CN1304512A - 为疗法选择提供指导的系统、方法和计算机程序产品 - Google Patents

为疗法选择提供指导的系统、方法和计算机程序产品 Download PDF

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CN1304512A
CN1304512A CN99806991A CN99806991A CN1304512A CN 1304512 A CN1304512 A CN 1304512A CN 99806991 A CN99806991 A CN 99806991A CN 99806991 A CN99806991 A CN 99806991A CN 1304512 A CN1304512 A CN 1304512A
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D·W·巴赖
C·S·翁德伍德
B·J·麦克雷戴
D·D·哈登
J·L·卢卡斯
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Abstract

本发明公开了为已知疾病(如HIV感染),提供疗法选择指导的系统、方法和计算机程序产品,该方法包括:(a)向计算机装置提供患者信息;该计算机装置包括:含疾病的多个不同疗法的第一知识库;含疾病疗法选择的多条专家规则的第二知识库;含给患者的有益的不同组成的不同疗法的咨询信息的第三知识库;和(b)在计算机装置中生成对患者可用的疗法列表(最好是已排序的疗法列表);和(c)在计算机装置中生成针对基于患者信息和专家规则的列表中的一个或多个疗法的咨询信息。

Description

为疗法选择提供指导的 系统、方法和计算机程序产品
发明领域
本发明涉及到为复杂病症，如癌症和HIV-1感染疗法选择提供指导的系统、方法和计算机程序产品，在此生成有效的排序的疗法和向患者提供有益的临床咨询信息。
发明背景
诸如HIV-1感染(获得性免疫功能丧失综合症或爱滋病)和癌症等疾病的疗法越来越复杂。新的数据和疗法不断地改进现有的疗法，除专家外，其它人几乎很难与最新的治疗信息保持同步。进一步说，即使是与最新的治疗信息保持同步的专家也需要花时间去吸收这些信息并搞清其与其它治疗信息的的关系以便向患者提供现有的最佳疗法。采取联合疗法时，由于药物可能的相互作用更复杂，使得这个问题更突出。最后，由于患者人群越来越复杂，面临大量的疾病治疗信息的消费者，如果对疗法仅仅是陈述而不作解释的话，难以为患者所接受。
R.Miller等，发表在国际医学年鉴127，p842-845(1997)的临床软件系统的可靠监控与调节综述，描述了系统期望的策略方针，为临床用户生成的建议易于为用户忽略。对解决这一需要既没有提出也没有公开。
M.Pazzani等，发表在杂志爱兹病与人体R15，p356-362(1997)(1997年5月12日接受)的专家系统在艾滋病病毒感染患者管理中的应用，该文通过克隆的HIV蛋白酶、保留转录酶及整合酶片段描述了基于规则的专家系统，进入专家系统，该系统推荐两种、三种或四种药物疗法。这种给出易于被忽略的建议方法，既没有提出也没有公开本发明。
专利申请号为5,672,154的美国专利中，Sillen描述了一种根据具体情况为患者分别给出药物治疗建议的方法。药物的推荐形式至少包括两种不同的药。没有公开多种治疗选择的排序方法，也没有给出不选择某治疗方法的解释的方法。而且，该系统主要侧重于从患者信息中生成新的规则，优化诸如帕金森氏病、癫痫症和异常血压等病症的特殊疗法。
专利申请号为5,694,950的美国专利中，MCMichael描述了一种应用于使用免疫抑制剂如环孢子菌素治疗的方法和系统。应用专家系统生成建议：免疫抑制剂剂量是否需要改变，以及如果需要改变是如何改变。该专利中没有提及对多个不同疗法的排序和选择。
专利申请号为5,594,638的美国专利中，Iliff描述了一个医疗诊断系统，该系统通过电话网络向普通公众提供医疗建议。该系统没有涉及到为已知疾病的联合疗法生成建议(也可参见美国专利5,660,176,Iliff)。
发明概述
如前所述，本发明的一个目的是为患者提供选择疗法的系统、方法和计算机程序产品，其中有效的疗法被列出并可选地排序，同时不可用的或已抛弃的疗法(比如无效或有危险的疗法)不被显示或排序靠后，这向用户表明由于患者个体的复杂因素，比如来自伴随药的药物反应，这些疗法可能无效或可能不是最好的。
本发明的另一个目的是提供选择疗法的系统、方法和计算机程序产品，使其中的可用的疗法选项易于被理解。
本发明的另一个目的是提供选择疗法的系统、方法和计算机程序产品，使其中复杂的特殊疗法的选择易于被理解。
本发明的另一个目的是提供选择疗法的系统、方法和计算机程序产品，使其中不选择某特殊疗法的原因易于被理解。
本发明还有另一个目的是提供选择疗法的系统、方法和计算机程序产品，以获取过去施于患者的疗法效果的信息。
本发明的方法包括向有不同知识库的计算机装置提供患者信息。比如，第一个知识库可以包括一种疾病或病症的多个不同的疗法。第二知识库可以包括为疾病或病症选择疗法的多条专家规则。第三知识库可以包括对应不同组成的不同疗法的有益于患者治疗的咨询信息。第四知识库可以包括以往的治疗信息，比如患者在过去的治疗中的进展如何。
对患者的疗法的列表(最好是已排序的列表)在计算机装置中生成。列表中一个或多个疗法的咨询信息基于患者信息和专家规则在计算机装置中生成。
在优选的实施方案中，上述方法还包括输入用户定义的疾病(或病症)疗法，它可能不从系统知识库生成的疗法中显示，并从计算机装置中生成用户定义的疗法咨询信息。
另外，在优选的实施方案中，上述方法还包括输入排除的疾病(或病症)疗法，它包括在第一知识库中但不被推荐排序(或给出很靠后的排序)，并在计算机装置中生成不推荐的/靠后排序的咨询信息，其中咨询信息至少包括一条不推荐(或靠后排序的)疗法的理由。
本发明的其它目的和特点将在下面的附图及说明中详细解释。
附图简述
附图作为说明书的一部分，图示了本发明的实施方案，结合描述，解释本发明的原理。
图1，图示了本发明的一个过程，包括输入用户定义的和“不被推荐的”疗法的例程。
图2，图示了本发明的系统或装置。
图3，图示了按照本发明的实施方案，在图2的系统中可以运行的客户-服务器环境，其中的中心服务器可以通过计算机网络如因特网，被至少一个本地服务器访问；其中的本地服务器可以被至少一个客户访问。
图4，图示了按照本发明的输入患者病史数据的病史用户界面。
图5，图示了按照本发明，用于在特殊疗法期间监视患者状态的用户界面图表。
图6，图示了按照本发明的疗法评估用户界面，它有益于从相关疗效、分别调整的相关疗效、剂量、频率、费用、医疗并发症和药物反应等方面来评估各种的疗法选择。
图7，图示了按照本发明，图6的疗法评估界面的疗法列表框的提供疗法选择信息的各种标志。
图8，图示了在“满屏”方式下图6的疗法详细列表框。
图9，图示了包括到PDR的索引链接的弹出菜单，链接可以在按照本发明的图6的疗法评估用户界面的疗法列表框中激活。
图10A-10D，图示了例1中的本发明的各种功能。
图11A-11E，图示了例2中的本发明的各种功能。
图12A-12C，图示了例3中的本发明的各种功能。
发明详述
下面将参见本发明优选实施方案附图，更详细地描述本发明。但是，本发明可以以很多不同的形式实施，这里例出的实施方案不应看做是限制；而且这些实施方案将本发明完整的范围陈述给本领域专业人员。全文中相同的标号表示相同的部件。
可以为本领域的专业人员所理解，本发明可以象一种方法、数据处理系统或计算机程序产品一样实施。因此，本发明可以是以完全的硬件形式、完全的软件形式或软硬件相结合的形式实施。而且，本发明可以是在具有在媒介中实施的计算机可读程序代码装置的计算机可用的存储媒介上。包括但不局限可以使用的任何适当的计算机可读媒介，硬盘、CD-ROMs、光存储装置及磁存储装置。
下面将结合按照本发明的实施方案的方法、设施(系统)和计算机程序产品的流程图图解，描述本发明。可以理解，流程图的每一块或块的组合能够通过计算机指令执行。这些计算机程序指令提供给通用计算机、专用计算机或其他可编程数据处理设施以产生一种机制，因此，通过计算机或其他可编程数据处理设施的处理器执行的指令生成完成流程图块或块组合中定义的功能的装置。
计算机指令也可以加载到计算机或其他可编程数据处理设施产生一个计算机执行的程序，因此，在计算机或其他可编程数据处理设施上执行的指令生成完成流程图块或块组合中定义的功能的步骤。
本发明的方法在图1中示出。第一步10，检查患者，测定患者信息。被收集的患者信息的示例包括以下内容的一项或多项：性别、年龄、体重、CD4+信息、病毒负荷信息、HIV基因型和显型信息、血红蛋白信息、神经病信息、嗜中性白细胞信息、胰腺炎、肝功能、肾功能、药物过敏和抗药信息以及其它疾病的药物治疗信息。信息可以包括疾病或病症疗法之前的历史信息。当患者一般地第一次接受检查测定患者信息时，可以理解，当患者信息已被事先测定时，信息也可以存储在计算机装置内或从其他计算机装置、存储装置或硬拷贝传送过来。
然后，给计算机装置提供患者信息11，计算机装置含有疗法知识库、根据患者信息决定有效疗法选择的专家规则知识库，还包括咨询信息知识库。利用专家规则从患者信息和现有疗法中生成有效疗法列表12，也生成有效疗法的咨询信息13。咨询信息可以包括警告患者在相应疗法开始之前停止禁忌的药物(治疗)或选择适当的药物和/或对执行相应疗法有益的临床信息。
比如，已知疾病是HIV-1感染，所说的疗法包括抗病毒药物，所说的疗法包括不适当的或可能有反作用的非抗病毒药物。特别地，当疗法包括蛋白酶抑制剂时，禁忌药物是TERFENADINE。当疗法包括INDINAVIR，禁忌药物是CISAPRIDE。
示范的抗病毒药物在表1中例出。
表1
缩写  正式名 俗名
ABC  ZIAGEN Abacavir
ADV  PREVEON Adefovir
APV  AGENERASE Amprenavir
AZT  RETROVIR Zidovuaine
ddI  VIDEX Didanosine
ddC  HIVID Zalcitabine
d4T  ZERIT Stavudine
EFV  SUSTIVA Efavirenz
3TC  EPIVIR Lamivudine
SQV  INVIRASE/FORTOVASE Saquinavir
IDV  CRIXIVAN Indinavir
RTV  NORVIR Ritonavir
DLV  RESCRIPTOR Delavirdine
NFV  VIRACEPT Nelfinavir
NVP  VIRAMUNE NeVirapine
示范的可以显示给用户的咨询信息归纳如表2所示。
表2
说明
药物疗法(下面所有的输出数据都与疗法相关) 推理引擎将处理来自含所有疗法结合的资源文件内的每一种疗法，系统支持多种药物的结合，被知识库推荐的疗法将与下面的所有数据一起显示出来。
注释 注释包括关于药物及不同患者情形的警告和咨询，每个注释将显示在用户界面的特定位置，注释有各种标志、触发器和输出位置。
拒绝事项 拒绝事项解释特定疗法为什么没有被推荐，拒绝事项通常出现在用户界面上预定的位置。
费用 推理引擎计算每种疗法每天的费用及疗法中每种药物的费用。
剂量 推理引擎计算基本的剂量以及根据患者具体情况的剂量的调整。
药的数量 疗法中药的数量。
频率 特定疗法中患者服药的时间，多药物疗法中，疗法的频率是服药频率最高的药物的频率，在有三种药的疗法中，其中两种是q12h，一种是q8h，则该疗法频率被认为是q8h。
管理 特殊药物管理指南
功效 相对功效代表各种疗法的相对功效的总数，1是最有效的疗法。
调整后的得分   “调整后的得分”是根据患者特点上下调整后的功效，大致表明该疗法对患者的疗效，比如：系统评估一种含药物的疗法，该药物与患者治疗史的医疗条件有关，因此该疗法排序靠后，疗法排序用整数表示，从0开始，没有上限，具有序号为1的疗法(RO=1)排在列表的最前面，序号为10(RO=10)的疗法对特定患者而言成功的几率小，每种疗法从代表其相对疗效得分的RO数字开始，相对疗效得分可以根据规则上下调整，“疗效”数字及“调整后的得分”数字同时显示。
本发明可以得到多个不同的疗法选项，有益于或改进疾病(或病症)的疗法。这些疾病或病症包括但不局限于心血管病(包括但不局限于充血性心力衰竭、高血压、高学脂和心绞痛)、肺病(包括但不局限于慢性阻塞性肺病、哮喘、肺炎、囊肿性纤维化和肺结核)、神经病(包括但不局限于早老性痴呆、帕金森氏病、癫痫、多发性硬化、肌萎缩性(脊髓)侧索硬化或抗淋巴细胞血清  精神病诸如精神分裂症和器质性脑综合症、神经衰弱症，包括焦虑、压抑和双极不适)、肝炎感染(包括肝炎B和肝炎C感染)、尿路感染、性病、癌症(包括但不局限于乳房癌、肺癌、前列腺癌、结肠癌)等。易于理解通过本发明有利于阻止上述疾病或病症的的发展或发作。
本发明对已知疾病比如HIV-1感染(获得性免疫缺损综合症或“AIDS”)或可以使用联合疗法的任何病症是有益的。特别是，当有效疗法列表中含多个(比如2个、10个、15个或更多)疗法，联合疗法(比如结合两个或多个治疗药剂)，其中潜在的药物反应增加和/或由于涉及多个因素，最佳疗法选择更复杂，这时本发明尤其有益。
更好的，可用疗法和咨询信息可以以多种方式再次生成。患者信息容易修改18。另外，如果用户感兴趣的某特殊疗法没有出现，用户定义的疗法可以被输入14和基于用户定义的疗法生成15咨询信息。进一步说，如果一种在知识库中的疗法被系统所拒绝(没有推荐显示)，没有被推荐的疗法可以输入16以及为之生成咨询信息17。这向用户表明他们不能继续使用其他病症的非关键药或选择不会导致冲突的/不推荐情形的适当替代品，以便使他们能进行选择的疗法。或者，非推荐疗法的咨询信息可以自动的生成。这些步骤可以在任何秩序以无冲突地重复，确保所有疗法选项都被足够地适当地考虑。
术语“疗法”和“治疗处置方法”在此可以互换，用在这里意味着无须考虑传送途径(比如口服、静脉内的、肌内的、皮下的、动脉内的、腹膜内的、鞘内的等)，对任何疾病(包括慢性和急性病症、不适等)的任何药剂或药物疗法。另外，可以理解到本发明限制对其有益的疾病疗法。本发明可以用于改进有各种病症的患者的治疗，而没有任何限制。
系统描述
本发明作为专家系统实施，向医生(或其他保健提供者)提供决断以帮助治疗患有已知疾病如HIV-1感染的患者。按照本发明的系统考虑联合疗法的选项并附上这些选项的所有相关信息。
如本领域专业人员所熟知的，专家系统，也称人工智能(AI)，是一个计算机程序，它能在特殊的领域内仿真具有专家知识和经验的机构或人的行为和判断。一个专家系统一般有含积累的经验的知识库和一套在每种情形下应用知识库的规则，各种情形在程序中描述。专家系统已为本领域的技术人员所熟知，因而无须在此进一步描述。
使用依次考虑特定患者的治疗史、目前状况和实验室评估的多条专家规则和功能构成的知识库导出抗病毒疗法选项(抗病毒药物的结合)。按照本发明的系统支持在大型中央数据库中输入、存储和分析患者数据。按照本发明的系统有灵活的数据驱动结构和用户报告能力，用以支持患者疗法管理和临床药物跟踪，如放映、患者跟踪和支持。可以预见，当需向患者提供最高标准的保健时，按照本发明的系统可以由保健提供者(包括医生)、临床研究科学家和可能的保健机构用来查找最高效的治疗选项。
执行本发明的系统20，如图2所示。系统20包括疗法知识库21，疗法可以按效力排序(如通过专家评议)或按系统规则排序，专家规则的知识库22、咨询信息的知识库23、患者治疗史的知识库24和患者信息25。患者信息最好存储在数据库中并配置为适时更新的。知识库和患者信息21-25可以通过输入/输出系统29更新，输入/输出系统由键盘(和/或鼠标)及视频监视器构成。也应注意到，当知识库和患者数据21-25作为单独的块出现时，知识库和患者数据21-25可以结合在一起(如在单独的数据库中专家规则和咨询信息可以结合)。
实施前面描述的方法时，块21-25的信息提供给推理引擎26，推理引擎从块21-25提供的信息中生成有效的疗法列表和相应的咨询信息。推理引擎可以是硬件、软件或软硬件的结合。推理引擎是熟知的以及任何形式的推理引擎都可以用来实施本发明。推理引擎示例包括但不局限于下面的专利中描述的：美国专利，授予Barabash等的5,263,127(专家系统的快速规则执行方法)；授予Kirk等的5,720,009(使用等效类分组数据库目标的专家系统中的规则执行方法)；授予Paillet的5,642,471(产生专家系统规则过滤机制和推理引擎)；授予Kim的5,664,062(高性能的模糊推理引擎极大化极小电路)。
优选的高性能推理引擎使得新数据输入时数据在不断地更新。对块21-25的知识库和患者信息而言，推理引擎26可以是以独立的块也可以在公共程序或例程中与知识库和患者信息结合在一起。
我们注意到对应任何有效疗法生成的咨询信息，基于不同的患者信息，各不相同。
系统结构
本发明可以作为一个在标准的单独的计算机装置上执行的系统而实现。本发明最好是在客户-服务器环境中执行。如本领域技术人员所熟知的，在客户-服务器关系中客户应用程序是请求程序。服务器应用程序等待并执行来自同一台或其他计算机的客户程序请求。客户-服务器环境可包括公共网络如因特网、专用网常被叫做“内部网”、局域网(LANs)、广域网(WANs)、虚拟专用网(VPNs)、帧中继或直接电话连接。可以理解客户应用程序或服务器应用程序包括计算机主机和服务器应用程序，或其他配置来执行程序代码的设施，程序代码象执行本发明的各种功能的装置和各种操作方法一样，在计算机可读媒介中实施。
现在参见图3，图示了根据本发明优选实施方案的客户-服务器环境30。图示的客户-服务器环境30包括中央服务器32，通过计算机网络36如因特网，中央服务器至少能被一台本地服务器34访问。各种计算机网络传输协议包括但不局限于TCP/IP，用于完成中央服务器32与本地服务器34之间的通讯。
中央服务器
中央服务器32包括中央数据库38，比如运行在MicrosoftSQLServer应用程序，版本6.5(可从Microsoft,Inc.Redmon,WA获得)。中央服务器32确保本地服务器34运行知识库的版本最新。中央服务器32也存储所有的患者信息和执行各种管理功能，包括添加和删除本地服务器及系统用户(20，图2)。得到中央服务器32的授权后本地服务器34才能为用户使用。患者数据最好存储在中央服务器32，从而形成患者数据中央资料库。但也可以将患者数据存储在本地服务器或本地存储媒介上。
本地服务器
一般地，每个本地服务器34服务于当地的多个用户。每个本地服务器34包括一个服务器应用程序、一个推理引擎、一个或多个知识库以及一个本地数据库39。每个本地服务器34执行人工智能程序完成本发明功能。当一用户通过客户机35登录到本地服务器34，如本领域技术人员所熟知的，用户最好通过身份和口令得到授权。一旦被授权，用户就获准访问系统(20，图2)并得到一定的管理权限。
每个本地服务器34还与中央服务器32通讯，以校核在请求的本地服务器上运行的应用程序及知识库版本是否为最新的。如果不是最新的，请求的本地服务器34在用户会话建立之前从中央服务器32下载最新有效的知识库和或应用程序。一旦用户登录到系统(20，图2)建立起会话，所有的数据和人工智能程序最好在本地服务器34上运行。图示的客户机-服务器配置的好处是大多数计算密集工作在本地服务器34上进行，从而允许“薄”的客户机35(即计算机装置有小的硬盘)和优化了系统速度。
在优选的实施方案中，每个本地服务器数据库39通过MicrosoftSQL Server应用程序，版本6.5运行。每个本地数据库39的主要目的是存储各种患者标示符、确保安全和被用户授权访问系统(20，图2)。但是，主机数据库38和本地数据库39都可以通过主机连接到中央服务器32。
本地客户机
每个本地客户机35也包括由图形用户界面(GUI)构成的应用程序和与本地服务器34通讯的中层程序。客户机应用程序的代码可以全部在本地客户机35上执行，也可以一部分在本地客户机35另一部分在本地服务器34上执行。正如下面将要描述的，用户通过输入(或访问)患者数据来完成与系统(20，图2)的交互作用，患者数据在客户机35内图形用户界面内显示。然后，客户机35与本地服务器34通讯，分析显示的患者信息。
执行本发明功能的计算机程序代码最好用面向对象的编程语言如JAVA、Smalltalk或C++写成。但是，执行本发明功能的计算机程序代码也可以用常规编程语言如“C”、注释文本语言如Perl、功能性(或第四代)编程语言如LISP、SML或FORTH来编写。
客户机的中层程序包括在本地客户机34内的推理引擎，推理引擎为用户提供不间断的在线指导，当给患者的药物或医疗条件与患者当前的抗病毒疗法冲突或造成禁忌时，立即警告用户。患者数据每次输入到系统(20，图2)或更新甚至随时间推移，推理引擎就评估患者的当前状态、分类、编目、排序和定制每一种可能的抗病毒疗法，以满足患者的特殊需要。
推理引擎
推理引擎已为本领域技术人员所熟知，在此无须详述。根据本发明，推理引擎使用的每个知识库收集的规则和方法都是HIV治疗医生和科学家的临床咨询小组制定的。知识库有主观规则、客观规则和系统生成的规则。客观规则是基于使用抗病毒药物治疗HIV建立起来的事实，是从抗病毒产品的软件封装信息中、从同等的评论和出版的期刊文章中提取的。下面是一个抗病毒禁忌症候的抗病毒客观规则的范例：
规则#1：如果评估的疗法含Zidovudine(AZT)和Stavudine(d4T)，就拒绝该疗法。
在规则#1中，术语“评估的疗法”指的是正在被系统(20，图2)分析的疗法。规则#1规定如果一种疗法中同时包括AZT和d4T，该疗法就不能显示在疗法选项列表中供患者选择。
对客观规则，本发明可以通过配置，使得当某决定性的患者数据未输入时，禁止用户接受新疗法选项的处方。可以理解，本发明并不禁止保健提供者如医生记录他/她的疗法决定，即使系统(20，图2)显示了该疗法可能对患者有害的理由。本发明允许保健提供者保留疗法的最终决定权。
主观规则基于专家意见、观察和经验。主观规则一般是在基于该领域内专家的意见的“最佳实践”信息的基础上形成的。这种专家意见可能基于本领域出版或提交的文献或他们自己的临床实践、研究或承认的或未被承认的临床记录。使用了大量的专家使得个人偏见减少。
系统生成的规则源自系统中患者记录的输出，患者接受已知的定义的疗法期间改进、稳定或恶化。由于HIV感染中有大量可用的疗法结合，源自他们的系统生成的数据库与规则包含的数据可能超过客观规则或主观规则所能达到的数据。
规则包括本发明的各种知识库(21-24，图2)，每个知识库有两个主要部分：前提和结论-也可以分别称作左边和右边。当规则的前提为真，就执行结论定义的动作。这就是本领域技术人员熟知的“激发”规则。举例来说，参见下面的规则：规则ID                前程             结论FiltDComAl--    如果评估的疗法含ddC    -注释18上述规则的前提是推理引擎判断被鉴定的疗法是否含抗病毒药物“ddC”。如果包含，本规则的结论是为疗法附上“注释18”。注释18可能是有关含ddC疗法的提供给用户的必须的一则文本信息。
根据本发明包括一个或多个知识库的示范性规则在如下的表3中列出。
表3
疗法初始/改变：提供疗法初始或改变信息的规则
临界条件规则：更新数据间隔的数据限制
注释数据时效规则：警告用户某一栏中的数据已经过时，应使用系统中最新的数据
由于在AVR药物结合疗法中的药物反应而排除疗法的规则
由于医疗条件排除疗法的规则
由于在病人血浆HIV中的基因突变而排除疗法的规则
由于在病人血浆HIV中的基因突变而排除疗法的规则
由于显型过敏/抗体而排除疗法的规则
抗病毒疗法排序规则
常规剂量规则
固定剂量规则
由于ARV-ARV药物结合的剂量调整
由于ARV-NonARV反应的剂量调整
由于医疗条件而进行的剂量调整
决定的注释
通用注释规则
由于医疗条件而增加的注释
由于药物反应而增加的注释
由于药物结合而增加的注释
服用大小规则
使用本发明的各种知识库和患者信息，推理引擎在患者病史(包括治疗史)、当前实验室评估的基础上可以为患者鉴定疗法选项。根据多种抗病毒药物结合可迅速准确地为特殊患者分析。进一步说，推理引擎可在表4列出的范围内迅速提供指导。
表4
数据完整性 患者的实验室数据和评估数据是否过时而被视为不可靠？实验室数据与显型数据之间是否有冲突？显型数据表明患者的当前疗法和表示病毒抑制特征的当前病毒负载数据之间的抗体
疗法实施 要开始抗病毒疗法吗？对患者的当前疗法达到了好的开始和长期的病毒抑制或疗法需要改变吗？在患者的当前疗法中对任何药物出现的抗体所能解释的含当前基因型和显型数据的疗法中，当缺乏病毒抑制时，是否可能出现不一直的结果？
剂量 给定疗法中抗病毒药物的基本剂量和调整剂量是什么？有否特殊的剂量管理说明？如果患者只能流体药物时，使用什么？
禁忌 使用什么抗病毒药物以及剂量做何调整？在患者当前的或可能的疗法中，服用的抗病毒药与非抗病毒药之间存在禁忌或反应吗？如果有，是什么？如果必要，需要对剂量作何调整？
医疗条件 为患者决定适当疗法时，是否有已知的医疗条件？如果有，对每个当前或历史疗法医疗条件的作用是什么？
药物费用和交付数据 每个疗法的选项的费用是多少？疗法中服药的频率是什么？对药丸的最小的数量，药丸的数量和最佳服用大小是什么？
疗法选项 所有的结合疗法选项是什么？医生如何从上百种疗法结合之中立即得到对患者最有效的疗法？适用患者的每种药物中的信息是什么？每种疗法的抗病毒效果的关系是什么？有没有能使疗法对患者更有效的特殊因素？
抗体 与患者当前基因型或显型相关的抗体的药物是什么？哪些药一起用能更好的缓解药物抗体？(如果有)哪些历史疗法中用过的如果在新疗法中再用能更有效？当前疗法中使用的药物可否在下次的治疗中使用使用？
用户界面
参见图4-图9，示出了根据本发明的用户界面范例。图4中，示出了按照本发明的输入患者病史的病史用户界面50。病史用户界面50可通过激活“Medical History”键50a而显示。图示的病史用户界面50允许用户生成、存储、更新和打印患者记录。当用户添加一位新患者，就出现含空白数据输入栏的病史用户界面50。通过图形用户界面接受数据输入栏的信息为那些本领域技术人员所熟悉，在此无须详述。当用户打开患者记录进行编辑时，在各栏中有患者数据的病史用户界面50显示出来。患者记录中关键的或要求的信息最好是高亮显示的。
在图示的病史用户界面50中的重要元件包括“print”按钮51，用来打印患者记录和疗法详情；“save”按钮52，存储患者记录；“speedentry”检查框53，允许用户在条目栏之间快速移动。另外，多组标题将患者病史分成相关的类。每组包括用户增加患者信息的输入栏。“add”按钮允许用户在选定的组添加新的信息到患者记录中。“delete”按钮允许用户从选定的组删除患者信息(尽管原信息还保留在数据库中)。“history”按钮允许用户浏览每各选定组的患者历史数据。
完成患者病史后，推理引擎分析数据并建议一种疗法是否需要；现有的疗法是否继续或改变；及给选定患者的最佳药物疗法。这些药物疗法最好根据预期的功效、用药频率、药的数量及费用进行排序。当用户点击列表中的一种药物疗法时，得到有关用药方式得信息。同时，也得到各种警告诸如药物反应警告和每种药的注意事项。这样就可以选择适当的药物疗法。
图5，图示了特殊药物疗法期间监测患者状态的用户界面曲线60。通过激活“chart”键60a可以显示用户界面曲线60。图示的用户界面曲线60跟踪CD4抗病毒负荷水平。沿Y轴61的左侧绘出了CD4数量。沿Y轴61的右侧绘出了病毒负荷数量。曲线62代表CD4测试和病毒负荷测试，能为有专业人员所理解。在用户界面曲线60范围内需要一段时间的药物治疗，指示如63，如图示，时间沿X轴绘出。
在图6中，图示了疗法评估用户界面70，考虑到相关功效、剂量、频率、费用医疗复杂程度和药物反应，有利于评估各种疗法选项。通过激活“Therapy Evaluation”键70a可以显示疗法评估用户界面70。疗法评估用户界面70中的重要元件包括“Evaluate Current Therapy”按钮71，开始评估当前疗法及“Current Therapy”栏72列出患者的当前疗法。关于患者疗法详情在疗法详情框73内显示。在框73内显示的疗法在框74内识别。
复选框75允许用户控制疗法评估用户界面70内的信息的显示。在疗法列表框76，显示对患者有效的疗法列表。在图示的实施方案中药物以标准的缩写形式列出。包括每种药物的其他显示信息在表5中列出。
表5
功效评估 不考虑患者的特殊情况，仅根据预期的效果列出疗法(排序为1是最有效的疗法)
调整后的评价 以功效评估为基础，根据患者特殊信息作上下调整(排序为1是最有效的疗法)
安全考虑 与疗法相关警告的两三个单词的总结。
频率 列出服药频率(q12h、q24h等)
药丸 列出整个方法中每天要求的药丸的数量
费用 列出疗法每天的费用
医疗警告 如果有一个或多个与疗法相关的黄色医疗警告，就显示Y；如果有一个或多个与疗法相关的红色医疗警告，就显示R。
药物反应 如果有一个或多个与疗法相关的黄色药物反应警告，就显示Y；如果有一个或多个与疗法相关的红色药物反应警告，就显示R。
可用的抗病毒药物列表在框77中显示。用户期望评价特别的药物联合疗法可以通过点击选择框77a来浏览框73中的详细信息。“Use asCurrent Therapy”按钮允许用户对患者采用特别的疗法。在疗法详情框73中的各种超链接79允许用户显示有关疗法评估的详细信息。比如，允许用户查看于显示文本相关的规则。
在框77显示的每个有效抗病毒药物附近提供了抗体评估报警80。比如，兰色图标“G”用来表示患者的最近一次基因测试含有突变，完全或部分抵抗相关的抗病毒药物。红色图表“P”用来表示患者的最近一次显型测试呈现出抗病毒药物抗体。
在疗法列表框76中，各种符号(在图7中描述)可用来提供有关药物疗法的信息。这些图标为每个疗法选项提供立即的图形警告等级。有些符号，如红色惊叹号，表明在疗法详情框73内有关键的可能危及生命的信息，为了合理地使用疗法必须阅读这些信息。
当某药物疗法被用户从疗法列表框76来评估时，图6的疗法详情框73以“满屏”形式显示，如图8所示。图示的疗法详情框73中的元件包括鉴定框73a用来鉴定疗法是否被评估；“Use as CurrentTherapty”按钮78允许用户对患者采用特别的疗法；“Show Therapy”按钮73b返回疗法详情框73的半屏显示，如图6所示。另外，各种超链接可嵌入疗法详情框73显示的文本中，可被用户激活显示各类信息。如图示，显目的报警标志73c和文本73d在疗法详情框73的上部显示。如图示，每种药物的剂量73e与特殊的管理说明一块可在疗法详情框73内显示。剂量调整信息73f和各种警告及咨询信息73g也在疗法详情框73内显示。
按照本发明优选的实施方案，如果为患者选择了无效的药物，疗法不为用户显示。
医生桌面参考(Physicians Desk Reference)
根据本发明优选的实施方案，医生桌面参考(PDR)28，是已知药物的参考源，它与图2的系统20完全结合在一起。用户可以访问PDR得到图6中疗法评估用户界面70中的疗法列表框76内列出的抗病毒药物的摘要。另外，用户可以访问PDR在线网络数据库得到有关特殊药物的附加信息或研究禁忌药物的替代。当用户选择了疗法评估用户界面70中的疗法列表框76的一种药物，最好装入web浏览器访问PDR在线网络数据库。也可以从PDR在线网络数据库中提取信息，为患者服用的非抗病毒药物提供药物选择列表，并详细说明名牌与普通药物的关系。
如图9所示，从图6的疗法评估用户界面70中的疗法列表框76激活可得到PDR弹出菜单90。从PDR弹出菜单90用户可以访问来自PDR的各种信息，包括但不局限于药物摘要、名牌药物的一般组成。下面非限制性的示例说明了本发明的不同特点。以便于解释而非限制的目的提供这些示例。
示例1
下面将参见图10A-10D来解释示例1。参见图10A，示出了含患者“dem1”评估了的数据的病史用户界面50。分组标题“Hemoglobin”54a改变了颜色向用户表明：患者先前(历史上)的血样的血色素值过低，不正常。如果使用关于造血引发的毒素的药物，当疗法评估键70a激活，疗法评估用户界面70(图10B)显示有关贫血史的病症警告和注意事项，如图10B的疗法详情框73中所示。
另外，分组标题“Renal Function”54b改变了颜色警告用户可能出现肾功能障碍，也可以通过栏F1的低估计肌氨酸酐清除率来表明(系统计算公式考虑了年龄、性别、体重和血清肌氨酸酐值-所有这些都是病史用户界面50的栏)。这些信息向用户指出，如果需要剂量调整，就使用这些信息，已知这些药物对肾功能有影响(被清除)。
显示当前的和最近的下一个CD4细胞数量和病毒负载(F2，病史用户界面50)。这一信息也用于判定何时开始或改变疗法以及评价新的受控的抗病毒疗法的初始抗病毒功效。
通过按栏旁边的“H”按钮可以查看病史用户界面50(图10A)内的所有栏的当前值和历史值。
在图10C中，图表用户界面60被激活。HIV RNA(病毒负载)按对数坐标绘制，CD4数量按线性坐标绘制，在图表用户界面60的底端的水平坐标上绘成甘特线图。
在图10D中，当选定“Therapy Evaluation”键70a时，弹出“ChangeTherapy Recommendation”信息框MB1。该框表示正在处理来自“MedicalHistory”键和知识库输出的数据，知识库的输出源自发表过的疗法指南的客观规则，表明疗法的开始或如果信息中注明了其他变化这种情形下可以调用改变的疗法。
有效疗法的列表及相关的排序如图10B的疗法详情框73所示。这表明知识库输出的疗法选项。下面的任何内容都可以包括在疗法列表中：带黄色三角形或红色惊叹号警告标志的安全咨询(剂量调整、药物反应等)；药丸的数量；全部三种药的每日费用；服药方式(q8h,q12h等)；一种方式下所有药物的剂量(包括必要时的剂量调整)以及对话框中给患者的永久信息。
示例2
下面结合图11A-11E来解释示例2，关于患者文件“ARV naivel”，是一个以前没有接受过抗HIV药物治疗的HIV感染患者的一个例子。在图11A中，图示了含患者“ARV naivel”评估过的数据的病史用户界面50。在图11B中，激活“Therapy Evaluation”键70a，显示疗法评估用户界面70时，弹出“Boundary and Prequalification Messages”信息框MB2，表明根据当前的公开的疗法指南，患者可以开始抗病毒疗法及当前指南推荐的联合疗法。
在图11C中，疗法评估用户界面70被激活，显示有关疗法评估的特点/功能，包括与疾病治疗相关的或与用户从评估过的疗法列表框中选择的特定疗法的一般警告W1和咨询A1、A2和A3(比如是否开始或改变疗法)。
图11D中图示了点击图11C中疗法列表框76中的单个疗法时可显示的各种信息。显示的信息包括含一般和针对患者的警告和咨询的所有药物的用法。
如图11E所示，右击图11C的疗法列表框76中列出的任一疗法，可得到其特点，包括链接电子PDR显示药物封装信息和执行药物研究信息；显示或掩藏疗法列表框中显示的信息栏；链接有“书”图标的疗法相关的出版物或摘要；以及各种打印功能。
示例3
下面结合图12A-12C来解释示例3，关于患者文件“Featuresl”，说明一些按照本发明的重要功能/特点，可以向由于使用多种抗病毒药物可能已建立抗体的患者提供高性能药物。解释包括属于新抗体和历史疗法规则的功能的特点，包括：
1)当激活图标键60a或疗法评估键70a时，可能的药物抗体咨询(A1，图12A)或(A2,12B)；
2)字头“P”和“G”标志(11和12，图12B)提示与抗HIV混合相关的显型或基因型抗体，正如为患者演示的(包括由于交差抗体，对患者当前没有服用的或以前服用过的药物的期望的/预期的进益型抗体)；
3)药物反应警告系统(由图12C的W3表示)。警告W3是针对Nevirapine和rifabutin(选自病史用户界面50可得到的非抗病毒药物列表)之间的反应。通过“右击”non-AVR标题栏54C可以从病史用户界面50查看药物反应警告信息，标题栏变成黄色表明ARV-nonARV药物反应的出现。这一信息也可以作为文本信息在疗法评估界面70(W3，图12B)显著的显示以及显示在药物列表框(76，图12B)的“安全考虑”一节中；和
4)图表用户界面60(图12A)为便于用户评估以图形形式说明了病毒负载、药物疗法及相关的药物抗体。
如前所述的本发明的解释不应看作是限制。尽管描述了几个实施范例，但那些本领域的技术人员在不背离本发明新颖的技术和优点的前提下，很容易地改进这些范例。因此，所有的这样的改进都包括在本发明权利要求所定义的范围内。所以，前述的本发明的说明不能看作公开的实施方案的限制，公开的实施方案的改进以及其他实施方案，都包括在附后的权利要求的范围内。下面的权利要求包括等效的要求在内，定义了本发明。

Claims (69)

1．一种为有已知疾病或病症的患者提供疗法选择指导的方法，该方法包括：
(a)向计算机装置提供患者信息，包括：
含有该疾病或病症的多个不同疗法的第一知识库；
含有该疾病或病症的评估和选择的多条专家规则的第二知识库；
含有给患者的有益的所述不同疗法的不同组成的咨询信息的第三知识库；和
(b)在所述计算机装置中生成对患者可用的疗法列表；和
(c)在所述计算机装置中基于患者信息和专家规则生成对所述列表中的一个或多个疗法的咨询信息。
2．如权利要求1的方法，还包括步骤：
(d)为该疾病或病症输入用户定义的不包括在第一知识库中的疗法；
(e)在计算机装置中为用户定义的联合疗法生成咨询信息。
3．如权利要求1的方法，还包括步骤：
(f)为该疾病或病症输入不被推荐的疗法，该疗法包括在第一知识库中而在所说的列表中不被推荐；和
(g)在计算机装置中为不被推荐的疗法生成咨询信息，该咨询信息至少包括一条该疗法不被推荐的理由。
4．如权利要求1的方法，其中所说的患者信息包括：性别、年龄、体重、CD4信息、病毒负荷信息、HIV基因型和显型信息、血红蛋白信息、神经病信息、嗜中性白细胞信息、胰腺炎、肝功能、肾功能、药物过敏和抗药信息以及其它疾病的药物治疗信息。
5．如权利要求1的方法，其中所说的患者信息包括以前的疗法信息。
6．如权利要求1的方法，其中所说的对患者可用的疗法列表包括已经排序了的对所述患者可用的疗法列表。
7．如权利要求1的方法，其中所说的患者信息包括以前存储在该计算机装置的患者信息。
8．如权利要求1的方法，其中所说的咨询信息包括：
警告患者在相应疗法开始之前停止禁忌的药物(治疗)；和
对执行相应疗法有益的临床信息。
9．如权利要求1的方法，其中所说计算机装置包括含有患者疗法历史的第四知识库；其中所说的咨询信息包括从第四知识库种提取的以前的疗法信息。
10．如权利要求8的方法，其中所说的已知疾病或病症是HIV-1感染，所说的疗法包括抗病毒药物，以及潜在有反作用的非抗病毒药物。
11．如权利要求8的方法，其中所说的疗法包括蛋白酶抑制剂，所说的禁忌药物是terfenadine。
12．如权利要求8的方法，其中所说的疗法包括indinavir，所说的禁忌药物是cisapride。
13．如权利要求1的方法，其中所说的已知疾病或病症是一种多重预防性或治疗性疗法单独或联合可用的一种已知疾病或病症。
14．如权利要求1的方法，其中所说的已知疾病或病症是心血管病。
15．如权利要求1的方法，其中所说的已知疾病或病症是肺病。
16．如权利要求1的方法，其中所说的已知疾病或病症是神经病。
17．如权利要求1的方法，其中所说的已知疾病或病症是癌症。
18．如权利要求1的方法，其中所说的已知疾病或病症是尿路感染。
19．如权利要求1的方法，其中所说的已知疾病或病症是肝炎。
20．如权利要求1的方法，其中所说的已知疾病或病症是HIV-1感染。
21．如权利要求1的方法，其中所说的知识库包括多个不同的疗法组合。
22．如权利要求1的方法，其中药物剂量信息必要时根据患者信息推荐和调整。
23．如权利要求1的方法，还包括步骤：
(d)通过计算机装置从药物参考源访问一个或多个疗法信息。
24．一种为有已知疾病或病症的患者提供疗法选择指导的系统，该系统包括：
(a)计算机装置，包括：
包含该疾病或病症的多个不同疗法的第一知识库；
包含该疾病或病症的选择的多条专家规则的第二知识库；
包含给患者的有益的不同组成的不同疗法的咨询信息的第三知识库；和
(b)向计算机装置提供患者信息的装置；
(c)在计算机装置中生成所述患者的疗法列表的装置；和
(d)在计算机装置中基于患者信息和专家规则生成列表中的一个或多个疗法的咨询信息的装置。
25．如权利要求24的系统，还包括：
(e)为该疾病或病症输入用户定义的不通过第一知识库中生成或显示的疗法的装置；
(f)在计算机装置中为用户定义的联合疗法生成咨询信息的装置。
26．如权利要求24的系统，还包括：
(f)为该疾病或病症输入不被推荐的疗法的装置，该疗法包括在第一知识库中而在所说的列表中不被推荐；和
(g)在计算机装置中为不被推荐的疗法生成咨询信息的装置，该咨询信息至少包括一条该疗法不被推荐的理由。
27．如权利要求24的系统，其中所说的患者信息包括：性别、年龄、体重、CD4信息、病毒负荷信息、HIV基因型和显型信息、血红蛋白信息、神经病信息、嗜中性白细胞信息、胰腺炎、肝功能、肾功能、药物过敏和抗药信息以及其它疾病的药物治疗信息。
28．如权利要求24的系统，其中所说的患者信息包括以前的疗法信息。
29．如权利要求24的系统，其中所说的对患者可用的疗法列表包括已经排序了的对患者可用的疗法列表。
30．如权利要求24的系统，其中所说的患者信息包括以前存储在该计算机装置内的患者信息。
31．如权利要求24的系统，其中所说的咨询信息包括：
警告患者在相应疗法开始之前停止禁忌的药物(治疗)；和
对执行相应疗法有益的临床信息。
32．如权利要求24的系统，其中所说的计算机装置包括含有患者疗法历史的第四知识库；所说的咨询信息包括从第四知识库种提取的以前的疗法信息。
33．如权利要求31的系统，其中所说的已知疾病或病症是HIV-1感染，所说的疗法包括抗病毒药物，以及潜在有反作用的非抗病毒药物。
34．如权利要求31的系统，其中所说的疗法包括蛋白酶抑制剂，所说的禁忌药物是terfenadine。
35．如权利要求31的系统，其中所说的疗法包括indinavir，所说的禁忌药物是cisapride。
36．如权利要求24的系统，其中所说的已知疾病或病症是一种多重预防性或治疗性疗法单独或联合可用一种疾病或病症。
37．如权利要求24的系统，其中所说的已知疾病或病症是心血管病。
38．如权利要求24的系统，其中所说的已知疾病或病症是肺病。
39．如权利要求24的系统，其中所说的已知疾病或病症是神经病。
40．如权利要求24的系统，其中所说的已知疾病或病症是癌症。
41．如权利要求24的系统，其中所说的已知疾病或病症是尿路感染。
42．如权利要求24的系统，其中所说的已知疾病或病症是肝炎。
43．如权利要求24的系统，其中所说的已知疾病或病症是HIV-1感染。
44．如权利要求24的系统，其中所说的知识库包括多个不同的疗法组合。
45．如权利要求24的系统，其中药物剂量信息必要时根据患者信息推荐和调整。
46．如权利要求24的系统，还包括：
(e)通过计算机装置从标准药物参考源访问一个或多个疗法信息的装置。
47．一种为有已知疾病或病症的患者提供疗法选择指导的计算机程序产品，该计算机程序产品包括计算机可读程序代码装置嵌入媒介的计算机可用存储媒介，可读的程序代码装置包括：
(a)生成计算机装置的可读的程序代码装置包括：
包含该疾病或病症的多个不同疗法的第一知识库；
包含该疾病或病症疗法选择的多条专家规则的第二知识库；
包含给患者的有益的不同组成的不同疗法的咨询信息的第三知识库；和
(b)向计算机装置提供患者信息的计算机可读程序代码装置；
(c)在计算机装置中生成对患者可用的疗法列表的计算机可读程序代码装置；和
(d)在计算机装置中基于患者信息和专家规则生成列表中的一个或多个疗法的咨询信息计算机可读程序代码装置。
48．如权利要求47的计算机程序产品，还包括：
(e)为该疾病或病症输入用户定义的不包括在第一知识库中的疗法的计算机可读程序代码装置；
(f)在计算机装置中为用户定义的联合疗法生成咨询信息的计算机可读程序代码装置。
49．如权利要求48的计算机程序产品，还包括：
(g)为该疾病或病症输入不被推荐的疗法的计算机可读程序代码装置，该疗法包括在第一知识库中而在所说的列表中不被推荐；和
(h)在计算机装置中为不被推荐的疗法生成咨询信息的计算机可读程序代码装置，该咨询信息至少包括以条该疗法不被推荐的理由。
50．如权利要求47的计算机程序产品，其中所说的患者信息包括：性别、年龄、体重、CD4信息、病毒负荷信息、HIV基因型和显型信息、血红蛋白信息、神经病信息、嗜中性白细胞信息、胰腺炎、肝功能、肾功能、药物过敏和抗药信息以及其它疾病的药物治疗信息。
51．如权利要求47的计算机程序产品，其中所说的患者信息包括以前的疗法信息。
52．如权利要求47的计算机程序产品，其中所说的患者信息包括之前存储在该计算机装置的患者信息。
53．如权利要求47的计算机程序产品，其中所说的咨询信息包括：
警告患者在相应疗法开始之前停止禁忌的药物(治疗)；和
对执行相应疗法有益的临床信息。
54．如权利要求47的计算机程序产品，其中所说计算机装置包括含有患者疗法历史的第四知识库；其中所说的咨询信息包括从第四知识库中提取的以前的疗法信息。
55．如权利要求53的计算机程序产品，其中所说的已知疾病或病症是HIV-1感染，所说的疗法包括抗病毒药物，以及潜在有反作用的非抗病毒药物。
56．如权利要求53的计算机程序产品，其中所说的疗法包括蛋白酶抑制剂，所说的禁忌药物是terfenadine。
57．如权利要求53的计算机程序产品，其中所说的疗法包括indinavir，所说的禁忌药物是cisapride。
58．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是一种多重预防性或治疗性疗法单独或联合可用的一种疾病或病症。
59．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是心血管病。
60．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是肺病。
61．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是神经病。
62．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是癌症。
63．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是尿路感染。
64．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是肝炎。
65．如权利要求47的计算机程序产品，其中所说的已知疾病或病症是HIV-1感染。
66．如权利要求47的计算机程序产品，其中所说的知识库包括多个不同疗法的组合。
67．如权利要求47的计算机程序产品，其中药物剂量信息必要时根据患者信息推荐和调整。
68．如权利要求47的计算机程序产品，还包括：
(e)通过计算机装置从标准药物参考源访问一个或多个疗法信息的计算机可读程序代码装置。
69．如权利要求47的计算机程序产品，其中所说的对患者有效的疗法列表是已经排序了的疗法列表。
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CN107241429A (zh) * 2017-06-30 2017-10-10 江西博瑞彤芸科技有限公司 信息交互处理方法和系统
CN109192262A (zh) * 2018-09-17 2019-01-11 北京惠每云科技有限公司 一种数据传输方法及装置
CN109743363A (zh) * 2018-12-18 2019-05-10 广州圆爱康生物科技有限公司 一种医学信息智能推送方法及装置
CN110146704A (zh) * 2019-03-28 2019-08-20 苏州举健生物科技有限公司 一种基于循环肿瘤细胞的用药及病理检测数据系统
CN114661995A (zh) * 2022-03-28 2022-06-24 北京泽桥医疗科技股份有限公司 一种医疗信息的智能检索推荐方法

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IL138620A0 (en) 2001-10-31
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