Biomedical subjects

D D Vincent

Publications and source records attributed to D D Vincent.

3 recordsLinked to original sources

PubMed1995

A knowledge-based care protocol system for ICU.

There is a growing interest in using care maps in ICU. So far, the emphasis has been on developing the critical path, problem/outcome, and variance reporting for specific diagnoses. This paper presents a conceptual knowledge-based care protocol system design for the ICU. It is based on the manual care map currently in use for managing myocardial infarction in the ICU of the Sturgeon General Hospital in Alberta. The proposed design uses expert rules, object schemas, case-based reasoning, and quantitative models as sources of its knowledge. Also being developed is a decision model with explicit linkages for outcome-process-measure from the care map. The resulting system is intended as a bedside charting and decision-support tool for caregivers. Proposed usage includes charting by acknowledgment, generation of alerts, and critiques on variances/events recorded, recommendations for planned interventions, and comparison with historical cases. Currently, a prototype is being developed on a PC-based network with Visual Basic, Level-Expert Object, and xBase. A clinical trial is also planned to evaluate whether this knowledge-based care protocol can reduce the length of stay of patients with myocardial infarction in the ICU.

Alberta↗

PubMed1993

Formalized decision support for cardiovascular intensive care.

The massive volume of hemodynamic data routinely available within the Cardiovascular Intensive Care Unit (CVICU) can adversely affect the quality, relevance, and timing of hemodynamic management decisions on patients after cardiac surgery. Yet, at the same time, the lack of appropriate treatment-outcome data and access to prior CV case histories deprives the clinician of any opportunity to improve personal decision-making skill and assess the effectiveness of various treatment methods. This paper presents a formalized decision-support model for CVICU that incorporates expert and quantitative knowledge, as well as prior outcome and case experience to augment the clinician's decision-making capability. This includes the use of optimal hemodynamic patterns derived from outcome analysis as therapy goals, expert rules and trend analysis to interpret incoming data, standardized protocols based on predefined hemodynamic patterns from clinical cases, and access to the database for similar case comparison. Most importantly, the model suggests an integrated approach where the clinical database not only is a documentation source for the patient, but also can serve as an outcome research database where clinical experience can be formalized and combined with expert knowledge to influence future therapy decisions. At present, a prototype is being developed at the CVICU of the University of Alberta Hospitals on a Unix platform using ART-IM, C and Ingres. Once implemented, the prototype will be evaluated on a small group of CV patients for its effectiveness and acceptability to clinicians.

Artificial Intelligence↗

PubMed1983

Continuous monitoring of mixed venous oxygen in neonatal pulmonary hypertension.

The management of persistent fetal circulation (PFC) in 3 neonates was facilitated by continuous monitoring of either pulmonary artery (PAP) or right ventricular pressure using an umbilical catheter with a catheter-tip electrode. The catheter was inserted without fluoroscopy via the umbilical vein, using continuously monitored oxygen tension and pressure waveform to determine entry into the right ventricle in 1 patient and the main pulmonary artery in 2 others. Right ventricular and PAP responses to dopamine, dobutamine, and tolazoline facilitated pharmacologic management, whereas continuous mixed venous oxygen tension (PVO2) provided an index of tissue oxygenation.

Catheters, Indwelling↗