Computer-based Support Systems Research Articles

Factors affecting the accuracy of nurse triage in tertiary care emergency departments.

OBJECTIVES:The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department.METHODS:This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00.RESULTS:The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% (n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts (P < 0.05).CONCLUSIONS:The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients.

Development of a Prototype for Early Identification Children with Specific Learning Disabilities

Early identification of children who may at risk of having difficulties in learning is crucial in order to assist them in overcoming barriers to learn. The adoption of computer related information technology has been greatly explored to support specific learning disabilities children. However, current computer-based support systems are lacking to guide parents and teachers with information about the children with the specific learning disabilities. The early awareness of learning disabilities problems will help the parents and teachers to take suitable action for their children’s academic and social development. Thus in this paper, a computer-based prototype for early identification children with specific learning disabilities using ontology (e-SLD) is developed and evaluated in terms of its usability based on Unified Theory of Acceptance and Use of Technology (UTAUT) factors. The research methodology consists of two main phases including software development life cycle and usability testing. The findings shows positive feedbacks of the prototype in terms of its usability, in which the average of 70% of the respondents agreed with the system’s performance expectancy, 72% of the respondents agreed with the system in terms of its effort expectancy, 68% of the respondents agreed with the system in terms of its social influence and around 72% of the respondents agreed that e-SLD is a tool to screening and recommending suitable activity of specific learning disabilities children.

Nationwide Epidemiological Study of Knowledge, Attitudes, and Practices Study of Greek General Practitioners Related to Screening.

Background:We aimed to assess general practitioners’ (GPs) knowledge, attitudes, and practices (KAPs) toward screening recommendation guidelines of the United States Preventive Services Task Force (USPSTF).Methods:The survey was conducted during a 6-month period in a stratified random sample of GPs, drawn from a national database of GPs in Greece. Participants were queried about their knowledge, attitudes, and self-reported practice patterns regarding screening in a primary care setting. Sociodemographic characteristics associated with vague screening practicing were identified using multivariable logistic regression models.Results:A total of 299 participants agreed and underwent telephonic survey (response rate: 78.2%). GPs agreed on the key role of population-based screening in improving patient care, and nine out of ten reported that their performance would be improved with the adoption of computer-based support systems in clinical practice. GPs, older than 50 years of age, those who those practicing for more than 15 years and GPs working in private sector, were less likely to comply with screening recommendations. Latent class analysis revealed that male physicians and those working in public sector were more likely to comply with USPSTF recommendations.Conclusions:Our findings highlight the need of educational intervention programs for GPs in order to promote the implementation of national evidence-based screening recommendation statements in clinical practice.

An Integrated Information and Decision-Support System for the Management of Mass Casualty Incidents

Mass casualty incidents are a challenging safety-critical domain with high complexity, where management and decision-making can make the difference between life and death. As current paper-based tools and software solutions have severe limitations, we examine the use of integrated computer-based support systems in this domain. Instead of being primarily focused on the replacement of paper-based tools, we are looking for additional value of computer systems to support the incident commanders by providing appropriate presentations and offering assistance functions with different automation approaches. For this purpose, we are developing modular software components that can be combined to an integrated system for the management of casualties. We use a user-centered design approach. Therefore, the needs and abilities of prospective users were analyzed thoroughly and considered in system design. This includes interviews and field observations as well as formative evaluations of prototypes. This article summarizes our research for such an integrated management system for MCIs.

Toward cognitive pipelines of medical assistance algorithms.

Assistance algorithms for medical tasks have great potential to support physicians with their daily work. However, medicine is also one of the most demanding domains for computer-based support systems, since medical assistance tasks are complex and the practical experience of the physician is crucial. Recent developments in the area of cognitive computing appear to be well suited to tackle medicine as an application domain. We propose a system based on the idea of cognitive computing and consisting of auto-configurable medical assistance algorithms and their self-adapting combination. The system enables automatic execution of new algorithms, given they are made available as Medical Cognitive Apps and are registered in a central semantic repository. Learning components can be added to the system to optimize the results in the cases when numerous Medical Cognitive Apps are available for the same task. Our prototypical implementation is applied to the areas of surgical phase recognition based on sensor data and image progressing for tumor progression mappings. Our results suggest that such assistance algorithms can be automatically configured in execution pipelines, candidate results can be automatically scored and combined, and the system can learn from experience. Furthermore, our evaluation shows that the Medical Cognitive Apps are providing the correct results as they did for local execution and run in a reasonable amount of time. The proposed solution is applicable to a variety of medical use cases and effectively supports the automated and self-adaptive configuration of cognitive pipelines based on medical interpretation algorithms.

Augmenting the senses: a review on sensor-based learning support.

In recent years sensor components have been extending classical computer-based support systems in a variety of applications domains (sports, health, etc.). In this article we review the use of sensors for the application domain of learning. For that we analyzed 82 sensor-based prototypes exploring their learning support. To study this learning support we classified the prototypes according to the Bloom's taxonomy of learning domains and explored how they can be used to assist on the implementation of formative assessment, paying special attention to their use as feedback tools. The analysis leads to current research foci and gaps in the development of sensor-based learning support systems and concludes with a research agenda based on the findings.

Automatisierte Segmentierung und Annotation in der Radiologie

The technical progress and broader indications for cross-sectional imaging continuously increase the number of radiological images to be assessed. However, as the amount of image information and available resources (radiologists) do not increase at the same pace and the standards of radiological interpretation and reporting remain consistently high, radiologists have to rely on computer-based support systems. Novel semantic technologies and software relying on structured ontological knowledge are able to "understand" text and image information and interconnect both. This allows complex database queries with both the input of text and image information to be accomplished. Furthermore, semantic software in combination with automatic detection and segmentation of organs and body regions facilitates personalized supportive information in topographical accordance and generates additional information, such as organ volumes. These technologies promise improvements in workflow; however, great efforts and close cooperation between developers and users still lie ahead.

Involving older people with dementia and their carers in designing computer based support systems: some methodological considerations

Older people with dementia are a particularly challenging user group to involve in the process of designing interactive systems that could assist them. It may also be difficult to involve family ca...

Functional requirements for computer-based design support systems, derived from experimental studies

In this paper, we examine the functions that a computational system for knowledge-based design support may undertake. We present a set of functions that bring together previous approaches and allow us to locate the work that has been developed to enhance these systems concerning those functions. We describe some new proposals, based on experimental research work, for improving some of these functions so that they can be taken into account in the development of design support systems to help the designer or group of designers reach a suitable solution in a more effective way.

Computer-based diagnostic support systems in histopathology: what should they do?

In many fields in histopathology diagnosis making is notoriously difficult. We explored the diagnostic process in the area of CL and related disorders. The field of cutaneous lymphomas (CL) and borderline lesions is complex and representative for the type of diagnostic problems encountered. A review of diagnostic support systems in diagnostic pathology revealed that the usefulness of these systems has been disappointing. We contribute this to the fact that these systems target only part of the diagnostic process. A tentative model of diagnosis making in pathology is presented. This model assumes a two-step process, from observation to feature recognition and from features to diagnosis. In a retrospective study of existing skin biopsy pathology reports we assessed detail and scope of the histological descriptions. In a second, prospective study, a pathologist panel described a set of 16 skin biopsies using a standard set of descriptors. The retrospective study showed a large variability in the nature and details of described features, whereas the prospective study showed lack of consensus regarding both feature descriptions and diagnostic category. Both studies provide an indication that lack of consensus in feature recognition may be an important contributor to lack of consensus at the diagnostic level. Diagnostic expert systems target the step from feature to diagnosis. Evidently different input into such systems produces different output. We conclude that support of the feature recognition step can contribute to better diagnostic consensus because of more uniform interpretation of observations.

Coping in Cyberspace: The Impact of Internet Use on the Ability of HIV-Positive Individuals to Deal with Their Illness

The human immunodeficiency virus (HIV) poses one of the greatest health threats of modern times. The Internet provides unparalleled access to resources that can assist individuals coping with HIV infection. Despite the promise of online resources to help individuals manage and cope with their illness, few studies have investigated the impact of their use. Those that have looked primarily at Internet use from a group perspective. These studies were usually 'bounded' as well, focusing on electronic support groups or highly structured computer-based support systems that offer select users prescribed resource options. Little is known about how individuals who are on their 'own' - without access to these services - use the vast, unstructured array of resources available through the Internet. The purpose of this study was to investigate the impact of Internet use on the coping ability of HIV-positive individuals. This research study employed a descriptive qualitative design that used in depth, semi structured, face-to-face interviews for data collection. The sample of 10 purposefully selected HIV-positive individuals reflected diversity in gender, age, race, education, employment, number of years living with HIV, and Internet use. Data analysis guided by the constant comparative method revealed that the impact of Internet use on coping ability involved three themes: The Internet promotes empowerment, augments social support, and facilitates helping others.

Rationalizing Medical Work: Decision-Support Techniques and Medical Practices

Reviewed by: Rationalizing Medical Work: Decision-Support Techniques and Medical Practices* Marcia L. Meldrum (bio) Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. By Marc Berg. Cambridge, Mass.: MIT Press, 1997. Pp. x+238; illustrations, figures, notes, bibliography, index. $30. Marc Berg undertakes in this very interesting volume to analyze the application of decision-support tools—computer-based support systems, protocols, and clinical decision analysis—to medical practice. In doing so he raises several interesting questions about the nature of medical diagnostic and therapeutic practice and about the use of computer-based and other “rationalizing” technologies in contemporary work and culture. Berg begins with an incisive discussion of the post-World War II medical literature, tracing how arguments for the use of decision-support tools were developed, supported, and critiqued. His demonstration that each tool was shaped by a particular concept of what “science-based medicine” is, or should be, is well reasoned and provocative, and prompts the reader to reexamine what we understand by scientific practice. The central section of the book considers the construction and implementation of several decision-support tools: a triage aid to help nurses decide which chest pain patients should be admitted to the coronary care unit, a computer program for the diagnosis of abdominal pain, a research protocol for an experimental breast cancer treatment. Based on these examples, Berg argues that structured, rationalized aids are usually transformed in practice by a variety of logistical, organizational, and value-based factors—staff skills and hierarchies, variations in patient presentation financial criteria, ethical questions, among many others; that where decision-support tools succeed, it is after the practice site is “disciplined to a formalism” (p. 79), that is, where structures are introduced or reinforced to support the tool’s operation; that this mutual transformation of tool and practice site by each other is highly localized in space and scope—and must be replicated and readjusted if the tool is introduced in another setting; finally, that even where the tool is successfully adapted for regular use, doctors and other staff routinely support, adjust, and retransform its operation. The tool and the practice in this way “co-produce” each other to form a new adaptive hybrid. In Berg’s view, both advocates and critics, wedded to prescriptive views of how decision-support tools “are supposed to work” or not to work, fail to understand the nature and potential of the way they actually do work. Berg’s argument is intelligent and well researched through interviews, practice observations, and reading of the literature. It is probably my historian’s bias, but I think the book might have been stronger if he had placed more emphasis on his unique material and slightly less on the theoretical discussion, which, as he notes, complements and extends analyses of scientific [End Page 719] practice and work by contemporary anthropologists and other scholars—Bruno Latour, Donna Haraway, Susan Leigh Star. His many interesting statements about the flow of medical practice, its embedded assumptions, and the work done to incorporate tools are supported with concise observations drawn rather disjointedly from his several cases, supplemented by only a few complete narratives showing us the internal processes. Particularly after the author tells us that very few tools have been introduced in more than a single site, or remained in permanent use, the reader is forced to question whether his model has reality only in localized instances. One tool that might have received more intensive analysis is the use of the problem-oriented medical record introduced by Lawrence Weed, which has been almost universally instituted, at least in the United States, and which Berg discusses in his review of the literature, but to which he fails to return. One of the principal technologies examined is the breast cancer research protocol. As Berg points out, research protocols are widely used and highly structured. But they also present a different rationale from decision tools introduced into established clinical practice. A research protocol carries with it the implication, often the promise, that existing rules and routines will change. This implicit assumption does not invalidate Berg’s model of “co-production,” but its operation will be different than in the other examples...

A Framework for Simulating Computer-Based Individual and Work-Group Communication

Abstract This article addresses the need for integrating computer-based communication support systems into business courses. Instruction that simulates business communication is necessary because of the increasing importance of interpersonal communication skills to the career success of business students. Though there is no single correct strategy to implement computer-based communication courses, this article suggests and discusses three interrelated elements necessary in the course design: hands-on training and education through an electronic messaging system, simulation of an environment in which networking tasks can be practiced, and encouragement of team formation and collaboration among students.

Operator Performance in Cognitively Complex Simulated Emergencies; Implications for Computer-Based Support Systems

An empirical study was conducted examining operator performance in cognitively demanding simulated nuclear power plant emergencies. During emergencies operators follow highly prescriptive written procedures. The objectives of the study were to understand and document what role higher-level cognitive activities such as diagnosis, or more generally ‘situation assessment,’ play in guiding operator performance, given that operators utilize procedures in responding to the events. The study examined crew performance in two simulated emergencies. Up to 11 crews from each of two plants participated in two simulated emergencies for a total of 38 cases analyzed. Crew performance was videotaped and partial transcripts were produced and analyzed. The results revealed a number of instances where higher-level cognitive activities such as situation assessment and response planning enabled operators to handle aspects of the situation that were not fully addressed by the procedures. This paper describes these cases and discusses their implications for the design of computer-based support systems.

A Database Approach to Course Timetabling

This paper discusses computer based support systems for the task of creating timetables in an educational establishment. In particular, we consider the use of a database management system for the ‘book-keeping’ aspects of timetable development. The system described has been implemented at Loughborough University Business School and has proved to be a very effective means of assisting the production of high quality timetables as well as related teaching lists and forms.

A Database Approach to Course Timetabling

This paper discusses computer based support systems for the task of creating timetables in an educational establishment. In particular, we consider the use of a database management system for the ‘book-keeping’ aspects of timetable development. The system described has been implemented at Loughborough University Business School and has proved to be a very effective means of assisting the production of high quality timetables as well as related teaching lists and forms.

Decision support systems for workers: A bridge to advancing productivity

This paper explores how and why the use of computer-based support systems could effectively serve as the bridge to attain higher levels of worker responsibility for and involvement in quality and productivity improvement. Economic, technological, and competitive conditions appear to provide compelling reasons for moving toward more advanced modes of worker participation utilizing computer support systems. A Worker Support System is described which contains components of knowledge-based (expert) systems for methods engineering, creativity-idea processing support, a Worker Information Center, and an Analytical Templates component. Such components can be introduced in a phased experimental mode, with more advanced levels of support kept in tandem with more advanced levels of worker participation.

A political model using influence diagrams and the Analytic Hierarchy Process: the Camp David negotiations

Quantitative models and computer-based decision analysis are rarely used to support complex political decision processes. Dynamic models that will encompass both the objective and subjective factors affecting any political decision are needed, and decision makers must be able to understand and interact with computer-based support systems. This paper demonstrates how microcomputer-based decision analysis and decision support techniques can be used to structure and simulate a complex political decision process in the area of international negotiations. The decision analysis tool of influence diagrams and the mathematical technique of the Analytic Hierarchy Process (AHP) are applied to the Camp David negotiations between Egypt and Israel. The theory of influence diagrams is discussed and the influence diagram analysis software package DAVID is used to create the logic structure of the Camp David negotiations based upon the historical record. The theory of AHP is discussed and the AHP-based software package EXPERT CHOICE is used to replicate the subjective value judgments of the Camp David negotiators. An interaction scheme between the two methods is constructed which enables negotiators to explore the logic of a negotiating problem, to promote a common understanding of the impending negotiations, and to explore trade-offs between alternative proposals.

Computer-Based Assessment of Cognitive Abilities: Current Status/Future Directions

Rapid advances in the computer industry and the concomitant knowledge explosion have created a revolution in the information handling electronics industry. The continued proliferation of computer technology in the educational environment appears inevitable. There seems to be little doubt that recent advances in educational technology will have important consequences for educational institutions at all levels during the coming decades. Students, teachers, and administrators alike have already come to rely on bibliographic and statistical data bases, automated dictionaries, micrographic storage and retrieval systems, and specialized interactive cable and videotext systems for information access. Despite the impact of computer technology in the school environment, guidelines for planning and developing useable software for assessing cognitive abilities has warranted little attention in educational literature. This article suggests that computer-based support systems are now available which could be instrumental in solving the problems associated with cognitive assessment.

Decision support for integrated cash management

Cash management has attracted the increasing attention of both academicians and practitioners in recent time. The expanding role and responsibilities of cash managers and corporate treasurers is likely to increase the focus on cash management as a vital organizational function. Academic research, however, has primarily focused on providing analytical tools to solve well structured problems that are relatively isolated in nature. Conspicuously, no attempt has been made to integrate the various sub-problems of cash management explicitly recognizing interrelationships among the sub-problems as well as between the sub-problems and other financial decisions. More importantly, there is an even greater need to provide a framework that in addition to recognizing the above interrelationships will enable the cash manager to recognize a more inclusive set of dependencies that exist in practice. Decision support systems have the potential to overcome the above deficiencies to a significant extent. This paper is aimed at providing a conceptual framework for designing an effective model-based decision support system (DSS) for integrated cash management. The framework should form a useful basis for any attempts at designing computer-based support systems for cash management.