Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Jaundice is a common and complex clinical symptom potentially occurring in hepatology, general surgery, pediatrics, infectious diseases, gynecology, and obstetrics, and it is fairly difficult to distinguish the cause of jaundice in clinical practice, especially for general practitioners in less developed regions. With collaboration between physicians and artificial intelligence engineers, a comprehensive knowledge base relevant to jaundice was created based on demographic information, symptoms, physical signs, laboratory tests, imaging diagnosis, medical histories, and risk factors. Then a diagnostic modeling and reasoning system using the dynamic uncertain causality graph was proposed. A modularized modeling scheme was presented to reduce the complexity of model construction, providing multiple perspectives and arbitrary granularity for disease causality representations. A “chaining” inference algorithm and weighted logic operation mechanism were employed to guarantee the exactness and efficiency of diagnostic reasoning under situations of incomplete and uncertain information. Moreover, the causal interactions among diseases and symptoms intuitively demonstrated the reasoning process in a graphical manner. Verification was performed using 203 randomly pooled clinical cases, and the accuracy was 99.01% and 84.73%, respectively, with or without laboratory tests in the model. The solutions were more explicable and convincing than common methods such as Bayesian Networks, further increasing the objectivity of clinical decision-making. The promising results indicated that our model could be potentially used in intelligent diagnosis and help decrease public health expenditure. <s> BIB001 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Case-based reasoning and data interpretation is an artificial intelligence approach that capitalizes on past experience to solve current problems and this can be used as a method for practical intelligent systems. Case-based data reasoning is able to provide decision support for experts and clinicians in health systems as well as lifestyle systems. In this project we were focusing on developing a solution for healthy ageing considering daily activities, nutrition as well as cognitive activities. The data analysis of the reasoner followed state of the art guidelines from clinical practice. Guidelines provide a general framework to guide clinicians, and require consequent background knowledge to become operational, which is precisely the kind of information recorded in practice cases; cases complement guidelines very well and helps to interpret them. It is expected that the interest in case-based reasoning systems in the health. <s> BIB002 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> The AntiPhospholipid Syndrome (APS) is an acquired autoimmune disorder induced by high levels of antiphospholipid antibodies that cause arterial and veins thrombosis, as well as pregnancy-related complications and morbidity, as clinical manifestations. This autoimmune hypercoagulable state, usually known as Hughes syndrome, has severe consequences for the patients, being one of the main causes of thrombotic disorders and death. Therefore, it is required to be preventive; being aware of how probable is to have that kind of syndrome. Despite the updated of antiphospholipid syndrome classification, the diagnosis remains difficult to establish. Additional research on clinically relevant antibodies and standardization of their quantification are required in order to improve the antiphospholipid syndrome risk assessment. Thus, this work will focus on the development of a diagnosis decision support system in terms of a formal agenda built on a Logic Programming approach to knowledge representation and reasoning, complemented with a computational framework based on Artificial Neural Networks. The proposed model allows for improving the diagnosis, classifying properly the patients that really presented this pathology (sensitivity higher than 85%), as well as classifying the absence of APS (specificity close to 95%). <s> BIB003 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Abstract Clinical narrative text includes information related to a patient’s medical history such as chronological progression of medical problems and clinical treatments. A chronological view of a patient’s history makes clinical audits easier and improves quality of care. In this paper, we propose a clinical Problem-Action relation extraction method, based on clinical semantic units and event causality patterns, to present a chronological view of a patient’s problem and a doctor’s action. Based on our observation that a clinical text describes a patient's medical problems and a doctor's treatments in chronological order, a clinical semantic unit is defined as a problem and/or an action relation. Since a clinical event is a basic unit of the problem and action relation, events are extracted from narrative texts, based on the external knowledge resources context features of the conditional random fields. A clinical semantic unit is extracted from each sentence based on time expressions and context structures of events. Then, a clinical semantic unit is classified into a problem and/or action relation based on the event causality patterns of the support vector machines. Experimental results on Korean discharge summaries show 78.8% performance in the F1-measure. This result shows that the proposed method is effectively classifies clinical Problem-Action relations. <s> BIB004 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Clinical decision support systems (CDSSs) have been proved as an efficient way to improve health care quality. However, the inflexibility in integrating multiple clinical practice guidelines (multi-CPGs), the mass input workload of patient data, and the difficulty in system sharing become barriers of CDSSs implementation. In this paper, we proposed a framework of CDSS for chronic disease based on ontology and service-oriented architecture (SOA) to improve these defects. We used ontology for knowledge base construction on multi-CPGs integration to overcome their differences as well as reduce the input procedure of patient data by ontology reasoning. Furthermore, we built the CDSS on an SOA structure to provide flexibility in system and data sharing, such that patients could get suggestions from the same system for self-management of chronic disease. A typical case was used to validate the CDSS functions and accuracy. Two clients were developed to illustrate the SOA superiority. <s> BIB005 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS. <s> BIB006 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Abstract Today, there is considerable interest in personal healthcare. The pervasiveness of technology allows to precisely track human behavior; however, when dealing with the development of an intelligent assistant exploiting data acquired through such technologies, a critical issue has to be taken into account; namely, that of supporting the user in the event of any transgression with respect to the optimal behavior. In this paper we present a reasoning framework based on Simple Temporal Problems that can be applied to a general class of problems, which we called cake&carrot problems, to support reasoning in presence of human transgression. The reasoning framework offers a number of facilities to ensure a smart management of possible “wrong behaviors” by a user to reach the goals defined by the problem. This paper describes the framework by means of the prototypical use case of diet domain. Indeed, following a healthy diet can be a difficult task for both practical and psychological reasons and dietary transgressions are hard to avoid. Therefore, the framework is tolerant to dietary transgressions and adapts the following meals to facilitate users in recovering from such transgressions. Finally, through a simulation involving a real hospital menu, we show that the framework can effectively achieve good results in a realistic scenario. <s> BIB007 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Accounting for patients with multiple health conditions is a complex task that requires analysing potential interactions among recommendations meant to address each condition. Although some approaches have been proposed to address this issue, important features still require more investigation, such as (re)usability and scalability. To this end, this paper presents an approach that relies on reusable rules for detecting interactions among recommendations coming from various guidelines. It extends a previously proposed knowledge representation model (TMR) to enhance the detection of interactions and it provides a systematic analysis of relevant interactions in the context of multimorbidity. The approach is evaluated in a case study on rehabilitation of breast cancer patients, developed in collaboration with experts. The results are considered promising to support the experts in this task. <s> BIB008 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Abstract Individuals with type 1 diabetes have to monitor their blood glucose levels, determine the quantity of insulin required to achieve optimal glycaemic control and administer it themselves subcutaneously, multiple times per day. To help with this process bolus calculators have been developed that suggest the appropriate dose. However these calculators do not automatically adapt to the specific circumstances of an individual and require fine-tuning of parameters, a process that often requires the input of an expert. To overcome the limitations of the traditional methods this paper proposes the use of an artificial intelligence technique, case-based reasoning, to personalise the bolus calculation. A novel aspect of our approach is the use of temporal sequences to take into account preceding events when recommending the bolus insulin doses rather than looking at events in isolation. The in silico results described in this paper show that given the initial conditions of the patient, the temporal retrieval algorithm identifies the most suitable case for reuse. Additionally through insulin-on-board adaptation and postprandial revision, the approach is able to learn and improve bolus predictions, reducing the blood glucose risk index by up to 27% after three revisions of a bolus solution. <s> BIB009 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Objectives ::: In this study, a clinical decision support system was developed to help general practitioners assess the need for orthodontic treatment in patients with permanent dentition. ::: ::: ::: Methods ::: We chose a Bayesian network (BN) as the underlying model for assessing the need for orthodontic treatment. One thousand permanent dentition patient data sets chosen from a hospital record system were prepared in which one data element represented one participant with information for all variables and their stated need for orthodontic treatment. To evaluate the system, we compared the assessment results based on the judgements of two orthodontists to those recommended by the decision support system. ::: ::: ::: Results ::: In a BN decision support model, each variable is modelled as a node, and the causal relationship between two variables may be represented as a directed arc. For each node, a conditional probability table is supplied that represents the probabilities of each value of this node, given the conditions of its parents. There was a high degree of agreement between the two orthodontists (kappa value = 0.894) in their diagnoses and their judgements regarding the need for orthodontic treatment. Also, there was a high degree of agreement between the decision support system and orthodontists A (kappa value = 1.00) and B (kappa value = 0.894). ::: ::: ::: Conclusions ::: The study was the first testing phase in which the results generated by the proposed system were compared with those suggested by expert orthodontists. The system delivered promising results; it showed a high degree of accuracy in classifying patients into groups needing and not needing orthodontic treatment. <s> BIB010 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Abstract Background The available antibiotic decision-making systems were developed from a physician’s perspective. However, because infectious diseases are common, many patients desire access to knowledge via a search engine. Although the use of antibiotics should, in principle, be subject to a doctor’s advice, many patients take them without authorization, and some people cannot easily or rapidly consult a doctor. In such cases, a reliable antibiotic prescription support system is needed. Methods and results This study describes the construction and optimization of the sensitivity and specificity of a decision support system named IDDAP, which is based on ontologies for infectious disease diagnosis and antibiotic therapy. The ontology for this system was constructed by collecting existing ontologies associated with infectious diseases, syndromes, bacteria and drugs into the ontology's hierarchical conceptual schema. First, IDDAP identifies a potential infectious disease based on a patient’s self-described disease state. Then, the system searches for and proposes an appropriate antibiotic therapy specifically adapted to the patient based on factors such as the patient’s body temperature, infection sites, symptoms/signs, complications, antibacterial spectrum, contraindications, drug–drug interactions between the proposed therapy and previously prescribed medication, and the route of therapy administration. The constructed domain ontology contains 1,267,004 classes, 7,608,725 axioms, and 1,266,993 members of “SubClassOf” that pertain to infectious diseases, bacteria, syndromes, anti-bacterial drugs and other relevant components. The system includes 507 infectious diseases and their therapy methods in combination with 332 different infection sites, 936 relevant symptoms of the digestive, reproductive, neurological and other systems, 371 types of complications, 838,407 types of bacteria, 341 types of antibiotics, 1504 pairs of reaction rates (antibacterial spectrum) between antibiotics and bacteria, 431 pairs of drug interaction relationships and 86 pairs of antibiotic-specific population contraindicated relationships. Compared with the existing infectious disease-relevant ontologies in the field of knowledge comprehension, this ontology is more complete. Analysis of IDDAP's performance in terms of classifiers based on receiver operating characteristic (ROC) curve results (89.91%) revealed IDDAP's advantages when combined with our ontology. Conclusions and significance This study attempted to bridge the patient/caregiver gap by building a sophisticated application that uses artificial intelligence and machine learning computational techniques to perform data-driven decision-making at the point of primary care. The first level of decision-making is conducted by the IDDAP and provides the patient with a first-line therapy. Patients can then make a subjective judgment, and if any questions arise, should consult a physician for subsequent decisions, particularly in complicated cases or in cases in which the necessary information is not yet available in the knowledge base. <s> BIB011 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Abstract Surgical training improves patient care, helps to reduce surgical risks, increases surgeon’s confidence, and thus enhances overall patient safety. Current surgical training systems are more focused on developing technical skills, e.g. dexterity, of the surgeons while lacking the aspects of context-awareness and intra-operative real-time guidance. Context-aware intelligent training systems interpret the current surgical situation and help surgeons to train on surgical tasks. As a prototypical scenario, we chose Thoracentesis procedure in this work. We designed the context-aware software framework using the surgical process model encompassing ontology and production rules, based on the procedure descriptions obtained through textbooks and interviews, and ontology-based and marker-based object recognition, where the system tracked and recognised surgical instruments and materials in surgeon’s hands and recognised surgical instruments on the surgical stand. The ontology was validated using annotated surgical videos, where the system identified “Anaesthesia” and “Aspiration” phase with 100% relative frequency and “Penetration” phase with 65% relative frequency. The system tracked surgical swab and 50 mL syringe with approximately 88.23% and 100% accuracy in surgeon’s hands and recognised surgical instruments with approximately 90% accuracy on the surgical stand. Surgical workflow training with the proposed system showed equivalent results as the traditional mentor-based training regime, thus this work is a step forward a new tool for context awareness and decision-making during surgical training. <s> BIB012 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Evoking strength is one of the important contributions of the field of Biomedical Informatics to the discipline of Artificial Intelligence. The University at Buffalo's Orthopedics Department wanted to create an expert system to assist patients with self-diagnosis of knee problems and to thereby facilitate referral to the right orthopedic subspecialist. They had two independent sports medicine physicians review 469 cases. A board-certified orthopedic sports medicine practitioner, L.B., reviewed any disagreements until a gold standard diagnosis was reached. For each case, the patients entered 126 potential answers to 26 questions into a Web interface. These were modeled by an expert sports medicine physician and the answers were reviewed by L.B. For each finding, the clinician specified the sensitivity (term frequency) and both specificity (Sp) and the heuristic evoking strength (ES). Heuristics are methods of reasoning with only partial evidence. An expert system was constructed that reflected the posttest odds of disease-ranked list for each case. We compare the accuracy of using Sp to that of using ES (original model, p < 0.0008; term importance * disease importance [DItimesTI] model, p < 0.0001: Wilcoxon ranked sum test). For patient referral assignment, Sp in the DItimesTI model was superior to the use of ES. By the fifth diagnosis, the advantage was lost and so there is no difference between the techniques when serving as a reminder system. <s> BIB013 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> Background:Immunosuppressant Bayesian dose adjustment (ISBA) is an online expert system, routinely used by approximately 140 transplantation centers in the world for the dose adjustment of immunosuppressive drugs in transplant patients. This system determines the area under the curve (AUC) of the dr <s> BIB014 </s> Artificial Intelligence in Clinical Decision Support: a Focused Literature Survey <s> Knowledge-based Decision Support <s> In the growing scenario, microarray data is extensively used since it provides a more comprehensive understanding of genetic variants among diseases. As the gene expression samples have high dimensionality it becomes tedious to analyze the samples manually. Hence an automated system is needed to analyze these samples. The fuzzy expert system offers a clear classification when compared to the machine learning and statistical methodologies. In fuzzy classification, knowledge acquisition would be a major concern. Despite several existing approaches for knowledge acquisition much effort is necessary to enhance the learning process. This paper proposes an innovative Hybrid Stem Cell (HSC) algorithm that utilizes Ant Colony optimization and Stem Cell algorithm for designing fuzzy classification system to extract the informative rules to form the membership functions from the microarray dataset. The HSC algorithm uses a novel Adaptive Stem Cell Optimization (ASCO) to improve the points of membership function and Ant Colony Optimization to produce the near optimum rule set. In order to extract the most informative genes from the large microarray dataset a method called Mutual Information is used. The performance results of the proposed technique evaluated using the five microarray datasets are simulated. These results prove that the proposed Hybrid Stem Cell (HSC) algorithm produces a precise fuzzy system than the existing methodologies. <s> BIB015
Out of the 75 papers we analysed, 26 reported the adoption of knowledge-based AI methods , possibly in combination with datadriven methods BIB009 BIB010 BIB001 BIB002 BIB003 BIB004 . This later group of 6 hybrid approaches will be specifically detailed in the next subsection. The knowledge-based methods explicitly represent knowledge as symbols in the form of rules, ontologies, past cases, or other types of knowledge structures. Specifically, the surveyed approaches ranged from the use of ontologies BIB009 BIB011 BIB005 BIB012 BIB006 , to rule-based reasoning (including the adoption of fuzzy rules) [64, 66-68, 72-75, 78-80, 82-85] , to the definition of semantic or associative networks BIB004  , to temporal reasoning BIB007 , to probabilistic models such as Bayesian Networks BIB013 BIB010 BIB001 BIB014 , and to case base reasoning CBR BIB009 BIB002 . As regards to the addressed task, most works deal with diagnosis [60, 62, 64, 70, 73, 74, 77-80, 82, 84, 85] or therapy/treatment support [61-63, 66, 75, 81] , while some works address classification BIB015 , patient's behaviour tracking or activity scheduling BIB007 , and training BIB012 . A set of papers deals with computer-interpretable guidelines (CIGs) BIB005 BIB006 BIB002 BIB008 . As an example, the paper in BIB005 affords the issue of reconciling multiple clinical guidelines for decision support in comorbid patients. The developed tool exploits semantic web technologies to achieve knowledge modelling and knowledge integration, by aligning multiple ontologically-modelled clinical pathways to develop a unified comorbid patient knowledge model. Guideline execution using reasoning engines to derive guideline-mediated recommendations is also supported. The tool has been analysed in the domain of Atrial Fibrillation and Chronic Heart Failure. Table 2 shows the distribution of the surveyed knowledge-based works by task and by methodology.