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Online support functions of prescription order system and prescription audit in an integrated hospital information system.

The role of the online prescription support functions of a prescription order entry system was analysed and the results of the prescription audit by pharmacists were examined. In the Kochi Medical School Hospital, an online prescription order system has been developed as part of an integrated hospital information system named IMIS (the Integrated Medical Information System), in which all the physicians enter their prescription orders into online display terminals. The prescription order entry system is provided with prescription support functions, which check the entered prescription data, issue warnings, and offer information about drugs or patients. The prescription order system reduces the incidence of simple prescription mistakes and greatly decreases the cases of inquiries by pharmacists. However, results of the analysis show that such functions as warnings of double order and repeated prescription of a drug do not work as well as expected. The system would thus require some kind of intelligence like that of the auditing pharmacists or that of the physicians with accurate knowledge of clinical pharmacology.

Drug Prescriptions↗

An expert systems facility for mumps.

This paper describes extensions to the Mumps language which facilitate writing expert systems in Mumps. These extensions are based upon the Prolog language and utilize the existing Mumps global array data base as well as other aspects of the Mumps environment. Details are given of an experimental implementation of the interpreter written in C for the Unix operating system.

Artificial Intelligence↗

Decision support systems for the outpatient office. Two examples of medical expert systems.

Although definitive decision-making systems remain beyond the scope of present-day applications available on the market, effective and efficient decision support systems have been developed and are entering the market place. These systems focus on very specific tasks in limited domains and can be valuable adjuncts in primary care settings. There are also a few large-scale applications with well-defined goals that have proved themselves. It is imperative to validate the organizational support and expertise underlying any expert decision support system.

Ambulatory Care↗

Development of intelligent design associates: a case study.

A number of human factors data sets provides guidelines and recommendations for the system design process. Much of this information is available to the human factors engineer in design handbooks, textbooks, and periodicals. While human factors design information is both available and abundant, it is not necessarily readily accessible or in a format that is easily assimilated into a particular design scenario. This paper discusses the feasibility of incorporating human factors design data into intelligent, knowledge-based systems referred to as design associates. Successful implementation of any design associate is dependent upon two key issues: conversion of human factors data into a valid knowledge base, and overcoming the knowledge representation constraints imposed by an intelligent software tool. Detailed results of a recent effort to address these issues, and subsequently implement a design associate on a commercially available intelligent software tool, are presented. This particular associate, implemented in a rule-based tool environment, aids in the selection of visual display technologies.

Journal Article↗

Computer expert system for the histopathologic diagnosis of salivary gland neoplasms.

The design, development, and testing of a prototype interactive histopathologic expert system capable of diagnosing 15 types of primary salivary gland neoplasms is described. The system incorporates a multiple subprogram modular design and makes use of multiple reasoning methods including: data-driven and goal-directed rule-based reasoning, linear pattern recognition, and Bayesian classification. Its user interface incorporates both a "hypertext" context-sensitive information assistance facility and the video display of stored and digitized photomicrographic images. The system can report a differential diagnosis of its findings with assessment of its confidence in its diagnosis. The system's performance was evaluated in a series of tests. The results of a weighted kappa analysis of the system's diagnoses versus those of four oral pathologists for 20 salivary gland neoplasms indicated no statistical difference in diagnostic performance between the system and the human experts and each of the experts in relationship to the others (Wilcoxon rank sums test). A modified version of Turing's test of artificial intelligence demonstrated no statistically significant difference in the system's diagnoses versus the diagnosis of four human expert pathologists (Fisher's exact test). The knowledge and experience gained in the development and testing of the expert system described in this study have demonstrated the validity of histopathologic diagnostic expert systems in a selected area of oral pathology.

Bayes Theorem↗

A new system for digital image acquisition, storage and presentation in an accident and emergency department.

OBJECTIVES: To develop a computer based storage system for clinical images-radiographs, photographs, ECGs, text-for use in teaching, training, reference and research within an accident and emergency (A&E) department. Exploration of methods to access and utilise the data stored in the archive. METHODS: Implementation of a digital image archive using flatbed scanner and digital camera as capture devices. A sophisticated coding system based on ICD 10. Storage via an "intelligent" custom interface. RESULTS: A practical solution to the problems of clinical image storage for teaching purposes. CONCLUSIONS: We have successfully developed a digital image capture and storage system, which provides an excellent teaching facility for a busy A&E department. We have revolutionised the practice of the "hand-over meeting".

Computer Security↗

Bioprocess supervision: neural networks and knowledge based systems.

Supervision of highly non-linear and time variant bioprocesses is of considerable importance to bioindustries as a means of achieving improved productivity and reduced process variability. Artificial intelligence methodologies, including artificial neural networks and knowledge based systems, can contribute significantly to the achievement of these objectives.

Biosensing Techniques↗

SYSTEMS: School-Years Screening Test for the Evaluation of Mental Status.

This paper introduces the School-Years Screening Test for Evaluation of Mental Status (SYSTEMS). It was designed to be used by neurologists, pediatricians, and other health professionals assessing children with suspected cognitive problems or changes. SYSTEMS was initially based on the adult Mini-Mental State Examination developed by Folstein, Folstein, and McHugh in 1975. SYSTEMS is a 7- to 12-minute, one-on-one interview test containing 46 items for use in children between 5 and 12 years of age. Although a full diagnosis cannot be made, the results do provide an indication of whether to send a child for further detailed cognitive assessment. The development of SYSTEMS comprised seven studies with a total of 1207 children involved from Sydney primary schools and neurology clinics of the New Children's Hospital, Westmead, New South Wales, Australia. All children were administered the SYSTEMS. Some of the children also were administered the Stanford-Binet Intelligence Test, 4th edition, or the Differential Ability Scales. Results showed that the SYSTEMS was internally consistent, unbiased by sex, socioeconomic indicators, or language groups; discriminated well by age; and strongly correlated (r = 0.88) with mental age. No significant differences in results obtained by two trained administrators were evident and no indication of apparent practice effect was found. The SYSTEMS was found to have desirable levels of sensitivity (83% and 92%), specificity (76% and 95%), and likelihood ratio for cognitive impairment (3.63 and 17.5) when compared with neurologic judgments and the Differential Ability Scales, respectively.

Child↗

MIMIC II: a massive temporal ICU patient database to support research in intelligent patient monitoring.

Development and evaluation of Intensive Care Unit (ICU) decision-support systems would be greatly facilitated by the availability of a large-scale ICU patient database. Following our previous efforts with the MIMIC (Multi-parameter Intelligent Monitoring for Intensive Care) Database, we have leveraged advances in networking and storage technologies to develop a far more massive temporal database, MIMIC II. MIMIC II is an ongoing effort: data is continuously and prospectively archived from all ICU patients in our hospital. MIMIC II now consists of over 800 ICU patient records including over 120 gigabytes of data and is growing. A customized archiving system was used to store continuously up to four waveforms and 30 different parameters from ICU patient monitors. An integrated user-friendly relational database was developed for browsing of patients' clinical information (lab results, fluid balance, medications, nurses' progress notes). Based upon its unprecedented size and scope, MIMIC II will prove to be an important resource for intelligent patient monitoring research, and will support efforts in medical data mining and knowledge-discovery.

Artificial Intelligence↗

A therapy planning architecture that combines decision theory and artificial intelligence techniques.

Through our experience with the ONCOCIN cancer therapy consultation system, we have identified a set of medical planning problems to which no single existing computer-based reasoning technique readily applies. In response to the need for automated assistance with this class of problems, we have devised a computer program called ONYX that combines decision-theoretic and artificial intelligence approaches to planning. We discuss our rationale for devising a new planning architecture and describe in detail how that architecture is implemented. The program's planning process consists of three steps: (i) the use of rules derived from therapy planning strategies to generate a small set of plausible plans, (ii) the use of knowledge about the structure and behavior of the human body to create simulations that predict possible consequences of each plan for the patient, and (iii) the use of decision theory to rank the plans according to how well the results of each simulation meet the treatment goals. This architecture explicitly manages the uncertainty inherent in many planning tasks, introduces a possible mechanism for the dissemination of decision-theoretic therapy advice, and potentially increases the number of problem solving domains in which expert system techniques can be effectively applied.

Artificial Intelligence↗

[Elemental research on intelligent non-invasive temporary pacemakers].

Some research on intelligent non-invasive temporary pacemakers is introduced in this paper. An industrial computer, some IC chips and other elements are used to construct its hardware, and its software is in C++ language. The experimental device has some intelligent functions of recognizing some arrhythmia. The system has a pacemaker module and an ECG monitor module. Its software includes a main program, a RS-232C communication program, a printer VxD, a pacing control VxD and ECG signal pretreatment and recognizing program and so on. The pacing-generating circuit is employed to make the precision control of pacing current. The communication between industrial-computer system and ECG module is completed through the DLL. The real time processing of ECG signals is based on filter method for a higher recognizing ratio. The system calculates several parameters to recognize certain arrhythmia and uses MIT/BIH database to validate the reliability of ECG recognition.

Algorithms↗

Simulation based cost-benefit analysis of a telemedical system for closed-loop insulin pump therapy of diabetes.

BACKGROUND: INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal closed loop system interacting with telemedical remote control. Cost-benefit analyses of such systems are needed to decide on the introduction of telemedical systems such as the INCA system to routine care. OBJECTIVE: To identify and apply suitable methods for a cost-benefit analysis from the perspective of the payor for health services (i.e. a health insurance company). METHODS: For the cost analysis MOSAIK-M was used, a method and tool that supports health information systems analysis and design. Two MOSAIK-M models were created during the INCA project. Both, the "As is"-model of conventional insulin pump based diabetes care, and the "To be"-model of the INCA system were parameterised with cost values. With both models a period of one year was simulated to determine the yearly costs of diabetes management and treatment for a patient who does not suffer from diabetes related complications yet. The HbA1c-value was chosen as effectiveness parameter for diabetes therapy. To determine the probability of developing complications and their probable duration the Archimedes-Model was used. It was parameterised with selected HbA1c-values anticipating the effect of INCA. The simulation results in form of years of disease within a 30-years time frame were multiplied with corresponding treatment costs from the KoDiM study. RESULTS: The yearly costs of conventional insulin pump treatment for a 19 year old diabetes type 1 patient with no complications are 5,907 euro (German health care system). Using the INCA system would raise the yearly costs by 7,348 euro. Almost all (98.53%) of the additional costs are generated by the continuous blood glucose measurement device. HbA1c-decreases from 7% (conventional treatment) to 6.5%, 6%, and 5.8 % would produce yearly savings (benefit) concerning the treatment of complications of 100.50 euro, 189.20 euro and 221.82 euro. CONCLUSIONS: The selected approach produces an estimation of a lower bound for cost savings. Further work is needed to improve the approximation and to include indirect and intangible costs. The INCA approach would be cost efficient from the chosen perspective, only if the costs of system operation were notably lowered.

Cost-Benefit Analysis↗

A systems model of leadership: WICS.

This article reviews a systems model of leadership. According to the model, effective leadership is a synthesis of wisdom, creativity, and intelligence (WICS). It is in large part a decision about how to marshal and deploy these resources. One needs creativity to generate ideas, academic (analytical) intelligence to evaluate whether the ideas are good, practical intelligence to implement the ideas and persuade others of their worth, and wisdom to balance the interests of all stakeholders and to ensure that the actions of the leader seek a common good. The article relates the current model to other extant models of leadership.

Character↗

AMON: a wearable multiparameter medical monitoring and alert system.

This paper describes an advanced care and alert portable telemedical monitor (AMON), a wearable medical monitoring and alert system targeting high-risk cardiac/respiratory patients. The system includes continuous collection and evaluation of multiple vital signs, intelligent multiparameter medical emergency detection, and a cellular connection to a medical center. By integrating the whole system in an unobtrusive, wrist-worn enclosure and applying aggressive low-power design techniques, continuous long-term monitoring can be performed without interfering with the patients' everyday activities and without restricting their mobility. In the first two and a half years of this EU IST sponsored project, the AMON consortium has designed, implemented, and tested the described wrist-worn device, a communication link, and a comprehensive medical center software package. The performance of the system has been validated by a medical study with a set of 33 subjects. The paper describes the main concepts behind the AMON system and presents details of the individual subsystems and solutions as well as the results of the medical validation.

Activities of Daily Living↗

New tools for learning.

In the last twenty-five years more has been learned about the human brain than in the past history of mankind. Through the use of new technologies such as PET and CAT scans and functional MRI's, it is now possible to see and learn much about the human brain while it is in the process of thinking. The research of neuroscientists, such as Marian Diamond, has demonstrated that the brain changes physiologically as a result of learning and experience--for better or worse--and that plasticity can continue throughout the lifespan. It appears that there are particular kinds of environments that are most conducive to the development of good mental equipment. They are positive, nurturing, stimulating, and encourage action and interaction. Many of the most effective schools and training programs have created such high-challenge low-threat environments. It is also very clear that intelligence is not a static structure, but an open, dynamic system that can continue to develop throughout life. This understanding is being utilized not only in school systems but in the workplace, where training programs show that even at the adult level people are able to develop their intelligence more fully. Corporations such as Motorola have implemented programs in which they are training their employees, managers, and executives to think, problem-solve and create more effectively using strategies developed by such educational innovators as Reuven Feurstein, J.P. Guilford, and Edward de Bono. A most recent development is in the new kinds of technology that make it possible for people to take responsibility for their own learning as they access and process information through the internet, communicate with experts anywhere in the world, and use software that facilitate higher order thinking and problem-solving. Computers are in no way replacing teachers, but rather these new tools allow them to spend more time being facilitators, mentors, and guides. As a result, teachers and students are able more often to collaborate on creating new knowledge as well as mastering the basics. As technology becomes more ubiquitous, there is growing recognition of the importance of the arts in humanizing the curriculum. "More high-tech, more need for high-touch" is becoming the by-word of many schools. They recognize that the arts are not only culturally important and civilizing influences, but they can facilitate the learning of almost any subject. I believe that these four concepts--the plasticity of the brain, the modifiability of intelligence, the use of technology as a powerful new tool for learning, and the renaissance of the arts in education--have major implications specifically for educational systems and generally for the future of our world. In this time of rapid change, leading-edge educational systems are equipping people with the ability to learn, unlearn, and relearn continually. They are giving students meaningful opportunities to apply what they have learned in order to turn information into knowledge. And--of critical importance if any of this is to lead to a healthy future--they are helping students to learn to use knowledge responsibly, ethically, and with integrity. Furthermore, they are involving students in experiences that develop compassion and altruism in the process of their education. Our complex world urgently needs more people who have developed their fullest potential in mind, body, and spirit.

Adult↗

Kinetic occlusion by apparent movement.

A small square and a large triangle below it were presented in the first frame. These were switched off and replaced by a triangle alone in the second frame, shifted horizontally and upwards. The triangle appeared to move obliquely, as expected, but most observers also saw the square moving horizontally and hiding behind the triangle, although there was no stimulus corresponding to it in the second frame. The visual system invokes the occlusion 'hypothesis' in order to explain the otherwise mysterious disappearance of the square. The experiment suggests that apparently intelligent solutions can be rapidly computed by the visual system.

Cognition↗

A knowledge-based system for assisted ventilation of patients in intensive care units.

The procedure for weaning a patient with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long clinical practice. We designed a knowledge-based system for the management of patients receiving respiratory support and implemented a weaning procedure. The system is intended for patients whose spontaneous respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during inspiration (Pressure Support Ventilation mode). Our closed-loop real-time system running on a Personal Computer continuously adapts the assistance provided by the ventilator to the patient's evolution, and indicates when the patient can be withdrawn from the ventilator. Three parameters are used to appreciate the 'respiratory comfort' of the patient: breathing frequency, which we consider the most informative index, tidal volume and end-tidal CO2 pressure. A preliminary study of 19 patients was performed to evaluate the ability of our system to adapt the assistance to the patient's needs, with the main objective of facilitating weaning by gradually lowering the level of assistance. In 10 of these patients, considered as good candidates for weaning on the strength of objective criteria, the system maintained the breathing pattern in a zone of comfort for 95% of the period of assisted ventilation and stated that they were 'weanable'. This was consistent with the clinical evolution of all 10 patients. These results show that such a system can provide effective management for mechanically ventilated patients.

Adult↗