Presentation of the paper "Conformance Checking of Executed Clinical Guidelines in presence of Basic Medical Knowledge" at the 4th International Workshop on Process-Oriented Information Systems in Healthcare (ProHealth’11).
This document discusses isolated head injuries in pediatric trauma patients and the association with shock and hypotension. The key points are:
1) A study found that among pediatric patients with isolated head injuries, rates of hypotension were highest in those aged 0-4 years, with 1/3 of hypotension cases associated with isolated head injuries in that age group.
2) Several potential causes for this association between isolated head injuries and hypotension in young pediatric patients were hypothesized, including neurogenic or autonomic responses.
3) Due to the risks of cerebral edema from large fluid volumes, providers may need to adjust treatment to include early vasopressors or anticholinergic drugs to support blood pressure in these
The document discusses the need for and experiences with simulation in a pediatric cardiac surgery program. It notes that pediatric cardiac patients have high risks and complex physiology. Studies have found high mortality rates and many postoperative complications. Real-time observations of surgeries found numerous minor failures that accumulate and increase risks of major events. The program introduced low-fidelity simulation to train on pediatric cases and complications. Early experiences with high-fidelity simulation show potential to help manage risks for these high-risk, complex pediatric patients.
Whole body ct adult versus ped centers (iep)bahlinnm
1) The study analyzed over 30,000 pediatric trauma patients treated at level I or II adult or pediatric trauma centers to compare the use of whole body CT (WBCT) scans between facilities.
2) It found WBCT scans were used significantly more often on pediatric patients treated at adult trauma centers (31.4%) compared to pediatric centers (17.6%).
3) After adjusting for factors, pediatric patients treated at adult centers were 1.8 times more likely to receive a WBCT, increasing their radiation risk without improving outcomes, as mortality did not differ between the groups. The study concludes guidelines are needed to minimize unnecessary WBCT use across centers.
This study compared outcomes for patients in the intensive care unit (ICU) who received contrast echocardiography (cTTE) versus non-contrast echocardiography (nTTE). cTTE patients had a significantly lower risk of death during hospitalization compared to nTTE patients. There was no significant difference in length of stay, ICU length of stay, total hospitalization cost, or cost of cardiac function tests between the two groups. However, cTTE patients required significantly fewer additional cardiac function tests after echocardiography compared to nTTE patients.
Seminar on "Verification of Relational Data-Centric Systems with External Services" at the KRDB Research Centre for Knowledge and Data, Faculty of Computer Science, Free University of Bozen-Bolzano (Italy), 03/05/2012.
Presentation of the paper "State-Boundedness in Data-Aware Dynamic Systems" at the 14th International Conference on Principles of Knowledge Representation and Reasoning (KR 2014)
This document discusses isolated head injuries in pediatric trauma patients and the association with shock and hypotension. The key points are:
1) A study found that among pediatric patients with isolated head injuries, rates of hypotension were highest in those aged 0-4 years, with 1/3 of hypotension cases associated with isolated head injuries in that age group.
2) Several potential causes for this association between isolated head injuries and hypotension in young pediatric patients were hypothesized, including neurogenic or autonomic responses.
3) Due to the risks of cerebral edema from large fluid volumes, providers may need to adjust treatment to include early vasopressors or anticholinergic drugs to support blood pressure in these
The document discusses the need for and experiences with simulation in a pediatric cardiac surgery program. It notes that pediatric cardiac patients have high risks and complex physiology. Studies have found high mortality rates and many postoperative complications. Real-time observations of surgeries found numerous minor failures that accumulate and increase risks of major events. The program introduced low-fidelity simulation to train on pediatric cases and complications. Early experiences with high-fidelity simulation show potential to help manage risks for these high-risk, complex pediatric patients.
Whole body ct adult versus ped centers (iep)bahlinnm
1) The study analyzed over 30,000 pediatric trauma patients treated at level I or II adult or pediatric trauma centers to compare the use of whole body CT (WBCT) scans between facilities.
2) It found WBCT scans were used significantly more often on pediatric patients treated at adult trauma centers (31.4%) compared to pediatric centers (17.6%).
3) After adjusting for factors, pediatric patients treated at adult centers were 1.8 times more likely to receive a WBCT, increasing their radiation risk without improving outcomes, as mortality did not differ between the groups. The study concludes guidelines are needed to minimize unnecessary WBCT use across centers.
This study compared outcomes for patients in the intensive care unit (ICU) who received contrast echocardiography (cTTE) versus non-contrast echocardiography (nTTE). cTTE patients had a significantly lower risk of death during hospitalization compared to nTTE patients. There was no significant difference in length of stay, ICU length of stay, total hospitalization cost, or cost of cardiac function tests between the two groups. However, cTTE patients required significantly fewer additional cardiac function tests after echocardiography compared to nTTE patients.
Seminar on "Verification of Relational Data-Centric Systems with External Services" at the KRDB Research Centre for Knowledge and Data, Faculty of Computer Science, Free University of Bozen-Bolzano (Italy), 03/05/2012.
Presentation of the paper "State-Boundedness in Data-Aware Dynamic Systems" at the 14th International Conference on Principles of Knowledge Representation and Reasoning (KR 2014)
Invited presentation on "Conformance Verification when Dealing with Computerized and Human-Enhanced Processes" at the Workshop on Foundations of Biomedical Knowledge Representation (FBKR 2012), Lorentz Centre, the Netherlands.
Physicians often have to combine clinical guideline recommendations with their own basic medical knowledge to cope with specific patients in specific contexts. Both knowledge sources may include temporal constraints for the execution of actions. In this paper we approach the problem of compliance analysis with both sources of knowledge, pointing
out discrepancies – including temporal ones – with respect to them, and where such discrepancies may be due to multiple and possibly conflicting recommendations.
This document presents a model to evaluate the potential budget impact of using the kSORT assay to monitor kidney transplant patients for subclinical rejection. The model projects costs over two years for a commercial health plan covering 285 kidney transplant patients under different monitoring scenarios, including using kSORT alone or with protocol biopsies. The results suggest using kSORT would have a minimal positive budget impact of $0.0057 per member per month, attributed to small patient numbers and low acute rejection and graft failure rates. Sensitivity analysis found costs of kSORT to be the most influential factor on budget impact.
Blood Groups Matcher Frame Work Based on Three -Level Rules in Myanmaraciijournal
Today Blood donation is a global interest for world to be survival lives when people are in trouble because
of natural disaster. The system provides the ability how to decide to donate the blood according to the rules
for blood donation not to meet the physicians. In this system, there are three main parts to accept blood
from donors when they want to donate according to the features like personal health. The application
facilitates to negotiate between blood donors and patients who need to get blood seriously on page without
going to Blood Banks and waiting time in queue there.
Blood groups matcher frame work based on three level rules in myanmaraciijournal
Today Blood donation is a global interest for world to be survival lives when people are in trouble because of natural disaster. The system provides the ability how to decide to donate the blood according to the rules for blood donation not to meet the physicians. In this system, there are three main parts to accept blood from donors when they want to donate according to the features like personal health. The application facilitates to negotiate between blood donors and patients who need to get blood seriously on page without going to Blood Banks and waiting time in queue there.
This document summarizes a case study involving a 19-year old male (EG) who was admitted to the ICU following a high-speed motorcycle accident and subsequent traumatic brain injury. EG remains intubated and sedated, with elevated heart rate, temperatures, and signs of sympathetic hyperactivity. The attending physician asks the clinical pharmacist about evidence for using propranolol to treat EG's sympathetic hyperactivity. The pharmacist then reviews the pathophysiology and presentation of paroxysmal sympathetic hyperactivity, current treatment options including beta blockers like propranolol, and a literature review on the use of beta blockers including propranolol in traumatic brain injury patients.
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
This document discusses the benefits and drawbacks of using positron emission tomography (PET) scans to monitor patients who have achieved complete remission from Diffused Large B-cell Lymphoma (DLBCL) after primary treatment. While PET scans can detect relapses early and lead to better outcomes, they also expose patients to radiation and may not be necessary, as the majority of relapses are detected without scans. The document concludes that despite costs and radiation exposure, regular PET scans for two years are important to diagnose the 30% of relapses detected by scans alone and improve prognosis for these patients.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Alan Garber: Value-Conscious Bio-Medical Innovation: Why? How? When?capstoneconference09
The document discusses value-conscious biomedical innovation and evaluating medical technologies based on their costs and benefits. It provides examples of how insurers and Medicare make coverage decisions based on whether a technology is medically necessary and cost-effective. The document also analyzes studies on different treatment options for prostate cancer and potential cost savings if lower-cost options were used. It examines cost-effectiveness analyses of COX-2 inhibitors compared to NSAIDs under various assumptions and for high-risk patients. Moving to a cost-effectiveness criterion could shift both health care expenditures and outcomes.
The CABANA trial showed that catheter ablation was not superior to antiarrhythmic drug therapy for reducing cardiovascular outcomes over 5 years in patients with atrial fibrillation. The trial randomized over 2,200 patients to either ablation or drug therapy. The primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest occurred in 8% of ablation patients and 9.2% of drug therapy patients, showing no significant difference. However, ablation did significantly reduce the secondary outcome of death or cardiovascular hospitalization compared to drug therapy. The PADIT trial found that using more extensive perioperative antibiotics for cardiac device implantation procedures did not significantly reduce device infections compared to a single preoperative dose of antibiotics. The SPritely trial will compare
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
Post-mastectomy radiotherapy (PMRT) involves delivering radiation to the chest wall and surrounding lymph node areas after a mastectomy. Studies have shown PMRT reduces the risk of local recurrence by around 20% and decreases breast cancer mortality by around 4%. While PMRT provides benefits, it also carries risks of side effects and increased non-breast cancer mortality. Current guidelines recommend PMRT for patients with large tumors, many positive lymph nodes, or an otherwise high risk of local recurrence despite optimal surgery and systemic therapy. Ongoing research continues to refine PMRT indications and techniques to maximize benefits and minimize risks.
This document discusses optimal fluid therapy for patients with traumatic hemorrhagic shock. It begins by noting that hemorrhage is a leading cause of preventable trauma deaths. Advances in treatment of hemorrhagic shock have often occurred during times of war. The document then reviews patient evaluation, massive transfusion protocols, and damage control resuscitation, which emphasizes early use of plasma over crystalloids. Large volumes of crystalloids are associated with worse outcomes for patients with hemorrhagic shock, and even small amounts may be harmful. Plasma should be the primary means of volume expansion in resuscitation of trauma patients with hemorrhagic shock.
Optimal treatment strategy for acute cholecystitis based on predictive factorsmailsindatos
This article summarizes the results of a large, international multicenter retrospective study examining optimal treatment strategies for acute cholecystitis. The study included over 5,000 patients from Japan and Taiwan who were divided into four treatment groups: primary cholecystectomy, cholecystectomy after gallbladder drainage, gallbladder drainage alone, or medical treatment alone. The study found significant differences in mortality rates between patients with low versus high Charlson comorbidity index scores. For less severe cases, factors like low BMI and higher CCI predicted higher mortality. For severe cases, jaundice, neurological or respiratory dysfunction predicted higher mortality. The study concluded that even for severe cases without predictive factors, primary cholecystectomy can be performed safely
Grand Rounds: Univ of Chicago CardiologyRobert Poston
This document discusses marketing strategies for less invasive cardiac surgery techniques like robotic CABG. It notes that patients generally prefer less invasive procedures due to quicker recovery times. The document outlines tactics for marketing robotic CABG such as developing websites, publications, presentations and advertising. It acknowledges both benefits like improved cosmesis but also challenges like higher costs and learning curves. Data on early ad campaigns for robotic CABG show they increased elective case volume and reduced length of stay. The document emphasizes integrating marketing messages and reassessing based on the local environment.
The document discusses challenges with modeling processes that involve multiple interacting objects. Conventional process modeling approaches encourage separating objects and focusing on one object type per process, which can lead to issues when objects interact. The document proposes modeling objects as first-class citizens and capturing relationships between objects to better represent real-world processes where objects corelate and influence each other. It provides examples of how conventional case-centric modeling can struggle to accurately capture a hiring process that involves interacting candidate, application, job offer and other objects.
Slides of our BPM 2022 paper on "Reasoning on Labelled Petri Nets and Their Dynamics in a Stochastic Setting", which received the best paper award at the conference. Paper available here: https://link.springer.com/chapter/10.1007/978-3-031-16103-2_22
More Related Content
Similar to Prohealth 2011 - Montali - Conformance Checking of Executed Clinical Guidelines in presence of Basic Medical Knowledge
Invited presentation on "Conformance Verification when Dealing with Computerized and Human-Enhanced Processes" at the Workshop on Foundations of Biomedical Knowledge Representation (FBKR 2012), Lorentz Centre, the Netherlands.
Physicians often have to combine clinical guideline recommendations with their own basic medical knowledge to cope with specific patients in specific contexts. Both knowledge sources may include temporal constraints for the execution of actions. In this paper we approach the problem of compliance analysis with both sources of knowledge, pointing
out discrepancies – including temporal ones – with respect to them, and where such discrepancies may be due to multiple and possibly conflicting recommendations.
This document presents a model to evaluate the potential budget impact of using the kSORT assay to monitor kidney transplant patients for subclinical rejection. The model projects costs over two years for a commercial health plan covering 285 kidney transplant patients under different monitoring scenarios, including using kSORT alone or with protocol biopsies. The results suggest using kSORT would have a minimal positive budget impact of $0.0057 per member per month, attributed to small patient numbers and low acute rejection and graft failure rates. Sensitivity analysis found costs of kSORT to be the most influential factor on budget impact.
Blood Groups Matcher Frame Work Based on Three -Level Rules in Myanmaraciijournal
Today Blood donation is a global interest for world to be survival lives when people are in trouble because
of natural disaster. The system provides the ability how to decide to donate the blood according to the rules
for blood donation not to meet the physicians. In this system, there are three main parts to accept blood
from donors when they want to donate according to the features like personal health. The application
facilitates to negotiate between blood donors and patients who need to get blood seriously on page without
going to Blood Banks and waiting time in queue there.
Blood groups matcher frame work based on three level rules in myanmaraciijournal
Today Blood donation is a global interest for world to be survival lives when people are in trouble because of natural disaster. The system provides the ability how to decide to donate the blood according to the rules for blood donation not to meet the physicians. In this system, there are three main parts to accept blood from donors when they want to donate according to the features like personal health. The application facilitates to negotiate between blood donors and patients who need to get blood seriously on page without going to Blood Banks and waiting time in queue there.
This document summarizes a case study involving a 19-year old male (EG) who was admitted to the ICU following a high-speed motorcycle accident and subsequent traumatic brain injury. EG remains intubated and sedated, with elevated heart rate, temperatures, and signs of sympathetic hyperactivity. The attending physician asks the clinical pharmacist about evidence for using propranolol to treat EG's sympathetic hyperactivity. The pharmacist then reviews the pathophysiology and presentation of paroxysmal sympathetic hyperactivity, current treatment options including beta blockers like propranolol, and a literature review on the use of beta blockers including propranolol in traumatic brain injury patients.
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
This document discusses the benefits and drawbacks of using positron emission tomography (PET) scans to monitor patients who have achieved complete remission from Diffused Large B-cell Lymphoma (DLBCL) after primary treatment. While PET scans can detect relapses early and lead to better outcomes, they also expose patients to radiation and may not be necessary, as the majority of relapses are detected without scans. The document concludes that despite costs and radiation exposure, regular PET scans for two years are important to diagnose the 30% of relapses detected by scans alone and improve prognosis for these patients.
This document discusses how telehealth and real-time analytics can help critical care achieve better health outcomes, better care, and lower costs. It describes how monitoring patients and gaining situation awareness is important for critical care. Real-time data analytics can help clinicians understand a patient's current physiological status and trajectory. Pattern recognition in patient data may help identify issues earlier. The challenges of big data in healthcare including volume, velocity, variety and veracity are discussed. Technologies that provide real-time situation awareness and predictive analytics could help improve patient care and outcomes in the ICU.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Alan Garber: Value-Conscious Bio-Medical Innovation: Why? How? When?capstoneconference09
The document discusses value-conscious biomedical innovation and evaluating medical technologies based on their costs and benefits. It provides examples of how insurers and Medicare make coverage decisions based on whether a technology is medically necessary and cost-effective. The document also analyzes studies on different treatment options for prostate cancer and potential cost savings if lower-cost options were used. It examines cost-effectiveness analyses of COX-2 inhibitors compared to NSAIDs under various assumptions and for high-risk patients. Moving to a cost-effectiveness criterion could shift both health care expenditures and outcomes.
The CABANA trial showed that catheter ablation was not superior to antiarrhythmic drug therapy for reducing cardiovascular outcomes over 5 years in patients with atrial fibrillation. The trial randomized over 2,200 patients to either ablation or drug therapy. The primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest occurred in 8% of ablation patients and 9.2% of drug therapy patients, showing no significant difference. However, ablation did significantly reduce the secondary outcome of death or cardiovascular hospitalization compared to drug therapy. The PADIT trial found that using more extensive perioperative antibiotics for cardiac device implantation procedures did not significantly reduce device infections compared to a single preoperative dose of antibiotics. The SPritely trial will compare
This document discusses the role of nurse practitioners (NPs) in emergency departments. It notes that NPs have practiced in emergency settings for over 4 decades and currently care for 13% of emergency department patients. With growing physician shortages and more insured patients under healthcare reform, NPs are well-positioned to help meet increasing demand as part of new models of emergency care that emphasize rapid triage, exams and disposition. The document also outlines educational and certification requirements for emergency NP practice as well as factors involved in successfully integrating NPs into emergency departments.
Post-mastectomy radiotherapy (PMRT) involves delivering radiation to the chest wall and surrounding lymph node areas after a mastectomy. Studies have shown PMRT reduces the risk of local recurrence by around 20% and decreases breast cancer mortality by around 4%. While PMRT provides benefits, it also carries risks of side effects and increased non-breast cancer mortality. Current guidelines recommend PMRT for patients with large tumors, many positive lymph nodes, or an otherwise high risk of local recurrence despite optimal surgery and systemic therapy. Ongoing research continues to refine PMRT indications and techniques to maximize benefits and minimize risks.
This document discusses optimal fluid therapy for patients with traumatic hemorrhagic shock. It begins by noting that hemorrhage is a leading cause of preventable trauma deaths. Advances in treatment of hemorrhagic shock have often occurred during times of war. The document then reviews patient evaluation, massive transfusion protocols, and damage control resuscitation, which emphasizes early use of plasma over crystalloids. Large volumes of crystalloids are associated with worse outcomes for patients with hemorrhagic shock, and even small amounts may be harmful. Plasma should be the primary means of volume expansion in resuscitation of trauma patients with hemorrhagic shock.
Optimal treatment strategy for acute cholecystitis based on predictive factorsmailsindatos
This article summarizes the results of a large, international multicenter retrospective study examining optimal treatment strategies for acute cholecystitis. The study included over 5,000 patients from Japan and Taiwan who were divided into four treatment groups: primary cholecystectomy, cholecystectomy after gallbladder drainage, gallbladder drainage alone, or medical treatment alone. The study found significant differences in mortality rates between patients with low versus high Charlson comorbidity index scores. For less severe cases, factors like low BMI and higher CCI predicted higher mortality. For severe cases, jaundice, neurological or respiratory dysfunction predicted higher mortality. The study concluded that even for severe cases without predictive factors, primary cholecystectomy can be performed safely
Grand Rounds: Univ of Chicago CardiologyRobert Poston
This document discusses marketing strategies for less invasive cardiac surgery techniques like robotic CABG. It notes that patients generally prefer less invasive procedures due to quicker recovery times. The document outlines tactics for marketing robotic CABG such as developing websites, publications, presentations and advertising. It acknowledges both benefits like improved cosmesis but also challenges like higher costs and learning curves. Data on early ad campaigns for robotic CABG show they increased elective case volume and reduced length of stay. The document emphasizes integrating marketing messages and reassessing based on the local environment.
Similar to Prohealth 2011 - Montali - Conformance Checking of Executed Clinical Guidelines in presence of Basic Medical Knowledge (20)
The document discusses challenges with modeling processes that involve multiple interacting objects. Conventional process modeling approaches encourage separating objects and focusing on one object type per process, which can lead to issues when objects interact. The document proposes modeling objects as first-class citizens and capturing relationships between objects to better represent real-world processes where objects corelate and influence each other. It provides examples of how conventional case-centric modeling can struggle to accurately capture a hiring process that involves interacting candidate, application, job offer and other objects.
Slides of our BPM 2022 paper on "Reasoning on Labelled Petri Nets and Their Dynamics in a Stochastic Setting", which received the best paper award at the conference. Paper available here: https://link.springer.com/chapter/10.1007/978-3-031-16103-2_22
Slides of the keynote speech on "Constraints for process framing in Augmented BPM" at the AI4BPM 2022 International Workshop, co-located with BPM 2022. The keynote focuses on the problem of "process framing" in the context of the new vision of "Augmented BPM", where BPM systems are augmented with AI capabilities. This vision is described in a manifesto, available here: https://arxiv.org/abs/2201.12855
Keynote speech at KES 2022 on "Intelligent Systems for Process Mining". I introduce process mining, discuss why process mining tasks should be approached by using intelligent systems, and show a concrete example of this combination, namely (anticipatory) monitoring of evolving processes against temporal constraints, using techniques from knowledge representation and formal methods (in particular, temporal logics over finite traces and their automata-theoretic characterization).
Presentation (jointly with Claudio Di Ciccio) on "Declarative Process Mining", as part of the 1st Summer School in Process Mining (http://www.process-mining-summer-school.org). The Presentation summarizes 15 years of research in declarative process mining, covering declarative process modeling, reasoning on declarative process specifications, discovery of process constraints from event logs, conformance checking and monitoring of process constraints at runtime. This is done without ad-hoc algorithms, but relying on well-established techniques at the intersection of formal methods, artificial intelligence, and data science.
1. The document discusses representing business processes with uncertainty using ProbDeclare, an extension of Declare that allows constraints to have uncertain probabilities.
2. ProbDeclare models contain both crisp constraints that must always hold and probabilistic constraints that hold with some probability. This leads to multiple possible "scenarios" depending on which constraints are satisfied.
3. Reasoning involves determining which scenarios are logically consistent using LTLf, and computing the probability distribution over scenarios by solving a system of inequalities defined by the constraint probabilities.
Presentation on "From Case-Isolated to Object-Centric Processes - A Tale of Two Models" as part of the Hasselt University BINF Research Seminar Series (see https://www.uhasselt.be/en/onderzoeksgroepen-en/binf/research-seminar-series).
Invited seminar on "Modeling and Reasoning over Declarative Data-Aware Processes" as part of the KRDB Summer Online Seminars 2020 (https://www.inf.unibz.it/krdb/sos-2020/).
Presentation of the paper "Soundness of Data-Aware Processes with Arithmetic Conditions" at the 34th International Conference on Advanced Information Systems Engineering (CAiSE 2022). Paper available here: https://doi.org/10.1007/978-3-031-07472-1_23
Abstract:
Data-aware processes represent and integrate structural and behavioural constraints in a single model, and are thus increasingly investigated in business process management and information systems engineering. In this spectrum, Data Petri nets (DPNs) have gained increasing popularity thanks to their ability to balance simplicity with expressiveness. The interplay of data and control-flow makes checking the correctness of such models, specifically the well-known property of soundness, crucial and challenging. A major shortcoming of previous approaches for checking soundness of DPNs is that they consider data conditions without arithmetic, an essential feature when dealing with real-world, concrete applications. In this paper, we attack this open problem by providing a foundational and operational framework for assessing soundness of DPNs enriched with arithmetic data conditions. The framework comes with a proof-of-concept implementation that, instead of relying on ad-hoc techniques, employs off-the-shelf established SMT technologies. The implementation is validated on a collection of examples from the literature, and on synthetic variants constructed from such examples.
Presentation of the paper "Probabilistic Trace Alignment" at the 3rd International Conference on Process Mining (ICPM 2021). Paper available here: https://doi.org/10.1109/ICPM53251.2021.9576856
Abstract:
Alignments provide sophisticated diagnostics that pinpoint deviations in a trace with respect to a process model. Alignment-based approaches for conformance checking have so far used crisp process models as a reference. Recent probabilistic conformance checking approaches check the degree of conformance of an event log as a whole with respect to a stochastic process model, without providing alignments. For the first time, we introduce a conformance checking approach based on trace alignments using stochastic Workflow nets. This requires to handle the two possibly contrasting forces of the cost of the alignment on the one hand and the likelihood of the model trace with respect to which the alignment is computed on the other.
Presentation of the paper "Strategy Synthesis for Data-Aware Dynamic Systems with Multiple Actors" at the 7th International Conference on Principles of Knowledge Representation and Reasoning (KR 2020). Paper available here: https://proceedings.kr.org/2020/32/
Abstract: The integrated modeling and analysis of dynamic systems and the data they manipulate has been long advocated, on the one hand, to understand how data and corresponding decisions affect the system execution, and on the other hand to capture how actions occurring in the systems operate over data. KR techniques proved successful in handling a variety of tasks over such integrated models, ranging from verification to online monitoring. In this paper, we consider a simple, yet relevant model for data-aware dynamic systems (DDSs), consisting of a finite-state control structure defining the executability of actions that manipulate a finite set of variables with an infinite domain. On top of this model, we consider a data-aware version of reactive synthesis, where execution strategies are built by guaranteeing the satisfaction of a desired linear temporal property that simultaneously accounts for the system dynamics and data evolution.
Presentation of the paper "Extending Temporal Business Constraints with Uncertainty" at the 18th Int. Conference on Business Process Management (BPM 2020). Paper available here: https://doi.org/10.1007/978-3-030-58666-9_3
Abstract: Temporal business constraints have been extensively adopted to declaratively capture the acceptable courses of execution in a business process. However, traditionally, constraints are interpreted logically in a crisp way: a process execution trace conforms with a constraint model if all the constraints therein are satisfied. This is too restrictive when one wants to capture best practices, constraints involving uncontrollable activities, and exceptional but still conforming behaviors. This calls for the extension of business constraints with uncertainty. In this paper, we tackle this timely and important challenge, relying on recent results on probabilistic temporal logics over finite traces. Specifically, our contribution is threefold. First, we delve into the conceptual meaning of probabilistic constraints and their semantics. Second, we argue that probabilistic constraints can be discovered from event data using existing techniques for declarative process discovery. Third, we study how to monitor probabilistic constraints, where constraints and their combinations may be in multiple monitoring states at the same time, though with different probabilities.
Presentation of the paper "Extending Temporal Business Constraints with Uncertainty" at the CAiSE2020 Forum. The paper is available here: https://link.springer.com/chapter/10.1007/978-3-030-58135-0_8
Abstract: Conformance checking is a fundamental task to detect deviations between the actual and the expected courses of execution of a business process. In this context, temporal business constraints have been extensively adopted to declaratively capture the expected behavior of the process. However, traditionally, these constraints are interpreted logically in a crisp way: a process execution trace conforms with a constraint model if all the constraints therein are satisfied. This is too restrictive when one wants to capture best practices, constraints involving uncontrollable activities, and exceptional but still conforming behaviors. This calls for the extension of business constraints with uncertainty. In this paper, we tackle this timely and important challenge, relying on recent results on probabilistic temporal logics over finite traces. Specifically, we equip business constraints with a natural, probabilistic notion of uncertainty. We discuss the semantic implications of the resulting framework and show how probabilistic conformance checking and constraint entailment can be tackled therein.
Presentation of the paper "Modeling and Reasoning over Declarative Data-Aware Processes with Object-Centric Behavioral Constraints" at the 17th Int. Conference on Business Process Management (BPM 2019). Paper available here: https://link.springer.com/chapter/10.1007/978-3-030-26619-6_11
Abstract
Existing process modeling notations ranging from Petri nets to BPMN have difficulties capturing the data manipulated by processes. Process models often focus on the control flow, lacking an explicit, conceptually well-founded integration with real data models, such as ER diagrams or UML class diagrams. To overcome this limitation, Object-Centric Behavioral Constraints (OCBC) models were recently proposed as a new notation that combines full-fledged data models with control-flow constraints inspired by declarative process modeling notations such as DECLARE and DCR Graphs. We propose a formalization of the OCBC model using temporal description logics. The obtained formalization allows us to lift all reasoning services defined for constraint-based process modeling notations without data, to the much more sophisticated scenario of OCBC. Furthermore, we show how reasoning over OCBC models can be reformulated into decidable, standard reasoning tasks over the corresponding temporal description logic knowledge base.
Keynote speech at the Belgian Process Mining Research Day 2021. I discuss the open, critical challenge of data preparation in process mining, considering the case where the original event data are implicitly stored in (legacy) relational databases. This case covers the common situation where event data are stored inside the data layer of an ERP or CRM system. This is usually handled using manual, ad-hoc, error-prone ETL procedures. I propose instead to adopt a pipeline based on semantic technologies, in particular the framework of ontology-based data access (also known as virtual knowledge graph). The approach is code-less, and relies on three main conceptual steps: (1) the creation of a data model capturing the relevant classes, attributes, and associations in the domain of interest (2) the definition of declarative mappings from the source database to the data model, following the ontology-based data access paradigm (3) the annotation of the data model with indications on which classes/associations/attributes provide the relevant notions of case, events, event attributes, and event-to-case relation. Once this is done, the framework automatically extracts the event log from the legacy data. This makes extremely smooth to generate logs by taking multiple perspectives on the same reality. The approach has been operationalized in the onprom tool, which employs semantic web standard languages for the various steps, and the XES standard as the target format for the event logs.
Keynote speech at the 7th International Workshop on DEClarative, DECision and Hybrid approaches to processes ( DEC2H 2019) In conjunction with BPM 2019.
This is a talk about the combined modeling and reasoning techniques for decisions, background knowledge, and work processes.
The advent of the OMG Decision Model and Notation (DMN) standard has revived interest, both from academia and industry, in decision management and its relationship with business process management. Several techniques and tools for the static analysis of decision models have been brought forward, taking advantage of the trade-off between expressiveness and computational tractability offered by the DMN S-FEEL language.
In this keynote, I argue that decisions have to be put in perspective, that is, understood and analyzed within their surrounding organizational boundaries. This brings new challenges that, in turn, require novel, advanced analysis techniques. Using a simple but illustrative example, I consider in particular two relevant settings: decisions interpreted the presence of background, structural knowledge of the domain of interest, and (data-aware) business processes routing process instances based on decisions. Notably, the latter setting is of particular interest in the context of multi-perspective process mining. I report on how we successfully tackled key analysis tasks in both settings, through a balanced combination of conceptual modeling, formal methods, and knowledge representation and re
Presentation at "Ontology Make Sense", an event in honor of Nicola Guarino, on how to integrate data models with behavioral constraints, an essential problem when modeling multi-case real-life work processes evolving multiple objects at once. I propose to combine UML class diagrams with temporal constraints on finite traces, linked to the data model via co-referencing constraints on classes and associations.
The document discusses representing and querying norm states using temporal ontology-based data access (OBDA). It presents the QUEN framework which models norms and their state transitions declaratively on top of a relational database. QUEN has three layers: 1) an ontological layer representing norms, 2) a specification of norm state transitions in response to database events, and 3) a legacy relational database storing events. It demonstrates QUEN on an example of patient data access consent, modeling authorizations and their lifecycles. Norm state queries are answered directly over the database using the declarative specifications without materializing states.
Presentation ad EDOC 2019 on monitoring multi-perspective business constraints accounting for time and data, with a specific focus on the (unsolvable in general) problem of conflict detection.
1) The document discusses business process management and how conceptual modeling and process mining can help understand and improve digital enterprises.
2) Process mining techniques like process discovery from event logs, decision mining, and social network mining can provide insights into how processes are executed in reality.
3) Replay techniques can enhance process models with timing information and detect deviations to help align actual behaviors with expected behaviors.
More from Faculty of Computer Science - Free University of Bozen-Bolzano (20)
The importance of sustainable and efficient computational practices in artificial intelligence (AI) and deep learning has become increasingly critical. This webinar focuses on the intersection of sustainability and AI, highlighting the significance of energy-efficient deep learning, innovative randomization techniques in neural networks, the potential of reservoir computing, and the cutting-edge realm of neuromorphic computing. This webinar aims to connect theoretical knowledge with practical applications and provide insights into how these innovative approaches can lead to more robust, efficient, and environmentally conscious AI systems.
Webinar Speaker: Prof. Claudio Gallicchio, Assistant Professor, University of Pisa
Claudio Gallicchio is an Assistant Professor at the Department of Computer Science of the University of Pisa, Italy. His research involves merging concepts from Deep Learning, Dynamical Systems, and Randomized Neural Systems, and he has co-authored over 100 scientific publications on the subject. He is the founder of the IEEE CIS Task Force on Reservoir Computing, and the co-founder and chair of the IEEE Task Force on Randomization-based Neural Networks and Learning Systems. He is an associate editor of IEEE Transactions on Neural Networks and Learning Systems (TNNLS).
This presentation by Tim Capel, Director of the UK Information Commissioner’s Office Legal Service, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
Gamify it until you make it Improving Agile Development and Operations with ...Ben Linders
So many challenges, so little time. While we’re busy developing software and keeping it operational, we also need to sharpen the saw, but how? Gamification can be a way to look at how you’re doing and find out where to improve. It’s a great way to have everyone involved and get the best out of people.
In this presentation, Ben Linders will show how playing games with the DevOps coaching cards can help to explore your current development and deployment (DevOps) practices and decide as a team what to improve or experiment with.
The games that we play are based on an engagement model. Instead of imposing change, the games enable people to pull in ideas for change and apply those in a way that best suits their collective needs.
By playing games, you can learn from each other. Teams can use games, exercises, and coaching cards to discuss values, principles, and practices, and share their experiences and learnings.
Different game formats can be used to share experiences on DevOps principles and practices and explore how they can be applied effectively. This presentation provides an overview of playing formats and will inspire you to come up with your own formats.
11June 2024. An online pre-engagement session was organized on Tuesday June 11 to introduce the Science Policy Lab approach and the main components of the conceptual framework.
About 40 experts from around the globe gathered online for a pre-engagement session, paving the way for the first SASi-SPi Science Policy Lab event scheduled for June 18-19, 2024 in Malmö. The session presented the objectives for the upcoming Science Policy Lab (S-PoL), which featured a role-playing game designed to simulate stakeholder interactions and policy interventions for food systems transitions. Participants called for the sharing of meeting materials and continued collaboration, reflecting a strong commitment to advancing towards sustainable agrifood systems.
This presentation by Katharine Kemp, Associate Professor at the Faculty of Law & Justice at UNSW Sydney, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
This presentation by Professor Giuseppe Colangelo, Jean Monnet Professor of European Innovation Policy, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
1.) Introduction
Our Movement is not new; it is the same as it was for Freedom, Justice, and Equality since we were labeled as slaves. However, this movement at its core must entail economics.
2.) Historical Context
This is the same movement because none of the previous movements, such as boycotts, were ever completed. For some, maybe, but for the most part, it’s just a place to keep your stable until you’re ready to assimilate them into your system. The rest of the crabs are left in the world’s worst parts, begging for scraps.
3.) Economic Empowerment
Our Movement aims to show that it is indeed possible for the less fortunate to establish their economic system. Everyone else – Caucasian, Asian, Mexican, Israeli, Jews, etc. – has their systems, and they all set up and usurp money from the less fortunate. So, the less fortunate buy from every one of them, yet none of them buy from the less fortunate. Moreover, the less fortunate really don’t have anything to sell.
4.) Collaboration with Organizations
Our Movement will demonstrate how organizations such as the National Association for the Advancement of Colored People, National Urban League, Black Lives Matter, and others can assist in creating a much more indestructible Black Wall Street.
5.) Vision for the Future
Our Movement will not settle for less than those who came before us and stopped before the rights were equal. The economy, jobs, healthcare, education, housing, incarceration – everything is unfair, and what isn’t is rigged for the less fortunate to fail, as evidenced in society.
6.) Call to Action
Our movement has started and implemented everything needed for the advancement of the economic system. There are positions for only those who understand the importance of this movement, as failure to address it will continue the degradation of the people deemed less fortunate.
No, this isn’t Noah’s Ark, nor am I a Prophet. I’m just a man who wrote a couple of books, created a magnificent website: http://www.thearkproject.llc, and who truly hopes to try and initiate a truly sustainable economic system for deprived people. We may not all have the same beliefs, but if our methods are tried, tested, and proven, we can come together and help others. My website: http://www.thearkproject.llc is very informative and considerably controversial. Please check it out, and if you are afraid, leave immediately; it’s no place for cowards. The last Prophet said: “Whoever among you sees an evil action, then let him change it with his hand [by taking action]; if he cannot, then with his tongue [by speaking out]; and if he cannot, then, with his heart – and that is the weakest of faith.” [Sahih Muslim] If we all, or even some of us, did this, there would be significant change. We are able to witness it on small and grand scales, for example, from climate control to business partnerships. I encourage, invite, and challenge you all to support me by visiting my website.
Prohealth 2011 - Montali - Conformance Checking of Executed Clinical Guidelines in presence of Basic Medical Knowledge
1. Alessio Bottrighi1, Federico Chesani2, Paola Mello2,
Marco Montali3, Stefania Montani1, Paolo Terenziani1
1DI, University of Piemonte Orientale
2DEIS, University of Bologna
3KRDB, Free University of Bozen-Bolzano
2. –
™ Clinical Guidelines (CGs) in the ideal and
real world
™ Real-life examples showing the interplay
between CGs and medical knowledge
™ Specialized activity lifecycle as a connection
point between them
™ Characterization of conformance and
evaluation with the Event Calculus
Outline
3. –
™ CGs developed by applying evidence-based
medicine to large classes of abstract patients
™ Assumptions
– Ideal patients
™ statistically relevant
™ with only the disease targeted by the CG
– Ideal physicians
– Ideal resources
™ ∞ resources
Ideal world
4. –
™ Context and patients are not ideal
– Resources may be missing
– Each single patient has its own story, condition,
preferences
à Unforeseen situations are common
à CGs are routinely adapted on a per patient basis,
using the Basic Medical Knowledge (BMK)
™ Physicians are not ideal
à they need (computerized) support
Real World
5. –
™ Compliance The act of conforming as requested by the
CG
™ Flexibility The ability of accommodating and promptly
adapting to change and unforeseen situations
Compliance vs Flexibility
Universe of Traces
Compliant
Traces
Compliance
Flexibility
6. –
™ Conformance problem: adherence of a CG
execution trace to the CG+BMK model
– The doctor has always the last word!
Big Question
How do BMK and CGs
interact?
7. –
Formalize the refined model towards conformance checking
Refine CGs (GLARE) to accommodate BMK
Understand how CGs are interpreted by healthcare professionals
Collecting real examples about BMK+CGs
Research agenda
8. –
Choice enforcement
CG BMK
Patients suffering from bacterial
pneumonia caused by agents sensible
to penicillin and to macrolid, must be
treated one of them
Don’t administer drugs to an allergic
patient.
™ BMK reinforces the CG helping in the discrimination
among possible alternatives
…
Administer penicillin
Administer macrolid
Patient
allergic to
penicillin
9. –
Openness
CG BMK
Calcemia and glycemia are routinely
performed for all patients admitted to
the internal medicine ward of Italian
hospitals.
™ BMK introduces further activities that can/must be
executed alongside the ones of the CG
™ The CG cannot be interpreted as a closed specification
– Closed = everything not explicitly mentioned is
forbidden
10. –
Exceptions
CG in GLARE [Terenziani et al.] BMK
Threats to patient’s life must be
addressed immediately.
™ (sometimes) CG’s prescriptions = standard behavior
™ BMK may introduce high-priority prescriptions used
to deal with exceptional situations
– They override the CG
Electrocardiographic"
study"
Echocardiographic"
study"
Coronary"
angiorgraphy"
11. –
Mandatory behaviors
CG BMK
In a patient affected by unstable
angina and advanced predialytic renal
failure, coronary angiography remains
mandatory, even if the contrast media
administration may cause a further
final deterioration of the renal func-
tions, leading the patient to dialysis.
Don’t administer treatments to the
patient when they are likely to be
dangerous
™ (sometimes) BMK = default situation
™ CG introduces mandatory activities in order to
handle special cases
– They override the BMK
12. –
™ BMK is used to fill the gap between the ideal world
targeted by CGs and the real world
™ The interplay between CG and BMK is complex
– It is likely the case they seem to contradict each other
™ Contradiction is only apparent
– CG actions should not be interpreted as “must do” actions
– Both CG and BMK are “defeasible”
™ Parts of the CG are amended by the BMK
™ Parts of the BMK are overriden by the CG
Lessons learnt 1/2
13. –
™ Both BMK and CG may involve declarative and
procedural knowledge
™ Procedural knowledge fixes the sequencing of
actions to be done
™ Declarative knowledge captures constraints and
properties to be satisfied, without saying “how”
Lessons learnt 2/2
CG in GLARE [Terenziani et al.] BMK
Threats to patient’s life must be
addressed immediately.
An hearth failure is a life threat.
Diuretic therapy is a possible immediate
response for acute heart failure.
Electrocardiographic"
study"
Echocardiographic"
study"
Coronary"
angiorgraphy"
14. –
™ The interplay between the two kinds of knowledge
occurs at execution time
à when performing activities
™ Brainstorming with physicians led to a specialized
activity life cycle
– Capturing the semantics of “executing activities” from
the viewpoint of domain experts
– Pointing out where BMK-driven decision making
comes into play
– Showing that data are as much as important than the
process
Binding CG with BMK
17. –
Activity Lifecycle
candidate
discarded
ready
NOT Precond
∨ Ab
Precond
∧ NOT Ab
Preconditions (CG) are
applicability conditions
over available patients
data and execution
context
Abnormality conditions
(BMK) point out when
the patient/context is not
ideal
21. –
Conformance
candidate
discarded discarded
completed
active
NOT Precond
∨ Ab
Precond
∧ NOT Ab
Ab
™ Ready and candidate states collapsed
™ Expected life cycle à triggered by logical conditions
™ Real life cycle à triggered by event occurrences
™ Conformance: detect and show deviations
expected real
candidate
discarded discarded
completed
active
start
discard abort
end
22. –
™ Ability to reason upon events, time and data
– Events characterizing the life cycle of activities
™ Glucose test completed at time …
– Events used to collect information about patient and
context
™ At time …, the patient had an hearth failure
™ Ability to deal with declarative and procedural
knowledge
– Rules
– States/milestones
Reasoning - Requirements
23. –
™ A logic-based framework for reasoning upon events
and their effects
™ Composed of
– EC ontology: a set of special predicates to represent how
events manipulate fluents
™ Fluent = property that changes over time à states!
– A logic-based formalization capturing the semantics of
the EC ontology
™ Can be axiomatized using logic programming with
NAF
– Prolog!
Event Calculus [Kowalski and Sergot, 1986]
25. –
The Simple EC Ontology
1 2 3 4 5 6 7 8 9 10 11 12 13 14
initiates(a,f,3) terminates(b,f,12)
happens(a,3)
holds_at(f,7)
declip
clip
0
f
f holds in (3,12]
a b
26. –
™ Events
– Life cycle events: exec(event(start, A))
– Patient-related events: heart_failure, glucose(91)
™ Status Fluents
– status(nextCGcandidate,As) indicates the next
activity (set of activities) according to the CG
™ Control-flow dimension
– status(A,S) indicates the current state during the
execution of A
™ Activity life cycle
– status(cg,nc) indicates the presence of a deviation
™ Other EC + Prolog rules to capture BMK
™ Facts to describe the structure of the CG and the
preconditions of each activity
Approach
27. –
™ Obviously, only relevant portions of the BMK can be considered
™ Threats to patient’s life must be addressed immediately
– Occurrence of a life threat gives raise to an abnormality situation
– The abnormality situation disappears only if a proper treatment is
started
initiates(exec(E),abnormality(E),T):- life_threat(E).
terminates(exec(event(start,A)),abnormality(E),T):-
treatment(E,A).
™ An hearth failure is a life threat
™ Diuretic therapy is a possible immediate response for acute heart failure
life_threat(hearth_failure).
treatment(hearth_failure,diuretic_therapy).
Capturing BMK
28. –
™ Easy to include further cases by adding rules
Capturing Deviations
CG next activity is B Operator starts A
initiates(exec(event(start,A)),status(cg,nc),T):-
holds_at(status(nextCGcandidate,B),T), A ≠ B.
CG A must be discarded Operator starts A
initiates(exec(event(start,A)),status(cg,nc),T):-
holds_at(status(A,candidate),T),¬preconditions(A,T).
initiates(exec(event(start,A)),status(cg,nc),T):-
holds_at(status(A,candidate),T),holds_at(abnormality(_),T).
CG A must be started Operator discards A
initiates(exec(event(discard,A)),status(cg,nc),T):-
holds_at(status(A,candidate),T),
preconditions(A,T),¬holds_at(abnormality(_),T).
29. –Running case with REC
hearth failure
REC http://www.inf.unibz.it/~montali/tools.html
30. –
™ Healthcare professionals use BMK to put CGs into
practice
™ Accommodating the BMK in CG modeling and
execution has many implications
– Specialized activity life cycle
– Complex interplay between BMK and CG
– Conformance as a tool for highlighting deviations
™ Event Calculus is a suitable framework to formalize
CG + BMK
™ Balancing between compliance and flexibility is,
again, the main issue!
Summary
31. –
™ Going on with our EC-based formalization
™ Combination with more declarative approaches such as
DECLARE
– EC-based formalization of DECLARE constraints with
temporal constraints already available (MOBUCON tool)
™ Connections with adaptive PAIS
™ Connections with artifact-centric business processes
™ Applying REC during the execution for clinical operational
decision support
™ Investigating what happens if we only have “start” and
“end” events
Ongoing/Future Work