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At least 757 records · Page 42Linked to original sources
PubMed2005

Toward personal eHealth in cardiology. Results from the EPI-MEDICS telemedicine project.

Despite many attempts to improve the management of acute myocardial infarction, only small trends to shorter time intervals before treatment have been reported. The self-care solution developed by the European EPI-MEDICS project (2001-2004) is a novel, very affordable, easy-to-use, portable, and intelligent Personal ECG Monitor (PEM) for the early detection of cardiac ischemia and arrhythmia that is able to record a professional-quality, 3-lead electrocardiogram (ECG) based on leads I, II, and V2; derive the missing leads of the standard 12-lead ECG (thanks to either a generic or a patient-specific transform), compare each ECG with a reference ECG by means of advanced neural network-based decision-making methods taking into account the serial ECG measurements and the patient risk factors and clinical data; and generate different levels of alarms and forward the alarm messages with the recorded ECGs and the patient's Personal electronic Health Record (PHR) to the relevant health care providers by means of a standard Bluetooth-enabled, GSM/GPRS-compatible mobile phone. The ECG records are SCP-ECG encoded and stored with the PHR on a secure personal SD Card embedded in the PEM device. The alarm messages and the PHR are XML encoded. Major alarm messages are automatically transmitted to the nearest emergency call center. Medium or minor alarms are sent on demand to a central PEM Alarm Web Server. Health professionals are informed by a Short Message Service. The PEM embeds itself a Web server to facilitate the reviewing and/or update of the PHR during a routine visit at the office of the general physician or cardiologist. Eighty PEM prototypes have been finalized and tested for several weeks on 697 citizens/patients in different clinical and self-care situations involving end users (188 patients), general physicians (10), and cardiologists (9). The clinical evaluation indicates that the EPI-MEDICS concept may save lives and is very valuable for prehospitalization triage.

Allied Health Personnel↗
PubMed2004

Improving patient safety--how can information technology help?

Reports by the Institute of Medicine (IOM) have brought patient safety concerns to the forefront in many health care facilities. The IOM and other organizations have said that increased use of technology has the potential to increase patient safety. This article looks at the reasons behind the increase in health care errors involving patients and considers how technology could help resolve some of these problems.

Hospital Information Systems↗
PubMed2000

Status of point-of-care testing: promise, realities, and possibilities.

Point-of-care testing (POCT) has evolved from the demand for analytical information more rapidly than is available from central laboratories. By bringing the analysis closer to the patient several process steps have been eliminated, facilitating a shorter time to result and faster management response with improved outcomes. Thus benefits include better therapeutic turnaround times, decreased blood loss as a result of reduced phlebotomy secondary to clinical improvement, and diminished resource utilization. These advantages depend on acceptable analytical performance in comparison with central laboratory methods and in relation to clinical criteria. Generally these requirements are met but there are problems particularly with atypical specimens. Outcomes and cost-benefit analyses have been difficult to perform and evaluate. Given the multitude of participants, quality assurance and program management are recognized as resource intensive. However, recognition of problem areas is driving continuous improvement and we envisage expansion of this paradigm.

Blood Specimen Collection↗
PubMed1997

Representing and developing temporally abstracted knowledge as a means towards facilitating time modeling in medical decision-support systems.

The utilization of the appropriate level of temporal abstraction is an important aspect of time modeling. We discuss some aspects of the relation of temporal abstraction to important knowledge engineering parameters such as model correctness, ease of model specification, knowledge availability, query completeness, inference tractability, and semantic clarity. We propose that versatile and efficient time-modeling formalisms should encompass ways to represent and reason at more than one level of abstraction, and we discuss such a hybrid formalism. Although many research efforts have concentrated on the automation of specific temporal abstractions, much research needs to be done in understanding and developing provably optimal abstractions. We provide an initial framework for studying this problem in a manner that is independent of the particular problem domain and knowledge representation, and suggest several research challenges that appear worth pursuing.

Artificial Intelligence↗
PubMed1998

Computer system validation: an overview of official requirements and standards.

A brief overview of the relevant documents for companies in the pharmaceutical industry, which are to be taken into consideration to fulfil computer system validation requirements, is presented. We concentrate on official requirements and valid standards in the USA, European Community and Switzerland. There are basically three GMP-guidelines. their interpretations by the associations of interests like APV and PDA as well as the GAMP Suppliers Guide. However, the three GMP-guidelines imply the same philosophy about computer system validation. They describe more a what-to-do approach for validation, whereas the GAMP Suppliers Guide describes a how-to-do validation. Nevertheless, they do not contain major discrepancies.

Computer Systems↗
PubMed2005

[Computer-assisted diagnosis and therapy for glaucoma].

Boolean algebra, or combinatory analysis and their related computer routines, can provide invaluable help in resolving classic diagnostic problems. However complex each case may be, the diagnosis is always made from a finite set of data, and the fundamental problem is thus how to exploit this data. Invention no longer has a place in ascertaining a diagnosis. Traditional ways of reasoning are numerous, personal, and fragile, but fortunately redundant. They may give rise to four types of error: omission or mistake (an error of judgment), either during the semiotic or the dialectic stages. Whereas the physiological capacity of the human brain and memory only enables it to make a limited number of hypotheses concerning certain aspects of glaucoma, computer programs can take the total number of hypotheses into account, i.e., 3000. For every input the program explores each of the 3,000 items, thus eliminating the four types of error. The probabilistic nature of data, which compromises the confidence one can have in conclusions resulting from such complex reasoning, is treated by the adjusted probabilities. The use of such diagnostic aids, whose thesaurus is updated regularly, is reserved for ophthalmologists, the only authority capable of assessing the pertinence of the computer responses. Consequently, the specialist can rest assured that the patient has benefited from the most comprehensive and updated knowledge in medical science.

Glaucoma↗
PubMed1999

[Requirements for the successful implementation of unity of care: study of a computer-assisted dispensation of pharmaceuticals].

PURPOSE: Even though computerized workstations bring undisputed benefits in nursing units, introducing them is still hard when most of the staff members have to share the workstation. We took advantage of the implementation of the drug prescription software SAUPHIX in a nephrology department to better define the encountered difficulties. The workstation described in this paper is shared by physicians who enter their prescriptions (proprietary names, doses, routes of administration), nurses who use dosage schedules for drug administration, and the chemist who has authority to control prescription orders. METHODS: Six months after the implementation of the workstation, physicians and nurses had to fill out an anonymous questionnaire aimed at assessing each function of the software. RESULTS: Prescriptions proved to be more accurate and legible, while management of drugs was more precise. However, interns complained that entering data was time consuming. Furthermore, they raised objections to control of prescription orders. Nurses criticized dosage schedules, the primary reason being that they had to change their practice. The convenience of notebooks was questioned by both physicians and nurses who would have preferred a greater number of desktop computers at their disposition. CONCLUSION: The implementation of a computerized workstation requires information, diplomacy and negotiations to obtain real implication of the staff. Tasks and schedules must be specified for everybody. The system has to be carefully customized, according to the requirement of the unit. Computers must be properly chosen and allocated in sufficient number. Finally, appropriate preparation, staff training and follow-up of the computerized system are essential.

Drug Prescriptions↗
PubMed2003

Australian nurses' perception of the impact of their postgraduate studies on their patient care activities.

Postgraduate nursing education, formal or informal, has grown enormously and the benefits, to the students, their employers or their patients or its impact on clinical practice has not been well researched, particularly in Australia. The authors commenced a 10 year longitudinal study at a university in Sydney, Australia to track five cohorts of postgraduates at two yearly intervals to determine their career paths, changes in professional behaviour and the perceived impact of their postgraduate education on the care they deliver. This paper will report these five cohorts' (N=236) perceptions of the impact of their postgraduate studies on their care delivery two years after completion of their study. The results indicate that their postgraduate education had a positive to strongly positive impact on the majority of items. These as well as those items identified as not being affected will also be presented and discussed.

Adult↗
PubMed2001

AI in medicine on its way from knowledge-intensive to data-intensive systems.

The last 20 years of research and development in the field of artificial intelligence in medicine (AIM) show a path from knowledge-intensive systems, which try to capture the essential knowledge of experts in a knowledge-based system, to data-intensive systems available today. Nowadays enormous amounts of information is accessible electronically. Large datasets are collected continuously monitoring physiological parameters of patients. Knowledge-based systems are needed to make use of all these data available and to help us to cope with the information explosion. In addition, temporal data analysis and intelligent information visualization can help us to get a summarized view of the change over time of clinical parameters. Integrating AIM modules into the daily-routine software environment of our care providers gives us a great chance for maintaining and improving quality of care.

Artificial Intelligence↗
PubMed2001

Proactive health computing.

In an analysis departing from the global health situation, the foundation for a change of paradigm in health informatics based on socially embedded information infrastructures and technologies is identified and discussed. It is shown how an increasing computing and data transmitting capacity can be employed for proactive health computing. As a foundation for ubiquitous health promotion and prevention of disease and injury, proactive health systems use data from multiple sources to supply individuals and communities evidence-based information on means to improve their state of health and avoid health risks. The systems are characterised by: (1) being profusely connected to the world around them, using perceptual interfaces, sensors and actuators; (2) responding to external stimuli at faster than human speeds; (3) networked feedback loops; and (4) humans remaining in control, while being left outside the primary computing loop. The extended scientific mission of this new partnership between computer science, electrical engineering and social medicine is suggested to be the investigation of how the dissemination of information and communication technology on democratic grounds can be made even more important for global health than sanitation and urban planning became a century ago.

Artificial Intelligence↗
PubMed2001

Multiple representations and multi-modal reasoning in medical diagnostic systems.

The paper examines the motivations for developing medical diagnostic systems exploiting multiple representations and multi-modal reasoning. The analysis is carried on by revisiting the architectural choices of the CHECK system (developed in late 1980s) which combined heuristic and causal knowledge. The results in the theory of diagnosis and in model-based reasoning (MBR) obtained in early 1990s are used for providing a formal characterization of the notion of diagnosis and of the reasoning mechanisms used in CHECK. The paper addresses also the problem of replacing heuristic knowledge provided by human experts with operational knowledge automatically derived from the deep model. In particular, the pros and cons of knowledge compilation and of the integration of case-based reasoning (CBR) with MBR are discussed by summarizing the experience gained in developing AID and ADAPtER. The problem of using an explicit representation of time in diagnostic systems is analyzed and recent work on the different characterizations of diagnosis arising when the temporal dimension is considered is reported. Finally, the implications of the results obtained in MBR and in temporal reasoning on the future of medical diagnostic systems are briefly discussed.

Artificial Intelligence↗