Health Informatics Assignment Week 19 to 21

Week 19 Questions

With the advent of full-text searching, should the National Library of Medicine abandon human indexing of citations in MEDLINE? Why or why not?

Explain why you think PMC is or is not a good idea.

How would you aggregate the clinical evidence-based resources described in the chap-ter into the best digital library for clinicians?

Devise a curriculum for teaching clinicians and patients the most important points about searching for healthrelated information.

Find a consumer-oriented Web page and determine the quality of the information on it.

What are the limitations of recall and precision as evaluation measures and what alternatives would improve upon them?

Select a concept that appears in two or more clinical terminologies and demonstrate how it would be combined into a record in the UMLS Metathesaurus.

Describe how you might devise a system that achieves a happy medium between of intellectual property and barrier-free access to the archive of science.

Week 20 Questions

Questions

Researchers in medical AI have argued that there is a need for more expert knowledgein medical decision-support systems, but developers of Bayesian systems have argued that expert estimates of likelihoods are inherently flawed and that advice programs must be based on solid data. How do you account for the apparent difference between these views? Which view is valid? Explain your answer.

Explain the meaning of Internist-1/QMR’s frequency weights and evoking strengths.What does it mean for a finding to have a frequency weight of 4 and an evoking strength of 2? How do these parameters relate to the concepts of sensitivity, specificity, and predictive value that were introduced in Chapters 2 and 3?

Let us consider how deDombal and other developers of Bayesian systems have usedpatient-care experience to guide the collection of statistics that they need. For example, consider the database in the following table, which shows the relationship between two findings (f₁and f₂) and a disease (D) for 10 patients.

Patient	f1	f2	D	,D
1	0	1	0	1
2	0	1	1	0
3	0	1	0	1
4	1	1	1	0
5	1	1	1	0
6	1	1	0	1
7	1	0	1	0
8	1	1	1	0
9	1	0	0	1
10	1	1	1	0

In the table, ,D signifies the absence of disease D. A 0 indicates the absence of a finding or disease, and a 1 indicates the presence of a finding or disease. For example, based on the above database, the probability of finding f1 in this population is 7/10570 percent.

Refer back to Chapters 2 and 3 as necessary in answering the following questions:

What are the sensitivity and specificity of each of f1 and f2 for the disease D? What is the prevalence of D in this 10-person population?

Use the database to calculate the following probabilities:

p[f₁uD]

p[f₁u,D]

p[f₂uD]

p[f₂u,D]

p[D] p[,D]

Use the database to calculate p[Duf₁and f₂].

Use the probabilities determined in b to calculate p[Duf1 and ,f2] using a heuristicmethod that assumes that findings f1 and f2 are conditionally independent given a disease and the absence of a disease. Why is this result different from the one in c? Why has it generally been necessary to make this heuristic approximation in Bayesian programs?

In an evaluation study, the decision-support system ONCOCIN provided adviceconcerning cancer therapy that was approved by experts in only 79 percent of cases (Hickam et al., 1985b). Do you believe that this performance is adequate for a computational tool that is designed to help physicians to make decisions regarding patient care? What safeguards, if any, would you suggest to ensure the proper use of such a system? Would you be willing to visit a particular physician if you knew in advance that she made decisions regarding treatment that were approved by expert colleagues less than 80 percent of the time? If you would not, what level of performance would you consider adequate? Justify your answers.

A large international organization once proposed to establish an independent laboratory—much like Underwriters Laboratory in the United States—that would test medical decision-support systems from all vendors and research laboratories, certifying the effectiveness and accuracy of those systems before they might be put into clinical use. What are the possible dimensions along which such a laboratory might evaluate decision-support systems? What kinds of problems might such a laboratory encounter in attempting to institute such a certification process? In the absence of such a credentialling system for decision-support systems, how can health-care workers feel confident in using a clinical decision aid?

Week 21 Questions

What are two advantages and two limitations of including visual material in the following teaching programs:

A simulated case of a patient who is admitted to the emergency unit with a gun-shot wound

A lecture-style program on the anatomy of the pelvis

A reference resource on bacteria and fungi

You have decided to write a computer-based simulation to teach students about the management of chest pain.

Discuss the relative advantages and disadvantages of the following styles of pres-entation: (1) a sequence of multiple-choice questions, (2) a simulation in which the patient’s condition changes over time and in response to therapy, and (3) a program that allows the student to enter free-text requests for information and that provides responses.

Discuss at least four problems that you would expect to arise during the process ofdeveloping and testing the program.

For each approach, discuss how you might develop a model that you could use toevaluate the student’s performance in clinical problem solving.

Examine two clinical simulation programs. How do they differ in their presentationof history taking or physical examination of the patient?

Select a topic in physiology with which you are familiar, such as arterial blood–gasexchange or filtration in the kidney, and construct a representation of the domain in terms of the concepts and subconcepts that should be taught for that topic. Using this representation, design a teaching program using one of the following methods: (1) a didactic approach, (2) a simulation approach, or (3) an exploration approach.

Describe at least three challenges you can foresee in dissemination of computer-basedmedical education programs from one institution to another.

Discuss the relative merits and problems of placing the computer in control of the teaching environment, with the student essentially responding to computer inquiries, versus having the student in control, with a much larger range of alternative courses of action.

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