DXplain is a Clinical decision support system (CDSS) available through the World Wide Web The World Wide Web, abbreviated as WWW and W3 and commonly known as The Web, is a system of interlinked hypertext documents contained on the Internet. With a web browser, one can view web pages that may contain text, images, videos, and other multimedia and navigate between them using hyperlinks. Using concepts from earlier hypertext systems, that assists clinicians A clinic is a small private or public health facility that is devoted to the care of outpatients, often in a community, in contrast to larger hospitals, which also treat inpatients. Some grow to be institutions as large as major hospitals, whilst retaining the name clinic. These are often associated with a hospital or medical school by generating stratified diagnoses Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships. Below are given as examples and tools used by based on user input of patient signs and symptoms, laboratory results, and other clinical findings [1]. Evidential In linguistics, evidentiality is, broadly, the indication of the nature of evidence for a given statement, that is, whether evidence exists for the statement and/or what kind of evidence exists. An evidential is the particular grammatical element (affix, clitic, or particle) that indicates evidentiality. Languages with only a single evidential support for each differential diagnosis A differential diagnosis is a systematic method used to identify unknowns. This method, essentially a process of elimination, is used by taxonomists to identify living organisms, and by physicians or other clinicians to diagnose the specific disease in a patient is presented, along with recommended follow-up that may be conducted by the clinician to arrive at a more definitive diagnosis Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships. Below are given as examples and tools used by. The system also serves as a clinician reference with a searchable database A Database is an integrated collection of logically related records or files consolidated into a common pool that provides data for one or more multiple uses. One way of classifying databases involves the type of content, for example: bibliographic, full-text, numeric, image. Other classification methods start from examining database models or of diseases and clinical manifestations.
Contents |
History
Designed by the Laboratory of Computer Science at the Massachusetts General Hospital Massachusetts General Hospital is a teaching hospital of Harvard Medical School and a biomedical research facility in Boston, Massachusetts. It is ranked as one of the top five hospitals in the USA, work on DXplain began in 1984 with a first version being released in 1986 [2]. DXplain contains a database with crude probabilities for over 4,900 clinical manifestations that are associated with over 2,200 unique diseases, yielding a total of over 230,000 unique finding-disease interconnections [2].
Educational tool
Use of DXplain as a tool for medical consultation has been common to some institutions since it fills a gap, particularly for medical students A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine in clinical rotations, that is not adequately covered by textbook literature [3]. The system's large knowledge base combined with its ability to formulate diagnostic hypotheses have made it a popular education tool for US-based medical schools; by 2005, DXplain was supporting more than 33,189 total users [4].
Methodology
DXplain generates ranked differential diagnoses A differential diagnosis is a systematic method used to identify unknowns. This method, essentially a process of elimination, is used by taxonomists to identify living organisms, and by physicians or other clinicians to diagnose the specific disease in a patient using a pseudo-probabilistic algorithm In mathematics, computing, and related subjects, an algorithm is an effective method for solving a problem using a finite sequence of instructions. Algorithms are used for calculation, data processing, and many other fields[5]. Each clinical finding entered into DXplain is assessed by determining the importance of the finding and how strongly the finding supports a given diagnosis for each disease in the knowledge base A knowledge base is a special kind of database for knowledge management, providing the means for the computerized collection, organization, and retrieval of knowledge. Using this criterion, DXplain generates ranked differential diagnoses with the most likely diseases yielding the lowest rank. Using stored information regarding each disease’s prevalence and significance, the system differentiates between common and rare diseases.
Accuracy
Analysis of accuracy has shown promise in DXplain and similar clinical decision support systems. In a preliminary trial investigation of 46 benchmark cases with a variety of diseases and clinical manifestations, the ranked differential diagnoses generated by DXplain were shown to be in alignment with a panel of five board-certified physicians [6]. In another study investigating how well decision support systems work at responding to a bioterrorism Bioterrorism is terrorism by intentional release or dissemination of biological agents ; these may be in a naturally-occurring or in a human-modified form event, an evaluation of 103 consecutive internal medicine Internal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called, "internists". Elsewhere, especially in Commonwealth cases showed that Dxplain correctly identified the diagnosis in 73% of cases, with the correct diagnosis averaging a rank of 10.7 [7].
Clinical usage
Despite its usage in clinician training, similar to other clinical decision support systems, DXplain has not expanded beyond the research laboratory or medical training setting, due in part to a lack of support by clinicians A clinic is a small private or public health facility that is devoted to the care of outpatients, often in a community, in contrast to larger hospitals, which also treat inpatients. Some grow to be institutions as large as major hospitals, whilst retaining the name clinic. These are often associated with a hospital or medical school in real-world settings [8].
References
- ^ Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain. An evolving diagnostic decision-support system. JAMA. 1987 Jul 3;258(1):67-74.
- ^ a b MGH Laboratory of Computer Science – projects – dxplain,” Laboratory of Computer Science, Massachusetts General Hospital. 2007.
- ^ London S. DXplain: a Web-based diagnostic decision support system for medical students. Med Ref Serv Q. 1998 Summer;17(2):17-28.
- ^ Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT. 2005.
- ^ Detmer WM, Shortliffe EH. Using the Internet to Improve Knowledge Diffusion in Medicine. Communications of the Association of Computing Machinery. 1997; 40(8):101-108. 1997.
- ^ Feldman MJ, Barnett GO. An approach to evaluating the accuracy of DXplain. Comput Methods Programs Biomed. 1991 Aug;35(4):261-6.
- ^ Bravata DM, Sundaram V, McDonald KM, Smith WM, Szeto H, Schleinitz MD, et al. Detection and diagnostic decision support systems for bioterrorism response. Emerg Infect Dis. 2004 Jan.
- ^ Coiera E. Guide to Health Informatics: 2nd Edition. Arnold, 2003; 332-343.
External links
Categories: Medical informatics Categories: Medicine | Health care informatics | Medical research | Medical law | Health software
768px x 1024px | 36.10kB
[source page]
Click here for examples of a Dxplain search Screen 1 Screen 2 Screen 3 Screen 4 Return to Table of Contents
K. Houston
hu, 20 Mar 2008 03:14:00 GM
DXplain. is a decision support system which uses a set of clinical findings (signs, symptoms, laboratory data) to produce a ranked list of diagnoses which might explain (or be associated with) the clinical manifestations. ...
