Bmc Med Inform Decis
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Bmc Med Inform Decis · Jan 2010
Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit--a before and after analysis.
Potassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation. ⋯ Computerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.
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Bmc Med Inform Decis · Jan 2010
Comparative StudyA novel time series analysis approach for prediction of dialysis in critically ill patients using echo-state networks.
Echo-state networks (ESN) are part of a group of reservoir computing methods and are basically a form of recurrent artificial neural networks (ANN). These methods can perform classification tasks on time series data. The recurrent ANN of an echo-state network has an 'echo-state' characteristic. This 'echo-state' functions as a fading memory: samples that have been introduced into the network in a further past, are faded away. The echo-state approach for the training of recurrent neural networks was first described by Jaeger H. et al. In clinical medicine, until this moment, no original research articles have been published to examine the use of echo-state networks. ⋯ This proof of concept study is the first to evaluate the performance of echo-state networks in an ICU environment. This echo-state network predicted the need for dialysis in ICU patients. The AUC's of the echo-state networks were good and comparable to the performance of other classification algorithms. Moreover, the echo-state network was more easily configured than other time series modeling technologies.
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Bmc Med Inform Decis · Jan 2010
Making it possible to measure knowledge, experience and intuition in diagnosing lung injury severity: a fuzzy logic vision based on the Murray score.
Murray score is the result of an equation that gives all its variables the same linear contribution and weight and makes use of consented cut-offs. Everyday physicians' vocabulary is full of terms (adjectives) like: little, small, low, high, etc. that they handle in an intuitive and not always linear way to make therapeutic decisions. The purpose of this paper is to develop a fuzzy logic (FL) vision of Murray's score variables to enable the measurement of physicians' knowledge, experience and intuition in diagnosing lung injury and test if they followed Murray's equation predictions. ⋯ The contiguous categories of the variables confirm the existence of fuzzy frontiers. An overestimation was found in the surveyed group's interpretation of severity. This overestimation was mainly due to the different weight assigned to PO2/FiO2 and chest film variables. The FL approach made it possible to measure knowledge, experience and intuition as they appear in physicians' thinking. FL methodology could overcome a series of restrictions that current tests have due to cut-offs.
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Bmc Med Inform Decis · Jan 2010
A regret theory approach to decision curve analysis: a novel method for eliciting decision makers' preferences and decision-making.
Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. ⋯ We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc).
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Bmc Med Inform Decis · Jan 2010
Has information technology finally been adopted in Flemish intensive care units?
Information technology (IT) may improve the quality, safety and efficiency of medicine, and is especially useful in intensive Care Units (ICUs) as these are extremely data-rich environments with round-the-clock changing parameters. However, data regarding the implementation rates of IT in ICUs are scarce, and restricted to non-European countries. The current paper aims to provide relevant information regarding implementation of IT in Flemish ICU's (Flanders, Belgium). ⋯ Most ICUs in Flanders use hospital IT systems such as computerized laboratory and radiology displays. The adoption rate of ICISs has doubled over the last 3 years but is still surprisingly low, especially in general hospitals. The major reason for not implementing an ICIS is the substantial financial cost, together with the lack of arguments to ensure the cost/benefit.