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

252 Pages·1983·6.69 MB·English

by  E. S. Derviniotis (auth.)

Lecture Notes in Medical Informatics
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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
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© 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