A Comparative Study of the Arden Syntax and GDL Clinical Knowledge Representation Languages.

The expressiveness of a medical knowledge representation language has significant impact on the effectiveness of a knowledge-based clinical decision support system. We assess the expressiveness of two such languages, Arden Syntax and the Guideline Definition Language. Using data extracted from both languages' specifications, we quantify expressiveness by means of language syntax and the number of supported operators.

Exploring Methods of Implementing Arden Syntax for CDS Hooks.

Background: Specifications for Arden Syntax lack provisions for the standardized access of clinical decision support (CDS) services. The CDS Hooks standard provides such access.

Objectives: To extend an ArdenSuite reference implementation of the Arden Syntax by providing a CDS-Hooks-compatible interface.

A Systematic Approach to Quality Requirement Management in Medical Software.

Background: The quality requirements for medical software have become increasingly demanding. Several quality standards and models are already in place, but there is a debate on whether these are specific enough for medical software. Moreover, mapping requirements to quality criteria can be challenging but is required throughout the software development process.

Informing, simulating experience, or both: A field experiment on phishing risks.

Cybersecurity cannot be ensured with mere technical solutions. Hackers often use fraudulent emails to simply ask people for their password to breach into organizations. This technique, called phishing, is a major threat for many organizations.

Creating Clinical Fuzzy Automata with Fuzzy Arden Syntax.

Formal constructs for fuzzy sets and fuzzy logic are incorporated into Arden Syntax version 2.9 (Fuzzy Arden Syntax). With fuzzy sets, the relationships between measured or observed data and linguistic terms are expressed as degrees of compatibility that model the unsharpness of the boundaries of linguistic terms.

Separating Business Logic from Medical Knowledge in Digital Clinical Workflows Using Business Process Model and Notation and Arden Syntax.

Background: Evidence-based clinical guidelines have a major positive effect on the physician's decision-making process. Computer-executable clinical guidelines allow for automated guideline marshalling during a clinical diagnostic process, thus improving the decision-making process.

Objectives: Implementation of a digital clinical guideline for the prevention of mother-to-child transmission of hepatitis B as a computerized workflow, thereby separating business logic from medical knowledge and decision-making.

Clinical Workflow Modeling in Obstetrics: Hepatitis B in Pregnancy.

Evidence-based clinical guidelines positively effect physician decision-making. Actionable clinical guidelines that actively trigger alerts, reminders, and instructive texts will increase effectiveness. We applied Activiti, a Business Process Model and Notation language system to model a clinical guideline for the prevention of mother-to-child transmission of hepatitis B as a computerized clinical workflow.

Context-Sensitive Clinical Alert Packages Written in Arden Syntax.

An increasing body of raw patient data is generated on each day of a patient's stay at a hospital. It is of paramount importance that critical patient information be extracted from these large data volumes and presented to the patient's clinical caregivers as early as possible. Contemporary clinical alert systems attempt to provide this service with moderate success.

Adverse Drug Event Monitoring with Clinical and Laboratory Data Using Arden Syntax.

In times of steadily increasing numbers of administered drugs, the detection of adverse drug events (ADEs) is an important aspect of improving patient safety. At present only about 1-13% of detected ADEs are reported. Raising the number of reported ADEs will result in greater and more efficient support of pharmacovigilance.

Arden Syntax Clinical Foundation Framework for Event Monitoring in Intensive Care Units: Report on a Pilot Study.

The creation of clinical decision support systems has received a strong impulse over the last years, but their integration into a clinical routine has lagged behind, partly due to a lack of interoperability and trust by physicians. We report on the implementation of a clinical foundation framework in Arden Syntax, comprising knowledge units for (a) preprocessing raw clinical data, (b) the determination of single clinical concepts, and (c) more complex medical knowledge, which can be modeled through the composition and configuration of knowledge units in this framework. Thus, it can be tailored to clinical institutions or patients' caregivers.

Arden Syntax MLM Building Blocks for Microbiological Concepts and Their Application in Infection Surveillance.

Background: The diagnosis - and hence definitions - of healthcare-associated infections (HAIs) rely on microbiological laboratory test results in specific constellations.

Objectives: To construct a library that provides interoperable building blocks for the analysis of microbiological laboratory test results.

Methods: We used Java for preprocessing raw microbiological laboratory test results and Arden Syntax for knowledge-based querying of data based on microbiology information elements used in European surveillance criteria for HAIs.

Detecting borderline infection in an automated monitoring system for healthcare-associated infection using fuzzy logic.

Background: Many electronic infection detection systems employ dichotomous classification methods, classifying patient data as pathological or normal with respect to one or several types of infection. An electronic monitoring and surveillance system for healthcare-associated infections (HAIs) known as Moni-ICU is being operated at the intensive care units (ICUs) of the Vienna General Hospital (VGH) in Austria. Instead of classifying patient data as pathological or normal, Moni-ICU introduces a third borderline class.

Clinical decision support systems at the Vienna General Hospital using Arden Syntax: Design, implementation, and integration.

Introduction: The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years.

Assessing the feasibility of a mobile health-supported clinical decision support system for nutritional triage in oncology outpatients using Arden Syntax.

Background: Nutritional screening procedures followed by regular nutrition monitoring for oncological outpatients are no standard practice in many European hospital wards and outpatient settings. As a result, early signs of malnutrition are missed and nutritional treatment is initiated when patients have already experienced severe weight loss.

Objective: We report on a novel clinical decision support system (CDSS) for the global assessment and nutritional triage of the nutritional condition of oncology outpatients.

Knowledge-based immunosuppressive therapy for kidney transplant patients--from theoretical model to clinical integration.

Immunosuppressive therapy is a risky necessity after a patient received a kidney transplant. To reduce risks, a knowledge-based system was developed that determines the right dosage of the immunosuppresive agent Tacrolimus. A theoretical model, to classify medication blood levels as well as medication adaptions, was created using data from almost 500 patients, and over 13.

Advances In Infection Surveillance and Clinical Decision Support With Fuzzy Sets and Fuzzy Logic.

By the use of extended intelligent information technology tools for fully automated healthcare-associated infection (HAI) surveillance, clinicians can be informed and alerted about the emergence of infection-related conditions in their patients. Moni--a system for monitoring nosocomial infections in intensive care units for adult and neonatal patients--employs knowledge bases that were written with extensive use of fuzzy sets and fuzzy logic, allowing the inherent un-sharpness of clinical terms and the inherent uncertainty of clinical conclusions to be a part of Moni's output. Thus, linguistic as well as propositional uncertainty became a part of Moni, which can now report retrospectively on HAIs according to traditional crisp HAI surveillance definitions, as well as support clinical bedside work by more complex crisp and fuzzy alerts and reminders.

Data use and effectiveness in electronic surveillance of healthcare associated infections in the 21st century: a systematic review.

Objective: As more electronic health records have become available during the last decade, we aimed to uncover recent trends in use of electronically available patient data by electronic surveillance systems for healthcare associated infections (HAIs) and identify consequences for system effectiveness.

Methods: A systematic review of published literature evaluating electronic HAI surveillance systems was performed. The PubMed service was used to retrieve publications between January 2001 and December 2011.

Delivering antibiotic resistance information specifically tailored to location and time.

Antibiotic resistance poses a significant threat to humanity. Hundred years since the beginning of the era of antibacterial drugs, we are facing increasing numbers of infections with multi-resistant pathogens. The current approach of distributing information on antibiotic resistance in printed form in the clinics has disadvantages with respect to the actuality of the data and the regional heterogeneity of resistance patterns.

Validation of fuzzy sets in an automated detection system for intensive-care-unit-acquired central-venous-catheter-related infections.

Central venous catheters play an important role in patient care in intensive care units (ICUs), but their use comes at the risk of catheter-related infections (CRIs). Electronic surveillance systems can detect CRIs more accurately than manual surveillance, but these systems often omit patients that do not exhibit all infection signs to their full degree, the so-called borderline group. By extending an electronic surveillance system with fuzzy constructs, the borderline group can be identified.

Concise healthcare-associated infection reporting and benchmarking with minimal staff resources.

We report on intelligent information technology tools that produce fully-automated surveillance reports of high precision for 12 intensive care units (ICUs) without relevant time expenditure of infection control or ICU staff. This is accomplished by MONI-ICU, a computerized system for automated identification and continuous monitoring of ICU-associated infections, which makes surveillance data readily accessible and presents them in easily perceptible reporting format.

Assessing the clinical uses of fuzzy detection results in the automated detection of CVC-related infections: a preliminary report.

Central venous catheters (CVCs) play an essential role in the care of the critically ill, but their use comes at the risk of infection. By using fuzzy set theory and logic to model clinical linguistic CVC-related infection criteria, clinical detection systems can detect borderline infections where not all infection parameters have been (fully) met, also called fuzzy results. In this paper we analyzed the clinical use of these results.

Effectiveness of an automated surveillance system for intensive care unit-acquired infections.

This study assessed the effectiveness of a fully automated surveillance system for the detection of healthcare-associated infections (HCAIs) in intensive care units. Manual ward surveillance (MS) and electronic surveillance (ES) were performed for two intensive care units of the Vienna General Hospital. All patients admitted for a period longer than 48 h between 13 November 2006 and 7 February 2007 were evaluated according to HELICS-defined rules for HCAI.

Scientific workflow management in proteomics.

Data processing in proteomics can be a challenging endeavor, requiring extensive knowledge of many different software packages, all with different algorithms, data format requirements, and user interfaces. In this article we describe the integration of a number of existing programs and tools in Taverna Workbench, a scientific workflow manager currently being developed in the bioinformatics community. We demonstrate how a workflow manager provides a single, visually clear and intuitive interface to complex data analysis tasks in proteomics, from raw mass spectrometry data to protein identifications and beyond.

The Arden Syntax standard for clinical decision support: experiences and directions.

Arden Syntax is a widely recognized standard for representing clinical and scientific knowledge in an executable format. It has a history that reaches back until 1989 and is currently maintained by the Health Level 7 (HL7) organization. We created a production-ready development environment, compiler, rule engine and application server for Arden Syntax.