A methodology for the design, implementation and evaluation of intelligent systems with an application to critical care medicine

This thesis illustrates the technology required to provide a new generation of clinical instrumentation systems for critical care medicine. This advance in measurement science is gained from the use of a knowledge-based component able to process information as well as data. To implement a clinical information system using knowledge-based technology requires prior knowledge of human and computer-based activity within the critical domain. A historical perspective is given to both of these topics which reflects the genesis of current practice. The application area is introduced by investigating a control system approach to managing patients who require ventilatory therapy. It was found that no current methodology is wholly appropriate when a knowledge-based component is included in the technological paradigm. Therefore, a novel methodology for system design, implementation and evaluation is proposed, and its utility tested in the aforementioned application domain. The detailed processes involved in the evolution of a prototype system which aids the clinical user in the art of ventilatory therapy are shown. Three levels of machine intelligence are shown to be required, based on: context-sensitive deterministic mechanisms; pattern cognition; and decision support elements. A wider discussion of the important points raised in the practical use of the methodology focuses upon the philosophical basis of clinical information systems and the processes of knowledge elicitation, knowledge representation and intelligent system evaluation

Research and theory for nursing and midwifery: Rethinking the nature of evidence

Background and Rationale: The rise in the principles of evidence-based medicine in the 1990s heralded a re-emerging orthodoxy in research methodologies. The view of the randomised controlled trial (RCT) as a “gold standard” for evaluation of medical interventions has extended recently to evaluation of organisational forms and reforms and of change in complex systems—within health care and in other human services. Relatively little attention has been given to the epistemological assumptions underlying such a hierarchy of research evidence. Aims and Methods: Case studies from research in maternity care are used in this article to describe problems and limitations encountered in using RCTs to evaluate some recent policy-driven and consumer-oriented developments. These are discussed in relation to theory of knowledge and the epistemological assumptions, or paradigms, underpinning health services research. The aim in this discussion is not to advocate, or to reject, particular approaches to research but to advocate a more open and critical engagement with questions about the nature of evidence. Findings and Discussion: Experimental approaches are of considerable value in investigating deterministic and probabilistic cause and effect relationships, and in testing often well-established but unevaluated technologies. However, little attention has been paid to contextual and cultural factors in the effects of interventions, in the culturally constructed nature of research questions themselves, or of the data on which much research is based. More complex, and less linear, approaches to methodology are needed to address these issues. A simple hierarchical approach does not represent the complexity of evidence well and should move toward a more cyclical view of knowledge development

Question-Driven Methodology for Analyzing Emergency Room Processes Using Process Mining

[EN] In order to improve the efficiency and effectiveness of Emergency Rooms (ER), it is important to provide answers to frequently-posed questions regarding all relevant processes executed therein. Process mining provides different techniques and tools that help to obtain insights into the analyzed processes and help to answer these questions. However, ER experts require certain guidelines in order to carry out process mining effectively. This article proposes a number of solutions, including a classification of the frequently-posed questions about ER processes, a data reference model to guide the extraction of data from the information systems that support these processes and a question-driven methodology specific for ER. The applicability of the latter is illustrated by means of a case study of an ER service in Chile, in which ER experts were able to obtain a better understanding of how they were dealing with episodes related to specific pathologies, triage severity and patient discharge destinations.This project was partially funded by Fondecyt Grants 1150365 and 11130577 from the Chilean National Commission on Scientific and Technological Research (CONICYT), the Ph.D. Scholarship Program of CONICYT Chile (CONICYT-Doctorado Nacional/2014-63140180), the Ph.D. Scholarship Program of CONICIT Costa Rica and by Universidad de Costa Rica Professor Fellowships.Rojas, E.; Sepúlveda, M.; Munoz-Gama, J.; Capurro, D.; Traver Salcedo, V.; Fernández Llatas, C. (2017). Question-Driven Methodology for Analyzing Emergency Room Processes Using Process Mining. Applied Sciences. 7(3):1-29. https://doi.org/10.3390/app7030302S12973Welch, S. J., Asplin, B. R., Stone-Griffith, S., Davidson, S. J., Augustine, J., & Schuur, J. (2011). Emergency Department Operational Metrics, Measures and Definitions: Results of the Second Performance Measures and Benchmarking Summit. Annals of Emergency Medicine, 58(1), 33-40. doi:10.1016/j.annemergmed.2010.08.040Jansen-Vullers, M., & Reijers, H. (2005). Business Process Redesign in Healthcare: Towards a Structured Approach. INFOR: Information Systems and Operational Research, 43(4), 321-339. doi:10.1080/03155986.2005.11732733Grol, R., & Grimshaw, J. (1999). Evidence-Based Implementation of Evidence-Based Medicine. The Joint Commission Journal on Quality Improvement, 25(10), 503-513. doi:10.1016/s1070-3241(16)30464-3Fernández-Llatas, C., Meneu, T., Traver, V., & Benedi, J.-M. (2013). Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation. International Journal of Environmental Research and Public Health, 10(11), 5671-5682. doi:10.3390/ijerph10115671Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science & Medicine, 74(3), 364-371. doi:10.1016/j.socscimed.2011.02.011Rojas, E., Munoz-Gama, J., Sepúlveda, M., & Capurro, D. (2016). Process mining in healthcare: A literature review. Journal of Biomedical Informatics, 61, 224-236. doi:10.1016/j.jbi.2016.04.007Neumuth, T., Jannin, P., Schlomberg, J., Meixensberger, J., Wiedemann, P., & Burgert, O. (2010). Analysis of surgical intervention populations using generic surgical process models. International Journal of Computer Assisted Radiology and Surgery, 6(1), 59-71. doi:10.1007/s11548-010-0475-yFernandez-Llatas, C., Lizondo, A., Monton, E., Benedi, J.-M., & Traver, V. (2015). Process Mining Methodology for Health Process Tracking Using Real-Time Indoor Location Systems. Sensors, 15(12), 29821-29840. doi:10.3390/s151229769Rebuge, Á., & Ferreira, D. R. (2012). Business process analysis in healthcare environments: A methodology based on process mining. Information Systems, 37(2), 99-116. doi:10.1016/j.is.2011.01.003Partington, A., Wynn, M., Suriadi, S., Ouyang, C., & Karnon, J. (2015). Process Mining for Clinical Processes. ACM Transactions on Management Information Systems, 5(4), 1-18. doi:10.1145/2629446Basole, R. C., Braunstein, M. L., Kumar, V., Park, H., Kahng, M., Chau, D. H. (Polo), … Thompson, M. (2015). Understanding variations in pediatric asthma care processes in the emergency department using visual analytics. Journal of the American Medical Informatics Association, 22(2), 318-323. doi:10.1093/jamia/ocu016Suriadi, S., Andrews, R., ter Hofstede, A. H. M., & Wynn, M. T. (2017). Event log imperfection patterns for process mining: Towards a systematic approach to cleaning event logs. Information Systems, 64, 132-150. doi:10.1016/j.is.2016.07.011De Medeiros, A. K. A., Weijters, A. J. M. M., & van der Aalst, W. M. P. (2007). Genetic process mining: an experimental evaluation. Data Mining and Knowledge Discovery, 14(2), 245-304. doi:10.1007/s10618-006-0061-7Aalst, W. M. P. van der. (2005). Business alignment: using process mining as a tool for Delta analysis and conformance testing. Requirements Engineering, 10(3), 198-211. doi:10.1007/s00766-005-0001-xVan der Aalst, W., Adriansyah, A., & van Dongen, B. (2012). Replaying history on process models for conformance checking and performance analysis. WIREs Data Mining and Knowledge Discovery, 2(2), 182-192. doi:10.1002/widm.1045Song, M., & van der Aalst, W. M. P. (2008). Towards comprehensive support for organizational mining. Decision Support Systems, 46(1), 300-317. doi:10.1016/j.dss.2008.07.00

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Artificial neural network-statistical approach for PET volume analysis and classification

Copyright © 2012 The Authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.The increasing number of imaging studies and the prevailing application of positron emission tomography (PET) in clinical oncology have led to a real need for efficient PET volume handling and the development of new volume analysis approaches to aid the clinicians in the clinical diagnosis, planning of treatment, and assessment of response to therapy. A novel automated system for oncological PET volume analysis is proposed in this work. The proposed intelligent system deploys two types of artificial neural networks (ANNs) for classifying PET volumes. The first methodology is a competitive neural network (CNN), whereas the second one is based on learning vector quantisation neural network (LVQNN). Furthermore, Bayesian information criterion (BIC) is used in this system to assess the optimal number of classes for each PET data set and assist the ANN blocks to achieve accurate analysis by providing the best number of classes. The system evaluation was carried out using experimental phantom studies (NEMA IEC image quality body phantom), simulated PET studies using the Zubal phantom, and clinical studies representative of nonsmall cell lung cancer and pharyngolaryngeal squamous cell carcinoma. The proposed analysis methodology of clinical oncological PET data has shown promising results and can successfully classify and quantify malignant lesions.This study was supported by the Swiss National Science Foundation under Grant SNSF 31003A-125246, Geneva Cancer League, and the Indo Swiss Joint Research Programme ISJRP 138866. This article is made available through the Brunel Open Access Publishing Fund