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At least 1,369 records · Page 76Linked to original sources
PubMed2001

Online pattern recognition in intensive care medicine.

In intensive care physiological variables of the critical-ly ill are measured and recorded in short time intervals. The existing alarm systems based on fixed thresholds produce a large number of false alarms. Usually the change of a variable over time is more informative than one pathological value at a particular time point. Intelligent alarm systems which detect important changes within a physiological time series are needed for suitable bedside decision support. There are various approaches to modeling time-dependent data and also several methodologies for pattern detection in time series. We compare several methodologies de-signed for online detection of measurement artifacts, level changes, and trends for a proper classification of the patient s state by means of a comparative case-study.

Aged↗
PubMed1975

[The future of estrogen substitution in the menopause. Psychological and sociological aspects (author's transl)].

The future of estrogen substitution (ES) in the menopause was examined in 425 patients in our clinic from the psychological and sociological aspects. Of the women questioned, one fourth would not consider estrogen substitution from the menopause onwards another fourth would only accept this for one year, one quarter for up to six years and the remaining quarter for longer than six years. The reasons for this decision were sought. The positive attitude towards estrogen substitution was seen to depend on age, education level, intelligence, knowledge of sexual hormones, experience with the pill, history of abortion, parity and personality factors.

Abortion, Spontaneous↗
PubMed2004

Medical decision-support systems and the concept of context.

Medical decision-support systems are of necessity multi-contextual in nature. There are always at least two contexts involved in the use of such systems: the expert knowledge-provider context and the end-user context. To show this, we present examples of context-dependent aspects significant to the use of decision-support systems. The existence of discrepancies between the contexts threatens to disrupt the rationale for using decision-support systems: for the system to transfer knowledge from the expert to the end-user. Both theoretical and empirical studies show that such discrepancies exist and that they may be detrimental to the use of decision-support systems. Systems must thus give support in interpreting the output produced by the system in the context of the end-user.

Artificial Intelligence↗
PubMed2003

Knowledge management system for benchmarking performance indicators using statistical process control (SPC) and Virtual Instrumentation (VI).

Healthcare is ever changing environment and with the Joint Commission for the Accreditation of Hospital Organization (JCAHO) emphasis on quality improvement during the past several years, and the cost-focused healthcare reforms of the 1990s, benchmarking with peer comparison, and more recently benchmarking against competitors, has taken on a new emphasis. All acute healthcare organizations accredited by JCAHO now require participation in a program titled ORYX, which is designed to use comparisons with other organizations and promote national benchmarks. The knowledge management system designed assists clinical engineering department to convert vast amounts of available data into information, which is ultimately transformed into knowledge to enable better decision-making. The systems assist in using the data as a comparison tool, to compare the performance internally and also compare performance with peer organizations using the same measures within the same measurement system. Collectively, these applications support better, faster data-driven decisions. This tool provides fast and easy access to financial and quality metrics to clinical engineering department managers, which increases their ability to perform sophisticated analysis to develop accurate models and forecasts, and make timely, data driven decisions. The project also provides a platform by means of which clinical engineering departmental procedures, data, and methods can be assessed and shared among institutions.

Artificial Intelligence↗
PubMed1996

Influence of the pathological psychological state of cancer patients on their decisions.

The diagnosis of cancer in many cases provokes a crisis, resulting in an increase of regression and defence mechanisms (splitting, projective identification, projection, denial, repression). This article reviews the increased sensitivity, the partial and temporary narrowing of consciousness, and the weakening of reality control. In many cases fluctuating depersonalisation and derealisation develop. At our Institute we performed a complex psychological examination of 41 patients, suffering from malignant lymphoma, immediately after informing them of the diagnosis but prior to their first treatment. The psychological examination of volunteering patients involved an initial interview, Rorschach and Szondi projective tests, a Wechsler intelligence test and a discussion of the results with the patient. The relatively frequent temporary pathological psychic conditions exert an influence on the decisions of patients make about their treatment and interventions, and may also influence the doctor patient relationship.

Adolescent↗
PubMedDate not supplied

Development of a decision support system for the introduction of alternative methods into local irritancy/corrosivity testing strategies. Creation of fundamental rules for a decision support system.

The notification procedure of the European Union (EU) for new chemicals requires the application of protocols on physicochemical and toxicological tests for the evaluation of physicochemical properties and probable toxic effects of each notified substance. A computerised database was developed from data sets and toxicological test protocols relating to substance properties responsible for skin and eye irritation/corrosion. To develop specific structure-activity relationship (SAR) models and to find rules for a decision support system (DSS) to predict local irritation/corrosion, physical property data, chemical structure data and toxicological data for approximately 1300 chemicals, each having a purity of 95% or more, were evaluated. The evaluation demonstrated that the lipid solubility and aqueous solubility of a chemical are relevant to, or - in some cases - responsible for, the observed local effects of a substance on the skins and eyes of rabbits. The octanol/water partition coefficient and the measured value of the surface tension of a saturated aqueous solution of the substance give additional information that permits the definition of detailed SAR algorithms that use measured solubility values. Data on melting points and vapour pressure can be used to assess the intensity and duration of local contact with a chemical. Considerations relating to the reactivity of a pure chemical can be based on molecular weight and the nature of the heteroatoms present. With respect to local lesions produced following contact with the skin and eyes of rabbits, the data evaluation revealed that no general "local irritation/corrosion potential" of a chemical can be defined. A variety of mechanisms are responsible for the formation of local lesions on the skin or in the eyes: serious lesions are produced by mechanisms different from those that cause moderate irritation in these organs. In order to develop a DSS that uses the information extracted from the database, chemical main groups were categorised on the basis of their empirical formulae, and rules were defined of the type IF (physicochemical property) A, THEN not (toxic) effect B, based on correlations between specific local effects and measured physicochemical values. Other rules of the type IF substructure A, THEN effect B were developed based on correlations between specific local effects and the submitted structural formulae. Reactive chemical substructures relevant to the formation of local lesions and rules for the prediction of the absence of any skin irritation potential were identified. Proposals are made relating to the development of alternatives to eye irritation testing with rabbits.

Animal Testing Alternatives↗
PubMed1997

The role of the Internet in medical decision making.

The Internet has dramatically changed the means by which information is obtained. Accurate, up-to-date information is vital to maintain the quality of healthcare, especially as US healthcare delivery changes to a primary care-based system. The availability of this new and potentially vast source of information also affects strategies for medical decision making. In this article, use of online information in our medical center is discussed, together with the impact of a locally-developed decision support system. This system first contained components for differential diagnosis as well as computer-assisted instruction. Initially, online searching was limited to Medline literature searches. This component has now been expanded to include important new tools for accessing medical information on the Internet.

Artificial Intelligence↗
PubMedDate not supplied

Medical plan-analysis by computer.

The traditional approach to computer-assisted medical decision-making involves designing a computer system which simulates a physician's decision-making process. This paper describes a different approach: Medical Plan-Analysis (MPA). Instead of trying to tell a physician how best to manage a patient, an MPA system critiques a physician's management plan. It is anticipated that this approach may have a number of potential social, medical, and medicolegal advantages. The MPA approach has been implemented in ATTENDING, a system designed using Artificial Intelligence techniques to critique a physician's plan for anesthetic management.

Anesthesiology↗
PubMed2006

Age-related changes in event-cued visual and auditory prospective memory proper.

We rely upon prospective memory proper (ProMP) to bring back to awareness previously formed plans and intentions at the right place and time, and to enable us to act upon those plans and intentions. To examine age-related changes in ProMP, younger and older participants made decisions about simple stimuli (ongoing task) and at the same time were required to respond to a ProM cue, either a picture (visually cued ProM test) or a sound (auditorily cued ProM test), embedded in a simultaneously presented series of similar stimuli (either pictures or sounds). The cue display size or loudness increased across trials until a response was made. The cue size and cue loudness at the time of response indexed ProMP. The main results showed that both visual and auditory ProMP declined with age, and that such declines were mediated by age declines in sensory functions (visual acuity and hearing level), processing resources, working memory, intelligence, and ongoing task resource allocation.

Adolescent↗
PubMed1996

A computerized induction analysis of possible co-variations among different elements in human tooth enamel.

In recent decades software tools in the area of artificial intelligence have rapidly developed for use in personal computers. Interactive rule induction utilizing mathematical algorithms has become a powerful tool in data analysis and in making rules and patterns explicit. Data from a Secondary Ion Mass Spectrometry (SIMS) elemental analysis of human dental enamel were used to elucidate co-variations between certain elements. A co-variation analysis was performed employing a computerized induction analysis program, as well as a neural network program. Both analyses, confirming each other, revealed co-variations between certain elements in dental enamel in addition to exclusion of data of no importance for chosen outcomes. The results are presented in hierarchic diagrams, in which the importance for every specific element is given by its position and level in the diagram (decision tree). From the results it became evident that elements such as chlorine and sodium expressed a high co-variation level. Similarly fluorine and potassium co-varied, as well as magnesium and the trace element strontium. It was demonstrated that data from an elemental analysis could be processed by an induction analysis to reveal co-variations between certain elements in tooth enamel. The biological significance of these data is not fully understood, and further analyses in the field are needed.

Algorithms↗
PubMed1999

Users' evaluation of OncoDoc, a breast cancer therapeutic guideline delivered at the point of care.

Despite the dissemination of computer-based "clinical practice guidelines" as decision support systems, low practical compliance rates are still observed. The reason commonly invoked is that such recommendations, suited to average patients, are not rules for all the patients. Rather than providing automatic decision support, OncoDoc allows the clinician to operationalize the implemented breast cancer therapeutic expertise through his hypertextual reading of the knowledge base. In this way, he has the opportunity to interpret the information provided in the context of his patient therefore controlling his categorization to the closest appropriate "average patient". After a four-month real-life experimentation of the system, a survey was conducted among the users. The observed compliance, significantly higher than the best figures found in the literature, and the clinicians objective and subjective evaluation of the system reinforced the implementation choices adopted in OncoDoc.

Artificial Intelligence↗
PubMed2000

Computerisation and decision making in neonatal intensive care: a cognitive engineering investigation.

This paper reports results from a cognitive engineering study that looked at the role of computerised monitoring in neonatal intensive care. A range of methodologies was used: interviews with neonatal staff, ward observations, and experimental techniques. The purpose was to investigate the sources of information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitoring played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often than indicated by self-reports. Factors that seemed to affect staff use of the computer were the lack (or shortage) of training on the system, the specific clinical conditions involved, and the availability of alternative sources of information. These findings have relevant repercussions for the design of computerised decision support in intensive care and suggest ways in which computerised monitoring can be enhanced, namely: by systematic staff training, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms.

Attitude to Computers↗
PubMed2002

Full circle to in-house facilities services.

Careful consideration must be taken prior to in-sourcing in order to ensure that the decision is right for the organisation. There will be pressure to go for the quick fix, or the option that involves the least pain or takes the least time (this may be a knee jerk reaction to go straight back out to the market). Contractors will be alert to this due to market intelligence and as a result one problem may be solved but a number of others created as the organisation is put over yet another barrel. Before any decision is taken, an analysis of the circumstances relating to the outsourced services will need to be undertaken. There are several stages to go through when considering in-sourcing and on the whole the steps will mirror those that need to be considered when outsourcing services in the first instance. It is important to recognise that the change management process associated with in-sourcing services will need to be carefully managed. This point cannot be stressed enough. In-sourcing will require management of the outgoing contractor, the in-house team and the customers during the mobilisation phase. A facilities strategy that is aligned to the organisation's strategic direction--sharing core values and goals alongside a good specification are essential. To ensure services are delivered as specified, a robust and effective monitoring system will need to be developed and put into operation. Just as all organisations are different, the drivers influencing the in-sourcing decision will be different--with factors relevant to the host organisation. If in-sourcing has been thoroughly and carefully considered there is absolutely no reason why it should not be effective (as long as it is specified, resourced, managed and monitored in an appropriate manner). In-sourcing is now being considered as a viable alternative to outsourcing, as a vehicle to add value, a sense of corporatism and team spirit to the organisation.

Cost Control↗
PubMed1994

Experiences from the use of data-driven decision support in different environments.

The paper reports experiences from the implementation and use of data-driven decision support based on the Arden Syntax in three different environments: in a health-care centre, in a clinical laboratory, and in a research department. Methods and tools used for realization of decision support systems (DSSs) are shortly presented, and integration aspects of the DSS with running clinical applications and existing patient databases are discussed. The application areas are also described, together with validation procedures for the developed knowledge modules.

Artificial Intelligence↗
PubMed2005

Places of social poverty and service dependency of people with intellectual disabilities: a case study in Baltimore, Maryland.

In the United States, post-asylum geographies of people with intellectual disabilities implicate the condition of service dependency in their social impoverishment, here defined as "isolation from the community and lack of real friendships and relationships" (The importance of income. The Self-Determination National Program Office of the Institute on Disability, University of New Hampshire, Concord, 1998, p. 2). Social historical geographies of people with intellectual disabilities, both general and local to Baltimore, Maryland, contextualize how one voluntary service organization re/created service dependency and social poverty of people with intellectual disabilities through residential location decisions.

Baltimore↗
PubMed2002

Genetic analysis of IQ, processing speed and stimulus-response incongruency effects.

Psychometric IQ (WAIS-III), onset and peak latency of the lateralized readiness potential (LRP), decision time, and accuracy were assessed during an Eriksen Flanker task in a young (149 families) and in an older (122 families) cohort of twins and their siblings. Stimulus-response incongruency effects were found on all measures of processing speed and accuracy. The effects on the percentages of wrong button presses and too slow (>1,000 ms) responses were larger in the older than in the younger age cohort. Significant heritability was found for processing speed (33-48%), accuracy (41%), and stimulus-response incongruency effects (3-32%). Verbal and performance IQ correlated significantly with stimulus-response incongruency effects on accuracy (-0.22 to -0.39), and this correlation was completely mediated by an underlying set of common genes. It is concluded that measures of the ability to perform well under conditions of stimulus-response incongruency are viable endophenotypes of cognitive ability.

Adult↗
PubMed1999

Protocol-based reasoning in diabetic patient management.

We propose a system for teleconsultation in Insulin Dependent Diabetes Mellitus (IDDM) management, accessible through the use of the net. The system is able to collect monitoring data, to analyze them through a set of tools, and to suggest a therapy adjustment in order to tackle the identified metabolic problems and to fit the patient's needs. The therapy revision has been implemented through the Episodic Skeletal Planning Methodi, it generates an advice and employs it to modify the current therapeutic protocol, presenting to the physician a set of feasible solutions, among which she can choose the new one.

Adult↗
PubMed1999

The role of vocabulary ability during visual word recognition in younger and older adults.

The role that vocabulary ability plays in adult age differences in word recognition was investigated. In Experiment 1, 44 older adults (ages 61-93 years) were compared with 44 younger adults (ages 18-39 years) on a standard lexical-decision task, with ambiguous words, unambiguous words, and pseudowords serving as stimuli. In Experiment 1, the Wechsler Adult Intelligence Scale-Revised (WAIS-R; D. Wechsler, 1981) vocabulary performance was uncontrolled across the younger and older adults, and the older adults had higher WAIS-R scores. There was no Group x Stimulus interaction. In Experiment 2, the data from the same 44 older adults were compared with data from a new sample of 44 younger adults (ages 18-44). Both groups were then matched on WAIS-R performance. Results revealed a significant Group x Stimulus interaction. Reaction time differences between the younger and older groups on the ambiguous words and unambiguous words were identical. The differences in reaction times for words and pseudowords were greater in the older adults. The importance of vocabulary ability during word recognition and lexical processing is discussed.

Adolescent↗