16 research outputs found
Exploring the Requirements for Technology Design to Support People with MCI or Early-Onset Dementia at Work
Work is an integral and meaningful part of many people’s lives. Research has shown that the consequences of mild cognitive impairment (MCI) and Early-Onset Dementia (EOD) before the age of sixty-five can profoundly affect a person’s vocational situation. Assistive technology plays an important role in supporting different abilities for people with MCI/EOD at communities and at home; however, there is little research to investigate the role of technology and address the technological requirements of people with MCI/EOD at work who are employed. This thesis proposes the cognitive task analysis - decision-centered design (CTA-DCD) model; a systematic human factors model to study people's tasks, activities, and requirements with the objective of developing a criteria for designing technology to support people with MCI/EOD at work. The CTA-DCD model was piloted with in-depth interviews with six people living with MCI/EOD and one caregiver. By characterizing the barriers or problems faced by people with MCI/EOD in the context of cognitive work, individual barriers of the participants in terms of macrocognitive activities and cognitive support requirements were characterized. The three design decisions that were derived for future technology design to support people with MCI/EOD at work were (1) having instruction options, (2) functions that support planning, and (3)
display of important information and reminder prompts. The CTA-DCD model can be used systematically in different occupational contexts and domains in providing design decisions
Separator fluid volume requirements in multi-infusion settings
INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume
Recommended from our members
ESICM LIVES 2017 : 30th ESICM Annual Congress. September 23-27, 2017.
INTRODUCTION. Unplanned readmission to intensive care is highly
undesirable in that it contributes to increased variance in care,
disruption, difficulty in resource allocation and may increase length
of stay and mortality particularly if subject to delays. Unlike the ICU
admission from the ward, readmission prediction has received
relatively little attention, perhaps in part because at the point of ICU
discharge, full physiological information is systematically available to
the clinician and so it is expected that readmission should be largely
due to unpredictable factors. However it may be that there are
multidimensional trends that are difficult for the clinician to perceive
that may nevertheless be predictive of readmission.
OBJECTIVES. We investigated whether machine learning (ML)
techniques could be used to improve on the simple published SWIFT
score [1] for the prediction of unplanned readmission to ICU within
48 hours.
METHODS. We extracted systolic BP, pulse pressure, heart and
respiration rate, temperature, SpO2, bilirubin, creatinine, INR, lactate,
white cell count, platelet count, pH, FiO2, and total Glasgow Coma
Score from ICU stays of over 2000 adult patients from our hospital
electronic patient record system. We trained our own custom
multidimensional / time-sensitive algorithmic ML system to predict
failed discharges defined as either readmission or unexpected death
within 48 hours of discharge. We used 10-fold cross validation to assess performance. We also assessed the effect of augmenting our
system by transfer learning (TL) with 44,000 additional cases from
the MIMIC III database.
RESULTS. The SWIFT score performed relatively poorly with an
AUROC of around 0.6 which our ML system trained on local data was
also able to match. However when augmented with an additional
dataset by TL, the AUROC for the ML system improved statistically
and clinically significantly to over 0.7.
CONCLUSIONS. Machine learning is able to improve on predictors
based on simple multiple logistic regression. Thus there is likely to
be information in the trends and in combinations of variables. A
disadvantage with this technique is that ML approaches require large
amounts of data for training. However, ML approaches can be
improved by TL. Basing prediction models on locally derived data
augmented by TL is a potentially novel approach to generating tools
that customised to the institution yet can exploit the potential power
of ML algorithms.
REFERENCES
[1] Gajic O, Malinchoc M, Comfere TB, et al. The Stability and
Workload Index for Transfer score predicts unplanned intensive care
unit patient readmission: initial development and validation. Crit Care
Med. 2008;36(3):676–82.
Grant Acknowledgement
This work was internally funded
Treatment of Later Humoral Rejection with Anti-CD20 Monoclonal Antibody Rituximab: A Single Centre Experience
Humoral or vascular rejection is a B cell-mediated production of immunoglobulin (Ig) G antibody against a transplanted organ that results in immune complex deposition on the vascular endothelium, activation of the complement cascade, production of endothelial dysfunction and regional ischaemic injury
Recommended from our members
Analysis of risk factors for catheter-related bloodstream infection in a parenteral nutrition population
Recommended from our members