Más contenido relacionado Abel Hinf6230 Cbr Hypo Knowledge Managmenet Health Informatics2. 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
© Abel M. Gebreyesus HINF 6230 2
3. 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 %
© Abel M. Gebreyesus HINF 6230 3
5. 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
© Abel M. Gebreyesus HINF 6230 5
6. 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
© Abel M. Gebreyesus HINF 6230 6
7. Hormones for Treatment
Maintain metabolic homeostasis by
regulating:
Intermediary metabolism
Body weight
Oxygen requirements
Body temperature
control of growth, reproduction and
differentiation
© Abel M. Gebreyesus HINF 6230 7
8. 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
© Abel M. Gebreyesus HINF 6230 8
9. 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
10. CBR Solving Problems
Solution
Review
Retain
Adapt
Database
Retrieve
Similar
New
Problem
© Abel M. Gebreyesus HINF 6230 10
11. CBR Assumption
New problem can be solved by
retrieving similar problems
adapting retrieved solutions
Similar problems have similar solutions
P P P
? PP
P PP
P
S
SX S
S S
SS S S
© Abel M. Gebreyesus HINF
6230 11
12. 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.
© Abel M. Gebreyesus HINF 6230 12
13. 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)
© Abel M. Gebreyesus HINF 6230 13
14. The Cycle of Hypothyroid CBR
Problem-Solution
Solution
Review
Retain
Here we go!
New solution….
What kind of
Adapt
patients treated with
Database which does and what
special prescription
Similar problem
to similar solution,
Retrieve but take uniqueness
into account
New Patients who got solutions
with similar problem
Problem
© Abel M. Gebreyesus HINF 6230 14
15. 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)
© Abel M. Gebreyesus HINF 6230 15
16. 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
© Abel M. Gebreyesus HINF 6230 16
17. CBML Document Hierarchy
CBML schema Case structure Case content
document (XSL) document (XML) document (XML)
•The CBML (XML-based Case Mark-Up
Language) Schema document
An XML Schema document describing the syntax
of the case structure document
Static, globally available document
•The Case Structure document
•The Case Content document
© Abel M. Gebreyesus HINF 6230 17
18. Case Representation
feature-value representation
Example
case
problem solution extra info
tablet
drug filler binder lubricant disintegrant surfactant
properties
dose
excipient
excipient
excipient
excipient
excipient
amount
amount
amount
amount
amount
physical
chemical properties YP SRS
properties
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 #
Problem
n
- Extra Weight
Solution
n
- Increase Thyroxin
amount
Further Patient History
n
- Diet
- Exercise © Abel M. Gebreyesus HINF 6230 18
19. 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
© Abel M. Gebreyesus HINF 6230 19
20. 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
© Abel M. Gebreyesus HINF 6230 20