JAMA April 2005
GIDEON: Global Infectious Disease and Epidemiology Network
GIDEON: The Global Infectious Disease and Epidemiology Network is a superbly designed expert system created to help physicians diagnose any infectious disease (337 recognized) in any country of the world (224 included). The program was created and has been progressively refined over more than a decade by a talented group of Americans, Canadians, and Israelis. GIDEON is now available in Internet and CD-ROM versions, under an individual or institutional license, each including updates. This diagnostic system is remarkable for its ease of use, breadth of scope, and depth of information. It is as practical a program as one could hope for.
GIDEON contains four operational modules, which are seamlessly integrated. The first, “Diagnosis,” requests specific clinical signs and symptoms, which one enters by checking boxes in a simple but comprehensive tree of terms and statements (eg, “fever”; “the patient is an adult”). Particular attention is paid to basic clinical findings, time sequences, and countries visited. A list of likely diagnoses is proposed; the probability of each is specified. One can ask, “Why not?” for any alternative diagnosis that is not listed in the differential diagnoses. Thus, at the outset, this becomes a teaching program as well as an expert diagnostic system. If additional information is needed to distinguish diagnostic possibilities, further history or diagnostic tests are proposed.
“Epidemiology” focuses on epidemiologic aspects of every possibility listed in the differential diagnosis. To provide detailed and well-organized epidemiologic information about every known infectious disease in the world is an impressive feat. High-quality photographs and in-depth clinical information are available with a keystroke. Most users will never have heard of at least several of the world’s infectious diseases, much less know useful information about many of them. All these factual data are neatly organized and do not appear unless requested. The screens are clean and easy to use.
“Therapy” proposes appropriate antibiotics, antihelminthics, antivirals, or vaccines for the microorganisms causing each of the diagnoses; it also lists mechanisms of action, doses, adverse effects, and brand names. If you’ve ever wondered which vaccines have ever triggered Guillain Barré syndrome, that information is a few mouse clicks away (there are 18).
“Microbiology,” the final module, can be used either diagnostically, by entering data from laboratory examination of the organism (eg, morphologic characteristics, test results, such as coagulase positive) or as an information source, to help distinguish the identifying characteristics of different microorganisms.
One will sensibly wonder, is it accurate? The developers state that the system has been checked diagnostically against 495 actual cases and was correct 94% of the time; 75% of the time the correct diagnosis was the first one listed in the differential. If I have at least whetted the reader’s interest, he or she should go directly to http://www.gideononline.com for a tutorial demonstration of the program. Should that be of interest, the developers offer a free 15-day trial.
Any physician capable of using the most elementary functions of a computer could easily use GIDEON. The program is an intellectual tour de force for helping physicians quickly and successfully respond to the diagnostic and therapeutic problems of seeing patients with infectious illnesses that either are intrinsically complex or may have originated in unfamiliar, foreign settings. In times when exotic travel brings exotic diseases into our offices, GIDEON provides world-class consultation. It continues to be the best designed expert program I have seen for medical practice.
Vincent J. Felitti, MD, Reviewer
Kaiser Permanente Medical Care Program
San Diego, California
Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; Journal Review Editor: Brenda L. Seago, MLS, MA, Medical College of Virginia Campus, Virginia Commonwealth University.