Enhancing reasoning through reduction of vagueness using fuzzy OWL-2 for representation of breast cancer ontologies.

The need to address the challenge of vagueness across several domains of applicability of ontology is gaining research attention. The presence of vagueness in knowledge represented with description logic impairs automating reasoning and inference making. The importance of reducing this vagueness in the formalization of medical knowledge representation is rising, considering the vulnerability of this domain to the expression of vague concepts or terms. This vagueness may be addressed from the perspective of ontology modeling language application such as ontology web language (OWL). Although several attempts have been made to tackle this problem in other disease prognoses such as diabetes and cardiovascular diseases, a similar effort is missing for breast cancer. Minimizing vagueness in breast cancer ontology is necessary to enhance automated reasoning and handle knowledge representation problems. This study proposes a framework for reducing vagueness in breast cancer ontology. The approach obtained breast cancer crisp ontology and applied fuzzy ontology elements based on the Fuzzy OWL2 model to formulate breast cancer fuzzy ontology. This was achieved by extending the elements of OWL2 (a more expressive version of OWL) with annotation properties to fuzzify the breast cancer crisp ontology. Results obtained showed a significant reduction of vagueness in the domain, yielding 0.38 for vagueness spread and 1.0 for vagueness explicitness. In addition, ontology metrics such as completeness, consistency, correctness and accuracy were also evaluated, and we obtained impressive performance. The implication of this result is the reduction of vagueness in breast cancer ontology, which provides increased computational reasoning support to applications using the ontology.

Implementing Patient-Directed Cancer Education Materials Across Nigeria.

PURPOSE: As access to cancer care expands in low-income countries, developing tools to educate patients is paramount. We took a picture booklet, which was initially developed by the nonprofit Global Oncology for Malawi and Rwanda, and adapted it for use in Nigeria. The primary goal was to assess acceptability and provide education. The secondary goals were (1) to describe the collaboration, (2) to assess knowledge gained from the intervention, (3) to assess patient understanding of their therapy intent, and (4) to explore patient's experiences via qualitative analysis. METHODS: We piloted the original English booklet at a single site and requested feedback from patients and providers. The booklet was updated; translated into Hausa, Yoruba, Igbo, and Pidgin English; and used at three additional sites. For the three-site cohort, we collected basic demographics, pretest and post-test assessing content in the booklet, and performed a qualitative analysis. RESULTS: The original booklet was widely acceptable and recommended by patients at site one (n = 31) and by providers (N = 26) representing all four sites. In the three-site cohort (n = 103), 94% of patients recommended the booklet. An immediate post-test focusing on when patients should present to care showed a statistically significant improvement in one of the seven questions. Fifty-one percent of the patients (n = 103) knew their treatment intent (curative v palliative). Qualitative analysis highlighted that the patient's thoughts on cancer are dominated by negative associations, although curability and modern therapy are also frequently cited. CONCLUSION: We adapted an educational booklet to a novel context and had it delivered by local partners. The booklet was widely recommended to future patients. The booklet had an impact on patient's knowledge of cancer treatment, potentially allowing for decreased abandonment.

Hepatitis C treatment and SVR: the gap between clinical trials and real-world treatment aspirations.

OBJECTIVE: Despite the remarkable improvements in pharmacologic treatment efficacy for hepatitis C (HCV) reported in published clinical trials, published research suggests that, in "real-world" patient care, these medical outcomes may be difficult to achieve. This review was undertaken to summarize recent experience in the treatment of HCV in clinical settings, examining the course of patients through the stages of treatment and barriers to treatment encountered. METHOD: A comprehensive and representative review of the relevant literature was undertaken to examine HCV treatment experience outside of clinical trials in the last decade. This review found 25 unique studies with data on course of treatment and/or barriers to treatment in samples of patients with HCV not preselected for inclusion in clinical trials. RESULTS: Results were examined separately for samples selected for HCV infection versus HCV/HIV coinfection. Only 19% of HCV-selected and 16% of HCV/HIV-coinfection selected patients were considered treatment eligible and advanced to treatment; even fewer completed treatment (13% and 11%, respectively) or achieved sustained virologic response (3% and 6%, respectively). Psychiatric and medical ineligibilities were the primary treatment barriers. CONCLUSION: Only by systematically observing and addressing potentially solvable medical and psychosocial barriers to treatment will more patients be enrolled in and complete HCV therapy.

The use of psychoeducation for a patient with hepatitis C and psychiatric illness in preparation for antiviral therapy: a case report and discussion.

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48 weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50 year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.

Superficial skin ulcers.

OBJECTIVE: To determine the underlying cause of superficial skin ulcers over a 15-year period. METHODS: A retrospective histopathological analysis of 670 cases of superficial skin ulcers diagnosed in the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from January 1991 to December 2005. RESULTS: A total of 670 superficial skin ulcers were analyzed. The male to female gender ratio was 409:261(1.5:1.0) and a peak age frequency of 44.3% (297) in the 5th and 6th decades. Spectrum of lesions encountered was categorized into inflammatory, infections, benign and malignant diseases. The malignant lesions were 309 (46.1%), non-specific inflammation 302 (45.1%), granulation tissue 25 (3.7%) and pseudoepitheliomatous hyperplasia 14 (2.1%). A total of 18 (2.7%) specific infections were encountered, which included bacterial, fungal and viral infection. Benign lesions were 2 (0.3%), comprising of neurofibroma and Bowen's disease. The most common malignant lesion was squamous cell carcinoma 203 (30.3%) with a male to female ratio of 128:75 (1.7:1.0). Of these, 161 were well-differentiated tumors. The lower limb was the prevalent site distribution of all the ulcers. CONCLUSION: Superficial ulcers may be harbinger of malignant diseases. Squamous cell carcinoma remains the most common malignant lesion arising from chronic superficial ulcers in our setting. Adequate tissue biopsy and early diagnosis may reduce the attendant morbidity of these ulcers.