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Citizen centered health and lifestyle management via interactive TV: The PANACEIA-ITV health system.

In the context of an IST European project with acronym PANACEIA-ITV, a home care service provisioning system is described, based on interactive TV technology. The purpose of PANACEIA-ITV is to facilitate essential lifestyle changes and to promote compliance with scientifically sound self-care recommendations, through the application of interactive digital television for family health maintenance. The means to achieve these goals are based on technological, health services and business models. PANACEIA-ITV is looking for communication of monitoring micro-devices with I-TV set-top-boxes using infrared technology, and embodiment of analogous H/W and S/W in the I-TV set-top-boxes. Intelligent agents are used to regulate data flow, user queries as well as service provisions from and to the household through the satellite digital platform, the portal and the back-end decision support mechanisms, using predominantly the Active Service Provision (ASP) model. Moreover, interactive digital TV services are developed for the delivery of health care in the home care environment.

Computer Systems↗

Utilization review and the family physician.

Family physicians are often in close contact with utilization review programs. Traditional hospital based review programs have included prehospital certification, outpatient and same-day surgery, second opinions, concurrent hospital review, and early discharge planning. The role of utilization review in ambulatory care is expected to increase in the future and will focus on the cost-effective allocation of resources. Family physicians need to be aware of several issues as they interact with utilization review programs, including the preservation of confidentiality, financial obligation in the face of negative review decisions, and the effect of utilization review on liability for adverse outcomes. Family medicine education should encourage familiarity with the structure and function of review programs and should enable practitioners to participate intelligently in such programs.

Adult↗

Batteries: from alkaline to zinc-air.

There is no perfect disposable battery--one that will sit on the shelf for 20 years, then continually provide unlimited current, at a completely constant voltage until exhausted, without producing heat. There is no perfect rechargeable battery--one with all of the above characteristics and will also withstand an infinite overcharge while providing an equally infinite cycle life. There are only compromises. Every battery selection is a compromise between the ideally required characteristics, the advantages, and the limitations of each battery type. General selection of a battery type to power a medical device is largely outside the purview of the biomed. Initially, these are engineering decisions made at the time of medical equipment design and are intended to be followed in perpetuity. However, since newer cell types evolve and the manufacturer's literature is fixed at the time of printing, some intelligent substitutions may be made as long as the biomed understands the characteristics of both the recommended cell and the replacement cell. For example, when the manufacturer recommends alkaline, it is usually because of the almost constant voltage it produces under the devices' design load. Over time, other battery types may be developed that will meet the intent of the manufacturer, at a lower cost, providing longer operational life, at a lower environmental cost, or with a combination of these advantages. In the Obstetrical Doppler cited at the beginning of this article, the user had put in carbon-zinc cells, and the biomed had unknowingly replaced them with carbonzinc cells. If the alkaline cells recommended by the manufacturer had been used, there would have been the proper output voltage at the battery terminals when the [table: see text] cells were at their half-life. Instead, the device refused to operate since the battery voltage was below presumed design voltage. While battery-type substitutions may be easily and relatively successfully made in disposable applications (for example, zinc-air for alkaline--if it is cost-effective), this is absolutely forbidden for secondary cells. Because of the differing cell voltages, charge characteristics and overcharge tolerance between different types of secondary cells, substituting a nickel-cadmium battery pack for the more expensive lithium-ion pack (if it is physically able to fit into the battery compartment), might appear to save money (e.g. $50 vs. $100) but it would be very ill advised. Since the cell characteristics are very different, it would be downright fatal to anyone within the 'kill radius' when the pack explodes. Those outside the kill radius would receive chemical burns from the electrolyte. Substitutions of secondary cell battery packs are generally not a good idea for biomeds to engage in. These are engineering decisions best left to either aftermarket battery pack manufacturers or the medical device manufacturer as a design engineering change.

Air↗

Integrating knowledge-based systems and databases.

In recent years, there has been an explosion of interest among the computing community in the field of artificial intelligence, particularly in the areas of natural language processing and knowledge-based systems (KBS). The medical domain has seen the development of hundreds of KBSs and there is substantial evidence to show that the application of a knowledge-based approach to decision support can go a long way towards overcoming the information overload experienced by many clinicians today. Yet many of these medical KBSs are still at the prototype stage and are mainly confined to research laboratories. There are many reasons for this apparently slow take-up of the technology, but one of the most significant is the lack of integration into the regular routine information processing of the organisation, in particular the database processing. This paper discusses the benefits of such integration and methods for achieving it in the context of general trends in information systems. Database technology provides efficient and secure management of large amounts of data in a multi-user, multi-application environment. Knowledge-based technology, on the other hand, provides mechanisms for building intelligent systems. Thus, for example, given a set of facts about a domain (symptoms, laboratory test results, etc.) together with a set of rules which apply to that domain (e.g. 'if TT4 > 150 nmol/l then suspect hyperthyroidism'), a KBS can deduce new information about that domain automatically. The effective integration of these two technologies is seen as a means of achieving the intelligent information systems of the future. There are three basic approaches to integrating KBSs and databases. The first is to start with the KBS and incorporate data management functions. Alternatively, intelligence from the KBS can be incorporated into the database. Finally, the two systems can be allowed to co-exist as independent systems which can talk to each other by means of standard interfaces. There are many advantages to this last approach since it offers much more flexibility and extensibility and is consistent with the general trend in computing towards open systems.

Artificial Intelligence↗

User modeling techniques as support in the clinical decision-making process.

This paper describes research work on the design and creation of a medical folder management system capable of establishing co-operative dialogue with users who have access to the information contained therein. The research work has addressed the problem of integrating into the system knowledge about the medical domain and that about users, both necessary to activate co-operative dialogue. The CADMIO [2] prototype has been developed since the study was made. The last version of the CADMIO system stores information about users for the use in recognizing and interpreting their behavior, providing help, and in acquiring and returning further information. Depending on this information the system retrieves and shows the data of the medical folder in an intelligent way by highlighting links between data. It simplifies and increases the speed of the interaction by focusing on the data useful to the decisional activity of the physician.

Bayes Theorem↗

Towards the development of a conceptual distance metric for the UMLS.

The objective of this work is to investigate the feasibility of conceptual similarity metrics in the framework of the Unified Medical Language System (UMLS). We have investigated an approach based on the minimum number of parent links between concepts, and evaluated its performance relative to human expert estimates on three sets of concepts for three terminologies within the UMLS (i.e., MeSH, ICD9CM, and SNOMED). The resulting quantitative metric enables computer-based applications that use decision thresholds and approximate matching criteria. The proposed conceptual matching supports problem solving and inferencing (using high-level, generic concepts) based on readily available data (typically represented as low-level, specific concepts). Through the identification of semantically similar concepts, conceptual matching also enables reasoning in the absence of exact, or even approximate, lexical matching. Finally, conceptual matching is relevant for terminology development and maintenance, machine learning research, decision support system development, and data mining research in biomedical informatics and other fields.

Algorithms↗

Potato Black Scurf and Stem Canker: Pathogen Biology, Global Distribution, and Traditional and Modern Diagnostics.

Rhizoctonia solani is a soil- and seed-borne fungal pathogen of potatoes. It is a persistent threat to potato production worldwide. The symptoms appear as black scurf on tubers and stem canker, causing severe yield and quality losses of potatoes. The pathogen reproduces asexually via hyphae and sclerotia. Its genetic diversity is organized into anastomosis groups (AGs), with AG3-PT being the predominant group on potato. The global trade of seed potatoes is very important for agricultural development; however, it has facilitated the dissemination of the pathogen across regions. Moreover, disease development is affected by environmental and agronomic factors, causing variable symptom severity and differential economic impacts. Given the pathogen's genetic complexity, accurate diagnosis is very important, necessitating a transition from traditional culture-based and biochemical methods toward molecular, genomic, and emerging digital technologies. Methods such as PCR, isothermal amplification, sequencing, sensor-based biosensing, and artificial intelligence-driven imaging have improved the detection, quantification, and noninvasive monitoring of the pathogen. Combining these diagnostic methods into a tiered framework will be helpful for precision disease surveillance, informed disease management decision-making, and the development of sustainable potato production systems.

black scurf↗

Social perceptions of the effects of Down syndrome facial surgery: a school-based study of ratings by normal adolescents.

This study examines how 277 normal adolescents from five Israeli schools perceive the Down syndrome face before and after plastic surgery. A seven-point Likert scale was used to rate slides of normal and Down syndrome faces on four dimensions. Down syndrome patients were seen as less attractive, intelligent, good-hearted, and socially appealing than normal individuals. The slides were in nonapparent order and contained preoperative and 1-year postoperative views of eight plastic surgical patients. Paired t tests were used to examine operative changes, and all four dimensions showed overall postoperative improvement (p less than 0.001), but case-to-case variation was considerable. A linear relationship was found between change in appearance ratings and change in intelligence ratings. Findings suggest that when improvements in facial appearance are realized, peer normal social perceptions of the Down syndrome child may be enhanced. The relationship between school placement, intellectual level, and surgical decision making is discussed.

Adolescent↗

Bioethics and conflicting ethical criteria.

Some of the major problematic issues in contemporary ethical discourse are highlighted in the field of bioethics. The need to incorporate new understandings and foundational shifts in essential criteria because of technological advances in the areas of medicine and human sciences increasingly challenges traditional and accepted notions of ethics. As the possibilities of technical progress increase, more and more pressure is put on traditional understandings of the human person, identity, and value. In the face of ethical relativism and emotivism, which are already widespread in social and political discourse, the immediacy of bioethics as a response to technology and its impact on human lives reinforces the need for ethics to become interdisciplinary, while attempting to provide some coherence to both the questions and the responses that contemporary life generates. In this paper, the author intends to sketch the outlines of some of these problems, and suggest one approach which might allow a certain methodical intelligibility to emerge which takes into account shifts in consciousness and the dependence on historically grounded perspective.

Bioethics↗

Influence of prolonged pregnancy on infant development.

Although prolonged pregnancy has been associated with a twofold to sevenfold increase in perinatal morbidity and mortality, few investigators have addressed the question of long-term outcome for postterm infants. The existing information, spanning several decades, is confounded by several factors, such as different treatment eras, different population demographics, limited predictive value of testing preschool children, absence of term controls, retrospective nature of many surveys and unreliable criteria used to define prolonged pregnancy. At the University of Toronto a prospective, controlled study to determine the extent and frequency (if any) of developmental disturbances associated with prolonged pregnancy in both eutrophic and dysmature neonates is nearing completion. The results obtained could be important when one is faced with a decision on how to manage a postterm pregnancy.

Child Development↗

Computerized support for case management ISAACC.

As the discipline of nursing strives to remain the logical orchestrator of case management, the ideal tool to support this effort would be based on a practice-oriented nursing theory. One such theory, Self-Care Deficit Nursing Theory, has formed a base for a computerized system that has the potential to support case management. This article briefly describes the Professional Care System and the component of the system that can support case management: Intelligent System Access to Automated Clinical Charting (ISAACC) and plans for further expansion of the system.

Case Management↗

Impaired decision-making in opiate-dependent subjects: effect of pharmacological therapies.

Cognitive dysfunction is a major feature of drug addiction. In the present paper, we compared the decision-making ability using the Iowa gambling task of methadone- and buprenorphine-maintained individuals to non opiate-dependent drug-free controls. Buprenorphine-maintained individuals performed better than methadone-maintained individuals, and not differently than non opiate-dependent controls. In addition, methadone-maintained individuals had more perseverative errors on the Wisconsin card sorting task (WCST) as compared with non opiate-dependent drug-free controls whereas buprenorphine-maintained individuals had intermediate scores. Scores on Weschler adult intelligence scale (WAIS-R) were similar for methadone- and buprenorphine-maintained individuals whereas drug-free controls had significantly higher scores. In addition, both opiate-dependent groups performed more poorly than drug-free controls on the Benton visual retention test (BVRT). The results suggest that buprenorphine in contrast to methadone improves decision-making, and thus may be more effective in rehabilitation programs of opiate-dependent subjects and this improvement may be related to its distinct pharmacological action as a k antagonist.

Adult↗

Case based reasoning in criminal intelligence using forensic case data.

A model that is based on the knowledge of experienced investigators in the analysis of serial crime is suggested to bridge a gap between technology and methodology. Its purpose is to provide a solid methodology for the analysis of serial crimes that supports decision making in the deployment of resources, either by guiding proactive policing operations or helping the investigative process. Formalisation has helped to derive a computerised system that efficiently supports the reasoning processes in the analysis of serial crime. This novel approach fully integrates forensic science data.

Crime↗

Implementation science: a role for parallel dual processing models of reasoning?

BACKGROUND: A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. DISCUSSION: Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. SUMMARY: It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.

Journal Article↗

The benefits and challenges of an electronic medical record: much more than a "word-processed" patient chart.

The electronic medical record (EMR) will constitute the core of a computerized health care system in the near future. The electronic storage of clinical information will create the potential for computer-based tools to help clinicians significantly enhance the quality of medical care and increase the efficiency of medical practice. These tools may include reminder systems that identify patients who are due for preventative care interventions, alerting systems that detect contraindications among prescribed medications, and coding systems that facilitate the selection of correct billing codes for patient encounters. Numerous other "decision-support" tools have been developed and may soon facilitate the practice of clinical medicine. The potential of such tools will not be realized, however, if the EMR is just a set of textual documents stored in a computer, i.e. a "word-processed" patient chart. To support intelligent and useful tools, the EMR must have a systematic internal model of the information it contains and must support the efficient capture of clinical information in a manner consistent with this model. Although commercially available EMR systems that have such features are appearing, the builders and the buyers of EMR systems must continue to focus on the proper design of these systems if the benefits of computerization are to be fully realized.

California↗

The development of an intelligent laboratory information system for a community health promotion centre.

This study aimed to develop an Intelligent Laboratory Information System (ILIS) for the community health promotion centre in Kwachun city to help process an increasing amount of laboratory test data in an efficient manner, and to support the clinical decision-making of public health doctors. A sample of 170 cases was used for validation of the system. Overall, the system correctly predicted 92.5% of the cases. This paper also analysed the economic feasibility of the ILIS based on the Information Economics approach. The results showed that the ILIS not only helps screen more people by increasing the capacity of a health promotion centre, but also brings in more revenue to the centre.

Clinical Laboratory Information Systems↗

Development of an intelligent laboratory information system for community health promotion center.

This study aimed to develop an Intelligent Laboratory Information System (ILIS) for the community health promotion center in Kwachun city to help process an increasing number of laboratory test data in an efficient manner, and to support the clinical decision-making of public health doctors. A sample of 170 cases was used for validation of the system. Overall, the system correctly predicted 92.5% of the cases. This paper also analyzed the economic feasibility of the ILIS based on the Information Economics approach. The results showed that the ILIS not only helps screen more people by increasing the capacity of a health promotion center, but also brings in more revenue to the center.

Clinical Laboratory Information Systems↗