The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

A multi-agent architecture for protection engineering diagnostic assistance

Protection engineers use data from a range of monitoring devices to perform post-fault disturbance diagnosis. In the past, heterogeneous intelligent systems have been developed to interpret the data and provide information to engineers to assist with the disturbance diagnosis task. The majority of these systems remain standalone due to the problems associated with systems integration. This paper proposes the use of multiagent systems for providing a flexible and scalable alternative to existing integration approaches. A novel multiagent system (MAS) has been developed entitled protection engineering diagnostic agents (PEDAs) which integrates a legacy SCADA interpretation system with new systems for digital fault recorder (DFR) record interpretation and for enhancing fault record retrieval from remote DFRs. The use of MAS technology provides a flexible and scalable architecture open to the introduction of new data interpretation systems. The paper discusses the benefits of a multiagent approach and the design and implementation of PEDA

A multi-agent approach to power system disturbance diagnosis

Power system disturbance diagnosis is a complex and time consuming task, requiring skilled engineers. Existing intelligent systems which assist with data interpretation require the engineer to further interpret and collate generated information so that a comprehensive diagnosis can be produced. Furthermore, long-term extensibility and flexibility are also restricted. This paper presents a multi-agent approach to power system disturbance diagnosis where existing intelligent systems are wrapped up as intelligent agents and, through a process of inter-agent communication, collaborate to provide disturbance diagnosis. This novel approach enables timely automated disturbance diagnosis within a flexible and extensible architecture

The use of internet technologies to enable flexible alarm processing

This paper discusses the concept of flexible alarm processing for provision of pertinent information to multiple and diverse information consumers. Flexibility is achieved by enabling the application of multiple alarm processing techniques and dynamic interpretation based on context, user and system requirements. The role Internet technologies could play in facilitating flexible alarm processing, including implementing the knowledge required to support alarm interpretation techniques, will also be discussed. An example case study scenario is used to illustrate the potential operation of a flexible alarm processing system

A multi-agent intelligent interpretation system for power system disturbance diagnosis

This paper discusses multi-agent intelligent interpretation system for power system disturbance diagnosis. It was presented at the 22nd SGAI International Conference on Knowledge Based Systems and Applied Artificial Intelligence in 2002