INTCARE: multi-agent approach for real-time intelligent decision support in intensive medicine

For an Intelligent Decision Support System to work in real-time, it is of great value the use of intelligent agents that cooperate with each other to accomplish their tasks. In a critical environment like an Intensive Care Unit, doctors should have the right information, at the right time, to better assist their patients. In this paper we present an architecture for a Multi-Agents System that will support doctors’ decision by in real-time, guaranteeing that all required clinical data is available and capable of predicting the patients’ condition for the next hour.Fundação para a Ciência e a Tecnologia (FCT

Step towards multiplatform framework for supporting pediatric and neonatology care unit decision process

Children are an especially vulnerable population, particularly in respect to drug administration. It is estimated that neonatal and pediatric patients are at least three times more vulnerable to damage due to adverse events and medication errors than adults are. With the development of this framework, it is intended the provision of a Clinical Decision Support System based on a prototype already tested in a real environment. The framework will include features such as preparation of Total Parenteral Nutrition prescriptions, table pediatric and neonatal emergency drugs, medical scales of morbidity and mortality, anthropometry percentiles (weight, length/height, head circumference and BMI), utilities for supporting medical decision on the treatment of neonatal jaundice and anemia and support for technical procedures and other calculators and widespread use tools. The solution in development means an extension of INTCare project. The main goal is to provide an approach to get the functionality at all times of clinical practice and outside the hospital environment for dissemination, education and simulation of hypothetical situations. The aim is also to develop an area for the study and analysis of information and extraction of knowledge from the data collected by the use of the system. This paper presents the architecture, their requirements and functionalities and a SWOT analysis of the solution proposed.CT - Fundação para a Ciência e Tecnologia within the Project Scope UID/CEC/00319/2013 and PTDC/EEI - SII/1302/2012 (INTCare II

Data mining predictive models for pervasive intelligent decision support in intensive care medicine

The introduction of an Intelligent Decision Support System (IDSS) in a critical area like the Intensive Medicine is a complex and difficult process. In this area, their professionals don’t have much time to document the cases, because the patient direct care is always first. With the objective to reduce significantly the manual records and, enabling, at the same time, the possibility of developing an IDSS which can help in the decision making process, all data acquisition process and knowledge discovery in database phases were automated. From the data acquisition to the knowledge discovering, the entire process is autonomous and executed in real-time. On-line induced data mining models were used to predict organ failure and outcome. Preliminary results obtained with a limited population of patients showed that this approach can be applied successfully.Fundação para a Ciência e a Tecnologia (FCT

Pervasive and intelligent decision support in Intensive Medicine – the complete picture

Series : Lecture notes in computer science (LNCS), vol. 8649In the Intensive Care Units (ICU) it is notorious the high number of data sources available. This situation brings more complexity to the way of how a professional makes a decision based on information provided by those data sources. Normally, the decisions are based on empirical knowledge and common sense. Often, they don’t make use of the information provided by the ICU data sources, due to the difficulty in understanding them. To overcome these constraints an integrated and pervasive system called INTCare has been deployed. This paper is focused in presenting the system architecture and the knowledge obtained by each one of the decision modules: Patient Vital Signs, Critical Events, ICU Medical Scores and Ensemble Data Mining. This system is able to make hourly predictions in terms of organ failure and outcome. High values of sensitivity where reached, e.g. 97.95% for the cardiovascular system, 99.77% for the outcome. In addition, the system is prepared for tracking patients’ critical events and for evaluating medical scores automatically and in real-time.(undefined

Plataforma de monitorização e suporte à decisão de doentes críticos

A situação complexa dos doentes críticos e a quantidade de dados disponíveis dificultam a obtenção de conhecimento profícuo para a decisão. Acrescendo o facto de nas Unidades de Cuidados Intensivos (UCI) ainda existir um elevado número de dados em papel, o decisor não consegue interpretar corretamente e em tempo útil toda a informação adquirida. Neste contexto, o fator humano pode provocar erros no processo de tomada de decisão (PTD), uma vez que, normalmente, não há tempo suficiente para analisar corretamente a situação clínica do doente. Para facilitar a aquisição de conhecimento e suportar o PTD por parte dos profissionais da UCI, foi desenvolvida uma plataforma global que, de entre as várias funcionalidades, permite um acompanhamento do doente e a previsão de eventos futuros de uma forma contínua e em tempo real, apresentando novos conhecimentos que podem contribuir de forma significativa para a melhoria da situação clínica de um doente.The complex situation of critical patients and the amount of data available in Intensive Care Units (ICU) makes difficult to obtain useful knowledge to the decision. Adding the fact that in ICU there is a large number of data on paper the decision maker cannot interpret correctly and in short time all the information acquired. In this context the human factor can cause errors in decision-making process (DMP), because normally the intensivist does not have enough time to properly analyse the clinical condition of the patient. To facilitate the acquisition of knowledge and support the ICU decision process by their professionals, a global platform was developed. Among the various features, this platform allows patient monitoring and forecasting future events continuously and in real time, presenting whenever is possible new knowledge which can contribute significantly to the improvement of the clinical status of a patient

Real-time decision support in intensive medicine: an intelligent approach for monitoring data quality

Intensive Medicine is an area where big amounts of data are generated every day. The process to obtain knowledge from these data is extremely difficult and sometimes dangerous. The main obstacles of this process are the number of data collected manually and the quality of the data collected automatically. Information quality is a major constrain to the success of Intelligent Decision Support Systems (IDSS). This is the case of INTCare an IDSS which operates in real-time. Data quality needs to be ensured in a continuous way. The quality must be assured essentially in the data acquisition process and in the evaluation of the results obtained from data mining models. To automate this process a set of intelligent agents have been developed to perform a set of data quality tasks. This paper explores the data quality issues in IDSS and presents an intelligent approach for monitoring the data quality in INTCare system.Fundação para a Ciência e a Tecnologia (FCT

Using domain knowledge to improve intelligent decision support in intensive medicine - a study of bacteriological infections

Nowadays antibiotic prescription is object of study in many countries. The rate of prescription varies from country to country, without being found the reasons that justify those variations. In intensive care units the number of new infections rising each day is caused by multiple factors like inpatient length of stay, low defences of the body, chirurgical infections, among others. In order to complement the support of the decision process about which should be the most efficient antibiotic it was developed a heuristic based in domain knowledge extracted from biomedical experts. This algorithm is implemented by intelligent agents. When an alert appear on the presence of a new infection, an agent collects the microbiological results for cultures, it permits to identify the bacteria, then using the rules it searches for a role of antibiotics that can be administered to the patient, based on past results. At the end the agent presents to physicians the top-five sets and the success percentage of each antibiotic. This paper presents the approach proposed and a test with a particular bacterium using real data provided by an Intensive Care Unit.This work has been supported by FCT – Fundação para a Ciência e Tecnologia in the scope of the project: Pest-OE/EEI/UI0319/2014 and PEst-OE/EEI/UI0752/2014. The authors would like to thank FCT (Foundation of Science and Technology, Portugal) for the financial support through the contract PTDC/EEI-SII/1302/2012 (INTCare II)

Intelligent decision support in Intensive Care : towards technology acceptance

Decision support technology acceptance is a critical factor in the success of the adoption this type of systems by the users. INTCARE is an intelligent decision support system for intensive care medicine. The main purpose of this system is to help the doctors and nurses making decisions more proactively based on the prediction of the organ failure and the outcome of the patients. To assure the adoption of INTCARE by the doctors and by the nurses, several requirements had taken into account: process dematerialization (information is now in electronic format); interoperability among the systems (the AIDA platform was used to interoperate with other information systems); on-line data acquisition and real-time processing (a set of software agents has been developed to accomplish these tasks). A technology acceptance methodology has been followed in the Intensive Care Unit (ICU) of Centro Hospitalar do Porto in order to assure the most perfect alignment between the functional and technical characteristics of INTCARE and the user expectations. Results showed that the ICU staff is permeable to the system. In general more than 90 % of the answers are scored with 4 or 5 points which gives a good motivation to continue the work.Fundação para a Ciência e a Tecnologia (FCT

Assessment of technology acceptance in intensive care units

The process of deploy a technology in critical services need to be very careful planned and processed. As an example it is the Intensive Care Unit (ICU). In the ICU the patients are in critically ill condit ions and there aren’t available time to make experiences or to develop incomplete systems. With the objective to improve the implementation process, the same should be accompanied in order to understand the environment and user behaviour. In this case and with the goal to evaluate the implementation process, an assessment model was applied to a real system called INTCare. INTCare is a Pervasive Intelligent Decision Support System (PIDSS). It was deployed in the ICU of Centro Hospitalar do Porto and was evaluated using the Technology Acceptance Model 3 (TAM). This assessment was made using the four constructs proposed by the TAM and a questionnaire-based approach guided by the Delphi Methodology. The results obtained so far show that although the users are satisfied with the offered information recognizing this importance, they demand for a faster system. This work present the main results achieved and suggest one way to follow when some technology is deployed in an environment like is ICU

Knowledge discovery for pervasive and real-time intelligent decision support in intensive care medicine

Pervasiveness, real-time and online processing are important requirements included in the researchers’ agenda for the development of future generation of Intelligent Decision Support Systems (IDSS). In particular, knowledge discovery based IDSS operating in critical environments such of intensive care, should be adapted to those new requests. This paper introduces the way how INTCare, an IDSS developed in the intensive care unit of the Centro Hospitalar do Porto, will accommodate the new functionalities. Solutions are proposed for the most important constraints, e.g., paper based data, missing values, values out- of-range, data integration, data quality. The benefits and limitations of the approach are discussed.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/EIA/72819/ 2006, SFRH/BD/70156/201