Design of a computer-assisted anticoagulant dosing system

At the moment current anticoagulation dosing computer programs use of relatively simple algorithms and provide a useful dose proposal in about half the cases. In the other cases medical staff has to come up with a dose and a return date. This thesis investigates the possibilities of supporting medical staff in anticoagulant dosing by extending current computer programs. Research has been done for improving the current algorithms and incorporating expert knowledge in a computer system. A literature survey showed that a lot of effort already has been made in improving algorithms. The ICAD seems to be the most promising, but still fails in about 20% of the cases to provide a dose or return date, mostly due to special circumstances. My aim was to find out whether the medical expert's knowledge was retrievable and if it was suitable for developing an expert system. Therefore I interviewed dosage doctors and dosage advisors in two Thrombosis Service Departments. The majority of the interviews were held at Star-MDC in Rotterdam, where I work as a Laboratory Manager. A couple of interviews were also held at Saltro, a comparable organization in Utrecht. Knowledge elicitation and representation techniques were applied and a prototype was developed. Further interviews were held, based on the prototype and a OODA-Loop technique. A lot of existing protocols at the Thrombosis Service organizations seemed to be suitable for converting in IF-THEN rules, as a basis for a rule-based expert system. Also the reasoning process of the relative low complex cases are obtainable in an expert system. This is specifically interesting, because the low complex cases are the majority of cases that have to be reviewed by medical staff.MediamaticsElectrical Engineering, Mathematics and Computer Scienc