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
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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 %
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Differential diagnosis
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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
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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
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Hormones for Treatment
Maintain metabolic homeostasis by
regulating:
Intermediary metabolism
Body weight
Oxygen requirements
Body temperature
control of growth, reproduction and
differentiation
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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
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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
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6230 9
CBR Solving Problems
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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
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6230 11
?
SSS
SS
S
SS
S
PP
PPPP
P
PP
X
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.
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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)
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The Cycle of Hypothyroid CBR
Problem-Solution
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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)
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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
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CBML Document Hierarchy
CBML schema
document (XSL)
Case structure
document (XML)
Case content
document (XML)
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•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
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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
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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
QUESTIONS????
THANK YOU!!!
21© Abel M. Gebreyesus HINF 6230
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