nutritional diagnosis presentation

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.

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


Nutrition Diagnosis Outcomes


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


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 non-experts

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.


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


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 )


Two knowledge Types Facts

• Format: The <attribute> of <object> is <value>• Example: “The BMI of patient number 1 is 24”

Procedures (A.K.A. Rules)


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.


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


Proposed Research MethodsDevelopment Environment:OS: Windows 7 EnterpriseVisual Studio 2008 SP1.NET Framework 3.5 SP1SQL server developer edition 2008 SP1

Hosting server: Windows 2003 server or up.Technologies usedASP.NET MVCEntity FrameworkWindows Workflow Rule Engine

Open source projects used:Telerik Extension for ASP.NET MVC, jQuery, Castle Project – Windsor, NUnit

Proposed Research MethodDatabase Schema

Proposed Research Method

Diagnostic Rules are stored in the database in forms ofXML

Database Schema for diagnostic rules

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 full-

featured 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

http://nutrition.thruhere.net/

http://nutrition.thruhere.net/

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;

Q & A

Thank You!

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