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Hybrid Reasoning Approach in Clinical Decision Support Systems By SYED SAOOD ZIA Department of Computer Science A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy (Information Technology) at Graduate School of Engineering Sciences and Information Technology Faculty of Engineering Sciences and Technology Hamdard University Karachi, Pakistan July, 2016 Copyright c Syed Saood Zia, 2016 All right reserved. Printed by: Hamdard University Graduate School of Engineering Sciences and Information Technology Faculty of Engineering Sciences and Technology Hamdard University Doctoral Defense We hereby recommend that the student SYED SAOOD ZIA Roll No.: ITP - F06 - 104 Enrollment No.: ICK - IT - 06 - 0023 may be accepted for Doctor of Philosophy Degree. Doctoral Defense Committee Held on 26 − 07 − 2017 DD - MM - YYYY Supervisor: P rof. Dr. P ervez Akhtar Signature with Date Co-Supervisor: (if appointed) Signature with Date GEC Member 1: P rof. Dr. Aqeel−ur−Rehman Internal Signature with Date GEC Member 3: Assoc. P rof. Dr. T ariq Javid Ali Internal Signature with Date GEC Member 3: P rof. Dr. Shahid Hafeez Mirza, SSUET, P akistan External GEC Member, Univesity and Country External Evaluator 2: Dr. Nadeem Mahmood, University of Karachi, P akistan Local External Expert Name, Univesity and Country External Evaluator 3: P rof. Dr. Coskun BAY RAK, University of Arkansas, USA Foreign Expert Name, Univesity and Country External Evaluator 4: P rof. Dr. Xiaohong Gao, Middlesex University, UK Foreign Expert Name, Univesity and Country COUNTERSIGNED Dated: DD - MM - YYYY Dean FEST Graduate School of Engineering Sciences and Information Technology Faculty of Engineering Sciences and Technology Hamdard University Certificate of Approval It is certified that Syed Saood Zia s/o Syed Zia Uddin Ahmed bearing enrollment no. ICK – IT – 06 - 0023 has successfully completed his PhD (Information Technology) research study entitled Hybrid Reasoning Ap- proach in Clinical Decision Support Systems under my supervision and his PhD dissertation meets the highest scholarly as set by the Hamdard University, Karachi, Pakistan. Dated: Prof. Dr. Pervez Akhtar DD - MM - YYYY PhD Supervisor Graduate School of Engineering Sciences and Information Technology Faculty of Engineering Sciences and Technology Hamdard University PhD Thesis Report Approval Dated: DD - MM - YYYY I hereby recommend that the project prepared and successfully defended under my su- pervision entitled: Hybrid Reasoning Approach in Clinical Decision Support Systems By SYED SAOOD ZIA be accepted in partial fulfillment of the requirement for the degree of Doctor of Philosophy in Information Technology from Graduate School of Engineering Sciences and Information Technology, Hamdard University. Prof. Dr. Pervez Akhtar Deputy Director GSESIT PhD Supervisor Chairman Postgraduate Dean FEST Graduate School of Engineering Sciences and Information Technology Faculty of Engineering Sciences and Technology Hamdard University PhD Dissertation Submission Declaration I certify the following about the research study entitled Hybrid Reasoning Approach in Clinical Decision Support Systems submitted for the degree of Doctor of Philosophy. I hereby declare that: a. This dissertation is the result of my own work and includes nothing which is the outcome of work done in collaboration except where specifically indicated in the text and bibliography. b. My dissertation (or any significant part of my dissertation) is not substantially the same as any that I have submitted, or that is being concurrently submitted, for a degree or diploma or other qualification at the Hamdard University or any other University or similar institutions. c. The work(s) are not in any way a violation or infringement of any copyright, trade- mark, patent, or other rights whatsoever of any person. d. All research integrity requirements have been complied with. e. No conflict of interest with the supervisor for this research work. I certify that the information provided in the form is correct. Dated: Syed Saood Zia DD - MM - YYYY PhD Scholar I would like to dedicate this research work to my Mother, Rehana Begum (Late) i Acknowledgements I am extremely appreciative to all those person who, directly or ramblingly, are responsi- ble for this thesis coming into being. I want to express my heartfelt thanks to Professor Dr. Pervez Akhtar who has been far more than an advisor. With his patience, guidance, inspiration, and overwhelming support, I was able to conquer my own Everest. It has always been fun and a great experience to work with him. I am also thankful to my GEC members Professor Dr. Shahid Hafeez Mirza, Professor Dr. Aqeel-ur-Rehman and Dr. Tariq Javid Ali for all their support, encouragement, intuitive ideas and for sharing interesting research thoughts during my studies. I am grateful to Dr.Asghar who is working as an oncologist consultant in Memon Medical Hospital Karachi-Pakistan, and Dr. Rufina Soomro working as an oncologist consultant in Liaquat National Hospital Karachi-Pakistan, for always being cooperative in providing me the knowledge that is prerequisite in this research. The work presented in this thesis would not have been possible without the help of my supervisor, GEC Committee members and medical consultants. Without their priceless guidance and support, the presented thesis has not been possible. I would like to thank both foreign examiners Prof. Dr. Coskun Bayrak, Department of Computer Science, University of Arkansas USA and Prof. Dr. Xiaohong Gao, Depart- ment of Computer Science, Middlesex University UK, and national examiner Dr. Nadeem Mahmood, Associate Professor, Department of Computer Science, University of Karachi, who evaluated my PhD thesis and advised to make some positive modification that is helpful to develop my PhD thesis as per international standard. I am very grateful to Prof. Dr. Vali Uddin, Dean, Faculty of Engineering Sciences and Technology (FEST), Hamdard University who have guided me to revise my thesis accord- ing to the required standard. A special thanks to Dr. Arshad Aziz, without his invaluable support, guidance, and encouragement, I could not have been able to publish my research ii papers in ISI indexed Journals. I also admire the continuous support, encouragement and guidance from Muhammad Iqbal Khan, Deputy Director GSESIT. I also appreciate the support and encouragement from Dr. Shakil Ahmed, Chairman, Computer Engineering Department at Sir Syed University of Engineering and Technology, who really supported me to complete this thesis in a given constraint of time. I am very much grateful to my mentor Syed Muhammad Mujahid Sultani for his encour- agement and motivation to start and being through with this thesis work successfully. I appreciate the efforts of my friend Mr. Farrukh Khan, senior software engineer at Abacu- soft, who has supported me while developing proposed system. Many thanks forwarded to my colleague Mr. Idris Mala and the fellow PhD students for all the great time together. Thanks to Mrs. Shugfta Yasmeen for her help in proofreading. Thanks to all the anonymous reviewers of my papers for their valuable feedback about the research. Many appreciations are also proceeded to the staff at GSESIT, Hamdard Uni- versity for always being helpful. In particular, thanks to Mr. Safwan Ahmed, Mr. Mazhar Hussain Shangi, Mr. Moin Uddin, Ms. Roomesa and more. Further, I appreciate the ser- vices received from Mr. Farooq and Mr. Fayaz during the course work and Mr. Faisal and Mr. Adil during the research work phases, respectively. Thanks to all for timely supply of tea, cookies, and chicken sandwiches. I am very much thankful to my all friends, relatives, siblings; especially thanks to my friends Mr. Ejaz Lateef, Mr. Adnan Zahoor, Mr. Jawaid Shabir, Mr. Sarfaraz Natha, Mr. Muhammad Naseem and Mr. Tauseef Mobeen who have always inspired me through- out these years. I would like to remember my father Syed Zia Uddin Ahmed, for their everlasting en- couragement and support during research work. Importantly, I must acknowledge love and warmth of my mother Rehana Begum (Late) for all the success of my efforts. For last, and most important, I am grateful beyond words to my wife Hiba Mujahid, my son Syed Muhammad Bin Saood and my daughters Maira Saood & Iffat Saood, they have encouraged and supported me always. I would not have been able to go through the process and finish the work without their invaluable love and support. Syed Saood Zia iii Abstract Through the advent of technological progression, different computer aided applications were introduced during last four decades to supplement the diagnosis and treatment phases of patient care. Now at different levels initiatives have been taken to encourage the medical practitioners for implementing these high-tech computer applications in their everyday clinical practices to enhance the graph of human well-being. Clinical decision support systems (CDSSs) were introduced as an ideal computer based application to in- fluence the medical diagnosis process with its capability to store large extent of data and provide prerequisite data at the time of patient evaluation phases without wasting time. However the efficient progression of CDSS impeded by a number of obstacles which if addressed could potentially unlock the significance of these systems. This research work reveals the comprehensive detail of the different CDSSs that were proposed during the last four decades after the innovation of these computer systems and

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