Using case-based reasoning in a learning system: a prototype of a pedagogical nurse tool for evidence-based diabetic foot ulcer care

Clara Bender*, Simon Lebech Cichosz, Alberto Malovini, Riccardo Bellazzi, Louise Pape-Haugaard, Ole Hejlesen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Background: Currently, evidence-based learning systems to increase knowledge and evidence level of wound care are unavailable to wound care nurses in Denmark, which means that they need to learn about diabetic foot ulcers from experience and peer-to-peer training, or by asking experienced colleagues. Interactive evidence-based learning systems built on case-based reasoning (CBR) have the potential to increase wound care nurses’ diabetic foot ulcer knowledge and evidence levels. Method: A prototype of a CBR-interactive, evidence-based algorithm-operated learning system calculates a dissimilarity score (DS) that gives a quantitative measure of similarity between a new case and cases stored in a case base in relation to six variables: necrosis, wound size, granulation, fibrin, dry skin, and age. Based on the DS, cases are selected by matching the six variables with the best predictive power and by weighing the impact of each variable according to its contribution to the prediction. The cases are ranked, and the six cases with the lowest DS are visualized in the system. Results: Conventional education, that is, evidence-based learning material such as books and lectures, may be less motivating and pedagogical than peer-to-peer training, which is, however, often less evidence-based. The CBR interactive learning systems presented in this study may bridge the two approaches. Showing wound care nurses how individual variables affect outcomes may help them achieve greater insights into pathophysiological processes. Conclusion: A prototype of a CBR-interactive, evidence-based learning system that is centered on diabetic foot ulcers and related treatments bridges the gap between traditional evidence-based learning and more motivating and interactive learning approaches.

Original languageEnglish
JournalJournal of Diabetes Science and Technology
Issue number2
Pages (from-to)454-459
Number of pages6
Publication statusPublished - Mar 2022


  • case-based reasoning
  • diabetic foot ulcers
  • dissimilarity score
  • education
  • evidence
  • interactive learning system
  • knowledge level
  • variables
  • wound care nurses


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