From attention to intention

1
From attention to intention

• Modelling decisions and plans in clinical practice

2
Hot buttons

• Notations
• cognitive processes
• tasks
• Planning and design
• Distributed and autonomous agents
• Software engineering

3
Motivation medicine and music
Guido d'Arezzo Benedictine monk, musical theorist
and teacher.
4
Elementary cognitive entities and processes

Actions
Goals
Beliefs
Candidate solutions
Arguments
Plans
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Reifying processes into tasks

Actions
Goals
Beliefs
Decisions
Plans
Candidate solutions
Arguments
Plans
6
Triple assessment of women with suspected breast
cancerV Patkar, C Hurt, , J Fox (Brit J Cancer
2006)
Triple assessment of women with suspected breast
cancer V Patkar, C Hurt, (Brit J Cancer 2006)
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Modelling decisions, plans and processes
decision 'WhichRadiologyDecision'
caption "Which radiology?" choice_mode
multiple support_mode symbolic
candidate 'mammogram' caption
"Do a mammogram of both breasts"
argument -, patientAge lt 35 '
caption "The patient is younger than
35yrs" argument ,
patient_latestHistory_priorThoracicRT "yes"
and patient_latestHistory_priorThoracicRT_ti
ming gt 8 and patientAge gt 30
caption "Patient is over 30 years of age and
has received chest radiotherapy
argument , (patient_historyPreviousMaligna
ncyType includes "breast in situ" or
patient_historyPreviousMalignancyType includes
"breast invasive") caption
"The patient has had a previous breast
malignancy" argument ,
patient_latestHistory_pain "yes" and
patient_latestHistory_pain_cyclicity "non
cyclical" caption "The
patient has non-cyclical breast pain
recommendation netsupport( WhichRadiologyDecisio
n, mammogramCandidate) gt 1 candidate
'ultrasound' caption "Do an
ultrasound of the affected area"
argument , patient_latestMammography_appea
rance includes "mass lesion" or
patient_latestMammography_appearance includes
"asymmetric density
recommendation netsupport(WhichRadiologyDecisio
n, ultrasoundCandidate) gt 1 candidate
'neither' caption "No imaging is
necessary" recommendation
netsupport(WhichRadiologyDecision,
ultrasoundCandidate) lt 1 AND netsupport(
WhichRadiologyDecision, mammogramCandidate) lt 1
end decision.
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PROforma decision

• decision 'Diagnosis_decision'
• caption "Diagnosis decision"
• candidate ''peptic ulcer''
• argument for,age lt 35 OR weight
  normal attributes
• argument_name 'age lt 35 OR
  weight normal'
• end attributes
• recommendation netsupport(decision_11,
  'peptic ulcer') gt 1
• candidate 'cancer'
• argument for,biopsy abnormal
  attributes
• argument_name 'biopsy
  abnormal'
• end attributes
• argument for,age gt 50 AND Weight
  down attributes
• argument_name 'age gt 50 AND
  Weight down'
• caption "Elderly patient has
  lost weight"
• end attributes
• recommendation netsupport(decision_11,
  'cancer') gt 1
• end decision.

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PROforma plan

• plan 'Simple_plan_example'
• caption "Example of a plan with 4
  components"
• abort patient_discharged yes
• terminate patient_recovered yes
• component 'Diagnosis_decision'
• schedule_constraint
  completed('Patient_history')
• number_of_cycles 1
• component 'Patient_history'
• number_of_cycles 1
• component 'Pathway_1'
• schedule_constraint
  completed('Diagnosis_decision')
• number_of_cycles 1
• component 'Pathway_2'
• schedule_constraint
  completed('Diagnosis_decision')
• number_of_cycles 1
• end plan.

10
Project proposal

• Back group

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Scenario

• Services
• Annotation
• Simulation
• Composition
• Review
• Debate
• Notation

• Synoptic process (agent)
• Describe (beliefs)
• Frame (Goals)
• Options (Worlds)
• Assess (Argue)
• Select (Commit)
• Do (Implement)