ebook img

Objective Medical Decision-making; Systems Approach in Acute Disease: Eindhoven, The Netherlands, 19–22 April 1983 Proceedings PDF

252 Pages·1983·6.69 MB·English
Save to my drive
Quick download

Preview Objective Medical Decision-making; Systems Approach in Acute Disease: Eindhoven, The Netherlands, 19–22 April 1983 Proceedings

Lecture Notes in Medical Informatics Vol. 1: Medical Informatics Europe 78. Proceedings 1978. Edited by J. Anderson. XI, 822 pages. 1978. Vol. 2: D. Fenna, S. Abrahamsson, S. O. L06w and H. Peterson, The Stockholm County Medical Information System. VI, 163 pages. 1978. Vol. 3: Long-Term Studies on Side-Effects of Contraception - State and Planning. Symposium 1977. Edited by U. Kellhammer and K. Oberla. VI, 240 pages. 1978. Vol. 4: Clinical Trials in 'Early' Breast Cancer. Proceedings 1978. Edited by H. R Scheurlen, G. Weckes~er and I. Armbruster. VI, 283 pages. 1979. Vol. 5: Medical Informatics Berlin 1979. Proceedings 1979. E9ited by B. Barber, F. Gremy, K. Oberla and G. Wagner. XXIII, 970 pages. 1979. Vol. 6: Health Care Technology Evaluation. Proceedings, 1978. Edited by J. Goldman. VII, 118 pages. 1979. Vol. 7: Technology and Health: Man and his World. Proceedings, 1978. Edited by G. Wagner, P. L. Reichertz and E. Mase. VI, 243 pages. 1980. Vol. 8: Mathematical Aspects of Computerized Tomography. Proceedings 1980. Edited by F. Natterer. VIII, 309 pages. 1981. Vol. 9: Computers and Mathematical Models in Medicine. Proceedings, 1977. Edited by D. Cardus and C. Vallbona. VIII, 315 pages. 1981. Vol. 10: B. Fries, Applications of Operations Research to Health Care Delivery Systems. V, 107 pages. 1981. Vol. 11: Medical Informatics Europe 81. Proceedings 1981. Edited by F. Gremy, P. Degoulet, B. Barber, and R Salamon. XXIII, 975 pages. 1981. Vol. 12: G. Wiederhold, Databases for Health Care. VI, 75 pages. 1981. Vol. 13: The Computer and Blood Banking. Proceedings, 1981. Edited by J. R Mohr and A. Kluge. X, 275 pages. 1981. Vol. 14.: F. Wingert, Medical Informatics. X, 247 pages. 1981. Vol. 15: Digital Image Processing in Medicine. Proceedings 1981. Edited by K. H. Hahne. VIII, 197 pages. 1981. Vol. 16: Medical Informatics Europe 82. Proceedings, 1982. Edited by RR O'Moore, B. Barber, P.L. Reichertz, and F. Roger. XX, 938 pages. 1982. Vol. 17: Biomedical Images and Computers. Proceedings, 1980. Edited by J. Sklansky and J.-C. Bisconte. VII, 332 pages. 1982. Vol. 18: D.P. Pretschner, Engymetry and Personal Computing in Nuclear Medicine. V, 129 pages. 1982. Vol. 19: R L. Blum, Discovery and Representation of Causal Relationships from a Large Time-Oriented Clinical Database: The RX Project XIX, 242 pages. 1982. Vol. 20: S. Biefang, W. Kopcke, M.A. Schreiber, Manual for the Planning and Implementation of Therapeutic Studies. V, 100 pages. 1983. Vol. 21: Influence of Economic Instability on Health. Proceedings, 1981. Edited by J. John, D. Schwefel, and H. Zollner. Viii, 528 pages. 1983. Vol. 22: Objective Medical Decision-making; Systems Approach in Acute Disease. Pro ceedings, 1983. Edited by J. E. W. Beneken and S. M. Lavelle. VIII, 243 pages. 1983. Lecture Notes in Medical Informatics Edited by D. A. B. Lindberg and P. L. Reichertz 22 Objective Medical Decision-making; Systems Approach in Acute Disease Eindhoven, The Netherlands, 19-22 April 1983 Proceedings Edited by J.E.W. Beneken and S.M. Lavelle Springer-Verlag Berlin Heidelberg New York Tokyo 1983 Editorial Board J. Anderson J. H. van Bemmel M. F. Collen S. Kaihara A. Levy DAB. Lindberg (Managing Editor) H. Peterson A. Pratt w. P. L Reichertz (Managing Editor) Spencer K. Oberla C. Vall bona Editors J.E.w. Prof.dr.ir. Beneken Division of Medical Electrical Engineering Eindhoven University of Technology P.O. Box 513, 5600 MB Eindhoven, The Netherlands Prof.dr. S. M. Lavelle Department of Experimental Medicine, University College Galway, Ireland ISBN 978-3-540-12671-3 ISBN 978-3-642-48334-9 (eBook) DOl 10.1007/978-3-642-48334-9 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to 'Verwertungsgesellschaft Wort", Munich. © by Springer-Verlag Berlin Heidelberg 1983 TABLE OF CONTENTS Introduction, J.E.W. Beneken and S.M. Lavelle VII Keynote papers Critical decision-making and simulation, E.S. Derviniotis 1. Fuzzy sets theory for medical decision-making, Ph. Smets 7. Diagnosis Pre-operative assessment of 'risk', P.W.Keane 20. Evaluation of cardiorespiratory function during sleep in infants at risk for sudden infant death syndrome : a computer system for acquisition and analysis, M.-J. Challamel, R. Bruckert, F. Perrin, J. Pernier, M.C. Leszczynski and M. Revol 24. Evaluation of cardiac function in acute coronary disease by integration of computerized cardiovascular signals, J. Col, J.L. Bachy, M. Pierart, J. Tremouroux, L. Lambotte, and Ch. Doyen 32. Evaluation of decision-making by humans and computers in acute abdominal and acute Chest pain, F.T. de Dombal 42. Results of the discussion around the subject "Diagnosis", S.M. Lavelle 54. Monitoring The use of the auditory evoked response to measure graded effects of general anaesthetics, J.G. Jones, C. Thornton, C.P.H. Heneghan, M.F.M. James and M. Navaratnarajan 57. EEG-analysis in monitoring anesthesia, A.J.R. Simons,and R.A.F. Pronk 65. IV An individual microprocessor device for gas exchange monitoring during artificial ventilation, C. Chopin and M.C. Chambrin 76. Man-machine interaction in disease pattern classification, J.H. van Bemmel, E.S. Gelsema, A. Hasman, J.L. Talmon and J.S. Duisterhout 85. A data acquisition and display system for improved medical pattern recognition, A.P. Meijler, J.E.W. Beneken, A. Nandorff, H.M. van Kessel, and J. Spierdijk 101. Results of the discussion arourid the subject "Monitoring", E. "Epple 113. Therapy and control Diabetes management insight from mathematical modelling, C. Cobelli 117. Role of the artificial pancreas in the understanding of the mode of action of insulin, L. Lambotte 131. Towards a generalized approach in clinical control systems, J.A. Blom, J.E.W. Beneken, N. de Bruyn and J. Spierdijk 141. Measurement and usefulness of flow, volume and airway pressure during mechanical ventilation, D. Robert, F. Perrin, L. Holzapfel and J. Pernier 162. Automatic control system of 02 and CO2 in artificial ventilation, F. Perrin, M.H. Giard, 0. Bertrand, D. Robert and J. Pernier 169. Model simulation for the prediction of haemodialysis, S. Dawids and A. Caspersen 176. Results of the discussion around the subject "Therapy and control", L. Lambotte 185. v Evaluation of criteria and procedures Human utility index of data used in diagnosis, S.M. Lavelle, B. Murphy, F.H. Given and u.S. Khoo 188. Evaluation of techniques for the diagnosis of upper G.I. tract bleeding, ~.O. Tsiftsis 194. Clinical importance of patterns in the coursesof on-line recorded vital parameters, E. Epple, W. Bleicher and U. Faust 202. Monitoring the respiratory effects of analgesic drugs in the post-operative period, O.M. Catley, J.R. Lehane, C. Thornton, C. Jordan/and J.G. Jones 209. Automated heart-lung-machine and blood gas data logger, N. Mendler, S. Balteskonis, W. Heimisch and F. Sebening 217. Numerical simulation of a cardiopulmonary system under therapy, its utilization in computer aided instruction and training, P. Mancini and F. Franchi 223. Results of the discussion around the subject "Evaluation of criteria and procedures", S. Oawids and J.E.W. Beneken 232. Subject index 234. INTRODUCTION Objective medical decision~making has shown itself to be an emerging discipline which is sufficiently robust to promote its further development. This book identifies many important areas for applications in the field of acute patient care. The different approaches require testing, evaluation and mutual co~parisons to ensure that the right method is used to solve the existing problem. Medical sciences and patient care are increasingly supported by system sciences, resulting in growing multi- and interdisciplinary research and development areas. In this context, system sciences involve the methods, techniques, concepts and approaches obtained f~om disciplines such as mathematics, statistics, stochastic signal theory, fuzzy set theory, systems and control theory, signal analysis, pattern recogni tion, simulation, computer languages, structured programming, data base management and computer sciences. This book contains the papers of a workshop "Objective Medical Decision making f Systems approach in acute disease" which was initia ted and supported by the SWG/COMAC on Biomedical Engineering, Evaluation of Technology, Transfer and Standardization of CRM/CREST of the European Community. In setting up the original programme we have been assisted by a group of experts and for their cooperation we are very gratef.ul to S. Dawids, Copenhagen E. Epple, Tlibingen ; J. Jones, Harrow; L. Lambotte, Brussels C. Marchesi, Pisa and D. Robert, Lyon. The papers have been arranged in four groups, each followed by a brief synopsis. The four groups are : diagnosis, monitoring, therapy and control, and evaluation of criteria and procedures. In addition, there are two keynote papers incorporated : on "Critical decision-making and simulation" and on "Fuzzy set theory and medical decision-making". The book will provide useful information for teachers, researchers and students active and/or interested in systems approaches to objective medical decision-making in acute disease. We are very much indebted to Dr. K. Gerbaulet, Dr. W. Skupinski and C. Evrard from the Directorate .General XII from the Commission of the European Communities, for their continuous endeavour to stimulate iniatives and to facilitate procedures for the exchange of knowledge and experience within the European Community as well as outside. Dr.lr. J.E.W. Beneken Dr. S.M. Lavelle Professor of Medical Electrical Professor of Experimental Engineering Medicine Eindhoven, the Netherlands Galway, Ireland CRITICAL DECISION MAKING AND SIMULATION (DECISION MAKING AND SYSTEMS THEORY) E.S. Derviniotis INTRODUCTION The present paper is divided into three parts/levels. In the first part some general considerations on systems theory are presented. The goal of this first part is to illustrate the disadvantages that a system theorist encounters when forcing a mechanistic view upon an or ganic reality, upon open or partially open systems. The second part deals with a methodology that can be used for the study of complex and dynamic problem situations. From within the family of operations research methods, System Dynamics was chosen because, in my opinion, it is the methodology (among the quantitative ones) that has a large degree of dynamic interaction with the user. In the third part of this paper are briefly presented some mechanisms of the decision-making process. These mechanisms will be supported with data obtained by examining decision-making under laboratory con ditions. The first part of this paper is strongly influenced by Erich Jantsch 1), the second part draws from J.W. Forrester 2), while the third part is based on E.S. Derviniotis & J.O. Riis 3). APPROACH, YARDSTICKS, GOALS When dealing with large scale complex systems, one is permanently faced with two fundamental questions. Firstly there is the question of rationality, i.e., is it sufficient to approach a problem by dividing subject from object and examining it armed only with logic in accor dance with the principles of scientific materialism? 2 The second question arises from the interpretation that the system theorist will give to the reality he is trying to depict and, whether this reality is part of : - a static "cosmos" created to perfection and balanced in this perfection (Parmenides, Newton) and contained in mathematical structures, i.e., the assumption that we are dealing with systems in equilibrium. Within this "cosmos", the physical energy in non equilibrium systems decreases to a state of maximum entropy (second law of thermodynamics); - an evolutionary "cosmos" appearing from void/All (hermetic philosophy, Einstein-space time continuum-, Tryon), i.e., the assumption that we are systems in non equilibrium. Within this "cosmos" physical energy in non equilibrium conditions mutates and finds renewed possibilities for (entropy production) self organization and self realitzation ("order through fluctuation" -Glansdorff and Prigogine-). Having 'survived" the above two questions, the system theorist will then proceed to formulate a goal to choose an appropriate approach and to define the measures to be used. The "easy" part of the system theorist's task, I propose to illustrate with three short stories. !h~_~1~Eh~~~_~~g_~h~_~!~_~1!~g_~~~ In a small town where six blind men were living, an elephant arrived. As none of these six men had seen an elephant in their lives, they decided to go to the market place to "see" this wonder. Upon their return they had all seen a different animal and their views were strongly influenced from the angle they had chosen to examine the elephant. The man that had felt the side of the elephant assumed that the elephant was like a wall, the one that felt the tusk assumed that the elephant looked like a apear, the third who felt the trunk visualized the elephant as a snake, for the fourth the elephant's ear made him believe that it looked like a rope and, finally, the one that held the knee thought that the elephant looked like a tree. !h~_£h~E2h_Q£_~~~_~!2h~~1_~~_~!~~~1~Y Stafford Beer 4) refers to the debate that arose in relation to the efffects that the building of the Third London Airport could have on the Church of St. Michael, since the runway would pass through the church. The debate focused on the material value that should be attributed to this priceless church and whether the church was really priceless or

Objective medical decision~making has shown itself to be an emerging discipline which is sufficiently robust to promote its further development. This book identifies many important areas for applications in the field of acute patient care. The different approaches require testing, evaluation and mut
See more

The list of books you might like

Upgrade Premium
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.