abel hinf6230 cbr hypo knowledge managmenet health informatics

Knowledge Management for Health Informatics

HINF 6230

© Abel M. Gebreyesus HINF 6230 1

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


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 %


Differential diagnosis


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


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


Hormones for Treatment

Maintain metabolic homeostasis by

regulating:

Intermediary metabolism

Body weight

Oxygen requirements

Body temperature

control of growth, reproduction and

differentiation


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


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

CBR Solving Problems


Retain Review

Adapt

Retrieve

Database

New

Problem

Similar

Solution

CBR Assumption

New problem can be solved by

retrieving similar problems

adapting retrieved solutions

Similar problems have similar solutions

© Abel M. Gebreyesus HINF

6230 11

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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.


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)


The Cycle of Hypothyroid CBR

Problem-Solution


Retain Review

Adapt

Retrieve

Database

Solution

Patients who got solutions

with similar problem

What kind of

patients treated with

which does and what

special prescription

Similar problem

to similar solution,

but take uniqueness

into account

Here we go!

New solution….

New

Problem

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)


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


CBML Document Hierarchy

CBML schema

document (XSL)

Case structure

document (XML)

Case content

document (XML)


•The CBML (XML-based Case Mark-Up Language) Schema documentAn XML Schema document describing the syntax of the case structure documentStatic, globally available document

•The Case Structure document•The Case Content document

Case Representation

feature-value representation

Example


excip

ient

am

ount

excip

ient

am

ount

excip

ient

am

ount

excip

ient

am

ount

excip

ient

am

ount

YP SRS

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 #

tablet

properties

caseextra infoproblem solution

filler surfactant

dose

physical

propertieschemical properties

drug disintegrantbinder lubricant

n Problem

- Extra Weight

n Solution

- Increase Thyroxin

amount

n Further Patient History

- Diet

- Exercise

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


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

(www.med.mun.ca/familymed/downloads/Hypothyroidism.ppt)

http://www.aanp.org/NR/rdonlyres/ewl4urqa4x5pletxro3a75q5utpp2

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


http://www.aafp.org/afp/20000215/contents.html

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