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

Modeling Decision Making In Trauma Centers From The Standpoint Of Complex Adaptive Systems

This research examines complex clinical decision-making processes in trauma center units of hospitals in terms of the impact of complexity on the medical team involved in the trauma event. The science of complex adaptive systems together with human judgment theories provide important concepts and tools for responding to health care challenges in this century and beyond. Clinical decision-makers in trauma centers are placed in urgent and anxious situations that are increasingly complex, making decision-making and problem-solving processes multifaceted. Under stressful circumstances, physicians must derive their decision-making schemas (―internal models‖ or ―mental models‖) without the benefits of judicious identification, evaluation, and/or application of relevant medical information, and always using fragmentary data. This research developed a model of decision-making processes in trauma events that uses a Bayesian Classifier model jointly with Convolution and Deconvolution operators to study real-time observed trauma data for decision-making processes under stress. The objective was to explore and explain physicians‘ decision-making processes during actual trauma events while under the stress of time constraints and lack of data. The research addresses important operations that describe the behavior of a dynamic system resulting from stress placed on the physician‘s rational decision making processes by the conditions of the environment. Deconvolution, that is, determining the impulse response of the system, is used to understand how physicians clear out extraneous environmental noise in order to have a clearer picture of their mental models and reach a diagnosis or diagnostic course of action

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review

Background: The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. Objective: The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. Methods: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. Results: The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. Conclusions: The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making.info:eu-repo/semantics/publishedVersio

The assessment of psychological resilience in sport performers

Why is it that some athletes are able to withstand the pressures of competitive sport and attain peak performances, whereas others succumb to the demands and under-perform? It is the study of psychological resilience that aims to address this question. To significantly advance psychologists’ knowledge and understanding of this area, there exists an urgent need to develop a sport-specific measure of resilience (Fletcher & Sarkar, 2012; Galli & Vealey, 2008; Gucciardi, Jackson, Coulter, & Mallett, 2011). The purpose of this thesis, therefore, is to investigate the assessment of psychological resilience in sport performers. To this end, the thesis is split into five chapters. Chapter one reviews and critiques the various definitions, concepts, and theories of resilience, and provides an overview of the research that has specifically examined psychological resilience in sport performers. Chapter two reviews psychometric issues in resilience research and its implications for sport psychology (part one), and discusses psychological resilience in sport performers via a review of the stressors athletes encounter and the protective factors that help them withstand these demands (part two). Drawing on these reviews of resilience in sport, Chapter three (studies one-three) describes the development and validation of the Sport Resilience Scale (SRS). More specifically, Study 1 explores the content validity of a pool of items designed to reflect psychological resilience in athletes, Study 2 examines the factorial structure of the SRS using exploratory factor analysis, and Study 3 tests the factorial structure of the SRS via confirmatory factor analysis, investigates whether the components of the measurement model are invariant across different groups, and examines the relationship between the SRS and other relevant concepts. Using the SRS, and based on Fletcher and Sarkar’s (2012) grounded theory of psychological resilience, Chapter four (studies 4 and 5) investigates resilience in sport performers via an examination of moderation and mediation hypotheses. Specifically, Study 4 tests whether the association between the stressors athletes encounter and athletes’ positive adaptation is moderated by the protective factors that athletes possess and Study 5 tests whether the association between the stressors athletes encounter and athletes’ positive adaptation is mediated by their cognitive appraisal processes. Lastly, Chapter five offers a summary, discussion, and conclusion of the thesis. Overall, the research reported in this thesis has developed the first valid and reliable measure of psychological resilience in sport performers and has provided quantitative support for Fletcher and Sarkar’s (2012) theoretical model of sport resilience by illustrating the moderating role of protective factors and the mediating role of cognitive appraisal

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 341)

This bibliography lists 133 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during September 1990. Subject coverage includes: aerospace medicine and psychology, life support systems and controlled environments, safety equipment, exobiology and extraterrestrial life, and flight crew behavior and performance

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 203

This bibliography lists 150 reports, articles, and other documents introduced into the NASA scientific and technical information system in January 1980

The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis

Epidemiologia; Disfunció d'òrgans; SèpsiaEpidemiology; Organ dysfunction; SepsisEpidemiología; Disfunción de órganos; SepsisObjective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.The authors volunteered their time to producing this manuscript and no funding was used to produce it

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches