On the development of intelligent medical systems for pre-operative anaesthesia assessment

This thesis describes the research and development of a decision support tool for determining a medical patient's suitability for surgical anaesthesia. At present, there is a change in the way that patients are clinically assessedp rior to surgery. The pre-operative assessment, usually conducted by a qualified anaesthetist, is being more frequently performed by nursing grade staff. The pre-operative assessmenet xists to minimise the risk of surgical complications for the patient. Nursing grade staff are often not as experienced as qualified anaesthetists, and thus are not as well suited to the role of performing the pre-operative assessment. This research project used data collected during pre-operative assessments to develop a decision support tool that would assist the nurse (or anaesthetist) in determining whether a patient is suitable for surgical anaesthesia. The three main objectives are: firstly, to research and develop an automated intelligent systems technique for classifying heart and lung sounds and hence identifying cardio-respiratory pathology. Secondly, to research and develop an automated intelligent systems technique for assessing the patient's blood oxygen level and pulse waveform. Finally, to develop a decision support tool that would combine the assessmentsa bove in forming a decision as to whether the patient is suitable for surgical anaesthesia. Clinical data were collected from hospital outpatient departments and recorded alongside the diagnoses made by a qualified anaesthetist. Heart and lung sounds were collected using an electronic stethoscope. Using this data two ensembles of artificial neural networks were trained to classify the different heart and lung sounds into different pathology groups. Classification accuracies up to 99.77% for the heart sounds, and 100% for the lung sounds has been obtained. Oxygen saturation and pulse waveform measurements were recorded using a pulse oximeter. Using this data an artificial neural network was trained to discriminate between normal and abnormal pulse waveforms. A discrimination accuracy of 98% has been obtained from the system. A fuzzy inference system was generated to classify the patient's blood oxygen level as being either an inhibiting or non-inhibiting factor in their suitability for surgical anaesthesia. When tested the system successfully classified 100% of the test dataset. A decision support tool, applying the genetic programming evolutionary technique to a fuzzy classification system was created. The decision support tool combined the results from the heart sound, lung sound and pulse oximetry classifiers in determining whether a patient was suitable for surgical anaesthesia. The evolved fuzzy system attained a classification accuracy of 91.79%. The principal conclusion from this thesis is that intelligent systems, such as artificial neural networks, genetic programming, and fuzzy inference systems, can be successfully applied to the creation of medical decision support tools.EThOS - Electronic Theses Online ServiceMedicdirect.co.uk Ltd.GBUnited Kingdo

Predicting the effects of polychlorinated biphenyls on cetacean populations through impacts on immunity and calf survival

This work was supported by funding from the International Whaling Commission's Pollution 2000+Program, the U.S. NOAA/NFMS Health and Stranding Response Program and the UK's Natural Environment Research Council (Grant Code SMRU 10001).The potential impact of exposure to polychlorinated biphenyls (PCBs) on the health and survival of cetaceans continues to be an issue for conservation and management, yet few quantitative approaches for estimating population level effects have been developed. An individual based model (IBM) for assessing effects on both calf survival and immunity was developed and tested. Three case study species (bottlenose dolphin, humpback whale and killer whale) in four populations were taken as examples and the impact of varying levels of PCB uptake on achievable population growth was assessed. The unique aspect of the model is its ability to evaluate likely effects of immunosuppression in addition to calf survival, enabling consequences of PCB exposure on immune function on all age-classes to be explored. By incorporating quantitative tissue concentration-response functions from laboratory animal model species into an IBM framework, population trajectories were generated. Model outputs included estimated concentrations of PCBs in the blubber of females by age, which were then compared to published empirical data. Achievable population growth rates were more affected by the inclusion of effects of PCBs on immunity than on calf survival, but the magnitude depended on the virulence of any subsequent encounter with a pathogen and the proportion of the population exposed. Since the starting population parameters were from historic studies, which may already be impacted by PCBs, the results should be interpreted on a relative rather than an absolute basis. The framework will assist in providing quantitative risk assessments for populations of concern.PostprintPostprintPeer reviewe

On the development of intelligent medical systems for pre-operative anaesthesia assessment

This thesis describes the research and development of a decision support tool for determining a medical patient's suitability for surgical anaesthesia. At present, there is a change in the way that patients are clinically assessedp rior to surgery. The pre-operative assessment, usually conducted by a qualified anaesthetist, is being more frequently performed by nursing grade staff. The pre-operative assessmenet xists to minimise the risk of surgical complications for the patient. Nursing grade staff are often not as experienced as qualified anaesthetists, and thus are not as well suited to the role of performing the pre-operative assessment. This research project used data collected during pre-operative assessments to develop a decision support tool that would assist the nurse (or anaesthetist) in determining whether a patient is suitable for surgical anaesthesia. The three main objectives are: firstly, to research and develop an automated intelligent systems technique for classifying heart and lung sounds and hence identifying cardio-respiratory pathology. Secondly, to research and develop an automated intelligent systems technique for assessing the patient's blood oxygen level and pulse waveform. Finally, to develop a decision support tool that would combine the assessmentsa bove in forming a decision as to whether the patient is suitable for surgical anaesthesia. Clinical data were collected from hospital outpatient departments and recorded alongside the diagnoses made by a qualified anaesthetist. Heart and lung sounds were collected using an electronic stethoscope. Using this data two ensembles of artificial neural networks were trained to classify the different heart and lung sounds into different pathology groups. Classification accuracies up to 99.77% for the heart sounds, and 100% for the lung sounds has been obtained. Oxygen saturation and pulse waveform measurements were recorded using a pulse oximeter. Using this data an artificial neural network was trained to discriminate between normal and abnormal pulse waveforms. A discrimination accuracy of 98% has been obtained from the system. A fuzzy inference system was generated to classify the patient's blood oxygen level as being either an inhibiting or non-inhibiting factor in their suitability for surgical anaesthesia. When tested the system successfully classified 100% of the test dataset. A decision support tool, applying the genetic programming evolutionary technique to a fuzzy classification system was created. The decision support tool combined the results from the heart sound, lung sound and pulse oximetry classifiers in determining whether a patient was suitable for surgical anaesthesia. The evolved fuzzy system attained a classification accuracy of 91.79%. The principal conclusion from this thesis is that intelligent systems, such as artificial neural networks, genetic programming, and fuzzy inference systems, can be successfully applied to the creation of medical decision support tools