Fuzzy ARTMAP and a hybrid chaos genetic algorithm for medical pattern classification

In this paper, an Evolutionary Artificial Neural Network (EANN), which combines the Fuzzy ARTMAP (FAM) neural network and a hybrid Chaos Genetic Algorithm (CGA), is proposed for undertaking pattern classification tasks. The hybrid CGA is a modified version of the hybrid real-coded genetic algorithms that includes a Chaotic Mapping Operator (CMO) in its search and adaptation process. It is used to evolve the connection weights in FAM, and the resulting EANN is known as FAM-hybrid CGA. The CMO in the hybrid CGA is used to generate a group of chromosomes that incorporates the characteristics of chaos. The chromosomes are then adapted with an arbitrary small amount of variation in every generation. As the evolution procedure proceeds, chromosomes with considerable differences are produced. Such chromosomes, which are located at different regions of interest in the solution space, are able to provide good solutions to undertake search and adaption problems. The effectiveness of the proposed FAM-hybrid CGA model is first evaluated using benchmark medical data sets from the UCI machine learning repository. Its applicability to medical decision support is then demonstrated using a real database of patient records with suspected Acute Coronary Syndrome. The results indicate that FAM-hybrid CGA is able to outperform its neural network counterpart (i.e., FAM), and it can be employed as a useful pattern classification tool for tackling medical decision support tasks.

General medical practitioners’ knowledge and beliefs about osteoporosis and its investigation and management

Summary This qualitative study explored beliefs and attitudes regarding osteoporosis and its management. General medical practitioners (GPs) were ambivalent about osteoporosis due to concern about financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered investigation and treatment in the context of patients' whole lives.

Purpose We aimed to investigate barriers, enablers, and other factors influencing the investigation and management of osteoporosis using a qualitative approach. This paper analyses data from discussions with general medical practitioners (GPs) about their beliefs and attitudes regarding osteoporosis and its management.

Methods Fourteen GPs and two practice nurses aged 27–89 years participated in four focus groups, from June 2010 to March 2011. Each group comprised 3–5 participants, and discussions were semi-structured, according to the protocol developed for the main study. Discussion points ranged from the circumstances under which GPs would initiate investigation for osteoporosis and their subsequent actions to their views about treatment efficacy and patient adherence to prescribed treatment. Audio recordings were transcribed and coded for analysis using analytic comparison to identify the major themes.

Results The GPs were not particularly concerned about osteoporosis in their patients or the general population, ranking diabetes, osteoarthritis, cardiovascular disease, and hypertension higher than concern about osteoporosis. They expressed confidence in the efficacy of anti-fracture medications but were concerned about the potential financial burden on patients with limited incomes. The GPs were unsure about guidelines for investigation and management of osteoporosis in men and the appropriate duration of treatment, particularly for the bisphosphonates in all patients.

Conclusions The GPs' ambivalence about osteoporosis appeared to stem from structural factors such as financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered the impact of investigating and prescribing treatment in the context of patients' whole lives.

Application of an Adaptive Neural Network to Medical Decision Support

Medical diagnostic and prognostic problems are prime examples of decision making in the face of uncertainty. In this paper, we investigate the applicability of the Fuzzy ARTMAP neural network as an intelligent decision support system in clinical medicine. In particular, Fuzzy ARTMAP is employed as a predictive model for prognosis of complications in patients admitted to the Coronary Care Units. A number of off-line and on-line experiments have been conducted with various network parameter settings, training methods, and learning rules. The results are compared with those from other systems including the logistic regression model. In addition, the outcomes of a set of on-line learning experiments revealed the potential of employing Fuzzy ARTMAP as an autono-mously learning system that is able to learn perpetually and, at the same time, to provide useful decision support.

A mystery to the medical world : Florence Nightingale, Rosendo Salvado and the risk of civilisation

In 1860 Florence Nightingale conducted a study on the mortality rates of indigenous children attending native colonial schools across the British Empire. Her study was driven by the question: ‘Can we civilise the natives without killing them?’ One colonial school that participated in the survey was New Norcia Benedictine mission in Western Australia. When Rosendo Salvado, the mission’s superintendent, responded, he drew on his daily encounters with the Yuat people, his statistics on the mission residents and his Benedictine philosophy of civilisation and conversion of colonised peoples. The correspondence between Salvado and Nightingale took place in the climate of intense debates about Aboriginal health, colonisation and extinction in Britain and the colonies. While many settlers and colonial observers understood Aboriginal depopulation to be the result of either the vices and diseases of unprincipled Europeans or an unstoppable destiny, whether Divine Providence or natural selection, Nightingale and Salvado shared a belief in practical solutions to what they understood to be a practical problem. Their collaboration is an example of the humanitarian opposition to the racial pessimism of Social Darwinism. They both sought to use the recently influential intellectual discipline of social statistics to support their conviction that Aborigines, if patiently and carefully handled, would survive the admittedly risky process of civilisation.

Medical evidence in child sexual assault cases

Purpose – Previous studies suggest that the presence of medical evidence is rare in child sexual assault (CSA) cases, and if present at all, such evidence is unlikely to identify a specific assailant. This study aims to examine the role medical evidence plays in criminal cases of CSA. Specifically, the prevalence of medical evidence in CSA cases, its impact on decisions to prosecute CSA cases, as well as its effect on conviction rates are examined.

Design/methodology/approach – A systematic literature review was conducted on the impact of medical evidence in criminal child sexual abuse (CSA) cases.

Findings – The results of the review suggest medical evidence increases the likelihood of prosecution; however the impact of medical evidence on conviction rate is equivocal.

Research limitations/implications – The implications of these findings for legal and psychological practice, government policy and future areas for academic research are discussed.

Originality/value – To the authors' knowledge, no other review has systematically examined the role of medical evidence on the prosecution and conviction of CSA cases.

Implementing scanned medical record systems in Australia : a structured case study on envisioned changes to elective admissions process in a Victorian hospital

In recent years, influenced by the pervasive power of technology, standards and mandates, Australian hospitals have begun exploring digital forms of keeping this record. The main rationale is the ease of accessing different data sources at the same time by varied staff members. The initial step in this transition was implementation of scanned medical record systems, which converts the paper based records to digitised form, which required process flow redesign and changes to existing modes of work. For maximising the benefits of scanning implementation and to better prepare for the changes, Austin Hospital in the State of Victoria commissioned this research focused on elective admissions area. This structured case study redesigned existing processes that constituted the flow of external patient forms and recommended a set of best practices at the same time highlighting the significance of user participation in maximising the potential benefits anticipated. In the absence of published academic studies focused on Victorian hospitals, this study has become a conduit for other departments in the hospital as well as other hospitals in the incursion.