An integrated fuzzy logic and web-based framework for active protocol support.

Objective: To develop a general purpose web-based system for active support in using protocols.
Methods: The conceptual model underlying the design of the overall decision support system is drawn from fuzzy set theory and fuzzy logic giving rise to a framework for both acquiring and representing descriptive and operational protocol knowledge. It has been conceived as a web application, designed and implemented according to the technological standards of Internet, in particular XML language and web services, to guarantee distributed functionalities for multicentric studies and the re-use of domain knowledge and problem solving strategies.
Results: Solutions have been evaluated experimentally addressing the specific domain of Temporomandibular disorders (TMD) specializing the general purpose procedures to the dedicated "Research Diagnostic Criteria" (RDC)/TMD protocol. The accuracy of the system was correlated with a set of 50 clinically cases consecutively selected from the Gnatology Department. The results were consistent in 100% of cases. The systematic observation by physicians of both activated rules and diagnostic judgements identified and explicitly formalized additional diagnostic rules in the same context.
Conclusions: Active protocol support based on fuzzy diagnostic reasoning and advanced web-based technologies shows great potentialities for the renewed role DSSs are called to play in the increasingly wide scale context of evidence-based medicine.