TOWARD CASE-BASED REASONING FOR DIABETES MANAGEMENT: A PRELIMINARY CLINICAL STUDY AND DECISION SUPPORT SYSTEM PROTOTYPE

This paper presents a case-based decision support system prototype to assist patients with Type 1 diabetes on insulin pump therapy. These patients must vigilantly maintain blood glucose levels within prescribed target ranges to prevent serious disease complications, including blindness, neuropathy, and heart failure. Case-based reasoning (CBR) was selected for this domain because (a) existing guidelines for managing diabetes are general and must be tailored to individual patient needs; (b) physical and lifestyle factors combine to influence blood glucose levels; and (c) CBR has been successfully applied to the management of other long-term medical conditions. An institutional review board (IRB) approved preliminary clinical study, involving 20 patients, was conducted to assess the feasibility of providing case-based decision support for these patients. Fifty cases were compiled in a case library, situation assessment routines were encoded to detect common problems in blood glucose control, and retrieval metrics were developed to find the most relevant past cases for solving current problems. Preliminary results encourage continued research and work toward development of a practical tool for patients.     

Streamlining patient consultations for sleep disorders with a knowledge-based CDSS

ObjectivesThis paper examines the workflow of sleep physicians during a patient consultation and how an innovative clinical decision support system (CDSS) provides efficiency and effectiveness gains.MethodsThe CDSS tools consisted of two input applications for patient data, with a knowledge based decision support system developed participatively with physicians and an international panel. An argument tree approach was used to produce diagnostic explanations and an evidence-based report for the physician using medically correct and shared terminology. A usability evaluation using a qualitative approach was carried out to ensure that the CDSS met the physicians׳ information needs, as well as the wider needs of a Sleep Investigation Unit.ResultsThe physicians found the CDSS both useful and usable with clear applications in triage and diagnostic decision-making, and in patient education.ConclusionThe CDSS both reduces the time and number of visits needed for consultations, and helps focus consultation on better individual patient care through informed explanation of diagnostic and treatment decisions.     

Attitude of Iranian physicians and nurses toward a clinical decision support system for pulmonary embolism and deep vein thrombosis

This research project sought to design and implement a computerized clinical decision support system (CDSS) that was able to identify patients who were at risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), as well as produce reminders for prophylactic action for these diseases. The main purpose of the CDSS was to attempt to reduce the morbidity and mortality caused by embolism and thrombosis in patients admitted to hospitals. After implementation of this system in one of the large educational hospitals of Iran, a standard questionnaire was used, and interviews were conducted with physicians and nurses to evaluate the performance of the designed system for reducing the incidence of pulmonary embolism and thrombosis. From physicians and nurses’ point of view, a system which assists the medical staff in making better decisions regarding patient care, and also reminds pulmonary embolism and thrombosis preventive procedures with timely warnings, can influence patient care quality improvement and lead to the improved performance of the medical staff in preventing the incidence of pulmonary embolism and thrombosis.     

Introducing hypertext in primary health care: a study on the feasibility of decision support for practitioners

A study on the feasibility of the introduction of hypertext systems for communication of medical knowledge in primary care is described. Shortliffe's constraints on areas for application of decision support are evaluated (i.e., theoretical barriers, observable and recognized needs among users, sources of usable knowledge, available system development method). Considering the barriers derived from the knowledge types and forms used by practitioners, hypertext was found suitable as support at 'breakdowns' in practice routines, to generate 'alarms', as well as for continued medical education. A survey of the a priori acceptance of decision support systems by general practitioners showed that 84% would use the computer support if it was available today and that full-text databases, such as hypertext, were given highest priority for introduction. Local specialist physicians were identified as knowledge sources for therapy advice. Implementation of prototype systems envisioned use of hypertext in primary care as the introduction of a communication medium for co-operative health care decision making. A model for the introduction into the work environment is described.     

DemaWare2: Integrating sensors,multimedia and semantic analysis for the ambient care of dementia

This paper presents DemaWare2, an Ambient Assisted Living framework to support the care of people with dementia. The framework integrates various sensor modalities, such as ambient, wearable, offline and cloud-based, together with sophisticated, interdisciplinary methods including image, audio and semantic analysis. Fine-grained, atomic events, such as object manipulation, are aggregated into complex activities through semantic fusion. Applications tailored to monitoring dementia symptoms support clinicians to drive effective, timely interventions and evaluate their outcomes. The framework was evaluated for its robustness, reliability and clinical value in real-world lab trials and home installations.     

The Office of the Future: Integrating Information in the Care System

Healthcare's shift in focus, demand and expectations presents medical practices with opportunities to effect change in office operations and patient services. Developing strategies to incorporate technology among staff and physicians is a high priority for practice administrators today. A computerized medical record is a significant change in the daily activities of physicians, clinical support staff, and patients. A multi-manufacturer, integrated information system that routes data from a patient's body through a point-of-care device and straight into a patient management system - all without keyboard entry - is the Office of the Future.     

Personalized emergency medical assistance for disabled people

Being able to promptly and accurately choose a proper course of action in the field is a crucial aspect of emergency response. For this reason, emergency medical services (EMS) rely on well established procedures that apply to the most frequent cases first responders encounter in their practice, but do not include special cases concerning (sensory, motor or cognitive) disabled persons. In these cases, first responders may end up applying suboptimal or possibly wrong procedures or lose precious time trying to adapt on-the-fly to the special case. This paper proposes both (i) a detailed patient model for EMS that can account for peculiar aspects of the many existing disabilities and (ii) an adaptive information system called PRESYDIUM (Personalized Emergency System for Disabled Humans) that provides tailored instructions in the field for helping medical first responders in dealing with disabled persons. More precisely, we will illustrate and discuss: (i) the design and development process of PRESYDIUM, (ii) the patient model, which is partly based on the ICF (International Classification of Functioning, Disability and Health) standard proposed by the World Health Organization, (iii) the knowledge base used by the system to provide tailored instructions to medical first responders, (iv) the Web-based architecture of the system, (v) the different interfaces??including one for mobile devices??the system provides to enable all the identified stakeholders (disabled persons, their families, clinicians, EMS call center operators, medical first responders) to easily access and possibly provide data to the system, (vi) the evaluation of the validity of the patient model and of the system usability which has been conducted with end users.     

Assessing the information environment in intensive care units

This paper describes the development and application of a methodology for evaluating how physicians and nurses view the usefulness of various sources of patient information available within a hospital intensive care unit (ICU). The methodology encompasses semi-structured interviews, task analysis, a simulated case study of a critically ill patient, verbal protocol analysis, questionnaire responses based on both past experiences in the ICU and performance on the simulated task, and a post-task interview. Eleven nurses and six physicians participated in the study. Analysis of the questionnaires revealed significant differences in the rankings of the information sources by both the nurses and the physicians on each of seven evaluation criteria. Significant differences were also found among both the physicians and the nurses in rankings of the relative importance of the individual information sources for meeting task requirements. A framework for describing information gathering applicable to critical care environments was proposed as a means for better understanding how information sources are used. Overall, the methodology was found to be useful in terms of providing valuable data regarding the utility and usability of information sources. The importance of using a systematic approach for assessing the usefulness of information sources, particularly from the perspectives of performing design interventions and predicting the effectiveness of new information technologies, as well as the limitations in adopting this type of approach, are also discussed.     

Assessing the information environment in intensive care units

This paper describes the development and application of a methodology for evaluating how physicians and nurses view the usefulness of various sources of patient information available within a hospital intensive care unit (ICU). The methodology encompasses semi-structured interviews, task analysis, a simulated case study of a critically ill patient, verbal protocol analysis, questionnaire responses based on both past experiences in the ICU and performance on the simulated task, and a post-task interview. Eleven nurses and six physicians participated in the study. Analysis of the questionnaires revealed significant differences in the rankings of the information sources by both the nurses and the physicians on each of seven evaluation criteria. Significant differences were also found among both the physicians and the nurses in rankings of the relative importance of the individual information sources for meeting task requirements. A framework for describing information gathering applicable to critical care environments was proposed as a means for better understanding how information sources are used. Overall, the methodology was found to be useful in terms of providing valuable data regarding the utility and usability of information sources. The importance of using a systematic approach for assessing the usefulness of information sources, particularly from the perspectives of performing design interventions and predicting the effectiveness of new information technologies, as well as the limitations in adopting this type of approach, are also discussed.     

Application of Embedded Network Distributed Network in Student Physical Health Management Platform

The embedded network platform for wearable telemedicine is primarily designed for the objective, accurate and non-invasive physical activity assessments. The site proposed here offers a trade-off between measurement potential and accuracy. The proposed site is easy to use for both athletes and researchers/physicians. The next stage in the evolution of predictive methods is decentralized prediction. This white paper outlines these structures, raspberry system setup tricks, and various possible projects. By using smart sensor gadgets with embedded telecommunication functions, molecular channel systems commonly used by administrators can be effectively activated to maintain battery health. Clinical and well-being administration admin, additionally called medical services heads or medical care presiding officers, plan, direct, and organize clinical and well-being administrations. The particular clinical territory or division, or clinical practice to gather through doctors' embedded devices. The Health Care Systems Manager coordinates medical care associations that convey clinical consideration through direct patient consideration in regions of specialization, including understudy clinical focus administrations, clinical crisis administrations, nursing, well-being and health focus the board, psychological wellness effort. Arranged implanted frameworks are pulling in increasingly more consideration, and their utilization in the current organization situation is of questionable significance. The exploration network and industry for network availability, information preparing and administration conveyance frequently propose novel installed arrangements dependent on network processors.     

A computational model of reasoning from the clinical literature

This paper explores the premise that a formalized representation of empirical studies can play a central role in computer-based decision support. The specific motivations underlying this research include the following propositions: Reasoning from experimental evidence contained in the clinical literature is central to the decisions physicians make in patient care. A computational model, based upon a declarative representation for published reports of clinical studies, can drive a computer program that selectively tailors knowledge of the clinical literature as it is applied to a particular case. The development of such a computational model is an important first step toward filling a void in computer-based decision support systems. Furthermore, the model may help us better understand the general principles of reasoning from experimental evidence both in medicine and other domains. Roundsman is a developmental computer system which draws upon structured representations of the clinical literature in order to critique plans for the management of primary breast cancer. Roundsman is able to produce patient-specific analyses of breast cancer management options based on the 24 clinical studies currently encoded in its knowledge base. The Roundsman system is a first step in exploring how the computer can help to bring a critical analysis of the relevant literature to the physician, structured around a particular patient and treatment decision.     

Modelling defeasible and prioritized support in bipolar argumentation

Cayrol and Lagasquie-Schiex introduce bipolar argumentation frameworks by introducing a second relation on the arguments for representing the support among them. The main drawback of their approach is that they cannot encode defeasible support, for instance they cannot model an attack towards a support relation. In this paper, we introduce a way to model defeasible support in bipolar argumentation frameworks. We use the methodology of meta-argumentation in which Dung??s theory is used to reason about itself. Dung??s well-known admissibility semantics can be used on this meta-argumentation framework to compute the acceptable arguments, and all properties of Dung??s classical theory are preserved. Moreover, we show how different contexts can lead to the alternative strengthening of the support relation over the attack relation, and converse. Finally, we present two applications of our methodology for modeling support, the case of arguments provided with an internal structure and the case of abstract dialectical frameworks.     

A computer program to fit a family and community medicine set-up

A local Personal Computer (PC) network program has been designed to improve training and patient care in Family and Community Medicine set-up. The software was designed to cope with the different clinical, preventive, promotive and statistical programs of the teaching set-up. This system serves multiple levels of patient priority, assigning each patient to an individual health team staff. The present software is designed to be used for IBM PC Pentium hardware with a Window's environment. This article is a summary of the main features of the program and its applications. Such a program is essential in comprehensive health care-related decision-making and in improving patient care. The authors recommend using similar programs in family practice and in primary health care centers.     

中文电子病历命名实体和实体关系语料库构建

电子病历是由医务人员撰写的面向患者个体描述医疗活动的记录,蕴含了大量的医疗知识和患者的健康信息.电子病历命名实体识别和实体关系抽取等信息抽取研究对于临床决策支持、循证医学实践和个性化医疗服务等具有重要意义,而电子病历命名实体和实体关系标注语料库的构建是首当其冲的.在调研了国内外电子病历命名实体和实体关系标注语料库构建的基础上,结合中文电子病历的特点,提出适合中文电子病历的命名实体和实体关系的标注体系,在医生的指导和参与下,制定了命名实体和实体关系的详细标注规范,构建了标注体系完整、规模较大且一致性较高的标注语料库.语料库包含病历文本992份,命名实体标注一致性达到0.922,实体关系一致性达到0.895.为中文电子病历信息抽取后续研究打下了坚实的基础.     

Computer-based support for clinical decision making

Although computers are now commonly used for financial purposes in hospitals and physicians' offices, most physicians do not routinely use them in patient care. And in hospitals where laboratory data are provided on computer terminals, the displays are often difficult to use and programs that offer assistance in interpreting the data are usually unavailable. We have developed decision support programs that are widely used with the clinical computing system at our hospital. This paper describes the programs and how the clinicians use them.     

Design and evaluation of a wireless decision-support system for heart rate variability study in haemodialysis follow-up procedures

In this paper a new wireless decision-support system for haemodialysis patients using heart rate variability (HRV) is presented. The telemedicine system provides connectivity to three participant sites: the general practitioner or nurse at the point of care in the dialysis unit, the remote information and processing server and the cardiologist. At the clinical point of care, the nurse acquires the electrocardiogram (ECG) by using a tailored mobile telecardiology system as well as other relevant physiological information during the clinical procedure, and sends it to the information server. The received information is stored in a secure file server, linked to the patient database and the ECG signal is automatically analyzed by using advanced signal processing tools in the processing server, where a complete clinical results report is generated. The cardiologist can then be linked by means of a web browser to the information server to analyze these results for further clinical diagnosis support. The system has been applied to study HRV in patients undergoing haemodialysis. The clinical report consisted of trends for time- and frequency-domain HRV indexes and other supplementary information automatically calculated, which show the response of the electrical activity of the heart to the dialysis process and that can be helpful for the follow-up of these patients. The telecardiology framework has been successfully evaluated both by the patients and the hospital personnel showing a high compliance with the system. The design and implementation of the telecardiology system have followed the most recent advances in web technologies, biomedical information and storage standards and signal processing techniques. The presented system can be used as a telemedicine tool for clinical diagnosis support and could also be used in other clinical settings.     

Design and evaluation of a wireless decision-support system for heart rate variability study in haemodialysis follow-up procedures

In this paper a new wireless decision-support system for haemodialysis patients using heart rate variability (HRV) is presented. The telemedicine system provides connectivity to three participant sites: the general practitioner or nurse at the point of care in the dialysis unit, the remote information and processing server and the cardiologist. At the clinical point of care, the nurse acquires the electrocardiogram (ECG) by using a tailored mobile telecardiology system as well as other relevant physiological information during the clinical procedure, and sends it to the information server. The received information is stored in a secure file server, linked to the patient database and the ECG signal is automatically analyzed by using advanced signal processing tools in the processing server, where a complete clinical results report is generated. The cardiologist can then be linked by means of a web browser to the information server to analyze these results for further clinical diagnosis support. The system has been applied to study HRV in patients undergoing haemodialysis. The clinical report consisted of trends for time- and frequency-domain HRV indexes and other supplementary information automatically calculated, which show the response of the electrical activity of the heart to the dialysis process and that can be helpful for the follow-up of these patients. The telecardiology framework has been successfully evaluated both by the patients and the hospital personnel showing a high compliance with the system. The design and implementation of the telecardiology system have followed the most recent advances in web technologies, biomedical information and storage standards and signal processing techniques. The presented system can be used as a telemedicine tool for clinical diagnosis support and could also be used in other clinical settings.     

Supporting a distributed execution of clinical guidelines

Clinical guidelines (GL) play an important role in medical practice: the one of optimizing the quality of patient care on the basis of evidence based medicine. In order to achieve this goal, the interaction between different agents, who cooperate in the execution of the same GL, is a crucial issue. As a matter of fact, in many cases (e.g. in chronic disorders) the GL execution requires that patient treatment is not performed/completed in the hospital, but is continued in different contexts (e.g. at home, or in the general practitioner's ambulatory), under the responsibility of different agents. In this situation, the correct interaction and communication between the agents themselves is critical for the quality of care, and human resources coordination is a key issue to be addressed by the managers of the involved healthcare services. In this paper we describe how GLARE (Guideline Acquisition, Representation, and Execution), a computerized GL management system, has been extended in order to support such a need. In particular, we have provided: (i) an extension to GL actions representation languages, (ii) proper scheduling and (iii) querying services. By means of these enhancements we aimed at guaranteeing (1) treatment continuity and (2) responsibility assignment support in the various steps of a coordinated and distributed patient care process. We illustrate our approach by means of a practical case study.     

MobileNurse: hand-held information system for point of nursing care

Healthcare information travels with patients and clinicians and therefore the need for information to be ubiquitously available is key to reliable patient care and reliable medical systems. We have implemented MobileNurse, a prototype point-of-care system using PDA. MobileNurse has four modules each of which performs: (1) patient information management; (2) medical order check; (3) nursing recording; and (4) nursing care plan. MobileNurse provides easy input interface and various outputs for nursing records. The system consists of PDAs and a mobile support system (MSS) which supports clinical data exchange between PDAs and hospital information system. Two synchronization modules have been developed to keep the patient data consistent between PDAs and MSS. Clinical trials were performed with six volunteered nurses. They tried MobileNurse for 1-day caring-simulated patients. According to the survey after the trials, most of volunteers agreed that MobileNurse is more helpful and convenient than other non-mobile care systems to check medical orders and retrieve the results of recent clinical tests at the bedside. Through the involvement, we found out that ease-to-use interface is the most critical successful factor for mobile patient care systems.