An Expert-Knowledge-Based Graph Convolutional Network for Skeleton- Based Physical Rehabilitation Exercises Assessment.

Physical therapists play a crucial role in guiding patients through effective and safe rehabilitation processes according to medical guidelines. However, due to the therapist-patient imbalance, it is neither economical nor feasible for therapists to provide guidance to every patient during recovery sessions. Automated assessment of physical rehabilitation can help with this problem, but accurately quantifying patients' training movements and providing meaningful feedback poses a challenge. In this paper, an Expert-knowledge-based Graph Convolutional approach is proposed to automate the assessment of the quality of physical rehabilitation exercises. This approach utilizes experts' knowledge to improve the spatial feature extraction ability of the Graph Convolutional module and a Gated pooling module for feature aggregation. Additionally, a Transformer module is employed to capture long-range temporal dependencies in the movements. The attention scores and weight matrix obtained through this approach can serve as interpretability tools to help therapists understand the assessment model and assist patients in improving their exercises. The effectiveness of the proposed method is verified on the KIMORE dataset, achieving state-of-the-art performance compared to existing models. Experimental results also illustrate the interpretability of the method in both spatial and temporal dimensions.

Combining deep neural networks, a rule-based expert system and targeted manual coding for ICD-10 coding causes of death of French death certificates from 2018 to 2019.

OBJECTIVE: For ICD-10 coding causes of death in France in 2018 and 2019, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team focused on certificates with a special public health interest and those for which DNNs have a low confidence index. METHODS: Supervised seq-to-seq DNNs are trained on previously coded data to ICD-10 code multiple causes and underlying causes of death. The DNNs are then used to target death certificates to be sent to the coding team and to predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign for 2018 and 2019 combines three modes of coding and a loop of interaction between the three. FINDINGS: In this campaign, 62% of the certificates are automatically batch coded by the expert system, 3% by the coding team, and the remainder by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 93.4% for ICD-10 coding of the underlying cause (95.6% at the European shortlist level). Some limitations (risks of under- or overestimation) appear for certain ICD categories, with the advantage of being quantifiable. CONCLUSION: The combination of the three coding methods illustrates how artificial intelligence, automated and human codings are mutually enriching. Quantified limitations on some chapters of ICD codes encourage an increase in the volume of certificates sent for manual coding from 2021 onward.

Scoring systems, expert assessment, and identification of risk factors for the emergence of delirium in paediatric patients: Prospective cohort study.

INTRODUCTION: Emergence delirium (ED) is a transient irritative and dissociative state that arises after the cessation of anaesthesia in patients who do not respond to calming measures. There are many risk factors for ED, but the exact cause and underlying mechanism have not been determined because the definition of ED is still unclear in consensus. This study aims to determine ED incidence, identify ED risk factors and external validation of Watcha, Cravero and expert assessment to Pediatric Anesthesia Emergence Delirium (PAED) scoring system in ED prediction. MATERIALS AND METHODS: This study is a prospective cohort study on 79 paediatrics who underwent elective surgery with general anaesthesia. Parameter measures include the incidence of ED, ED risk factors, and the relationship between PAED, Watcha, Cravero score and expert assessment. The ED risk factor was analysed using univariate and multivariate analysis. The relationship between PAED, Watcha, Cravero score, and expert assessment was determined using Receiver Operating Characteristic (ROC) curve analysis. RESULTS: The incidence of ED was 22.8%. All parameters examined in this study showed p < 0.05. Watcha's scoring correlates with the PAED scoring and shows the highest discrimination ability with AUC 0.741 and p < 0.05. CONCLUSION: The incidence of ED in paediatrics is relatively high. Compared to others, Watcha score are more reliable for ED prediction. However, some demographic and perioperative factors are not the risk factor of ED.

Diagnosis of heart diseases: A fuzzy-logic-based approach.

Cardiovascular diseases (CVD) also known as heart disease are now the leading cause of death in the world. This paper presents research for the design and creation of a fuzzy logic-based expert system for the prognosis and diagnosis of heart disease that is precise, economical, and effective. This system entails a fuzzification module, knowledge base, inference engine, and defuzzification module where seven attributes such as chest pain type, HbA1c (Haemoglobin A1c), HDL (high-density lipoprotein), LDL (low-density lipoprotein), heart rate, age, and blood pressure are considered as input to the system. With the aid of the available literature and extensive consultation with medical experts in this field, an enriched knowledge database has been created with a sufficient number of IF-THEN rules for the diagnosis of heart disease. The inference engine then activates the appropriate IF-THEN rule from the knowledge base and determines the output value using the appropriate defuzzification technique after the fuzzification module fuzzifies each input depending on the appropriate membership function. Moreover, the fusion of web-based technology makes it suitable and cost-effective for the prognosis of heart disease for a patient and then he can take his decision for addressing the problem based on the status of his heart. On the other hand, it can also assist a medical practitioner to reach a more accurate conclusion regarding the treatment of heart disease for a patient. The Mamdani inference method has been used to evaluate the results. The system is tested with the Cleveland dataset and cross-checked with the in-field dataset. Compared with the other existing expert systems, the proposed method performs 98.08% accurately and can make accurate decisions for diagnosing heart diseases.

Patient-Centered Clinical Decision Support-Where Are We and Where to Next?

Patient-centered clinical decision support (PC CDS) includes digital health tools that support patients, caregivers, and care teams in healthcare decisions that incorporate patient-centered factors related to four components: knowledge, data, delivery, and use. This paper explores the current state of each factor and how each promotes patient-centeredness in healthcare. We conducted a literature review, reviewing 175 peer-reviewed and grey literature, and eighteen key informant interviews. Findings show a need for more research on how to incorporate patient input into the guideline selection and prioritization for PC CDS, development and implementation of PC CDS tools, technical challenges for capturing patient contributed data, and optimizing PC CDS across various settings to meet patient and caregiver needs. While progress is being made in each of the four components of PC CDS, critical gaps remain.

Assessing the Safety of a New Clinical Decision Support System for a National Helpline.

We assessed the safety of a new clinical decision support system (CDSS) for nurses on Australia's national consumer helpline. Accuracy and safety of triage advice was assessed by testing the CDSS using 78 standardised patient vignettes (48 published and 30 proprietary). Testing was undertaken in two cycles using the CDSS vendor's online evaluation tool (Cycle 1: 47 vignettes; Cycle 2: 41 vignettes). Safety equivalence was examined by testing the existing CDSS with the 47 vignettes from Cycle 1. The new CDSS triaged 66% of vignettes correctly compared to 57% by the existing CDSS. 15% of vignettes were overtriaged by the new CDSS compared to 28% by the existing CDSS. 19% of vignettes were undertriaged by the new CDSS compared to 15% by the existing CDSS. Overall performance of the new CDSS appears consistent and comparable with current studies. The new CDSS is at least as safe as the old CDSS.

Designing, validation and evaluation of the expert system of "Healthy Menopause" and assessing its effect on the management of menopause symptoms: an exploratory mixed method study protocol.

BACKGROUND: Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, practical and affordable way for meeting women's related needs is important. In addition, women should be able to incorporate such programs into their daily work. Considering the dearth of suitable services in this regard, this study will be conducted with the aim of designing, validating and evaluating the "Healthy Menopause" expert system on the management of menopausal symptoms. METHODS/DESIGN: A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase is a qualitative conventional content analysis study with purposes of exploring the women's experience of menopausal symptoms and extracting their needs, and collecting data about their expectations from a healthy menopause expert system.. The purposive sampling (In his phase data will be gathered through interviewing menopaused women aged 40 to 60 years old and other persons that have rich information in this regard and will be continued until data saturation. The second phase includes designing a healthy menopause expert system in this stage, the needs will be extracted from the qualitative findings along with a comprehensive literature review. The extracted needs will be again confirmed by the participants. Then, through a participatory approach (Participatory Design) using nominal group or Delphi technique the experts' opinion about the priority needs of menopaused women and related solutions will be explored based on the categories of identified needs. Such findings will be used to design a healthy menopause expert system at this stage. The third phase of study is a quantitative research in which the evaluation of the healthy menopause expert system will be done through a randomized controlled clinical trial with the aim of determining the effect of the healthy menopause expert system on the management of menopause symptoms by menopausal women themselves. DISCUSSION: This is the first study that uses a mixed method approach for designing, validating and evaluating of the expert system "Healthy Menopause". This study will fill the research gap in the field of improving menopausal symptoms and designing a healthy menopause expert system based on the needs of the large group of menopause women. We hope that by applying this expert system, the menopausal women be empowered to management and improving their health with an easy and affordable manner.

Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, easy for use and affordable way for managing related problems and meeting related needs is important. Menopause is a period of women's life that has physical, psychological and social consequences. It is important to identify methods that are effective, practical and affordable. New technologies can increase women's ability to access educational information. This is the first study for designing, validating and evaluating of the expert system "Healthy Menopause". A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The conventional content analysis method will be used. The second phase: Designing a healthy menopause expert system: It is based on the codes of women's challenges from the first phase, along with conducting interviews and literature review. The participatory approach (Participatory Design) through nominal group or if needed, Delphi method based on the categories of needs and solutions by considering the opinions of the participants, available experts related to this issue will be listed. It should be used to design a healthy menopause expert system at this stage. The third phase (quantitative): The evaluation of the healthy menopause expert system will be a randomized clinical trial that determine the effect of the healthy menopause expert system on the management of menopause symptoms. In the present study an expert system (ES) will be designed that can be installed on mobile phones and computers. This tool is not only educational but also interactively helps to adapt to continuous changes, so by asking questions about menopause the system will respond as if an expert (midwife or gynecologist) is giving advice.

ESforRPD2: Expert System for Rice Plant Disease Diagnosis.

One of the factors causing rice production disturbance in Indonesia is that farmers lack knowledge of early symptoms of rice plant diseases. These diseases are increasingly rampant because of the lack of experts. This study aimed to overcome this problem by providing an Expert System that helps farmers to make an early diagnosis of rice plant diseases. Data of rice plant pests and diseases in 2016 were taken from Samarinda, East Kalimantan, Indonesia using an in-depth survey, and rice experts from the Department of Food Crops and Horticulture of East Kalimantan Province were recruited for the project. The Expert System for Rice Plant Disease Diagnosis, ESforRPD2, was developed based on the pest and disease experiences of the rice experts and uses a Waterfall Paradigm and Unified Modeling Language. This Expert System can detect 48 symptoms and 8 types of diseases of rice plants from 16 data tests with a sensitivity of 87.5%. The system can also provide recommendations for the treatment of identified diseases. ESforRPD2 is available in Indonesian at http://esforrpd2.blog.unmul.ac.id.

Uso da inteligência articial como armamento no diagnóstico e condução clínica da estenose de canal lombar / Use of Articial Intelligence in Diagnosis and Clinical Conduct of Lumbar Spinal Stenosis

A estenose do canal vertebral lombar (ECL) é uma patologia complexa, com alta incidência entre pessoas acima de 65 anos de idade. No entanto, o diagnóstico correto é, por vezes, difícil de ser confirmado. O uso de modelos de Inteligência Articial (IA) na medicina é, em geral, desconhecida para a maioria da comunidade médica, mas tem sido usada há décadas na assistência em UTI, os métodos de imagem e dispositivos de diagnóstico eletrônico (ECG). Através de uma revisão sistemática da literatura, com foco nos achados clínicos e radiológicos, juntamente com todas as modalidades de tratamento, foi possível identicar o ambiente completo de pacientes LSS, para responder a quatro questões: (a) "Com base no quadro clínico, o paciente tem um, cenário moderado ou grave?"; (b) "Com base nos dados radiológicos, o paciente pode ser classicado com um cenário leve,moderada ou grave?"; (c) "Qual é a probabilidade, com base na anamnese, do paciente ter ECL?"; (d) "Qual é o melhor tratamento a ser oferecido?".þ. Como auxílio de um software usando Sistema Especialista (Expert Sinta), uma linguagem de IA, alocamos todas as variáveis e seus valores para orientar o software responder às quatro perguntas. Foi possível identicar 657 artigos cientícos, no entanto apenas 63 poderia mencionar não apenas as variáveis, mas a sua probabilidade de ocorrência ou teve disponibilidade texto completo. Foi possível classicar a intensidade do quadro clínico e radiológico, criar um índice de probabilidade para LSS e oferecer o melhor tratamento. Recomendamos o uso, sob supervisão médica, em de Neurocirurgia ou clínicas ortopédicas como um conselheiro para os pacientes com ELA.

The lumbar spinal stenosis (LSS) is a complex pathology with high incidence among people above 65 years old. However, the correct diagnose is sometimes difcult to perform. The use of Articial Intelligence (AI) models in medicine is, in general, unfamiliar for the majority of medical community, but has been used for decades in assistance in ICUs, image methods and electronic diagnostic devices (EKG). Through a systematic literature review focused in the clinical and radiological ndings, in addition to all treatmentmodalities, we identied the complete environment of LSS patients, to answer four questions. (a) "Based on the clinical presentation, the patient has a mild, moderate or severe scenario?", (b) "Based on the radiological data, the patient can be classied having a mild, moderate or severe scenario?", (c) "What is the probability, based on the anamneses, the patient has LSS?", and (d) "What is the best treatment to be offered?".With the aid of a software using Expert System (Expert Sinta), a language of AI, we allocate all the variables and their values to orient the software to answer the four questions. It was possible to identify 657 scientic articles, however only 63 could mention not only the variables, but their occurrence probability or had full text availability. It was possible to classify the intensity the clinical and radiological scenario, create a probability index for LSS and offer the best treatment. We recommend the use, under medical supervision, in neurosurgery or orthopedic clinics as an adviser for patients with LSS.

Uma ferramenta baseada em computação evolutiva para o apoio ao diagnóstico da cardiopatia isquêmica / Una herramienta basada en la computación evolutiva para apoyar el diagnóstico de la cardiopatía isquémica / A based on evolutionary computation tool to support the diagnosis of heart disease

Objetivo: O trabalho em questão vem apresentar a proposta de uma ferramenta desenvolvida com técnicas de computação evolutiva e reconhecimento baseado em casos para auxílio no diagnóstico da cardiopatia isquêmica. Método: Análises bibliográficas e aplicação combinada das técnicas de Algoritmos Genéticos (AG?s) e reconhecimento baseado em casos (RBC?s) e derivações da função de distância euclidiana Resultado: Os testes realizados na ferramenta mostraram que esta possui grande grau de acertos em suas indicações de diagnóstico, chegando a 97,01% de acertos nas etapas de treinamento com acurácia, especificidade e sensibilidades superiores a 92%. Conclusão: A escolha das tecnologias citadas bem como dos métodos aplicados para evolução do algoritmo dentro das técnicas de AG, proporcionaram a ferramenta grande capacidade de decisão levando-a grandes taxas de acertos em sua indicação diagnóstica.

Objective: The work in question is presenting the proposal of a tool developed with evolutionary computation techniques and recognition based on cases to aid in the diagnosis of ischemic heart disease. Method: literature analysis and the combined use of techniques of Genetic Algorithms ( GAs ) and recognition based on cases (RBC ?s) and derivations of the function of Euclidean distance. Result: The tests performed on the tool showed that it has high degree of accuracy for their diagnostic indications, reaching 97.01 % accuracy in the training stages with accuracy, specificity and sensitivity higher than 92 %. Conclusion: The choice of technologies cited as well as the methods used for the evolution of the algorithm within the AG techniques, provided a great capacity for decision - taking tool to major hit ratios in the diagnostic statement.

Objetivo: La obra en cuestión es la presentación de la propuesta de una herramienta desarrollada con técnicas de computación evolutiva y el reconocimiento basado en casos para ayudar en el diagnóstico de la cardiopatía isquémica. Método: análisis de la literatura y el uso combinado de técnicas de algoritmos genéticos ( GAs ) y reconocimiento basado en casos ( RBC ) y derivaciones de la función de distancia euclídea. Resultado: Las pruebas realizadas en la herramienta demostró que tiene alto grado de respuestas correctas en sus indicaciones diagnósticas, alcanzando una precisión 97,01 % en las etapas de formación con precisión, especificidad y sensibilidad superior al 92 %. Conclusión: La elección de las tecnologías citadas, así como los métodos utilizados para la evolución del algoritmo dentro de las técnicas de AG, a condición de una gran capacidad para la toma de decisiones herramienta para los cocientes de ataque en el estado de diagnóstico.

Sistema interativo em ambiente móvel para o diagnóstico diferencial de cardiopatias congênitas / Interactive system on mobile environment for differential diagnosis of congenital heart disease / Sistema interactivo para el entorno móvil en el diagnóstico diferencial de la enfermedad cardíaca congénita

Objetivo: Descrever a elaboração de um sistema interativo de apoio ao diagnóstico de cardiopatias congênitas (CCs). Métodos: Para a captação da Base de Conhecimento foi usado um fluxograma elaborado por cardiologistas pediátricos sobre sinais e sintomas das CCs. Para a construção do sistema utilizou-se o ambiente de desenvolvimento para Sistema Android ?App Inventor?, elaborado pelo Massachusetts Institute of Technology (MIT). Resultados: Repostas pré-determinadas levam a grupos de CCs mais prováveis. Os sintomas iniciais foram cianose, insuficiência cardíaca congestiva (ICC), a associação de ambas ou apenas sopro isolado. Nas perguntas sequenciais também foram utilizadas características dos sopros, do raio-x, do ECG, dos pulsos e do precórdio. A resposta sequencial leva a grupos cada vez mais restritos de patologias. Conclusão: Um sistema de apoio ao diagnóstico diferencial das cardiopatias congênitas elaborada para não especialistas na área que lidam com neonatos pode ter impacto positivo na morbimortalidade neonatal.

Objective: To describe the development of an interactive system to support the diagnosis of congenital heart disease (CHDs). Methods: To capture the knowledge base we used a flow chart prepared by pediatric cardiologists about signs and symptoms of CHDs. For the construction of the system we used the environment Development System for Android ?App Inventor?, prepared by Massachusetts Institute of Technology (MIT). Results: Responses lead to predetermined groups of CHDs more likely. Initial symptoms were cyanosis, congestive heart failure (CHF), the combination of both or just blowing isolated. In sequential questions were also used features of blows, x-ray, ECG, pulses and precordium. The response sequential groups leads to increasingly restricted conditions. Conclusion: A support system for differential diagnosis of congenital designed for non-specialists in the area dealing with newborns can have positive impact on neonatal morbidity and mortality.

Objetivo: Describir el desarrollo de un sistema interactivo para apoyar el diagnóstico de las cardiopatías congénitas (CCs). Métodos: Para capturar la base de conocimientos se utilizó un diagrama de flujo elaborado por cardiólogos pediatras acerca de las señales y síntomas de CCs. Para la construcción del sistema que se utiliza el medio ambiente Sistema de Desarrollo para Android ?App Inventor?, preparado por Massachusetts Institute of Technology (MIT). Resultados: Las respuestas conducen a grupos predeterminados de CC más probables. Los síntomas iniciales fueron cianosis, insuficiencia cardíaca congestiva (ICC), la combinación de ambos o simplemente soplando aislado. En las preguntas secuenciales eran características también se utilizan de golpes, rayos x, ECG, legumbres y región precordial. Los grupos secuenciales de respuesta da lugar a condiciones cada vez más restringido. Conclusión: Un sistema de apoyo para el diagnóstico diferencial de la congénita diseñado para quienes no son especialistas en el área frente a los recién nacidos pueden tener un impacto positivo en la morbilidad y mortalidad neonatal.

Sistema especialista para apoiar a decisão na terapia tópica de úlceras venosas / Expert system to support the decision in topical therapy for venous ulcers / Sistema especialita para apoyar la decisión en la terapia tópica de úlceras venosas

Apesar de o tratamento das úlceras venosas exigir um conjunto de conhecimentos específicos, os enfermeiros não especialistas desconhecem as terapias adequadas, o que constitui uma dificuldade na terapia tópica dessas lesões de pele. Este artigo tem como objetivo apresentar um sistema especialista para apoiar o processo de decisão dos enfermeiros na terapia tópica das úlceras venosas. Trata-se de uma pesquisa de desenvolvimento, operacionalizada em cinco etapas: modelagem do sistema, aquisição do conhecimento, representação do conhecimento a partir de regras de produção, implementação e avaliação do sistema. O conjunto das regras é apresentado, assim como casos que simulam o comportamento do sistema especialista, mostrando a viabilidade da sua utilização na prática do enfermeiro. O sistema poderá auxiliar na tomada de decisão sobre as condutas tópicas em úlceras venosas, porém, a avaliação da úlcera deve ser realizada de forma correta, a fim de que o sistema forneça sugestões adequadas, permitindo melhor organização e planejamento da assistência.

Although the treatment of venous ulcers requires a set of specific knowledge, non-specialist nurses are unaware of the appropriate therapy, which is a concern in the topical therapy for these skin lesions. This paper aims to present an expert system to support the nursing decision making process in the topical therapy of venous ulcers. It is a development research implemented in five stages: system modeling, knowledge acquisition, knowledge representation from production rules, and system implementation and evaluation. The production rules are presented, as well as some cases to simulate the expert system behavior, demonstrating the viability of its usage in nurse's practice. The system may support the decision making about the topical therapy of venous ulcers. However, ulcer evaluation should be correctly made, so that the system provides appropriate suggestions, allowing better organization and planning assistance.

Aunque el tratamiento de las úlceras venosas exige un conjunto de conocimientos específicos, los enfermeros no especializados desconocen la terapia adecuada, lo que constituye una dificultad en la terapia tópica de esas lesiones de piel. Este artículo tiene como objetivo presentar un sistema especializado para apoyar el proceso de decisión de los enfermeros en la terapia tópica de las úlceras venosas. Se trata de una investigación del desarrollo, operado en cinco etapas: modelaje del sistema, adquisición de conocimientos, representación del conocimiento a partir de reglas de producción, de implementación y evaluación del sistema. El conjunto de reglas es presentado, así como algunos casos que simulan el comportamiento del sistema especializado. El sistema puede ayudar a tomar decisiones sobre la terapia tópica, pero, la evaluación de la úlcera se debe realizar correctamente para que el sistema proporcione sugerencias adecuadas, lo que permite una mejor organización y planificación de la asistencia.

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.

Estudo da progressão da diabetes e da neuropatia periférica: classificação da severidade e caracterização cinética da locomoção / Study of the progression of diabetes and peripheral neuropathy: classification of the severity and kinetic characterization of locomotion

Esta tese assumiu a premissa de que a neuropatia periférica é um sinal de piora da diabetes, além de levantar a questão de que estudos prévios sobre a biomecânica da marcha de diabéticos não têm distinguido os graus de progressão da diabetes nos grupos estudados. Neste contexto, não é possível identificar as diferenças nos padrões de geração da marcha entre estágios precoces e avançados da diabetes. Esta identificação poderia facilitar a intervenção terapêutica precoce nestes pacientes, o que poderá impedir a formação de úlceras e amputações recorrentes subseqüentes. Assim, apresentamos ao longo desta tese, três estudos para investigar a natureza das supostas alterações na marcha (estudo 1) e no descer escadas (estudo 2) de diabéticos, assim como para propor uma forma de classificar a progressão da diabetes levando em consideração as incertezas de fronteiras entre os subgrupos de neuropatas, por meio de um sistema especialista fuzzy (estudo 3). Os estudos 1 e 2 foram feitos com os mesmos três grupos: indivíduos diabéticos (GD) e diabéticos neuropatas (GDN) diagnosticados clinicamente e indivíduos saudáveis (GC). Para a avaliação cinemática e cinética do membro inferior foram utilizadas câmeras infravermelhas e uma plataforma de força durante o andar no plano e descendo uma escada. O cálculo dos momentos articulares de membro inferior foi feito por meio do método da dinâmica inversa. Os principais resultados do estudo 1 mostraram que independente da presença da neuropatia, os pacientes diabéticos exibiram uma maior flexão das três principais articulações do membro inferior e um importante uso da articulação do quadril como uma estratégia cinética de progressão do corpo à frente, em substituição ao tornozelo, que mostrou ser a articulação mais prejudicada. Os principais resultados do estudo 2 indicaram as mesmas mudanças significativas no padrão cinemático do tornozelo durante a fase de propulsão, mesmo na ausência da neuropatia. No entanto, não houve...

This study assumed the premise that the peripheral neuropathy is a sign of worsening of diabetes, as well as raising the issue that previous studies on the biomechanics of gait in diabetics do not have distinguished the degree of progression of diabetes in both groups. Therefore, it is not possible to identify differences in patterns of gait generation between early and advanced stages of diabetes. This identification would facilitate early therapeutic intervention in these patients, which could prevent the formation of recurrent ulcers and subsequent amputations. We present throughout this thesis, three studies to investigate the nature of the alleged changes in gait (study 1) and stair descent (study 2) of diabetics, and to propose a way to classify the progression of diabetes, taking into account the uncertainties of boundaries between the subgroups of neuropathy through a fuzzy expert system (study 3). Studies 1 and 2 were performed with the same three groups: diabetics (GD) and diabetic neuropathic (GDN) diagnosed clinically and healthy subjects (CG). For the kinematic and kinetic evaluation of the lower limb, we used infrared cameras and a force plate during walking on a level walkway (10 m) and descent a staircase. The calculation of net joint moments of the lower limb was performed using the method of inverse dynamic. The main results of Study 1 showed that, regardless of the presence of neuropathy, diabetic patients exhibited a greater flexion of the three major joints of the lower limb and an important use of the hip joint as a kinetic strategy of progression the body forward, replacing the ankle, which proved to be the most affected joint. The main results of Study 2 showed the same significant changes in the pattern of the ankle kinematics during propulsion phase, even in the absence of neuropathy. However, there was no difference between the kinetic patterns in early and advanced stages of the disease, but showed the same trend observed ...

Sistema de auxílio aos diagnósticos de enfermagem para vítimas detrauma no atendimento avançado pré-hospitalar móvel utilizando asTaxonomias NANDA e NIC / Computer-aided diagnosis system to the nursing diagnosis of trauma victims in mobile pre-hospital careusing the NANDA and NIC Taxonomies

Uma das metodologias habituais para elaboração do Diagnóstico de Enfermagem é a utilização de consulta manual à taxonomia NANDA (North American Nursing Diagnosis Association), quase sempre argumentada como morosa e de difícil aplicabilidade prática. Contudo, para auxiliar no processo de diagnóstico em enfermagem, principalmente em situações de emergência é viável a utilização de uma ferramenta computacional, que pode reduzir o período para sua efetivação, permitindo ao enfermeiro disponibilizar mais tempo para o cuidado humanizado ao paciente vítima de trauma. O objetivo desse trabalho é desenvolver um sistema de auxílio à tomada de decisão sobre os diagnósticos de enfermagem em vítimas de trauma no atendimento avançado pré-hospitalar móvel considerando a Taxonomia NANDA (North American Nursing Diagnoses Association), bem como propor a intervenção a ser realizada baseando-se na NIC (Nursing Interventions Classification). Para o desenvolvimento da aplicação utilizou-se o sistema operacional Windows XP Professional, a linguagem de programação PHP (Hypertext Preprocessor) e o servidor Web Apache HTTP Server. Todavia, os dados foram gerenciados pelo Sistema Gerenciador de Banco de Dados Oracle Enterprise Edition release 8.1.7. Para validar o sistema realizou-se uma avaliação qualitativa com usuários. Os resultados apresentados indicam que as informações são gerenciadas e armazenadas corretamente, bem como o tempo de retorno das informações é ideal, tanto para a consulta do diagnóstico como para a consulta das intervenções. Assim, é possível concluir que o sistema implementado é viável aos profissionais de enfermagem, contribuindo na otimização do tempo despendido para a elaboração do diagnóstico de enfermagem de clientes vítimas de trauma.

One of the methodologies in Nursing Diagnosis makes use of manual search through the NANDA taxonomy (North American Nursing Diagnoses Association), which is regarded as time-consuming and difficult to use in practice. However, in order to help conduct nursing diagnosis, particularly in the case of emergencies, the use of computers to assist the process is viable, which may limit manual search and allow the nurse to dedicate extra time to more humanized care to trauma victims. This study aims to develop an auxiliary system to decision-making in the nursing diagnosis of trauma victims in mobile pre-hospital care using the NANDA taxonomy as well as to recommend the applicable intervention according to the NIC (Nursing Interventions Classification). The Windows XP Professional operating system was used in the development of the software written in PHP (Hypertext Preprocessor). In addition, the Apache HTTP web server and the Oracle Enterprise Edition release 8.1.7 database manager have been used. In order to validate the system, users completed a qualitative assessment of the application. The findings show that information is stored and handled correctly, and that the time used to retrieve information is short in searches for both diagnoses and interventions. Thus, it is possible to conclude that the implemented system is beneficial to nursing professionals, contributing to the optimization of the time required to complete diagnosis and to plan nursing interventions concerning trauma patients.

The use of expert systems on the differential diagnosis of urinary incontinence / Uso de sistemas especialistas para o diagnóstico diferencial de incontinência urinária / Uso de los sistemas especialistas en el diagnóstico diferencial de la incontinencia urinaria

The differential diagnosis of urinary incontinence classes is sometimes difficult to establish. As a rule, only the results of urodynamic testing allow an accurate diagnosis. However, this exam is not always feasible, because it requires special equipment, and also trained personnel to lead and interpret the exam. Some expert systems have been developed to assist health professionals in this field. Therefore, the aims of this paper are to present the definition of Artificial Intelligence; to explain what Expert System and System for Decision Support are and its application in the field of health and to discuss some expert systems for differential diagnosis of urinary incontinence. It is concluded that expert systems may be useful not only for teaching purposes, but also as decision support in daily clinical practice. Despite this, for several reasons, health professionals usually hesitate to use the computer expert system to support their decision making process.

O diagnóstico diferencial dos tipos de incontinência urinária é algumas vezes difícil de estabelecer. Via de regra, somente os resultados de exames urodinâmicos permitem um diagnóstico acurado. Entretanto, esse exame nem sempre é factível, porque requer equipamento especial e também pessoal treinado para realizar e interpretar o exame. Alguns sistemas especialistas têm sido desenvolvidos para assistir profissionais que atuam nessa área. Propõe-se aqui apresentar a definição de inteligência artificial; explicar o que são sistemas especialistas, sistemas de apoio à decisão e sua aplicação na área da saúde e, discutir alguns sistemas especialistas desenvolvidos para o diagnóstico diferencial da incontinência urinária. Conclui-se que esses sistemas podem ser úteis não somente para o ensino, mas também como apoio à decisão na prática clínica diária. A despeito disso, por várias razões, os profissionais de saúde usualmente hesitam em usar o sistema especialista computacional para dar suporte ao processo de decisão.

El diagnóstico diferencial de los tipos de incontinencia urinaria es algunas veces difícil. En general, solamente los resultados de exámenes urodinâmicos permiten uno diagnóstico preciso. Entretanto, no es siempre posible hacer ése examen porque requiere equipo especial y personal entrenado hacia realizar y interpretar lo examen. Sistemas especialistas tienen sido hechos hacia asistir los profesionales de salud en ese campo. Propone-se presentar aquí lo que es inteligencia artificial; explicar lo que son sistemas especialistas, sistemas hacia apoyo a la decisión y suya aplicación en el área de la salud y discutir sistemas especialistas hacia el diagnóstico diferencial de la incontinencia. Concluye-se que los sistemas especialistas puedan ser usados no solamente hacia la enseñanza, mas también como apoyo a la decisión en la práctica clínica. A pesar de eso, por varias razones, profesionales de salud usualmente resisten en emplear el sistema especialista computacional hacia dar soporte al proceso de decisión.

Sistema baseado em conhecimento para apoio à identificação dos focos do processo corporal da CIPE® / Sistema basado en el conocimiento de apoyo a la identificación de los focos de CIPE® / Knowledge- based CIPE® outbreak identification support systems

A CIPE® vem se consolidando no cenário mundial como um sistema unificado da linguagem de enfermagem, que permite ao enfermeiro documentar sistematicamente a prática assistencial. Demanda para sua maior utilização ferramentas facilitadoras que favoreçam sua incorporação nas ações diárias dos profissionais. O objetivo deste estudo é descrever a concepção e desenvolvimento de um sistema baseado em conhecimento de apoio para a identificação dos focos da CIPE®. Trata-se de um estudo híbrido que contemplou o desenvolvimento do sistema e pesquisa para validação do conteúdo. O sistema é constituído por 219 regras de produção, relacionadas aos focos do processo corporal, com perguntas de interface formuladas de forma semelhante àquela utilizada pelo enfermeiro, quando da elaboração do histórico de enfermagem. Obteve-se 88,43 por cento no Índice de Validade de Conteúdo. Acredita-se que o sistema proposto contribuirá para que o valor do conhecimento trazido pela CIPE® seja realçado e disseminado aos atores que dela necessitam.

CIPE® has been consolidating itself worldwide as a unified nursing language system, and thus allows nurses to systematically document their care practice. Increased use of CIPE® demands facilitating tools which favor its incorporation into daily nursing actions. The aim of this study is to describe the design and development of a knowledge-based system used to support the identification of CIPE® outbreaks. This is a hybrid study that included the development of the system and research for content validation. The system consists of 219 production rules in relation to outbreaks of the body process, with questions raised in an interface similar to that used by nurses when preparing the history of nursing. It obtained an 88.43 percent Content Validity Index. It is believed that the proposed system will contribute to the value of knowledge brought by CIPE ® and will be highlighted and disseminated to actors who need it.

El CIPE® se ha consolidado en el mundo como un sistema unificado del lenguaje de la enfermería, permitiendo que el enfermero documente de forma sistemática la práctica asistencial. El sistema demanda para su mejor utilización herramientas que promuevan su incorporación en las actividades diarias de los profesionales. El objetivo de este estudio es describir el diseño y desarrollo de un sistema basado en el conocimiento para apoyar la identificación de los focos del CIPE®. Se trata de un estudio híbrido que incluye el desarrollo del sistema y la investigación para la validación de contenido. El sistema consta de 219 normas de producción relacionadas a los focos del proceso, con preguntas planteadas en una interfaz similar a la utilizada por los enfermeros durante la elaboración de la historia de enfermería. Se obtuvo el 88, 43 por ciento en el Índice de Validez del Contenido. Se cree que ese sistema contribuirá para que el valor de los conocimientos presentados por CIPE® sea destacado y difundido a los que lo necesitan.

Avaliação de um sistema especialista em diagnóstico de enfermagem relacionados à eliminação urinária / Evaluación de un sistema especialista en diagnósticos de enfermeria relacionados a la eliminiación urinária / Evaluation of an expert system on nursing diagnoses related to urinary elimination

Foi desenvolvido e avaliado um sistema especialista em diagnósticos de enfermagem relacionados à eliminação urinária, segundo a taxionomia da NANDA. Para coleta de dados utilizou-se um roteiro e um checklist com as características definidoras. Os diagnósticos obtidos por consenso entre três especialistas foram considerados padrão-ouro. Foram testados 197 casos. O Sistema mostrou ser adequado para a determinação dos diagnósticos 'incontinência urinária (IU) por pressão', 'IU por impulso', 'retenção urinária ' e 'IU total', com sensibilidade e especificidade superiores a 98 por cento. A pequena casuística não possibilitou avaliar a acurácia em relação à 'eliminação urinária prejudicada', 'IU reflexa' e 'IU funcional'. Esta experiência de desenvolvimento e avaliação poderá ser aplicada na criação de outros sistemas especialistas.

An expert system on nursing diagnoses related to urinary elimination, according NANDA's taxonomy, was developed and evaluated. Data were collected using a form and a checklist of defining characteristics. The obtained consensus diagnoses by three specialists were considered gold standard. 197 cases were tested. The system proved to be adequate for determining diagnoses such as 'stress urinary incontinence', 'urge urinary incontinence', 'urinary retention' and 'total urinary incontinence' with sensitivity and specificity above 98 percent. The accuracy evaluation in relation to 'impaired urinary elimination', 'reflex urinary incontinence' and 'functional urinary incontinence' was not possible to be established due to the small size of the sample. The experience in developing and evaluating this program can be applied in creating other expert systems.

Fue desarrollado y avaluado un sistema especialista en diagnósticos relacionados a la eliminación urinaria, usando la taxonomia de NANDA. Para colectar los datos fue utilizado un programa de entrevista y un checklist conteniendo las características definidoras. Los diagnósticos obtenidos por concordancia de tres especialistas fueron considerados como prototipo-oro. Fueran testados 197 casos. El sistema desarrollado, mostró ser adecuado en la determinación de los diagnósticos 'incontinencia urinaria por presión', 'incontinencia urinaria por impulso', 'retención urinaria' e 'incontinencia urinaria total' con sensibilidad y especificidad superior a 98 por ciento. Debido a pequeña casuística, no fue posible avaluar los diagnósticos 'eliminación urinaria perjudicada', 'incontinencia urinaria refleja' e 'incontinencia urinaria funcional'. Esta experiencia de desenvolvimiento e avaluación podrá ser aplicada en la creación de otros sistemas.

Sistema inteligente para auxílio ao diagnóstico no monitoramento fetal eletrônico por análise de cardiotocografias / A computer aided diagnostic intelligent system for electronic fetal monitoring based on cardiotocographies

A análise acurada da frequência cardíaca fetal (FCF) correlacionada com as contrações uterinas permite diagnosticar, e consequentemente antecipar, diversos problemas relativos ao bem estar fetal e à preservação de sua vida. O presente trabalho apresenta os resultados de um sistema híbrido, baseado em regras determinísticas e em um módulo de inferência nebuloso do tipo Mamdani, para análise de sinais coletados através de exames denominados cardiotocografias (CTG). As variáveis analisadas são: o valor basal da FCF, suas variabilidades de curto e de longo prazo, acelerações transitórias e desacelerações, sendo estas classificadas por seu tipo e número de ocorrências. São utilizados dois modelos de classificação. A saída do sistema, em qualquer dos modelos, é um diagnóstico de primeiro nível baseado nestas variáveis de entrada. O sistema inteligente para auxílio ao diagnóstico no monitoramento fetal eletrônico por análise de cardiotocografias (SISCTG) foi desenvolvido na linguagem de scripts do programa MATLAB® v.7. O projeto conta também com uma parceria multi-institucional entre o Brasil e a Alemanha, envolvendo o Departamento de Engenharia de Teleinformática (DETI) da Universidade Federal do Ceará (UFC), a Maternidade-Escola Assis Chateaubriand (MEAC), a Technische Universitãt München e a empresa alemã Trium GmbH, que fornece a base de dados utilizada neste trabalho. Os resultados apresentados pelo SISCTG mostram-se promissores, com um índice de acertos (comparando-se os dois modelos utilizados) variando de 83% a 100%, de acordo com o tipo de diagnóstico. Isto permite projetar o aprimoramento deste sistema com novas variáveis de entrada (como a entropia aproximada da FCF e da sua variabilidade). A validação do sistema contou com especialistas brasileiros e alemães na área obstétrica.

The accurate analysis of the fetal heart rate (FHR) and its correlation with uterine contractions (UC) allow the diagnostic and the anticipation of many problems related to fetal distress and the preservation of its life. This paper presents the results of a hybrid system based on a set of deterministic rules and fuzzy inference system developed to analyze FHR and UC signals collected by cardiotocography (CTG) exams. The studied variables are basal FHR, short and long-term FHR variability, transitory accelerations and decelerations, these lasts classified by their type and number of occurrences. Two classification models are used. For both models, the system output is a first level diagnostic based on those input variables. The system is developed using the MATLAB® v.7 script language. The project is also supported by a multi-institutional agreement between Brazil and Germany, among the DETI (Departamento de Engenharia de Teleinformática of the Universidade Federal do Ceará), the MEAC (Maternidade-Escola Assis Chateaubriand), the TUM (Technische Universitãt München), and the Trium GmbH, a German company who supplied the database used in this project. The results are very promising with a diagnostic accuracy (considering the two models used) varying from 83% to 100%, according to the type of diagnostic. These results allow the projection of refinements of the proposed system, inserting new input variables (such as the approximate entropy of the FHR and its variability). The system validation methodology was based on the knowledge of Brazilian and German obstetricians.