Some implications of the emergence and diffusion of medical expert systems

This paper has two sections. The first introduces the area of medical decision making and the use of artificial intelligence techniques for developing medical expert systems. It also briefly discusses how a physician and an expert system interact, using the INTERNIST-I system as an example. An elaboration of several technical problems which expert systems must overcome for them to be accepted and used by physicians ends this discussion. The second section considers the implications medical expert systems for physicians and patient care. It suggests that medical expert systems regulate and routinize physicians' work. Moreover, the encoding of expert knowledge in a computer program will likely demystify the practice of medicine, nullifying much of the art of medicine. Alternatively, medical expert systems may improve the physician's decision making, extend the practitioner's capabilities, and hence increase the physician's prestige. Moreover, computer aided decision making could speed diagnosis, especially for difficult cases, thus providing the doctor with time for other pursuits. However, medical expert systems will be a mixed blessing for patient care. On the one hand, they could provide expert advice in medically underserved areas, decrease the number of referrals patients and physicians must contend with, while offering expert advice to a greater number of patients. On the other hand, expert systems could further alienate patients from practitioners and from the health system in general. Even more than other medical technologies, computers in the doctor's office could increase the separation between the doctor and patient, while lowering the physician's confidence in her or his own decision making. The conclusion discusses the importance of control over work in determining the use of technology and the influence of the changing medical power structure on the use of expert systems.I thank J. Zvi Namenwirth for his careful review and thoughtful comments on this and previous drafts of this paper. I also appreciate the useful suggestions offered by anonymous reviewers of an earlier draft.     

Juvenile offender rehabilitation in Estonia: interprofessional collaboration in written assessments and specialists’ perceptions

Qualitative and quantitative research methods were used to study an interprofessional assessment model in rehabilitation services and its implementation in Estonia based on (1) a sample of rehabilitation plans for 160 juvenile offenders aged 7–18 and (2) expert interviews with 10 members of an interprofessional assessment team. Each specialist’s role was compared with the assessments. While each team member is assigned a discrete role based on discipline, in practice, the disciplines’ work overlapped considerably during the assessment process. The overlap seems to occur because team members conduct their assessments individually, rather than following the collaborative best practice model for interprofessional teams described in the literature. The expert interviews indicate that rehabilitation specialists perceive the individual-level elements of interprofessional teamwork to be consistent with the ideals articulated in the Perception of Interprofessional Collaboration Model, while the substantial overlap in assessments that occurred in practice could be related to lack of interprofessional collaboration at group and organizational levels. Recommendations to improve the functioning of teams serving juvenile offenders include establishing an interprofessional education system, increasing the flexibility of the legal framework for service provision, and improving the interprofessional assessment instrument.     

Developing Expert Systems

Summary

This article provides an overview of the general procedure and steps involved in developing expert systems. The first consideration is to select a suitable problem. Actual development of the expert system begins with formulating and representing the knowledge base. Then a programming tool is selected for use in developing the expert system and a working prototype is developed. After a period of evaluation and reformulation the full expert system is completed. Finally, the performance of the expert system is formally evaluated, final modifications are made, and the expert system is put into everyday use. Additional resources are provided for further reference.     

Computerizing protective services intake expertise: Preliminary research

Decision making at child welfare intake has been the subject of considerable investigation for the last thirty years. Previous reserach on the dynamics of abuse and neglect resulted in complexity and inconsistency to the extent that research moved away from determining the relevant information for creating a more structured decision making process. Recent developments in knowledge engineering and computerized expert systems provide new tools for examining protective services intake decision making. These tools are appropriate for organizing the vast amount of information workers use during decision making, extracting decisions from that information, and presenting the decisions and their supporting logic. This research examines existing expertise with a small sample of child welfare experts to determine the feasibility of developing an expert system for supporting intake decisions.     

Expert System Development in III-Structured Domains

Summary

The paper is an examination of the problems and promise of knowledge creation and representation in the Human Services. It is the general proposition of the paper that expertise found in welfare agencies can be exploited to develop expert system software.

The contention of the paper is (hat the knowledge base of a system is never complete, that disciplines vary in terms of what constitutes acceptable levels of proof and measurement of certainty; that limitations intrinsic to an expert system are not limitations of design, but are limitations demonstrating conceptual and theoretical limits in the simulation of dynamic expertise; and finally that an acceptance of the limitations of knowledge acquisition and representation may paradoxically lead to the design of usable expert systems.     

Acceptability of a stage-matched expert system intervention for domestic violence offenders

Most interventions for men who batter are standardized and "one-size-fits-all," neglecting individual differences in readiness to change. A multimedia expert system intervention based on the transtheoretical model (the "stage model") was developed as an adjunct to traditional court-mandated programs. The expert system assesses stage of change, decisional balance, self-efficacy, and processes of change and provides immediate individualized stage-matched feedback designed to increase readiness to end the violence. Fifty-eight male batterer intervention program clients were invited by agency staff to complete an expert system session and an evaluation of the program; 33 men were recruited at program intake and the remainder from ongoing groups. Responses to the intervention were very positive. For example, 87% of participants reported that they found the program to be easy to use, and 98% said it could probably or definitely help them change their attitudes or behaviors. Findings provide encouraging evidence of the acceptability of this stage-matched approach to intervention for domestic violence offenders.     

Between the state and global civil society: non‐official experts and their network in the Asia‐Pacific, 1925–45

This article stresses the need for a more rigorous scrutiny of the power structure in which an expert network produces its ‘expert knowledge’. It defines a pioneering multinational expert network in the Asia‐Pacific region in the interwar years as a prototype of an epistemic community, and examines how far it challenged the state‐centred and North Atlantic‐centred dominant structure of international politics, and became ‘global’. In this article I argue that this particular network largely reinforced the dominant structure. This meant that it remained inter‐national and colonial, and served the interests of the state/empire, neither becoming global nor advancing a universalist cause for the global civil society. The failure owes a lot to historical circumstances. Yet this case study also demonstrates that the structure in which the expert network produced specific knowledge is still dominant and that a constant scrutiny of the role of an expert network remains critical.     

Managing Risk: Self-Regulation Among Homeless Youth

While homeless youth are characterized by their risky behaviours we know little about how they conceptualize and manage risk in their everyday lives. This article will flesh out one aspect of a doctoral study that explored homeless youth’s conceptualizations of risk, by unearthing their self-regulation practices. Deploying an ethnographic lens, 18 youth were followed over a 1–4 year period to capture their risk perception and practices as they unfolded. The findings question the relevancy of the prominence of expert discourses in theories of risk. The study’s empirical findings run counter to the thesis that expert systems predominate in practices of self-regulation. In contrast, practices of self-regulation were not so much in response to expert discourses or social norms but were balanced by personal experience, intuition, and situated knowledges. Results provide valuable insights into the interplay of lay and expert knowledges in the construction of risk among an identified risky and at-risk group. Lessons can also be drawn for clinical practice and the relevancy of the expert role that social workers play in the lives of homeless youth.     

Settlement has many faces: physicians, attorneys and medical malpractice

We conduct an analysis of the jurisdictional dispute over the management of medical malpractice lawsuits, focusing on the process through which liability is defined. We utilize a North Carolina sample of physicians who have been sued, their defense counsel, and counsel for the plaintiff in the case. A comparison of the perspectives of these three parties reveals that over half of the physicians who settle perceive themselves as not liable. Defense counsel are more adept at predicting both negotiated resolutions and whether or not money will be paid than either plaintiffs' counsel or physicians. Almost two-thirds of physicians who thought they were not liable expressed a desire for vindication. Almost half the time when the physicians denied liability money was nonetheless paid to resolve the claim. Physician responses to the outcome of their cases focus on the need for reform, especially in terms of a call for peer or expert review. We identify and discuss culture conflict between law and medicine. For lawyers "settlement" is not a negative thing, but for physicians it implies fault. We challenge existing literature which analyzes the settlement of medical malpractice claims solely in terms of rational economic models, and we argue that social psychological variables are equally important.     

Establishing Laws and Policies on Parent to Child Violence in Finland 1965–1983

This study explores perceptions of parent to child violence, the arguments for imposing legal regulation, and the intended objectives of the legislative process that led to a ban in Finland in 1983. This qualitative policy analysis examines policy documents alongside expert interviews with professional on the legislative process. The example of Finland shows that a significant change in attitudes and decreased levels of violence towards children can be achieved without the threat of legal punishment, even without specific intervention policies. However, the study emphasises the importance of establishing clear practices alongside altering legislation which has been inadequate in Finland.     

The subpoena and a day in court: guidelines for nurses

Psychiatric nurses or therapists may be subpoenaed to appear as direct or expert witnesses. The response must be carefully prepared, and nurses must be aware that testifying in court can be an anxiety-provoking experience. Testifying often involves being an advocate for a client. Clients who have a mental illness, are developmentally disabled, or have a history of abuse or recent violence deserve a conscientious response. The legal process is the avenue for providing safety or empowerment, for assuring that needs are met, and rights are obtained, and being part of that process is an important role. Being prepared for the role is essential.     

Healthcare professionals' priorities for child abuse educational programming: A Delphi study

Child abuse reporting and intervening are a complex process. A comprehensive training program with targeted goals and priorities enables professionals to effectively address the needs of abused children and their families. The study purpose was to identify the content and priorities of health professional education in child abuse by integrating expert opinions and achieving consensus. A 3-round Delphi study was conducted with 25 multidisciplinary experts in health care, social welfare, psychology and counseling, and law and jurisdiction. Structured questionnaires collected expert opinion of appropriateness and importance of knowledge, subjective norms, attitudes, skills, team collaboration and teaching strategies. The expert response rates ranged from 96 to 100% for the 3 rounds, and consensus was achieved. Knowledge was regarded as the most important element. Two items on forensic evidence in the skill category received the highest importance score. Results provide a basis to develop educational programs achieving clinical competence in child abuse care.     

The development of an evidence based assessment protocol for intimate partner violence in the U.S. Army

The importance of conducting evidence based assessment has been widely acknowledged by many professions, including social work. In this study, the U.S. Army, in partnership with University researchers, developed an evidence based assessment protocol to assist the individual social worker in conducting his/her assessment of intimate partner violence. The protocol development process involved posing answerable research questions about intimate partner violence assessment content and method and then adhering to the steps of evidence based practice to answer those questions. Key to the protocol development process was the partnership created between researchers and practitioners as part of an expert panel.     

Media orientation of German university decision makers and the executive influence of public relations

This study investigated the executive influence of public relations managers in the German higher education system. The study is based on a whole-population survey of German university decision makers (N = 1619). It provides evidence that the mediatization of German higher education offers an important opportunity for the empowerment of university PR departments. They can benefit from the New Public Management reforms in recent years as power shifts to management-oriented administrators and the public image of universities turns into a competitive asset. Nevertheless, an indispensable precondition for PR departments’ organizational advancement resides in professionalization. PR workers need to claim a status of expert boundary spanners between their universities and the public stakeholders.     

GIS and development control system for a local authority in Malaysia

The process of development control involves a technique for the systematic compilation of expert quantitative analysis and qualitative assessment of project land use and property development viability, including its effect on the surrounding area, and the presentation of results in a way that enables the importance of the predicted results, and the scope of modifying or mitigating them to be properly evaluated by the relevant decision making body before a planning permission is rendered. Taking the local authorities in Malaysia as an example, this paper will discuss and demonstrate the development of a GIS database and its integration and application for development and building control. The first part of the paper examines the functions of local authorities particularly in the context of development control. In this study, the procedure involved in granting a planning permission as well as enforcement becomes the main focus because it determines the bulk of the system design. The study identifies seven sub-systems namely planning permission, building control, planning enforcement, geospatial database, information kiosk, document processing and presentation sub-systems. The system is developed using a combination of office automation, CAD, GIS, multimedia and other software packages. This paper will focus on the development of the GIS for the purpose of development control. The components of the GIS database include land information, buildings, existing developments, planning information, development plans, utilities, community facilities, transportation, environment and the socio-economy database. The GIS database will be used at every stage of development control, for example, in initial discussions, registration, invitation of objections, the development control process, the consideration by Technical Committee and the consideration by Planning Committee. It is anticipated that the GIS database could be used by many parties involved in the process as a reference point in evaluating a planning submission. Having access to the database will provide flexibility in assessing a proposed development and deciding on the overall urban growth management programme in the most cost-effective manner. The system will also provide transparency and consistency in the development control procedure.     

Quick Exposure Check (QEC): a cross-cultural adaptation into Brazilian-Portuguese

Most instruments used by occupational safety and health professionals have been originally developed in English. Cross-cultural adaptation enables the use of these instruments in other countries, cultures and languages in countries like Brazil, where the official language is not English. This methodology ensures that the translation process includes the cultural and linguistic equivalence between the original instrument and the translated version. Therefore, this study aimed to translate and cross-culturally adapt the instrument Quick Exposure Check (QEC) into Brazilian-Portuguese. The process of cross-cultural adaptation followed the steps of translation, synthesis, back-translation, expert committee review and pretesting. The final questionnaire was pretested by two raters in 40 workers employed in an expedition of knitting and textile industry. All versions resulting from the translation process (T1, T2) and back-translation (BT1, BT2) showed good agreement. During the pre-test was not presented any difficulty in understanding or completing the instrument adapted QEC for Brazilian language.     

Optimizing an immersion ESL curriculum using analytic hierarchy process

The main purpose of this study is to fill a substantial knowledge gap regarding reaching a uniform group decision in English curriculum design and planning. A comprehensive content-based course criterion model extracted from existing literature and expert opinions was developed. Analytical hierarchy process (AHP) was used to identify the relative importance of course criteria for the purpose of tailoring an optimal one-week immersion English as a second language (ESL) curriculum for elementary school students in a suburban county of Taiwan. The hierarchy model and AHP analysis utilized in the present study will be useful for resolving several important multi-criteria decision-making issues in planning and evaluating ESL programs. This study also offers valuable insights and provides a basis for further research in customizing ESL curriculum models for different student populations with distinct learning needs, goals, and socioeconomic backgrounds.     

基于PDCA的高职经管类专业顶岗实习质量保障体系研究

针对高职经管类专业顶岗实习存在的主要问题进行系统分析,重点从顶岗实习过程管理的角度,引入美国全面质量管理专家戴明博士提出的全面质量管理循环（PDCA闭环系统）这一先进理念,探讨如何构建顶岗实习的质量保障体系。     

The use of video in research dissemination: Children as experts on their own family lives

The paper considers the use of video as a medium for the dissemination of research findings in the context of a study of children's concepts of care and their experience and contribution to family life. While the video medium was chosen to give a direct voice to children, it served other purposes. It served as an opportunity to feed back research results to children and to reflect on the ways researchers had interpreted data concerning their own views and experiences of family life. It also provided a public context in which children enacted competences namely in the articulation of expert opinions. The process of making a professional video in many respects mirrored the process of doing research.