1. Mestrado Integrado Introdução à Medicina I Turma 6 6fmup0910@gmail.com 27-10-2009 Professor Altamiro Pereira ARTIFICIAL INTELLIGENCE SYSTEMS FOR DIRECT PATIENT CARE IN INTENSIVE CARE UNITS: A SYSTEMATIC REVIEW

2. 2 Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 AI: Definition Medical artificial intelligence is primarily concerned with the construction of AI programs that perform diagnosis and make therapy recommendations. [1] AI in medicine: AI in medicine appeared as an answer to an evolving problem –the escalating amount of information that doctors have to deal with everyday. Introduction [1] Enrico Coiera ; Guide to Medical Informatics, the Internet and Telemedicine [Internet]; 1 st Edition; London; Arnold; August 1997; Chapter 19, Introduction; [cited 2009 Oct 27]; Available from: http://www.openclinical.org/aiinmedicine.html http://www.openclinical.org/aiinmedicine.html

3. 3 Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Introduction AI and ICU Intensive care medicine frequently involves making rapid decisions on the basis of a large and disparate array of information. [2] Since the technology of monitoring astronauts’ vital signs in space was transferred to the bedside in the 1960s, patient monitoring systems have become an indispensable part of critical care. [3] Today, with more biosensors and computational power, these systems can simultaneously gather and display multiple physiological signals, derive clinically important parameters, and generate alerts to clinicians. [3] [2] Jason H. T. Bates and Michael P. Young; Applying Fuzzy Logic to Medical Decision Making in the Intensive Care Unit; 2003 Apr [3] Ying Zhang, MEng Real-Time Development of Patient-Specific Alarm Algorithms; Proceedings of the 29th Annual International; Conference of the IEEE EMBS; Cité Internationale, Lyon, France August 23-26, 2007

4. 4 Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Introduction Direct Patient Care Since trauma injuries have specific causes, all with established methods of treatment, fatal complications and long-term disabilities can be reduced by making less subjective and more accurate decisions in trauma units. [4] Critically-ill patients need continuous monitoring, which is an impractical, if not impossible, task for the caregivers to carry out solely in the ICU and other critical care settings. [3] [3] Ying Zhang, MEng Real-Time Development of Patient-Specific Alarm Algorithms; Proceedings of the 29th Annual International; Conference of the IEEE EMBS; Cité Internationale, Lyon, France August 23-26, 2007 [4]Soo-Yeon Ji, Rebecca Smith, Toan Huynh and Kayvan Najarian; A comparative analysis of multi-level computer-assisted decision making systems for traumatic injuries; 2009 Jan

5. 5 Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Introduction Important concepts related to Artificiall Intelligence: [5] Management information system (MIS) Data stream. Rule-based (expert) systems Data mining Neural networks Machine learning Case-based reasoning Data visualization [5] Hanson CW 3rd, Marshall BE; Artificial intelligence applications in the intensive care unit; Critical care medicine; 2001 Feb; 29 (2); 427-35

6. 6 Are artificial intelligence systems used and useful when applied to direct patient care in the intensive care unit when compared to the traditional methods? Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Research question

7. 7 To review the current applications of artificial intelligence for direct patient care in the intensive care unit. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Aim

8. 8 Determine if artificial intelligence systems are currently being used in intensive care units for direct patient care; Inspect the benefits and drawbacks of artificial intelligence systems for direct patient care compared to traditional methods of analysis; Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Specific objectives

9. 9 Expose the use of artificial intelligence systems as decision support mechanisms for direct patient care in intensive care units; Evaluate the acceptance of artificial intelligence systems by the health professionals. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Specific objectives

10. 10 4-Interpretation of results and Report Writing. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods Study design: Systematic review 1- A comprehensive, exhaustive search, in electronic databases, and inclusion of primary studies. 2- Quality assessment of included studies and data extraction (review, by two persons, of the title and the abstract or the article. Same process for the full article. A third opinion may be requested). 3 - Synthesis of study results (SPSS and Review Manager).

11. 11 Data collection: MEDLINE articles; Scopus articles; ISI Web of Knowledge articles. Additional direct search in critical care journals Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods

12. 12 Search: Artificial Intelligence, since 2001. 30248 Articles Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods ("2001-01-01"[PDAT] : "3000"[PDAT]) AND (("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields]) OR AIs[All Fields] OR ("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields] OR ("computer"[All Fields] AND "reasoning"[All Fields]) OR "computer reasoning"[All Fields]) OR ("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields] OR ("machine"[All Fields] AND "intelligence"[All Fields]) OR "machine intelligence"[All Fields]) OR ("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields] OR ("machine"[All Fields] AND "learning"[All Fields]) OR "machine learning"[All Fields]) OR (("knowledge"[MeSH Terms] OR "knowledge"[All Fields]) AND Representation[All Fields]) OR ("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields] OR ("computer"[All Fields] AND "vision"[All Fields] AND "systems"[All Fields]) OR "computer vision systems"[All Fields]) OR ("artificial intelligence"[MeSH Terms] OR ("artificial"[All Fields] AND "intelligence"[All Fields]) OR "artificial intelligence"[All Fields] OR ("computer"[All Fields] AND "vision"[All Fields] AND "system"[All Fields]) OR "computer vision system"[All Fields]))

13. 13 Search: Intensive Care Unit, since 2001. 122153 Articles Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods ("2001-01-01"[PDAT] : "3000"[PDAT]) AND (("intensive care"[MeSH Terms] OR ("intensive"[All Fields] AND "care"[All Fields]) OR "intensive care"[All Fields]) OR ("intensive care units"[MeSH Terms] OR ("intensive"[All Fields] AND "care"[All Fields] AND "units"[All Fields]) OR "intensive care units"[All Fields]) OR ICU[All Fields] OR NICU[All Fields] OR PICU[All Fields] OR ("critical care"[MeSH Terms] OR ("critical"[All Fields] AND "care"[All Fields]) OR "critical care"[All Fields]) OR CC[All Fields])

14. 14 Search: Direct Patient Care, since 2001. 688782 Articles. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods ("01-01-2001"[PDAT] : "3000"[PDAT]) AND ((Direct[All Fields] AND ("patient care"[MeSH Terms] OR ("patient"[All Fields] AND "care"[All Fields]) OR "patient care"[All Fields])) OR DPC[All Fields] OR ("patient care"[MeSH Terms] OR ("patient"[All Fields] AND "care"[All Fields]) OR "patient care"[All Fields]))

15. 15 Search: Previous queries all together. Since 2001. 263 Articles Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods 963 356 44438

16. 16 Inclusion criteria: Articles which refer AI monitoring techniques in ICU; Articles which refer AI techniques for decision supporting in ICU; Articles which refer AI alerting techniques in ICU. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods

17. 17 Exclusion criteria: Articles in which AI systems are used only as database; Articles only with a theoretical approach to the subject, without a concrete study. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods

18. 18 Study variables: Characteristics of the articles (year, author and country of publishing, etc…) Type of study (number of participants, duration, etc…) Domain of application (neurological, respiratory, cardiovascular, etc…) Area of Application (Monitoring, Alerting, Decision Supporting, etc..) Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods

19. 19 Statistical analysis: Analysis of the study variables using the appropriate frequency measures; Possible associative analysis between factors and outcomes in the cases in which such aspects are included, resorting to adequate association measures. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Methods

20. 20 Description of few systems that apply artificial intelligence in intensive care units; Reduced acceptance; Greater number of benefits when compared to the drawbacks. Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 Expected results

21. 21 Professor Altamiro Pereira Turma 6 6fmup0910@gmail.com 27-10-2009 References [1] Enrico Coiera ; Guide to Medical Informatics, the Internet and Telemedicine [Internet]; 1 st Edition; London; Arnold; August 1997; Chapter 19, Introduction; [cited 2009 Oct 27]; Available from: http://www.openclinical.org/aiinmedicine.html http://www.openclinical.org/aiinmedicine.html [2] Jason H. T. Bates and Michael P. Young; Applying Fuzzy Logic to Medical Decision Making in the Intensive Care Unit; 2003 Apr [3] Ying Zhang, MEng Real-Time Development of Patient-Specific Alarm Algorithms Proceedings of the 29th Annual International Conference of the IEEE EMBS Cité Internationale, Lyon, France August 23-26, 2007 [4]Soo-Yeon Ji, Rebecca Smith, Toan Huynh and Kayvan Najarian; A comparative analysis of multi-level computer-assisted decision making systems for traumatic injuries; 2009 Jan [5] Hanson CW 3rd, Marshall BE; Artificial intelligence applications in the intensive care unit; Critical care medicine; 2001 Feb; 29 (2); 427-35