Method Inform Med
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Knowledge-based systems (KBS) have been proposed to solve a large variety of medical problems. A strategic issue for KBS development and maintenance are the efforts required for both knowledge engineers and domain experts. The proposed solution is building efficient knowledge acquisition (KA) tools. ⋯ Their design was facilitated by the development of a methodology for KBS construction. It views this process as comprising two activities: the tailoring of the epistemological model to the specific medical task to be executed and the subsequent translation of this model into a computational architecture so that the connections between computational structures and their knowledge level counterparts are maintained. The KA tools we developed are illustrated taking examples from the behavior of a KBS we are building for the management of children with acute myeloid leukemia.
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Even today, the diagnosis of acute abdominal pain represents a serious clinical problem. The medical knowledge in this field is characterized by uncertainty, imprecision and vagueness. This situation lends itself especially to be solved by the application of fuzzy logic. ⋯ The hybrid concept of the system enables the integration of rule-based, heuristic and case-based reasoning on the basis of imprecise information. The central idea of the integration is to use case-based reasoning for the management of special cases, and rule-based reasoning for the representation of normal cases. The heuristic principle is ideally suited for making uncertain, hypothetical inferences on the basis of fuzzy data and fuzzy relations.
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The administration rate of general anaesthetic drugs is at present guided by clinical experience, and indirect indicators such as haemodynamic parameters. In the presence of muscle relaxants most of the clinical signs of inadequate anaesthesia are lost and accidental awareness may occur. A number of monitoring modalities, primarily based on analysis of the electroencephalogram (EEG), have been proposed for measurement of the anaesthetic depth. ⋯ To facilitate this, it is essential to combine analysis of the spontaneous EEG with recording of evoked potentials, to assess both cortical and subcortical activity/events. None of the reviewed methods, however promising, can alone meet all of the requirements for intraoperative monitoring of cerebral function. We suggest that the future direction should be to integrate several modalities in a single device, to provide valuable new information, upon which to base clinical management decisions.
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Starting with the quotation by Paul Ricoeur: Man needs love indeed; he needs justice still more; but most of all he needs meaning, this paper states that in this present situation medical education does not prepare students to deal with human needs, neither their own nor those of their patients. This is due to the almost exclusive devotion to hard sciences, contaminated by unscientific ideological drift, which tends to negate subjectivity and to suppress any significance of human destiny. Although medical informatics, by definition, eliminates meaning and knowledge, it can - if properly used as a complement and not as a competitor of human intelligence - help to renovate medical education, introduce true humanistic dimensions, and restore the element of human subjectivity.
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Education in medical informatics in The Netherlands: a nationwide policy and the Erasmus curriculum.
The curricula of all Medical Faculties still bear the characteristics of an era in which the physician was not educated in managing medical information systems, using communication networks, and processing knowledge. In attempting to formulate the prerequisites for developing and adjusting future curricula, we discuss the evolution of medical information technology during the past 25 years and give examples to illustrate that, by extrapolating current trends, future developments in information technology, medicine and education can be predicted. A plea is made for a strong interaction between scientific developments in medical informatics and academic education. ⋯ Furthermore, a nationwide policy on medical informatics in The Netherlands, is discussed. Our treatise is concluded by presenting the outline of the curriculum in medical informatics at the Erasmus University in Rotterdam. Educational recommendations conclude the paper.