Service-oriented subscription management of medical decision data in the intensive care unit.

OBJECTIVES: This paper addresses the design of a platform for the management of medical decision data in the ICU. Whenever new medical data from laboratories or monitors is available or at fixed times, the appropriate medical support services are activated and generate a medical alert or suggestion to the bedside terminal, the physician's PDA, smart phone or mailbox. Since future ICU systems will rely ever more on medical decision support, a generic and flexible subscription platform is of high importance. METHODS: Our platform is designed based on the principles of service-oriented architectures, and is fundamental for service deployment since the medical support services only need to implement their algorithm and can rely on the platform for general functionalities. A secure communication and execution environment are also provided. RESULTS: A prototype, where medical support services can be easily plugged in, has been implemented using Web service technology and is currently being evaluated by the Department of Intensive Care of the Ghent University Hospital. To illustrate the platform operation and performance, two prototype medical support services are used, showing that the extra response time introduced by the platform is less than 150 ms. CONCLUSIONS: The platform allows for easy integration with hospital information systems. The platform is generic and offers user-friendly patient/service subscription, transparent data and service resource management and priority-based filtering of messages. The performance has been evaluated and it was shown that the response time of platform components is negligible compared to the execution time of the medical support services.

Implementation of a real-time electronic alert based on the RIFLE criteria for acute kidney injury in ICU patients.

Acute kidney injury (AKI) is very common among critically-ill patients and is correlated with significant morbidity and mortality. The RIFLE criteria (an acronym comprising Risk, Injury, Failure, Loss and End-stage kidney disease), were developed by a panel of experts aiming at standardizing the definition of AKI and to subdivide AKI into different categories of severity. However, although these criteria are clear and easy to understand, they are still complex and labour-intensive, and therefore mostly used in retrospective. The use of an electronic alert based on the RIFLE criteria, which warns the physician in real-time when kidney function is deteriorating can help to implement these criteria in daily clinical practice. In this paper we describe the successful implementation of such an alert system. Not only were there technological barriers to solve; also acceptance of the alert by the end user was of pivotal importance. Further research is currently performed to investigate whether the implementation of real-time electronic RIFLE alerts induce faster therapeutic intervention, and to evaluate the impact of a more timely intervention on improved preservation of kidney function and patients' outcome.

Design of a flexible platform for execution of medical decision support agents in the intensive care unit.

This paper addresses the design of a generic and scalable platform for the execution of medical decision support agents in the intensive care unit (ICU). As will be motivated, medical decision support agents can impose high computational load and in practical setups a large amount of such agents are typically running in parallel. Future ICU systems will rely on extensive medical decision support. However, in current systems only one workstation is typically dedicated for the execution of medical decision support agents. Therefore, we propose an architecture based on middleware technology to allow for easy distribution of the agents along multiple workstations. The architecture allows for easy integration with a general ICU data flow management architecture.

Healthcare and Catholic identity in the universal Church.

Two topics that are closely related to the daily work and the primordial concern of Catholic healthcare givers are the meaning and sense of Catholic healthcare institutions, and the relationship between a particular Church and the universal Church, especially since the Second Vatican Council. Some question whether it is worthwhile to maintain independent Catholic institutions, rather than working with others in nondenominational healthcare institutions. Christian institutions are indispensable as a defense against the well-organized forces of evil in the world, and because togetherness is needed in the struggle for good and for faith. Without this togetherness, the danger exists that the power of faith will be taken over by the power of money and financial interest groups. The elements of the Catholic identity of institutions and organizations are a service to the world, the Gospel message, a balance between technology and humanism, a permanent solicitude for the whole person, and a respect for human liberty. This Catholic identity must be fostered in our institutions, especially among the laypeople working there. The relationship between the universal Church and local Churches has come under stress since the Second Vatican Council, and a balance must be found. The problem has two aspects: the theological, and the cultural and psychological. A sound communion theology must be established to provide a good perspective on the relationship. In addition, a dialogue must be established between Rome and the particular Churches to prevent the universal message of Christ in his Gospel from conflicting more and more with local styling of the message.(ABSTRACT TRUNCATED AT 250 WORDS)