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pain assessment can be applied for pain measurement in patients with musculoskele-
tal disorder with reduction in the range of motion, as exemplified in [5].
This conditional restriction is the information that defines the actual reasoning
process in the decision making and will affect the final and accurate decision as
given in Fig. 16.6h.
The compositional rule of inference states that the cylindri-
M
cal extension, cyl
, is the first operation to extend this measure (Fig. 16.6c)
upon the knowledge base (Fig. 16.6d and Fig. 16.6e). In sequence, the conjunc-
(
(
x
))
tion principle, con j cyl
) , is the operation that reduce the knowledge
base according to the input fuzzy restriction, as illustrated in (Fig. 16.6f). The con-
M
(
(
x
)) ,
R
(
x
,
y
junction operation, cyl
) , is accomplished by using a t-norm that
allows determining a partial fuzzy set in the relation R , restricted by the measure,
M through the cylindrical extension. The logical operator of conjunction is min .
M
(
(
x
))
R
(
x
,
y
Finally, the projection principle, pro j con j cyl
) , is the operation
employed to obtain the final approximate decision (also classification, assessment,
diagnosis, therapeutic conduct etc.), as show in Fig. 16.6h). The resulting projected
surface upon the output fuzzy sets is accomplished by the logical operation of max .
In the case a precise, exact output is required, the defuzzification method is em-
ployed. The most common defuzzification method is the Center of Area (COA):
M
(
(
x
)) ,
R
(
x
,
y
= i M a i y o pioid (
x i )
opioid
.
(16.11)
i M y o pioid (
x i )
The induced precise and exact output value concerning the opioid linguistic variable
is 7
140950 for this example when computed by the COA for the input given in
(16.10).
Determining a precise and certain therapeutic conduct from an imprecise and un-
certain measure is a task not easily performed even by human beings. The resulting
value obtained with this hypothetical Fuzzy Decision Support Systems (FDSS) for
opioid administration - i.e., a Fuzzy Opioid Prescription System (FOPS) - means
not prescribing an overdose that eliminates the pain but let the patient lethargic, or
not administering a low dose that let the patient lucid but does not eliminate the
pain. When designed according to experimental data and/or the heuristic, the FOPS
can, thus, be a feasible alternative to reduce errors in prescribing the therapeutic
conduct because it is a natural mechanism for dealing with vagueness, subjectivity,
and fuzziness during the medical and healthcare process.
.
16.4
Conclusion
Fuzziness concerns all activity within the medical and healthcare context. The sub-
jectivity, fuzziness, or vagueness is a constant in all aspects of sign and symptom
measurements as a mechanism of providing evidence as well as during the deci-
sion, diagnosis, classification, analysis, therapeutic conduct, and so forth. In this
sense, fuzzy systems and approximate reasoning are a natural mechanism for being
employed by medical and healthcare professionals.
 
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