically discuss their results in their papers. Our e~riences in editing
these proceedings were not always positive: some authors seem to find thelr argumentation so
striking that it aoes not need any scientific disCltssion, some seem to believe that high-tech
editing of manuscripts is more important than the meaningful scientific content of the paper.
We therefore decidcil not to include some manuscripts in thiS volume.
After so many years of work on medical decision support researchers need time to review and to
systematize. This was the intention of this specill.l topic conference on decision support in
medicine. The editors strongly believe that researchers need a meta-methodology in order to
develop computer support for medical reasoning and to more easily relate their research efforts
to a systematized anarXSis of the experiences gathered thus avoiding unnecessary efforts in toy
systems that have to fall. We hope that this proceedings volume will contribute to this aim.
Finally, we would like to thank all our colleagues in Hannover, namely I. Chami, A Heimers, A
Peter, B. SchAfer, R. Koch and B. Engelke, who helped to prepare this volume.
Hannover, July 1988
Otto Rienhoff Ursula Piccolo Berthold Schneider
III
Table of Contents
INTRODUCTION AND MEMORIAL SESSION
Decision Support in Medicine
Comparative Methodology and Impact on the Medical Curriculum
Bemme~ 1.H. van 3
SPECIAL TOPIC CONTRIBUTIONS
Decision Support in Western Clinical Medicine
Medical Practice -Decision Making: A Logical Model
Moidu, K; Driankov, D.; Wigertz, O. 23
New Decision Support Concepts for the Pharmacy Application in the HELP
System
Prokosch, H.u.; Hulse, RK; Wal~ M.; Wong, T.w.; Pryor, T.A. 31
ROPES -A Rule-Based Outpatient Expert System
Moon, Y.S.; Lo, T.F. 38
DIACONS -A Consultation System to Assist in the Management of Diabetes
Schneider, 1.; Piwemetz, K; Engelbrecht, R; Renner, R 44
Using Default Reasoning to Find Interactions of Drugs
Dicht~ M. 50
Decision Support for Cardiac Care Unit Admission -Evaluation of
Methodological Approaches in Relation to Clinical Applicability
Tusch, G.; Rienhoff, 0.; Reichertz, P.L.+; VICtOr, N. 55
MESSE -A Medical Expert System of Special Examinations
Balkany~ L; Molnar, K; Santa, E.; Toth, M. 60
Decision Support System in Oncology
HyOdynmaa, S.; Kolari, P.; Niiriiiinen, K; Ojala, A.; Rantanen, 1.;
Saranumm~ N. 65
A Computer-Aided Diagnosis System for Lung Cancer
Yang, Z.-N.; Fang, 1.-Q. 69
Medical Diagnosis by Negotiation Amongst Experts
Werner, G. 74
Aiding Medical Inferences by the Relational Rules Acquired from Medical
Experts; Consultation System for Use in a Gynecologic Out-Patient Clinic
78
Ruszkows~ 1.
IV
Decision Support in Traditional Chinese Medicine
Principles of Developing Expert Systems of Traditional Chinese Medicine
Qin, D. 85
Computer Simulation System on Diagnosing and Treating Hypertension
by Traditional Chinese Medicine Associated with Modem Medicine
Deng, Q.; Fu, w.; Liang. Z. '4
An Expert System for Diagnosing and Treating Ectopic Pregnancy with
Combined Traditional Chinese and Western Medicines
Xie, B.; Yao, CX; Yu, ZJ. '8
Knowledge-Based Systems and Statistical Decision Support
Statistical Reasoning and Learning in Knowledge-bases Represented as
Causal Networks
Spiegelhalter, D.!.; Lauritzen, St.L. lOS
The Use of the Diagnostic Paradigm in Modelling Medical Decision Making
Feldmann, U. 113
The Computer-Aided DitTerential Diagnosis of Diseases of the Urinary Tract
in Children
Wang, Q.; Wang. Q.; Sh~ H. 120
Qualitative Modelling in Vascular Surgery
Dessi, N.; Fanni, A.; Manca, M.G.; Scintu, F.; 126
Statistical Approach to the Acute Abdomen Diagnosis in Children
Emparanza,!. 1.; Aldamiz-Echevarria, L.; Perez-Yarza, E.G.; Aldazabal, P.;
Tovar, !. 131
A Probabilistic Approach to Health Care Delivery in Tropical Africa
Byass, P. 136
A New Approach to the Solution of Decision Making Problems in Medical
Expert Systems
Czoga1a, E.; Brodziak, A. 142
Computer-Assisted Construction of Conceptual Frameworks for Health
Systems Research
Hornung, B.R.; Opitz, E. 146
Clinical Studies and Decision Support
A Strategy for Identifying Clusters of Similar Response
Hecker, H. 15S
Error Rate Estimation in Discriminant Analysis in the Presence of Variable
Selection
KOnig, !. 162
v
Assessment of the Diagnostic Importance ofBAL-F1uid Values with
ROC-Curves
Zaiss, A w.; Costabe~ u.; Klar, R 169
Scoring Systems and Compnter-Aided Prognosis in Patients with Bleeding
Oesophageal or Gastric Varices
Ohmann, C.; StOltzing, H; Wms, L.; Thon, K; 175
On the Use of Statistical Expert Systems for Supporting Quality Assurance
in Analysis of Oinieal Trials
Wzttkowsld, KM. 182
Informatics as Applied to Expert Systems
An Expert System for Interpretation and Diagnosis of ECG Signals
Ledos, J.P.; Colas des Francs, X; Strauss, A.; Le Beux, P.; Auvert, B.;
Fontaine, D. 191
An Expert System for Genetic Counseling
u.;
Seuchter, S.A.; Prokosch, H Keir, D.; Skolnick, M.H
MECOS-2: An Artificial Intelligence Tool System for Developing Medical
Expert Systems in Various Subjects
Guo, c.-G. 202
Diagnostic Expert Systems in Neurology -A Comparison between a Rule
Based Prototype and a Database Oriented Approach
Bunke, H; Flilcldger, F.; Ludin, HP.; Conti, F. 209
~iction of MSOF EVOlut~~ ~eans of. Nine Vital Systems Trltiectories
c.;
PlZZl, R.; De Gaetano. A; G up" P.; ChIara, 0.; Columbano,
Sicurello, F. 213
An Expert System for Cardiopulmonary Diseases in Primary Health Care
Cano, F.; Lazaro, P.; Luna, G.; Marin, E.; Martin, J.; del Rio, A.;
Santesmases, J.G.; Yurramend~ Y. 218
Experiences with Expert Systems
Knowledge-Based Decision Support for Laryngeal Tumor Diseases:
Design and Structure of the ESTHER System
Haux, R; Holmer. J.; Ingeneif, J.; Repges, R; Richter, M.M.; Mosges, R;
Schlondorjf, G.; Schmelzer, B. 225
An Expert System for Diagnosis and Therapy Planning in Patients
with Ovarian Cancer
Giron, A.; George, M.; Jan, P.; Pejovic, M.H; Wartelle, M.; Le Beux, P.;
Flamant, R 235
Electrolyte and Haemostasis Test Interpretation by Expert Systems
on Microcompnter in Medical Laboratory
Pradella, M.; Dorizzi, R; Giavarina, D.; Camerotto, A.; Rigolin, F.
VI
Representation of Neuroanatomle:al Knowledge by PROLOG
Ohe, K; Kaihara, Sh.
Knowledge-Based Decision Support for Monitoring in Anesthesia: Problems,
Design and User Interaction
Schecke, Th.; Langen, M.; Rau, G.; KiJsmacher, H.; Kalff, G.; 256
Shock Trauma Manual Computer Consultation Expert System
L~ w,; Zhao, R 264
An Expert System for Medical Evacnations
Nagy, LL; Christensen, B.; Nagy, T.L 270
A Computer Oriented Diagnosis of Acute Renal Failure in the
Critically III Patient
Michetti, v,; Cavaliere, F.; Sciarra, M; Proiem R; Vagnoni, S. 275
Decision Support in Medical Management of Personnel Resources:
Duty Roster in an Anesthesiologic Department
Pollwein, B.; Beyer, A.; Gier~ L; Heyde, G. 279
Computer.Aided Diagnosis: Experience with Knowledge Based Methods
Schnabe~ M; Ruch, u.; Eckardt, M.; Thunnayr, R. 283
A Commonly Used Expert System of Traditional Chinese Medicine (TCM)
Sh~ C. 288
On the Assessment of Medical Expert Systems
Rossi Morl, A; Ricc~ F.L 292
nata Bases and Expert Systems
PBASE: A Prolog BASEd Query Language
Hm, L-C.; Le Beux, P. 301
Case Description and Case Retrieval on TIme Oriented Patient Data
Bernauer, 1.; Rading, M.; Tusch,. G.; Reichertz, P.L +; Gubernatis, G.;
Pichlmayr, R; 308
ARTEL: An Expert System in Hypertension for the General Practitioner
Lavri~ M.; Chatellier, G.; Degoulet, P.; Sauquet, D., Jeunemaitre, X;
Menard, 1.; Rovani, C. 314
Computer Assisted Generation of Heuristic Rules in the Management
of Cardiac Arrhythmias
Binder, Th. 322
A Bac~und Knowledge Base to Assist Coding of Medical Documents
RiccardI, M.; Rossi Morl, A. 328
DES: A Domain Independent Expert System Running on a Microcomputer:
Diagnostle: of Thyroid Disorders
Degner, F.L; Santen, R. 334
Extraction of Knowledge from a Database
Chowdhury, S.L; Wigertz, a.B. 338
VII
A CoDlputer-Based Referenee System for Medical Diagnosis
W'Jeding, J.u.; Naue, T.; SchOnle, P.w. 343
Know1ed&e Acquisition tor Sdlente-Based Medical Expert Systems:
The Dysmorphic Syndrome Example
Gierl, L.; Arias-Lewing, G.; Stengel-Rutkowski, S.; Jakobeit, M.; Lohse, K 347
Evaluation and Measuring ofBeDeftt of an Expert System for Dift'erential
Diagnosis in Rheumatology
Schewe, S.; Schemnann, w.; Gierl, L. 352
POSCH Experience Intearatlq Expert Systems and Clinkal Data Analyses
Long, J.M.; Slagle, J.R.; WICk, }./.R.; Irani, EA.; Weisman, P.R.; Matts, J.P.;
Claikson, P.F. 355
Future Trends and Possibilities
Status of and Research Needs for Expert SYSteDlS in Medicine
Engelbrecht, R. 361
Statistics, Modelling, Operational Research, Decision-Making and
Expert Systems in the Public Health Control of Infectious Diseases
Bailey, IV. TJ . 367
Expert SySteDl Knowledge Transfer
W'JgeTtz, O.B.; Clayton, P.D.; Haug, PJ .; Pryor, T.A. 371
Philosophical Considerations about the Illusions and Delusions of
Informatics in Health and Medicine
Gremy, F. 378
FREE CONTRIBUTIONS
Statistical and Laboratory Animals Methods
Statistische und Tierexperimentelle Verfahren
Estimation of the Conftdence Interval of a Rate and the Choice of
Sample Size
Konfidenzbereichsschitzungen einer Rate und Wahl der StichprobengroBe
BiJhning, D. 387
Sensitivity of the Multi-Process Kalman Filter for Renal Transplant
Mouitorlng ..
Sensitivitit des Multi-Process Kalman-Filter fUr das Uberwachen von
Nierentransplantat-Patienten
Mau,J. 393
Experiences with Explorative and Conftrmative Evaluations
of a Prospective Study on Gravidity
. ~en mit explorativen und konfirmativen Auswertungen einer
prospektiVen Scbwangerscbaftsstudie
Koller, S. 400
VIII
Methods of Estimation of Cancer Prevalence in the F.R. of Germany
Methoden der Pravalenzschitzung von Krebserkrankungen in der
Bundesrepublik Deutschland
Meisner, Chr.; Pietsch-Breitfeld, B. 405
Computer Simulation of the Kinetics of LabeUed Cells in the
Intestinal Tract
Computersimulation der Kinetik von markierten Zellen im Darmepithel
w.;
Chen, Meinier, H.-P.,. Sandblad, B. 412
Monitoring and Securing Data Quality in Multicentre Clinical
Trials
Die Oberwachung und Sicherung der Datenqualitat bei multizentrischen
klinischen Studien
Fischer, Chr.; Holle, R. 416
Skewness and Kurtosis of the Distribution of Body Weight in Artificial
Populations of Laboratory Rats
Schiefe und WOlbung der Verteilung der Korpergewichte in
Kunstpopulationen von Laboratoriumsratten
Corsing, c.; Glirtner, K; Rapp, K 421
Medical Documentation and Information Systems
Medizinische Dokumentations-und Informationssysteme
Advantages and Disadvantages of Decentral Documentation Systems
Gewinn und Gefahren dezentraler Dokumentationssysteme
Wieding, 1.u.; Kretschmar, T. 429
Computerized Textstring Standardization in the Medical Basic
Documentation
Computerunterstiitzte Textstandardisierung in der medizinischen
Basisdokumentation
Graubner, B. 435
Syntax Analysis of CytopatholoRical Summaries
Syntaktische Analyse zytopathofogischer Beurteilungstexte
Pietrzyk, P.M. 443
A Knowledge-Based System for Interactive Medical Diagnosis Encoding
Ein wissensbasiertes System zur Verschliisselung natfulichsprachiger
medizinischer Diagnosen
Wagner, 1.; Baud, R.; Borst, F.; KOhler, C.-D.; Scherrer, 1.-R. 449
Knowledge-based Indexing of Medical Phrases on the Basis of SNOMED:
Methodolo~cal Considerations and the Realisation of EIDOS
Wissensbaslertes Indexieren von medizinischen Phrasen auf der
Basis von SNOMED: Methodik und Realisation von EIDOS
Ingenerf, 1.; Haux, R.; Repges, R.; Richter, M.M. 455
Managing the Evolution of an Integrated Hospital Infomation System
by Using Efficient Concepts, Methods and Tools
Zur Evolution eines integrierten Krankenhausinformations-und
Kommunikationssystems unter Verwendung leistungsfahiger informations
technischer Konzepte, Methoden und Werkzeuge
Carstensen, K; Hedderich, 1.; Sauter, K 462
IX