Nutritional Diagnosis Presentation

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Developing a Rule-based Expert System according to ADA’s Nutritional Care Process for Nutritional Diagnosis 台北醫學大學醫學資訊研究所 研究生:陳昱全 G158097008 指導教授:徐建業 老師 共同指導教授:劉 立 老師

Topics  Introduction • Literature Review  Proposed Research Methods and Design  Live Demo of the progress so far  Expected Difficulties  Expected Results  References

Introduction  Research Background • Gov’t Research project (DOH) • Assoc. Prof. Sherry Yang  Research Motivation • The importance of developing a national standard for dietetics in Taiwan. • To assist dietetics in making decisions for nutritional diagnosis. • To provide a tool for dietetics professionals for decision making while making a diagnosis.

Nutrition Diagnosis  Nutrition Diagnosis is the second step in the Nutritional Care Process (NCP) defined by the American Dietetics Association in Aug 2003.  Nutrition Diagnosis • Definition: A food and nutrition professional’s identification and labeling of an existing nutrition problem that the food and nutrition professional is responsible for treating independently.  NCP includes 4 separate but interconnected steps • Nutrition Assessment • Nutrition Diagnosis • Nutrition Intervention • Nutrition Monitoring and Evaluation (2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Nutrition Diagnosis Outcomes  Nutrition Diagnosis PESS Statement • Problem ( Diagnostic Label ) • Etiology ( Cause/contributing factors ) • Signs/Symptoms ( Defining characteristics )  A well written PESS statement should be • Clear and concise • Specific to one patient • Limited to one problem • Based on signs and symptoms from assessment data

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Nutrition Diagnosis Outcomes

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Expert System  A computer program that provides expert-level solutions to important problems. • Heuristic • Transparent • flexible  Attempt to imitate expert reasoning processes and knowledge in solving specific problem.  Most popular applied AI technology • Enhance productivity • Augment work forces  Expert System do not replace Experts, but they • Make their knowledge and experience more widely available • Permit non-experts to work better

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Expert System - Expertise  The extensive, task specific knowledge acquired from training, reading, and experience • Theories • Procedures (Rules) • Facts  Enable experts to be better and faster than nonexperts  Expertise is usually associated with vast quantity of knowledge.  Expert knowledge is well stored, organized and provides a way for easy retrieval from an expert.  Experts have excellent memory.

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Human Experts        

Recognize and formulate the problem Solve problems quickly and properly Explain the solution Learn from experience Restructure knowledge Break rules Determine relevance Degrade

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Transferring Expertise  Objective of an expert system • To transfer expertise from experts to a computer system  Activities • Knowledge acquisition • Knowledge representation • Knowledge inferencing (Reasoning/Thinking ) • Knowledge transfer to the user  Knowledge is stored in a knowledge base • Facts • Rules( Procedures )

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Two knowledge Types  Facts • Format: The of is • Example: “The BMI of patient number 1 is 24”  Procedures (A.K.A. Rules)

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Rules  If-Then-Else statement  Example in English: • If this patient’s BMI is greater than or equal to 24 and is less than 27 • Then this patient is Over Weight • Else this patient is not over weight  Example in the proposed system: • If(NDAdmin.Models.Patient.BMI(this) >= 24 && NDAdmin.Models.Patient.BMI(this) < 27) • Then(this.AddDiagnosisToLatestVisit(2))  Explanation capability • The capability to trace the rules inferenced to form a conclusion. (2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Example of Diagnosis ES  MYCIN – analyze medical data about a patient with a severe infection. (Shortliffe, 1976) • A rule based system developed at Stanford U. in 70’s • Diagnoses the likely cause of the infection • Recommends best therapy for the patient • Contains 450 Rules, a thousand facts about medicine. Mostly about meningitis infections

(2008). "Nutrition Care Process and Model Part I: The 2008 Update.“ Journal of the American Dietetic Association 108(7): 1113-1117.

Proposed Research Methods Development Environment: OS: Windows 7 Enterprise Visual Studio 2008 SP1 .NET Framework 3.5 SP1 SQL server developer edition 2008 SP1 Hosting server: Windows 2003 server or up. Technologies used ASP.NET MVC Entity Framework Windows Workflow Rule Engine Open source projects used: Telerik Extension for ASP.NET MVC, jQuery, Castle Project – Windsor, NUnit

Proposed Research Method Database Schema

Proposed Research Method Database Schema for diagnostic rules  Diagnostic Rules are stored in the database in forms of XML

Microsoft Entity Framework  ORM( Object Relational Mapping)  Eliminate the need to manually write SQL statements  Saves a programmer a lot of time in generating all the CRUD (Create, Read, Update, Delete) codes  Code generation • Generate classes automatically from the database with relationships among classes

Computer Model

Microsoft ASP.NET MVC  An architectural pattern used in software engineering  Isolates business logic from input and presentation.  Separation of concern • To create functional parts that when created or modified, do not affect other areas of the system.  ASP.NET MVC addresses some “Separation of concern” principle in OOP(Object Oriented Programming) by separating the web development to 3 distinct areas.  Allows web applications to run faster. Traditional web form based web applications are just too “fat”.

Microsoft ASP.NET MVC  Draw backs • Learn new techniques/concepts • such as ViewData, TempData, RouteCollection, Controller Action, Linq to SQL, Lambda Expression, Custom Route, repository pattern, Inversion of control and HTML Helpers • Abandon all existing web form controls available. • Writing View Contents the Old ASP-Like Way • Unit Test Makes the Learning Curve Steeper

Windows Workflow Rule Engine  Benefits • Supports simple conditions • Supports complex RuleSets executed by a fullfeatured forward chaining rules engine • It’s FREE. It comes with .NET Framework 3.5 SP1 • It can be used stand alone, without using windows workflow.  Drawbacks • It only supports a single .NET type (class)

Live DEMO

DEMO  http://nutrition.thruhere.net  Rule Editor

Expected Difficulties  The major challenge of this research would be in acquiring and transforming dietetics knowledge and experiences into a set of rules.  The standard of nutrition diagnosis is still being defined in Taiwan. No standard coding for nutritional diagnosis.  Limitation of WF Rule engine. • It can only handle a single type. • Resulting in a less flexible system.

Expected Result  Finish developing a nutrition diagnosis expert system which eventually would help adoption of the new nutritional care process in Taiwan.  To accurately give diagnoses for a patient with given conditions.

References      





  

1. Nutrition Care Process and Model Part I: The 2008 Update. Journal of the American Dietetic Association. 2008;108(7):1113-7. 2. Nutrition Care Process Part II: Using the International Dietetics and Nutrition Terminology to Document the Nutrition Care Process. Journal of the American Dietetic Association. 2008;108(8):1287-9, 91-93. 3. Ayres EJ, Hoggle LB. ADA Nutrition Informatics Member Survey: Results and Future Steps. Journal of the American Dietetic Association. 2008;108(11):1822, 4-6. 4. Baksi D. Model checking of healthcare domain models. Computer Methods and Programs in Biomedicine. 2009;96(3):217-25. 5. Dunton GF, Atienza AA. The Need for Time-Intensive Information in Healthful Eating and Physical Activity Research: A Timely Topic. Journal of the American Dietetic Association. 2009;109(1):30-5. 6. Hakel-Smith N, Lewis NM. A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes. Journal of the American Dietetic Association. 2004;104(12):1878-84. 7. Hakel-Smith N, Lewis NM, Eskridge KM. Orientation to Nutrition Care Process Standards Improves Nutrition Care Documentation by Nutrition Practitioners. Journal of the American Dietetic Association. 2005;105(10):1582-9. 8. Hakel-Smith N, Lewis NM, Eskridge KM. Orientation to Nutrition Care Process Standards Improves Nutrition Care Documentation by Nutrition Practitioners. Journal of the American Dietetic Association. 2005;105(10):1582-9. 9. Hoggle LB, Michael MA, Houston SM, Ayres EJ. Electronic Health Record: Where Does Nutrition Fit In? Journal of the American Dietetic Association. 2006;106(10):1688-95. 10. 李蕙蓉 , DOH, Establishing and Studying the Model of Nutritional Diagnosis, 2005; 11. 彭巧珍 , 唐威莉 , DOH, Developing and Validating Nutrition Diagnosis System, 2005;

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