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PubMed2005

A systems engineering perspective on the human-centered design of health information systems.

The discipline of systems engineering, over the past five decades, has used a structured systematic approach to managing the "cradle to grave" development of products and processes. While elements of this approach are typically used to guide the development of information systems that instantiate a significant user interface, it appears to be rare for the entire process to be implemented. In fact, a number of authors have put forth development lifecycle models that are subsets of the classical systems engineering method, but fail to include steps such as incremental hazard analysis and post-deployment corrective and preventative actions. In that most health information systems have safety implications, we argue that the design and development of such systems would benefit by implementing this systems engineering approach in full. Particularly with regard to bringing a human-centered perspective to the formulation of system requirements and the configuration of effective user interfaces, this classical systems engineering method provides an excellent framework for incorporating human factors (ergonomics) knowledge and integrating ergonomists in the interdisciplinary development of health information systems.

Artificial Intelligence↗
PubMed2005

Fully automatic segmentation of white matter hyperintensities in MR images of the elderly.

The role of quantitative image analysis in large clinical trials is continuously increasing. Several methods are available for performing white matter hyperintensity (WMH) volume quantification. They vary in the amount of the human interaction involved. In this paper, we describe a fully automatic segmentation that was used to quantify WMHs in a large clinical trial on elderly subjects. Our segmentation method combines information from 3 different MR images: proton density (PD), T2-weighted and fluid-attenuated inversion recovery (FLAIR) images; our method uses an established artificial intelligent technique (fuzzy inference system) and does not require extensive computations. The reproducibility of the segmentation was evaluated in 9 patients who underwent scan-rescan with repositioning; an inter-class correlation coefficient (ICC) of 0.91 was obtained. The effect of differences in image resolution was tested in 44 patients, scanned with 6- and 3-mm slice thickness FLAIR images; we obtained an ICC value of 0.99. The accuracy of the segmentation was evaluated on 100 patients for whom manual delineation of WMHs was available; the obtained ICC was 0.98 and the similarity index was 0.75. Besides the fact that the approach demonstrated very high volumetric and spatial agreement with expert delineation, the software did not require more than 2 min per patient (from loading the images to saving the results) on a Pentium-4 processor (512 MB RAM).

Aged↗
PubMed2000

The future of bedside monitoring.

Today's intensivists are provided with more information than ever before, yet current monitors present data from multiple sources in a relatively raw form with virtually no intelligent data integration and processing. In the next century, technological advances in miniaturization, biosensors and computer processing, coupled with an improved understanding of critical illnesses at the molecular level, will lead to the development of a new generation of monitors. Monitoring will move from the traditional macroscopic invasive approach to a noninvasive, molecular analysis of evolving critical disease processes. It is likely that disturbances in homeostasis will become known immediately or before they would otherwise be manifest clinically. Nanotechnology will permit monitoring of critical changes in the intracellular environment or the by-products of cellular metabolism and signal messaging. This article discusses monitoring technologies that hold promise for further development in the next century and point out techniques likely to be abandoned.

Artificial Intelligence↗
PubMed2002

Information management.

The desire and requirements for information across the continuum of the enterprise are evident, because outcome measures, quality report cards, and financial pressures effect health care contracting. The real or perceived obstacles to having a comprehensive information management solution (the price tag, the compatibility of hardware and software, multiple locations, ownership of the information, and confidentiality) are so daunting that many are loathe to press ahead. The introduction of modern information technology into the AEC requires a systematic stepwise approach working with trusted partners and stable standards. Intelligent investment in these systems results in a more efficient and effective operating environment based on ongoing data monitoring.

Ambulatory Care Facilities↗
PubMed2006

Principles and implementations of dissipative (dynamic) self-assembly.

Dynamic self-assembly (DySA) processes occurring outside of thermodynamic equilibrium underlie many forms of adaptive and intelligent behaviors in natural systems. Relatively little, however, is known about the principles that govern DySA and the ways in which it can be extended to artificial ensembles. This article discusses recent advances in both the theory and the practice of nonequilibrium self-assembly. It is argued that a union of ideas from thermodynamics and dynamic systems' theory can provide a general description of DySA. In parallel, heuristic design rules can be used to construct DySA systems of increasing complexities based on a variety of suitable interactions/potentials on length scales from nanoscopic to macroscopic. Applications of these rules to magnetohydrodynamic DySA are also discussed.

Gold↗
PubMed2003

A multiagent architecture for developing medical information retrieval agents.

Information that is available on the world wide web (WWW) is already more vast than can be comprehensibly studied by individuals and this quantity is increasing at a staggering pace. The quality of service delivered by physicians is dependent on the availability of current information. The agent paradigm offers a means for enabling physicians to filter information and retrieve only information that is relevant to current patient treatments. As with many specialized domains, agent-based information retrieval in medical domains must satisfy several domain-dependent constraints. A multiple agent architecture is developed and described in detail to efficiently provide agent-based information retrieval from the WWW and other explicit information resources. A simulation of the proposed multiple agent architecture shows a 97% decrease in information overload and an 85% increase in information relevancy over existing meta-search tools (with even larger gains over standard search engines).

Artificial Intelligence↗
PubMedDate not supplied

Neurodevelopmental and health outcomes in term infants treated with surfactant for severe respiratory failure.

OBJECTIVE: Analysis of health, neurodevelopmental, and school performance outcomes in a pilot study of term and near-term infants with respiratory failure due to pneumonia or meconium aspiration treated with surfactant. STUDY DESIGN: Retrospective review of medical records, neurodevelopmental and psychosocial evaluations, and parent and teacher surveys. RESULTS: Of the 14 patients enrolled, only one was rehospitalized, for pneumonia. Three were reported to have episodes of wheezing, two of whom required bronchodilators. One patient had unilateral hearing loss, one had a full-scale intelligence quotient that was below normal, and all but one patient for whom complete results were obtained were performing at or above grade level. CONCLUSION: Term and near-term newborns with moderately severe respiratory failure treated with surfactant can, in general, be expected to recover completely and have normal general health, neurodevelopmental outcome, and school performance.

Achievement↗
PubMed1998

Communication with chemical chaos in the presence of noise.

We use control of chaos to encode information into the oscillations of the Belousov-Zhabotinsky reaction. An arbitrary binary message is encoded by forcing the chaotic oscillations to follow a specified trajectory. The information manipulating control requires only small perturbations to vary the binary message. In this paper we extend our recent theoretical work [Bollt and Dolnik, Phys. Rev. E 64, 1196 (1990)] by introducing a new and simplified encoding technique which can be utilized in the presence of experimental noise. We numerically and theoretically study several practical aspects of controlling symbol dynamics including: modeling noisy time-series, learning underlying symbol dynamics, and evaluation of derivatives for control by observing system responses to an intelligent and deliberate sequence of input parameter variations. All of the modeling techniques incorporated here are ultimately designed to learn and control symbol dynamics of experimental data known only as an observed time-series; the simulation assumes no global model. We find that noise affects reliability of encoding information and may cause coding errors. But, if the level of noise is confined to relatively small values, which are achievable in experiments, the control mechanism is robust to the noise. Thus we can still produce a desired symbolic code. However, scarce errors in encoding may occur due to rare but large fluctuations. These errors may be corrected during the decoding process by a variation of the filtering technique suggested by Rosa et al. [Phys. Rev. Lett. 78, 1247 (1997)]. (c) 1998 American Institute of Physics.

Journal Article↗
PubMed2001

Telepresence surgery: first experiences with laparoscopic radical prostatectomy.

The concept of an intelligent steerable surgical instrument system has been described by various authors. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system, mainly for cardiac bypass surgery. We present our initial experience using the device for robot-assisted laparoscopic radical prostatectomy. The intuitive surgical system consists of two main components: the surgeon's viewing and control console with 3D-imaging, and the surgical arm unit that positions and manoeuvres detachable surgical instruments. These instruments are introduced via two 8 mm trocars and allow movements in all six degrees of freedom (DoF). The surgeon performs the procedure while seated at the console holding specially designed instruments. Highly specialised computer software and mechanics transmit the surgeon's hand movements exactly to the microsurgical movements of the manipulators at the operative site. The system used is a W-shaped five trocar arrangement, with the robot's arms at the lateral trocars (8 mm) and two assistant trocars medially (10 mm). A sixth trocar was used in the right suprapubic area for retraction of the gland (Foley catheter). The left assistant used different instruments, such as bipolar forceps, Ultracision, and Endoclip, wheras the right assistant mainly used the suction–irrigation device. The Intuitive System was attached after trocar placement and exposure of Retzius' space. We treated six patients (two pT2, four pT3, median Gleason score 6). The operating room time averaged 315 (range 242–480) min, including pelvic lymph-node dissection. No intra-operative complications occured, one patient required transfusions. There were no positive margins, median catheter time was 5 days. Three patients were completely continent after 1 month. Telerobotic laparoscopic radical prostatectomy is feasible. There is a learning curve with the device, mainly due to the magnification, 3D image and lack of tactile feedback. However, the experienced surgeon can become familiar with the device after a short time. There is still a need for further development of instruments for urological procedures.

Journal Article↗