OBJECTIVE: To establish a clinically applicable model of rapid identification of adverse drug reaction program (RiADP) for risk management and decision-making of clinical drug use. METHODS: Based on the theory of disproportion analysis, frequency method and Bayes method, a clinically applicable RiADP model in R language background was established, and the parameters of the model were interpreted by MedDRA coding. Based on the actual monitoring data of FDA, the model was validated by the assessing hepatotoxicity of lopinavir/ritonavir (LPV/r). RESULTS: The established RiADP model included four parameters: standard value of adverse drug reaction signal information, empirical Bayesian geometric mean value, ratio of reporting ratio and number of adverse drug reaction cases. Through the application of R language parameter package "phViD", the model parameters could be output quickly. After being encoded by MedDRA, it was converted into clinical terms to form a clinical interpretation report of adverse drug reactions. In addition, the evaluation results of LPV/r hepatotoxicity by the model were matched with the results reported in latest literature, which also proved the reliability of the model results. CONCLUSIONS In this study, a rapid identification method of adverse reactions based on post marketing drug monitoring data was established in R language environment, which is capable of sending rapid warning of adverse reactions of target drugs in public health emergencies, and providing intuitive evidence for risk management and decision-making of clinical drugs.
Databases, Pharmaceutical ; Decision Making, Computer-Assisted ; Drug Monitoring ; Drug-Related Side Effects and Adverse Reactions ; HIV Protease Inhibitors ; adverse effects ; pharmacology ; Humans ; Liver ; drug effects ; Lopinavir ; adverse effects ; toxicity ; Models, Statistical ; Reproducibility of Results ; Software ; standards

PURPOSE: This study was designed to develop and evaluate the a web-based simulation program on patient rights education using integrated decision making model into values clarification for nurse students. METHODS: The program was designed based on the Aless & Trollip model and Ford, Trygstad-Durland & Nelms's decision model. Focus groups interviews, surveys on learning needs for patient rights, and specialist interviews were used to develop for simulation scenarios and decision making modules. The simulation program was evaluated between May, 2011 and April, 2012 by 30 student nurses using an application of the web-based program evaluation tools by Chung. RESULTS: Simulation content was composed of two scenarios on patient rights: the rights of patients with HIV and the rights of psychiatric patients. It was composed of two decision making modules which were established for value clarifications, behavioral objective formations, problems identifications, option generations, alternatives analysis, and decision evaluations. The simulation program was composed of screens for teacher and learner. The program was positively evaluated with a mean score of 3.14+/-0.33. CONCLUSION: These study results make an important contribution to the application of educational simulation programs for nurse students' behavior and their decision making ability in protecting the patient rights.
Computer-Assisted Instruction ; Decision Making* ; Education* ; Family Characteristics ; Focus Groups ; HIV ; Human Rights ; Humans ; Learning ; Patient Rights* ; Program Evaluation ; Specialization

PURPOSE: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lower urinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in this study. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physicians and the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR) analysis. RESULTS: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2 (+/-7.3, standard deviation) years and 47.3 (+/-25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated by physician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589 (53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladder outlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question 3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume (R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to the LR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised (0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820, P=0.063) to the LR model. CONCLUSIONS: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenced decision-making in physicians treating patients with LUTS/BPH.
Bayes Theorem ; Decision Making, Computer-Assisted ; Decision Support Techniques ; Humans ; Linear Models ; Lower Urinary Tract Symptoms* ; Prostate ; Prostatic Hyperplasia* ; ROC Curve ; Urinary Bladder Neck Obstruction ; Urodynamics

BACKGROUNDChinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy.

METHODSWe proposed the development of the SuiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management (DataTCM), simulation of cases (SimTCM), analyses and validation of datasets (SciTCM), clinical examination and pattern differentiation (DiagTCM, TongueTCM, and PulseTCM), intervention selection (AcuTCM, HerbsTCM, and DietTCM), management of medical records (ProntTCM), epidemiologic investigation of sampled data (ResearchTCM), and medical education, training, and assessment (StudentTCM).

DISCUSSIONThe SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.

OBJECTIVES: This study demonstrates the feasibility of using expert system shells for rapid clinical decision support module development. METHODS: A readily available expert system shell was used to build a simple rule-based system for the crude diagnosis of vaginal discharge. Pictures and 'canned text explanations' are extensively used throughout the program to enhance its intuitiveness and educational dimension. All the steps involved in developing the system are documented. RESULTS: The system runs under Microsoft Windows and is available as a free download at http://healthcybermap.org/vagdisch.zip (the distribution archive includes both the program's executable and the commented knowledge base source as a text document). The limitations of the demonstration system, such as the lack of provisions for assessing uncertainty or various degrees of severity of a sign or symptom, are discussed in detail. Ways of improving the system, such as porting it to the Web and packaging it as an app for smartphones and tablets, are also presented. CONCLUSIONS: An easy-to-use expert system shell enables clinicians to rapidly become their own 'knowledge engineers' and develop concise evidence-based decision support modules of simple to moderate complexity, targeting clinical practitioners, medical and nursing students, as well as patients, their lay carers and the general public (where appropriate). In the spirit of the social Web, it is hoped that an online repository can be created to peer review, share and re-use knowledge base modules covering various clinical problems and algorithms, as a service to the clinical community.
Archives ; Caregivers ; Decision Making, Computer-Assisted ; Decision Support Systems, Clinical ; Expert Systems ; Humans ; Knowledge Bases ; Peer Review ; Product Packaging ; Software Design ; Students, Nursing ; Tablets ; Uncertainty ; Vaginal Discharge

This paper, analyzes the defects and its limitations of computer-aided diagnosis system (CADS) in clinical practice in the past, proposes a new pattern CADS of designing method. We used the theory of multidetection, stored the accumulated experience in computer, established the knowledge base, and made the medical diagnosis through maximizing a posteriori (MAP) judgement rule. Statistical data revealed that the CADS had a high accuracy rate. The medical diagnosis can meet the demand for clinical treatments, and realize the clinical diagnostic application of information technology.
Bayes Theorem ; Decision Making, Computer-Assisted ; Diagnosis, Computer-Assisted ; methods ; Humans

OBJECTIVETo discuss the development module of ontology-based computerized clinical practical guideline, and to supply the technology support for implement of alerm/reminding, data sharing, evidence-based medicine and clinical decision making in the medical information system.

METHODSAnalyse the structure and field ontology of the Guideline Interchange Format (GLIF); expand GLIF based on the Guideline of Cerebrovascular Disease Prevention and Treatment in China and Neurology Disease Ontology.

RESULTSA Chinese computerized guideline of intravenous thrombolytic therapy of acute cerebral infarction is constructed, which included metadata of edition description, list of drug data item, explanation of evidence strength, steps of indications decision, contraindication decision and drug selection.

CONCLUSIONThe computerized clinical practical guideline combined with clinical information system and Electronic Medical Records plays an important role in clinical pathways optimizing and decision making.

Accurate pre-operative localization and removal of disc material are important for minimizing morbidity in dogs with thoracolumbar disc extrusions. Computed tomography (CT) is an established technique for localizing disc extrusions in dogs, however the effect of multi-planar reformatting (MPR) on surgeon diagnostic performance has not been previously described. The purpose of this study was to test the effect of MPR CT on surgeon diagnostic accuracy, certainty and agreement for localizing thoracolumbar disc extrusions in dogs. Two veterinary surgeons and one veterinary neurologist who were unaware of surgical findings independently reviewed randomized sets of two-dimensional (2D) and MPR CT images from 111 dogs with confirmed thoracolumbar disc extrusions. For each set of images, readers recorded their localizations for extruded disc material and their diagnostic certainty. For MPR images, readers also recorded views they considered most helpful. Diagnostic accuracy estimates, mean diagnostic certainty scores and inter-observer agreement were compared using surgery as the gold standard. Frequencies were compared for MPR views rated most helpful. Diagnostic accuracy estimates were significantly greater for MPR vs. 2D CT images in one reader. Mean diagnostic certainty scores were significantly greater for MPR images in two readers. The change in agreement between 2D and MPR images differed from zero for all analyses (site, side, number affected) among all three readers. Multi-planar views rated most helpful with the highest frequency were oblique transverse and curved dorsal planar MPR views. Findings from this study indicate that multi-planar CT can improve surgeon diagnostic performance for localizing canine thoracolumbar disc extrusions.
Animals ; Decision Making ; Dog Diseases/*radiography ; Dogs ; Female ; Humans ; Image Processing, Computer-Assisted/*methods/standards ; Intervertebral Disk Displacement/radiography/*veterinary ; Male ; Observer Variation ; Tomography, X-Ray Computed

In this paper is used the rough set theory to deal with the information contained in electrocardiographic waveforms and to find out the correlation between coronary heart disease (CHD) and the selected indices in electrocardiographic lead I. The principles of attribute reduction are applied, the redundancy of a decision-making table is reduced, and the important characters and diagnostic rules are extracted. The real case analysis shows that clear and concise diagnostic rules can be established by using rough set theory, which can be helpful to the clinical diagnosis of CHD.
Algorithms ; Coronary Disease ; diagnosis ; Decision Making, Computer-Assisted ; Electrocardiography ; methods ; Humans ; Predictive Value of Tests ; Signal Processing, Computer-Assisted

This paper presents a typical Clinical Information System for ICU and its design and implementation. This system is able to capture and archive vital data from the monitor network, providing a whole digital solution in ICU. These vital data can be used in quantitative analysis in the computer-assisted decision support.
Decision Making, Computer-Assisted ; Information Systems ; Intensive Care Units ; Monitoring, Physiologic ; statistics & numerical data ; Software Design