Computer methods and programs in biomedicine
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Comput Methods Programs Biomed · Feb 2008
Development and pilot testing of the Neuromuscular Blockade Advisory System.
The neuromuscular blocker advisory system (NMBAS) is a computer program developed to provide advisory guidance to anesthesiologists on the timing and dose of rocuronium to paralyze patients during surgery. It is believed that the use of such a system will administer the minimally effective amount of drug, maintaining the patient in a state of paralysis that is useful for surgery yet easily reversible. This will improve patient safety and result in more efficient care. ⋯ New methods of handling nonlinearities at the neuromuscular junction to allow application of adaptive control techniques are presented. A novel form of modelling combining model swapping and RLSE adaptation to accommodate the patient variation seen with NMB drugs is introduced. A pilot study testing the NMBAS was undergone to prepare the NMBAS for application in a full clinical trial, in which patients undergoing prostate brachytherapy surgeries using rocuronium for intubation were admitted.
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Comput Methods Programs Biomed · Jan 2008
Elimination of vesicular sounds from pulmonary crackle waveforms.
Pulmonary crackles and their parameters are very useful in the diagnosis of pulmonary disorders. A new automatic method has been proposed for the elimination of background vesicular sound from crackle signal with a view to introduce minimum distortion to crackle parameters. A region of interest is designated and a distortion metric based on the correlation between raw and filtered waveforms in that region is defined. ⋯ The algorithm is validated on simulated crackles superimposed on recorded vesicular sound with results indicating that filtering is achieved with minimal distortion of crackle parameters. The algorithm is also applied on real crackles from subjects with various respiratory disorders. The results show the extent of the effect of vesicular sound on crackle parameters, emphasizing the significance of proper filtering in crackle studies.
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Comput Methods Programs Biomed · Feb 2007
Use of OSWALD for analyzing longitudinal data with informative dropout.
OSWALD (Object-oriented Software for the Analysis of Longitudinal Data) is flexible and powerful software written for S-PLUS for the analysis of longitudinal data with dropout for which there is little other software available in the public domain. The implementation of OSWALD is described through analysis of a psychiatric clinical trial that compares antidepressant effects in an elderly depressed sample and a simulation study. In the simulation study, three different dropout mechanisms: completely random dropout (CRD), random dropout (RD) and informative dropout (ID), are considered and the results from using OSWALD are compared across mechanisms. ⋯ Under an ID mechanism, OSWALD does not provide standard error estimates. We supplement OSWALD with a bootstrap procedure to derive the standard errors. This report illustrates the usage of OSWALD for analyzing longitudinal data with dropouts and how to draw appropriate conclusions based on the analytic results under different assumptions regarding the dropout mechanism.
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Comput Methods Programs Biomed · Sep 2006
Parameter identification and sedative sensitivity analysis of an agitation-sedation model.
Sedation administration and agitation management are fundamental activities in any intensive care unit. A lack of objective measures of agitation and sedation, as well as poor understanding of the underlying dynamics, contribute to inefficient outcomes and expensive healthcare. Recent models of agitation-sedation dynamics have enhanced understanding of the underlying dynamics and enable development of advanced protocols for semi-automated sedation administration. ⋯ However, while the variation between patients is observed to be as large as a factor 10, the observed variation in time is smaller, and varies slowly over a period of days rather than hours. The high fitted model performance across all patients show that the agitation-sedation model presented captures the fundamental dynamics of the agitation-sedation system. Overall, these results provide additional insight into the system and clinical dynamics of sedation management.
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Comput Methods Programs Biomed · Jun 2006
Integral-based filtering of continuous glucose sensor measurements for glycaemic control in critical care.
Hyperglycaemia is prevalent in critical illness and increases the risk of further complications and mortality, while tight control can reduce mortality up to 43%. Adaptive control methods are capable of highly accurate, targeted blood glucose regulation using limited numbers of manual measurements due to patient discomfort and labour intensity. Therefore, the option to obtain greater data density using emerging continuous glucose sensing devices is attractive. ⋯ Monte-Carlo simulation for each patient resulted in an average absolute 1-h glucose prediction error of 6.20% (range: 4.97-8.06%) with an average standard deviation per patient of 5.22% (range: 3.26-8.55%). Note that all the methods and results are generalizable to similar applications outside of critical care, such as less acute wards and eventually ambulatory individuals. Clinically, the results show one possible computational method for managing the larger errors encountered in emerging continuous blood glucose sensors, thus enabling their more effective use in clinical glucose regulation studies.