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PubMed2026

Alarms and alarm management with automated versus conventional ventilation in neurocritical care patients.

INTRODUCTION: False or clinically irrelevant alarms are a major driver of ICU alarm fatigue and nursing workload. Ventilator alarms make up a large share, and although automated ventilation modes can reduce manual adjustments, their effect on alarm burden is still unclear. This issue can be particularly relevant in neurocritical care patients, where precise ventilator and alarm management is imperative for patient safety. OBJECTIVES: This explorative post hoc analysis of a randomized clinical trial compared alarm frequency and management between automated ventilation and conventional ventilation in neurocritical care patients. METHODS: Ventilator alarms and manual ventilator changes were captured continuously from the ventilator for up to 24 h per patient. The primary endpoint was a composite of workload-relevant alarms; with alarm management interventions at the ventilator as a key secondary outcome. Additional endpoints included redundant alarms, alarm duration and ventilator management. RESULTS: 13 patients received automated ventilation and 24 received conventional ventilation. No difference was observed in workload-relevant alarm frequency between automated and conventional ventilation (3.28 [2.87 to 4.30] vs 3.73 [1.66 to 7.33] alarms per hour; P = 0.81), while alarm management interventions at the ventilator were lower with automated ventilation (0.14 [0.10 to 0.15] vs 0.21 [0.17 to 0.31] interventions per hour; P = 0.01). Other alarm frequencies, duration of alarms and ventilator management were similar. CONCLUSIONS: In this exploratory post hoc analysis of a randomized clinical trial in neurocritical care patients during the early phase of mechanical ventilation, automated ventilation did not reduce the frequency of total or workload-relevant alarms, nor their duration, but was associated with fewer alarm management interventions compared to conventional ventilation. IMPLICATIONS FOR CLINICAL PRACTICE: Automated ventilation may not reduce alarm frequency in neurocritical care patients, but the observed reduction in alarm-related bedside interventions suggests a potential benefit for nursing workload.

Humans↗
PubMed2002

Comparison of manual and automated leukocyte counts for determination of the absolute neutrophil count: application to a pediatric oncology clinic.

BACKGROUND: Determination of the absolute neutrophil count (ANC) is a critical test prior to initiation of chemotherapy and is a standard component of cancer therapy protocols. Automated determination of this parameter potentially shortens the turnaround time necessary between specimen phlebotomy and chemotherapy infusion in an outpatient setting. However, there are certain factors that can lead to spuriously elevated or lowered ANCs, possibly leading to inappropriate dosage. We therefore compared ANC results in a series of samples in which both automated and manual results were available. PROCEDURE: Sets of 111 specimens, tested over a 1-month period, had matched automated and manual ANC results available for initial retrospective analysis. An additional set of 35 specimens with ANCs of <1.5 x 10(9)/L were subsequently analyzed in a similar fashion. Automated ANC results were obtained with a Cell-Dyn 3500 (Abbott Diagnostics, Santa Clara, CA, USA) automated hematology analyzer, and manual ANC results were obtained using 100 cell differentials performed by 1 of 13 medical technologists. Results were tabulated and analyzed using standard linear regression and scatter plot analyses. RESULTS: Of the initial 111 specimens, automated ANC values ranged from 0.16-14.2 x 10(9)/L (median=2.6 x 10(9)/L), as compared with 0.24-13.9 x 10(9)/L (median 3.0 x 10(9)/L) for manual ANC values (R(2) = 0.99; SE=0.49). Differences between the ANC values ranged from -55 to +33% (SD=14%) of the manual value. Of the second set of 35 specimens, regression analysis yielded an R(2) value of 0.92, with a SE of 0.11. Both data sets yielded acceptable degrees of variation on scatter plot analyses. CONCLUSIONS: Automated ANC values appear adequate for determining suitability for chemotherapy and lessen the turnaround time between specimen phlebotomy and result verification.

Analysis of Variance↗
PubMed2004

Predicting competency in automated machine use in an acquired brain injury population using neuropsychological measures.

The purpose of the current study was to explore whether performance on standardised neuropsychological measures could predict functional ability with automated machines and services among people with an acquired brain injury (ABI). Participants were 45 individuals who met the criteria for mild, moderate or severe ABI and 15 control participants matched on demographic variables including age- and education. Each participant was required to complete a battery of neuropsychological tests, as well as performing three automated service delivery tasks: a transport automated ticketing machine, an automated teller machine (ATM) and an automated telephone service. The results showed consistently high relationship between the neuropsychological measures, both as single predictors and in combination, and level of competency with the automated machines. Automated machines are part of a relatively new phenomena in service delivery and offer an ecologically valid functional measure of performance that represents a true indication of functional disability.

Adult↗
PubMed2005

[Automation of the immunohematology laboratory].

Automation finds a particularly justified application in the field of immunohematology in which any human failure can have dramatic consequences for the patients. The purposes of automation, indissociable from computerization, were reminded by the French regulatory: to decrease the risks of human error linked to each step of the tests performed; to guarantee a reliable traceability of all the elements having contributed to the test process; to manage all the alarms of dysfunction of the system. The main devices available today permit automation of a part of the pre-analytical phase and of all the steps of the analytical phase by the realization in routine of ABO-RH1 grouping, phenotyping, of irregular antibody screening and of compatibility testing. They use the reaction of agglutination either in micro-plates or in filtration. One distinguishes two types of materials: full automates managing all the steps from the sample positioning on the carrier down to the final result without any handling of the samples (Autovue, Galileo, ID gel station, Qwalys, Tango, Techno) and the semi-automates, which require intervention of an operator for the phases of centrifugation, stirring and incubation (Mitis 2, Hemos, Rosys, Swing) the reading being automated for all. All include the possibility of a connection to the central data processing system . If some devices allow the choice of reagents, others can only work with the reagents supplied by the manufacturer. In all the cases, optimization of the automated systems implies a specific training of the staff and the strict compliance with the standard operating procedures by each individual.

Automation↗
PubMed2000

Adaptive automation, trust, and self-confidence in fault management of time-critical tasks.

An experiment on adaptive automation is described. Reliability of automated fault diagnosis, mode of fault management (manual vs. automated), and fault dynamics affect variables including root mean square error, avoidance of accidents and false shutdowns, subjective trust in the system, and operator self-confidence. Results are discussed in relation to levels of automation, models of trust and self-confidence, and theories of human-machine function allocation. Trust in automation but not self-confidence was strongly affected by automation reliability. Operators controlled a continuous process with difficulty only while performing fault management but could prevent unnecessary shutdowns. Final authority for decisions and action must be allocated to automation in time-critical situations.

Adult↗
PubMed2004

An automated scoring procedure for the micronucleus test by image analysis.

The micronucleus assay (MNT) in human lymphocytes is frequently used to assess chromosomal damage as a consequence of environmental mutagen exposure, to assess the effect of mutagens or to search for reduced DNA repair capacity after a mutagenic challenge. We have established an automated scoring procedure for the cytokinesis blocked MNT based on computerized image analysis (Metasystems Metafer 4 version 2.12). To evaluate the results we used the reproducibility of counts, established a dose-response curve for gamma-irradiation and used the ability of the system to differentiate between breast cancer patients and controls as a biological reference, a difference which we had observed before by visual counting. Blood cultures were irradiated with gamma-rays (2 Gy) at the beginning and treated with cytochalasin B during the last 24 h. The slides were stained with Giemsa for visual counting and with DAPI for automated analysis. Our test sample consisted of 73 persons (27 with breast cancer and 26 female and 20 male controls). A comparison between visual counting (controls, mean MN frequency 313) and automated counting (mean MN frequency 106) in slides from the same culture revealed a large drop for the automated counts. However, the automated counts were as reproducible as the visual counts [coefficient of variation (CV) on the sample approximately 20%; CV on repeated counts of the same slides approximately 5%] and both counts were highly correlated. Furthermore, the discrimination between cases and controls improved for automated counting of slides from the same cultures [visual odds rato (OR) < or = 4.0, P = 0.009; automated OR > 16, P < 0.0001], with a strong dependence on the set of parameters used. This improvement was confirmed in a validation sample of an additional 21 controls and 20 cases (OR = 11, P = 0.0018) performed as a prospective or diagnostic test.

Algorithms↗
PubMed2006

Automation of manual components and image quantification of direct dual label fluorescence in situ hybridization (FISH) for HER2 gene amplification: A feasibility study.

Determination of HER2 status by fluorescence in situ hybridization (FISH) in breast carcinoma correlates well with response to targeted therapy and prognosis. However, manual time consuming methods and quantification aspects of the procedure may be challenging for some laboratories. We examined the feasibility of automating these components of the FISH assay using a tissue microarray (TMA-118 clinically annotated cases) and a series of 41 whole sections. An in situ hybridization automated staining workstation was used to automate a programmed overnight start, on line baking, deparaffinization, cell conditioning, protease digestion, and prehybridization buffer washing. Dual label probe/target codenaturation/hybridization and stringency washing were done off line. The HER2 and CEP17 spot counts were quantified, and the HER2/CEP17 ratio calculated, via an imaging workstation. Results were benchmarked against manual counts for whole sections, and bright field in situ hybridization [silver in situ hybridization (SISH)] for the TMA. Automated FISH results using whole sections correlated well with manual results: HER2/CEP17 ratio correlation coefficient r = 0.9154, r = 0.8380, P < 0.0001. Correlation between automated and manual TMA FISH results was also excellent, and disease-free survival was significantly shorter (P < 0.001) for the HER2 amplified cases. Automation of the laborious manual prehybridization and image quantification components of FISH using directly labeled probes is feasible. Operational gains and enhanced consistency are inherent in this automated approach to HER2 clinical FISH testing.

Automation↗
PubMed1971

Automation of a hemagglutination-inhibition test for parainfluenza 3 antibodies in bovine sera.

An automated hemagglutination-inhibition (HI) test for the "shipping fever" strain (SF-4) of parainfluenza 3 antibody in bovine sera was developed and compared to manual tube and microtiter test procedures. The automated system operating at 60 samples per hr provided the most test results per specified time period, and the manual tube test provided the least. The manual microtiter test and the automated system at 40 samples per hr, falling between the two above procedures, were comparable in the number of sera that could be titrated in 1 day by one technician. There was little difference between automated and manual test reproducibility when measured at the twofold titer one-dilution difference level. However, the automated system titrated a higher number of sera at the same titer on repeat runs than either of the manual test procedures. The automated one-quartile difference reproducibility (each twofold dilution subdivided into 4 units-"quartiles") was equal to the manual test one-dilution difference reproducibility. The standard deviation of the per cent variation from the mean of paired serum titers for 40-sample-per-hr runs ranged from +/-3.49 to +/-5.36%. The manual and automated systems were of comparable sensitivity in their detection of negative sera.

Animals↗
PubMed2004

Evaluation of automated sample preparation and quantitative PCR LCx assay for determination of human immunodeficiency virus type 1 RNA.

Efforts have been made to achieve full automation of molecular assays for quantitative detection of human immunodeficiency virus type 1 (HIV-1). In the present study, the Abbott LCx HIV RNA Quantitative assay was evaluated in conjunction with automated HIV-1 RNA extraction on the MagNA Pure LC instrument and compared to the conventional LCx HIV RNA Quantitative assay, which uses a manual nucleic acid extraction protocol. Accuracy, linearity, and interassay and intra-assay variations were determined. The performance of the assay in a routine clinical laboratory was tested with a total of 105 clinical specimens. When the accuracy of the LCx HIV RNA Quantitative assay with the automated sample preparation protocol was tested, all results were found to be within +/- 0.5 log unit of the expected results. Determination of linearity resulted in a quasilinear curve over 3.5 log units. For determination of interassay variation, coefficients of variation were found to be between 21 and 66% for the LCx HIV RNA Quantitative assay with the automated sample preparation protocol and between 10 and 69% for the LCx HIV RNA Quantitative assay with manual sample preparation. For determination of intra-assay variation, coefficients of variation were found to be between 7 and 25% for the LCx HIV RNA Quantitative assay with the automated sample preparation protocol and between 7 and 19% for the LCx HIV RNA Quantitative assay with manual sample preparation. When clinical samples were tested by the LCx HIV RNA Quantitative assay with the automated sample preparation protocol and the results were compared with those of the LCx HIV RNA Quantitative assay with manual sample preparation, 95% of all positive results were found to be within +/- 0.5 log unit. In conclusion, the assay with automated sample preparation proved to be suitable for use in the routine diagnostic laboratory and required significantly less hands-on time.

Automation↗
PubMed2000

Automation bias and errors: are crews better than individuals?

The availability of automated decision aids can sometimes feed into the general human tendency to travel the road of least cognitive effort. Is this tendency toward "automation bias" (the use of automation as a heuristic replacement for vigilant information seeking and processing) ameliorated when more than one decision maker is monitoring system events? This study examined automation bias in two-person crews versus solo performers under varying instruction conditions. Training that focused on automation bias and associated errors successfully reduced commission, but not omission, errors. Teams and solo performers were equally likely to fail to respond to system irregularities or events when automated devices failed to indicate them, and to incorrectly follow automated directives when the contradicted other system information.

Aerospace Medicine↗
PubMed2003

Elimination of instrument-driven reflex manual differential leukocyte counts. Optimization of manual blood smear review criteria in a high-volume automated hematology laboratory.

Automated peripheral blood leukocyte differential counts (LDCs) are widely accepted in routine practice. However, many laboratories still reflexively perform manual LDCs based solely on abnormal automated results or instrument "flags," before any manual triage step. We describe our transition to a procedure that uses manual methods to validate, rather than to replace, automated LDCs (an approach recommended early in the development of automated methods, but still not used in many clinical laboratories). Manual microscopic scans were performed in lieu of manual LDCs. Each scan that revealed cell types not quantifiable by the instrument triggered a manual LDC. However, if the manual scan simply confirmed the cell types seen on automated LDC, then the automated result was released, even if clinically significant quantitative abnormalities were present. This policy reduced manual LDCs by more than 70% and was validated by a manual retrospective audit. Patient care and laboratory operations can be optimized by using manual microscopic examination as a validation procedure rather than as a reflexive substitute for automated methods. There is no clinical rationale for reflex performance of manual LDCs based solely on instrument warnings.

Automation↗
PubMed2005

Sharing control between humans and automation using haptic interface: primary and secondary task performance benefits.

This paper describes a paradigm for human/automation control sharing in which the automation acts through a motor coupled to a machine's manual control interface. The manual interface becomes a haptic display, continually informing the human about automation actions. While monitoring by feel, users may choose either to conform to the automation or override it and express their own control intentions. This paper's objective is to demonstrate that adding automation through haptic display can be used not only to improve performance on a primary task but also to reduce perceptual demands or free attention for a secondary task. Results are presented from three experiments in which 11 participants completed a lane-following task using a motorized steering wheel on a fixed-base driving simulator. The automation behaved like a copilot, assisting with lane following by applying torques to the steering wheel. Results indicate that haptic assist improves lane following by least 30%, p < .0001, while reducing visual demand by 29%, p < .0001, or improving reaction time in a secondary tone localization task by 18 ms, p = .0009. Potential applications of this research include the design of automation interfaces based on haptics that support human/automation control sharing better than traditional push-button automation interfaces.

Analysis of Variance↗
PubMed2000

[Communications among components of automated clinical laboratory systems].

Laboratory Automation Systems has been developed with original specifications from each vender. To construct a system in a multi-vender environment, remodeling of the interface and software had to be done by the user. The standard concerning automated laboratory systems was made by NCCLS in 1997. This standard provides a protocol for communications among Laboratory Automation Systems(LAS), Laboratory Information Systems(LIS), automated instruments (analyzers), and pre- and post-analytical automated devices. This document explains the current details and the overall content of the communication standards for automated laboratory systems developed by the NCCLS Subcommittee on Communications between Automation Systems.

Autoanalysis↗
PubMed2004

Workflow improvement and impact of the new Beckman Coulter LH 1500 high throughput automated hematology workcell.

Our core laboratory at St. Joseph's Medical Center (SJMC) recently installed the new Beckman Coulter LH 1500 fully automated hematology workcell. Like many laboratories in North America and other parts of the world, we are under significant pressure to improve productivity, reduce costs, and improve service provision to our hospital and clinician bases. The difficulty of meeting this challenge is often further compounded by an increasing shortage of qualified technologist personnel. We recently reported on the significant productivity gains with the introduction of the LH 750 hematology system into the core laboratory, including a 23% reduction in slide review rate, automation of reticulocyte and nucleated red blood cell counts, and an 82% increase in the pass-through rate. Evolution to the next stage of automation has come much quicker than anticipated owing to a steep rise in workload and an ever increasing shortage of trained and experienced technologists to fill vacancies in the 24-hour core laboratory operation. We chose to upgrade our LH 750 analyzers to the newly introduced LH 1500 hematology workcell in order to cope with the increased workload and shortage of available experienced hematology technologists. The LH 1500 is a compact, high throughput, fully automated hematology workcell. It is designed to automate all manual process and handling steps associated with hematology analyses, including sample sorting, loading and unloading of cassettes, automatic rerun and reflex testing, sample storage, and tracking of samples. The LH 1500 is comprised of a minimum of 2, and up to 4, LH 750 instruments (with or without integrated slidemaker/stainers). The instruments are bidirectionally interfaced and linked to a fully automated conveyor track, specimen inlet and outlet stations, a sample stockyard, and a line controller. The configuration we chose at SJMC incorporates 1 LH 750 and 1 LH 755. We report that the upgrade to the LH 1500 was a relatively straightforward process and required no redesign of the core laboratory. Based on our evaluation, we estimate cost savings with the LH 1500 of between three quarters to 1 full-time equivalent, which eliminated or decreased many manual handling steps. In addition, this increase in efficiency has freed up our technologist resources to concentrate on the more difficult and clinically important samples. This is the first published report on the new LH 1500 hematology workcell. Our research indicates that the LH 1500 is the first hematology workcell to offer hematology laboratories the next level of automation and virtually eliminate preanalytical and postanalytical sample handling and sorting. For core laboratories and high-throughput hematology laboratories that face similar pressures to ours, the LH 1500 would appear as an attractive solution to maximize hematology productivity and improve service delivery.

Automation↗
PubMed2006

Automated contrast injection in contemporary practice during cardiac catheterization and PCI: effects on contrast-induced nephropathy.

OBJECTIVES: To evaluate the incidence of contrast-induced nephropathy (CIN) with the use of an automated contrast injection system in conjunction with contemporary measures to prevent CIN after cardiac catheterization and percutaneous coronary intervention (PCI). BACKGROUND: The use of automated contrast injection systems can reduce the volume of procedural contrast, but whether lower contrast volume is associated with a lower incidence of CIN is uncertain. METHODS: The incidence of CIN was assessed in 1,798 patients after diagnostic catheterization or PCI at Wake Forest University Baptist Medical Center from April 2002 to November 2004 using traditional handheld manifold injection systems, and in 377 subsequent patients using an automated contrast injection system. Preprocedural hydration was used on a routine basis, and N-acetylcysteine and bicarbonate infusion were used on an ad hoc basis. Outcomes were adjusted by standard logistic regression modeling. RESULTS: Mean contrast volume (+/- standard deviation) per case was reduced from 204 +/- 147 ml to 146 +/- 108 ml, p < 0.05 by use of automated contrast injection. The incidence of CIN was 19.3% using manifold injection, and was 13.3%, p < 0.05, after use of automated contrast injection. The use of automated contrast injection was associated with a reduced relative risk of CIN, 0.66 (0.47-0.93), compared to manual injection, even after adjustment for baseline clinical and procedural covariates. CONCLUSIONS: The use of an automated contrast injection system in conjunction with contemporary hydration and pharmacologic strategies to prevent CIN during diagnostic catheterization and PCI was associated with a significant reduction in the use of contrast volume, as well as in the incidence of CIN.

Aged↗
PubMed1991

Laboratory systems integration: robotics and automation.

Robotic technology is going to have a profound impact on the clinical laboratory of the future. Faced with increased pressure to reduce health care spending yet increase services to patients, many laboratories are looking for alternatives to the inflexible or "fixed" automation found in many clinical analyzers. Robots are being examined by many clinical pathologists as an attractive technology which can adapt to the constant changes in laboratory testing. Already, laboratory designs are being altered to accommodate robotics and automated specimen processors. However, the use of robotics and computer intelligence in the clinical laboratory is still in its infancy. Successful examples of robotic automation exist in several laboratories. Investigators have used robots to automate endocrine testing, high performance liquid chromatography, and specimen transportation. Large commercial laboratories are investigating the use of specimen processors which combine the use of fixed automation and robotics. Robotics have also reduced the exposure of medical technologists to specimens infected with viral pathogens. The successful examples of clinical robotics applications were a result of the cooperation of clinical chemists, engineers, and medical technologists. At the University of Virginia we have designed and implemented a robotic critical care laboratory. Initial clinical experience suggests that robotic performance is reliable, however, staff acceptance and utilization requires continuing education. We are also developing a robotic cyclosporine which promises to greatly reduce the labor costs of this analysis. The future will bring lab wide automation that will fully integrate computer artificial intelligence and robotics. Specimens will be transported by mobile robots. Specimen processing, aliquotting, and scheduling will be automated.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗
PubMed1999

CAFASP-1: critical assessment of fully automated structure prediction methods.

The results of the first Critical Assessment of Fully Automated Structure Prediction (CAFASP-1) are presented. The objective was to evaluate the success rates of fully automatic web servers for fold recognition which are available to the community. This study was based on the targets used in the third meeting on the Critical Assessment of Techniques for Protein Structure Prediction (CASP-3). However, unlike CASP-3, the study was not a blind trial, as it was held after the structures of the targets were known. The aim was to assess the performance of methods without the user intervention that several groups used in their CASP-3 submissions. Although it is clear that "human plus machine" predictions are superior to automated ones, this CAFASP-1 experiment is extremely valuable for users of our methods; it provides an indication of the performance of the methods alone, and not of the "human plus machine" performance assessed in CASP. This information may aid users in choosing which programs they wish to use and in evaluating the reliability of the programs when applied to their specific prediction targets. In addition, evaluation of fully automated methods is particularly important to assess their applicability at genomic scales. For each target, groups submitted the top-ranking folds generated from their servers. In CAFASP-1 we concentrated on fold-recognition web servers only and evaluated only recognition of the correct fold, and not, as in CASP-3, alignment accuracy. Although some performance differences appeared within each of the four target categories used here, overall, no single server has proved markedly superior to the others. The results showed that current fully automated fold recognition servers can often identify remote similarities when pairwise sequence search methods fail. Nevertheless, in only a few cases outside the family-level targets has the score of the top-ranking fold been significant enough to allow for a confident fully automated prediction. Because the goals, rules, and procedures of CAFASP-1 were different from those used at CASP-3, the results reported here are not comparable with those reported in CASP-3. Nevertheless, it is clear that current automated fold recognition methods can not yet compete with "human-expert plus machine" predictions. Finally, CAFASP-1 has been useful in identifying the requirements for a future blind trial of automated served-based protein structure prediction.

Algorithms↗
PubMed1999

Comparison of the quality of temporal subtraction images obtained with manual and automated methods of digital chest radiography.

The authors have been developing a fully automated temporal subtraction scheme to assist radiologists in the detection of interval changes in digital chest radiographs. The temporal subtraction image is obtained by subtraction of a previous image from a current image. The authors' automated method includes not only image shift and rotation techniques but also a nonlinear geometric warping technique for reduction of misregistration artifacts in the subtraction image. However, a manual subtraction method that can be carried out only with image shift and rotation has been employed as a common clinical technique in angiography, and it might be clinically acceptable for detection of interval changes on chest radiographs as well. Therefore, the authors applied both the manual and automated temporal subtraction techniques to 181 digital chest radiographs, and compared the quality of the subtraction images obtained with the two methods. The numbers of clinically acceptable subtraction images were 147 (81.2%) and 176 (97.2%) for the manual and automated subtraction methods, respectively. The image quality of 148 (81.8%) subtraction images was improved by use of the automated method in comparison with the subtraction images obtained with the manual method. These results indicate that the automated method with the nonlinear warping technique can significantly reduce misregistration artifacts in comparison with the manual method. Therefore, the authors believe that the automated subtraction method is more useful for the detection of interval changes in digital chest radiographs.

Humans↗