Search

Background Improper endotracheal tube (ETT) positioning is frequently observed and potentially hazardous in the intensive care unit. The authors developed a deep learning–based automatic detection algorithm detecting the ETT tip and carina on portable supine chest radiographs to measure the ETT–carina distance. This study investigated the hypothesis that the algorithm might be more accurate than frontline critical care clinicians in ETT tip detection, carina detection, and ETT–carina distance measurement. Methods A deep learning–based automatic detection algorithm was developed using 1,842 portable supine chest radiographs of 1,842 adult intubated patients, where two board-certified intensivists worked together to annotate the distal ETT end and tracheal bifurcation. The performance of the deep learning–based algorithm was assessed in 4-fold cross-validation (1,842 radiographs), external validation (216 radiographs), and an observer performance test (462 radiographs) involving 11 critical care clinicians. The performance metrics included the errors from the ground truth in ETT tip detection, carina detection, and ETT–carina distance measurement. Results During 4-fold cross-validation and external validation, the median errors (interquartile range) of the algorithm in ETT–carina distance measurement were 3.9 (1.8 to 7.1) mm and 4.2 (1.7 to 7.8) mm, respectively. During the observer performance test, the median errors (interquartile range) of the algorithm were 2.6 (1.6 to 4.8) mm, 3.6 (2.1 to 5.9) mm, and 4.0 (1.7 to 7.2) mm in ETT tip detection, carina detection, and ETT–carina distance measurement, significantly superior to that of 6, 10, and 7 clinicians (all P < 0.05), respectively. The algorithm outperformed 7, 3, and 0, 9, 6, and 4, and 5, 5, and 3 clinicians (all P < 0.005) regarding the proportions of chest radiographs within 5 mm, 10 mm, and 15 mm error in ETT tip detection, carina detection, and ETT–carina distance measurement, respectively. No clinician was significantly more accurate than the algorithm in any comparison. Conclusions A deep learning–based algorithm can match or even outperform frontline critical care clinicians in ETT tip detection, carina detection, and ETT–carina distance measurement. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

When the World Health Organization (WHO) analyzed the culprits of global warming, it was found that in developed countries with relatively few high-polluting heavy industries, the medical sector is one of the sources of high-density carbon emissions. Therefore, the medical industry has a noticeable impact on the environment. Amid the current COVID-19 epidemic, this study adopts the theory of planned behavior (TPB), widely used in decision-making science. We selected a regional teaching hospital with 339 employees in Taiwan to obtain valid questionnaire data. We explore the comparative analysis of different intra-organizational stakeholders’ “attitudes,” “subjective norms,” and “perceived behavioral control” on the hospital’s behavioral intention to promote green healthcare. The results show that the TPB model has reliable explanatory power. All three factors have a positive and significant effect on promoting green hospital behavior. Among them, perceived behavioral control was the most notable. A comparative analysis of the differences among stakeholders in the research model shows that “medical administrators” and “nursing staff” have a higher proportion of significant influence effects in various hypotheses, highlighting the critical roles of these two groups in promoting green hospitals. This research policy suggests that the cross-departmental staff in the hospital put forward green innovation ideas, strengthen internal environmental education and management, establish a good incentive system for front-line nursing staff, and implement the sustainable development strategy of the hospital.

Background In recent years, studies have disclosed that electronic WOM (eWOM) more directly reflects consumers' post-purchase psychological perception, and directly affects repurchase behavior, which is valued by institutions in various fields. Within the scope of service characteristic evaluation, medical service is the most invisible and difficult to evaluate service attribute. They are service organizations that must have high trust attributes. Therefore, the eWOM review will significantly influence people's decision-making process for choosing a healthcare provider. The purpose of this research is to combine eWOM reviews with the SERVQUAL scale in a comparative study of positive and negative eWOM reviews of a certain regional teaching hospital in Taiwan. Methods This research obtained data of eWOM reviews publicly available on Google maps from a Regional Teaching hospital in Taiwan in the past 10 years (from June 24, 2011, to December 31, 2021) by using website scraping technology. The semantic content analysis method was used in this study to classify WOM reviews according to the revised PZB SERVQUAL scale. Results Statistical analysis is then conducted. During the COVID-19 pandemic, the positive reviews have shown a downward trend. Among the five determiners of SERVQUAL of PZB, positive WOM reviews performed best in “Assurance”, with a positive review rate of 60.00%, followed by 42.11% of “Reliability”. In negative WOM reviews, “Assurance” performed the worst, with a positive rate of 72.34%, followed by “Responsiveness” at 28.37% and “Reliability” at 26.95%. Conclusion Since the onset of the COVID-19 in 2020, negative eWOM has increased significantly and exceeded the numbers of positive eWOM. Regardless of the positive and negative reviews, what patients care most about is “Assurance” of the professional attitude and skills of the medical staff, which needs to be strengthened most urgently. In addition, good “Reliability” will help to build up positive eWOM. However, the "Responsiveness" of poor service waiting time can easily lead to the spread of negative eWOM. This study suggests that the hospital management should focus on these few service-oriented qualities.

BACKGROUND Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). OBJECTIVE i-Dashboard is a custom-developed visualization dashboard that supports (1) key information retrieval and reorganization, (2) time-series data, and (3) display on large touch screens during MDRs. This study aimed to evaluate the performance, including the efficiency of prerounding data gathering, communication accuracy, and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. METHODS A cluster-randomized controlled trial was performed in 2 surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performance and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire surveys. RESULTS Between April 26 and July 18, 2021, a total of 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For prerounding data gathering, the median time was 10.4 (IQR 9.1-11.8) and 4.6 (IQR 3.5-5.8) minutes using the established EMR and i-Dashboard (Pi-Dashboard (median 0, IQR 0-0) than with the established EMR (4, IQR 3-5; Pi-Dashboard than with the established EMR (Pi-Dashboard in association with the enhancement of care plan development and team participation during MDRs. CONCLUSIONS i-Dashboard increases efficiency in data gathering. Displaying i-Dashboard on large touch screens in MDRs may enhance communication accuracy, information exchange, and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. CLINICALTRIAL ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698

Purpose Promoting customer–company identification (CCI) has become a crucial relationship marketing strategy for service firms. The purpose of this study is to examine how customers’ perceptions of service quality and corporate social responsibility (CSR) affect CCI over time. More importantly, a comparative analysis is conducted to compare the long-term effectiveness of service quality versus CSR in forming CCI. Design/methodology/approach A conceptual framework is developed and then empirically examined using latent growth curve modeling. The study data were collected from restaurant customers in Taiwan in four waves of 213 repeated measures. Findings The results of this study show that customers’ perceptions of both service quality and CSR affect CCI. Particularly, the results of this study indicate that compared with service quality, customers’ perceived CSR has a stronger effect in the promotion of CCI over time. Practical implications This study offers a new insight for service marketing practitioners who are planning and implementing strategies for enhancing CCI. The findings suggest that relationship investments are more effective over the long term when service firms shift their investment priority over time from achieving high service quality to increasing consumers’ belief in the firm’s commitment to CSR. Originality/value Though previous research has explored the various drivers of CCI, longitudinal examinations are surprisingly scarce in this context. Using latent growth curve modeling, this study examines how CCI antecedents influence changes in CCI over time. More importantly, this study reveals that CSR has a stronger long-term impact on CCI than service quality.

Background: Lactate is a widely used biomarker for patients with conditions such as infection or trauma. The value of lactate level in risk stratification is rarely investigated for patients admitted to the surgical Intensive Care Unit (ICU), regardless of diagnosis. Purposes: This study examines whether arterial lactate levels at the approximate time of admission can predict short-term mortality in all unscheduled surgical ICU patients. Materials and Methods: A retrospective cohort study of all unscheduled surgical ICU admissions from July 2010 to June 2013 was conducted. Patients were stratified into low (

Besides the traditional indices such as biochemistry, arterial blood gas, rapid shallow breathing index (RSBI), acute physiology and chronic health evaluation (APACHE) II score, this study suggests a data science framework for extubation prediction in the surgical intensive care unit (SICU) and investigates the value of the information our prediction model provides. A data science framework including variable selection (e.g., multivariate adaptive regression splines, stepwise logistic regression and random forest), prediction models (e.g., support vector machine, boosting logistic regression and backpropagation neural network (BPN)) and decision analysis (e.g., Bayesian method) is proposed to identify the important variables and support the extubation decision. An empirical study of a leading hospital in Taiwan in 2015&ndash, 2016 is conducted to validate the proposed framework. The results show that APACHE II and white blood cells (WBC) are the two most critical variables, and then the priority sequence is eye opening, heart rate, glucose, sodium and hematocrit. BPN with selected variables shows better prediction performance (sensitivity: 0.830, specificity: 0.890, accuracy 0.860) than that with APACHE II or RSBI. The value of information is further investigated and shows that the expected value of experimentation (EVE), 0.652 days (patient staying in the ICU), is saved when comparing with current clinical experience. Furthermore, the maximal value of information occurs in a failure rate around 7.1% and it reveals the &ldquo, best applicable condition&rdquo, of the proposed prediction model. The results validate the decision quality and useful information provided by our predicted model.

Wei-Chieh Lin,1 Chang-Wen Chen,1 Chin-Li Lu,2,3 Wu-Wei Lai,4 Min-Hsin Huang,4 Liang-Miin Tsai,1 Chung-Yi Li,2,5,* Chao-Han Lai4,* 1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Graduate Institute of Food Safety, College of Agriculture and Nature Resources, National Chung Hsing University, Taichung, Taiwan; 4Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan *These authors contributed equally to this work Purpose: COPD is associated with coronary artery disease, and exacerbations are major events in COPD. However, the impact of recent hospitalized exacerbations on outcomes of percutaneous coronary intervention (PCI) remains underdetermined. Patients and methods: Using the National Health Insurance Research Database of Taiwan, we identified 215,275 adult patients who underwent first-time PCI between 2000 and 2012. Among these patients, 15,485 patients had COPD. The risks of hospital mortality, overall mortality, and adverse cardiovascular outcomes after PCI (ie, ischemic events, repeat revascularization, cerebrovascular events, and major adverse cardiac and cerebrovascular events [MACCEs]) in relation to COPD, and the frequency and timing of recent hospitalized exacerbations within 1 year before PCI were estimated. Results: COPD was independently associated with increased risks of hospital mortality, overall mortality, ischemic events, cerebrovascular events, and MACCE during follow-up after PCI. Among cerebrovascular events, ischemic rather than hemorrhagic stroke was more likely to occur. In COPD patients, recent hospitalized exacerbations further increased the risks of overall mortality, ischemic events, and MACCE following PCI. Notably, patients with more frequent or more recent hospitalized exacerbations had a trend toward higher risks of these adverse events (all P-values for trend

Purpose Customer satisfaction (CS) and customer-company identification (CCI) are two important relational constructs and play a complementary role in the service-profit chain. Drawing from the theory of relationship dynamics, the purpose of this paper is to define CS velocity and CCI velocity as the rate and direction of change in CS and CCI, respectively. A comparison of the relative effects of CCI velocity and CS velocity on customer loyalty is done through a latent growth curve modeling approach. Design/methodology/approach A conceptual model is developed and empirically tested based on four waves of a longitudinal survey of 213 restaurant customers. Findings The results show that both CCI velocity and CS velocity have positive effects on customer loyalty. More importantly, the effects of CCI velocity on customer loyalty over time are stronger than those of CS velocity. The moderation analysis further shows that the higher the frequency of visits to the service firm, the stronger the effects of relationship velocity on customer loyalty. Practical implications The results provide new insights for service marketing managers by suggesting that, to benefit the long-term effectiveness of relationship investments, service firms should shift the priority from increasing CS to engendering CCI. Originality/value This paper contributes to the theory of relationship dynamics by conceptualizing new constructs of CS velocity and CCI velocity and by empirically comparing their relative effects on customer loyalty over time.

Purpose Enhancing consumer-company identification (CCI) is a useful means by which to build deeper, more committed relationships with consumers. The purpose of this paper is to examine how consumers’ perceptions about the company (service quality and corporate social responsibility) and construal of the self (independent self-construal and interdependent self-construal) affect their identification with a service firm. This study also investigates how consumers’ involvement with the service firm moderates the relationships between CCI and four specific drivers. Design/methodology/approach A conceptual model is developed and empirically tested through two field-based studies (restaurant services and financial services) and one follow-up laboratory experiment. Findings The results of this research show that service quality, corporate social responsibility and interdependent self-construal positively affect CCI and that independent self-construal has a negative effect on CCI. In particular, the greater the involvement of the consumer with the service firm, the more positive the effects of service quality and corporate social responsibility are on CCI. Practical implications This research provides new insight into services marketing management by suggesting that service firms can enhance CCI and, consequently, consumer loyalty by adopting different strategies for specific consumer segments. Originality/value This is the first empirical study to simultaneously incorporate both company characteristics and consumer personal factors into a framework, and provide an integrative understanding of what factors determine consumers’ identification with a service firm.

Customer gratitude represents the emotional core of reciprocity and plays a key force in developing and maintaining successful seller–buyer relational exchanges. Based upon personal interviews with 239 members of loyalty card programs of a department chain store, this study shows that alternative relationship marketing investments (i.e., direct mail, tangible rewards, interpersonal communication, and preferential treatment) have a differential influence on customers' gratitude and consequently behavioral loyalty. More specifically, results of this study indicate that preferential treatment is the most effective relationship marketing tactic to enhance customer gratitude, followed by interpersonal communication and tangible rewards, respectively. Management implications for retailers to increase customers' gratitude are discussed.

Background Demand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated. Objectives To compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team. Methods We conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation. Results A total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions. Conclusion Incorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.

Enhancing the customer-company identification (CCI) has become an important relationship marketing strategy for marketers since a customer with a high level of identification with a service firm is more likely to show various supportive behaviors which can promote the financial success of the firm. This paper examines the dynamics of customer-company identification (CCI) and its antecedents in the service context. Two focal drivers of CCI are tested, namely, corporate social responsibility (CSR) and service quality (SQ). A longitudinal study based on panel data of 213 customers from the restaurant chain was conducted over a 1-year period. By employing latent growth curve modeling, this study finds that the mean level of CCI increases significantly over time. More importantly, although CSR relates positively to the change rate of CCI, SQ does not contribute to CCI growing over time. Results of this study provide new insights into managerial implications about how to invest in customer-company relationship in the long run.

PurposeThe purpose of this study is to investigate the role of brand equity in handling service failure and examine the effects of brand equity on service recovery.Design/methodology/approachA conceptual framework is proposed which includes that satisfaction, as a mediator, accounts for the relationship between service recovery attributes (distributive, procedural, and interactional justice) and post‐recovery behavior (repatronage intentions and word‐of‐mouth behavior). More importantly, brand equity is used to serve as the moderator in the hypothesized research model. Structural equation modeling techniques are applied to data collected from a field study in Taiwan to test the framework.FindingsResults from the current field study found that strong brand equity provides an overall advantage over weak brands in increasing service recovery satisfaction and behavior intentions (repatronage intentions and word‐of‐mouth behavior).Research limitations/implicationsThe data used in this study were collected in a single metropolitan area in Taiwan. Future research might be conducted in a variety of countries.Practical implicationsService recovery strategies in responding to service failures are part of the critical task for service managers. This paper suggests that building brand equity is a means by which post‐failure satisfaction and behavioral intentions may be enhanced.Originality/valueThis is the first study to completely compare the high brand equity with low brand equity in the effect of service recovery.

This article examines consumers’ price sensitivity for private labels and national brands within different socioeconomic environments. A theoretically plausible consumer economics demand system (the almost ideal demand system or AIDS model) is developed to measure price elasticities for seven product categories that are sold in six stores. These stores are in geographic areas that are populated by higher- and lower-income consumers. Results show that national brands have larger price elasticities than private labels. These results are hold not only for stores located in lower-income areas but also for higher-income areas. Implications of effective pricing for both retailers and manufacturers are discussed.

The importance of store brands in frequently purchased consumer goods marketing has been clearly established over the past decade. Marketing studies have consistently shown that perceived quality is a key determinant of store brands' success. This paper examines the impacts of five dimensions of retail service quality on the perceived quality of store brands: physical aspects, reliability, personal interaction, problem solving and policy. A conceptual model is developed and empirically tested against a sample of supermarket consumers in Taiwan. Results show that the delivery of high service quality of retailers increases the perceived quality of their store brands. In particular, reliability and personal interaction are shown to have the strongest effects among the five dimensions of retail service quality. Implications for increasing overall service quality and perceived quality of store brands for retailing practices and researchers are discussed.

Cigarette smoke-induced cell death contributes to the pathogenesis of chronic obstructive pulmonary disease, though the relative roles of apoptosis and autophagy remain unclear. The inducible stress protein heme oxygenase-1 (HO-1) confers cytoprotection against oxidative stress. We examined the relationships between these processes in human bronchial epithelial cells (Beas-2b) exposed to cigarette smoke extract (CSE). CSE induced morphological and biochemical markers of autophagy in Beas-2b cells and induced autophagosome formation as evidenced by formation of GFP-LC3 puncta and electron microscopic analysis. Furthermore, CSE increased the processing of microtubule-associated protein-1 light chain-3 (LC3B-I) to LC3B-II, within 1 hr of exposure. Increased LC3B-II was associated with increased autophagy, since inhibitors of lysosomal proteases and of autophagosome-lysosome fusion further increased LC3B-II levels during CSE exposure. CSE concurrently induced extrinsic apoptosis in Beas-2b cells involving early activation of death-inducing-signaling-complex (DISC) formation and downstream activation of caspases (-8,-9,-3). The induction of extrinsic apoptosis by CSE was dependent in part on autophagic proteins. Reduction of Beclin 1 levels with beclin 1 siRNA inhibited DISC formation and caspase-3/8 activation in response to CSE. LC3B siRNA also inhibited caspase-3/8 activation. The stress protein HO-1 protected against CSE-induced cell death by concurrently downregulating apoptosis and autophagy-related signaling. Adenoviral mediated expression of HO-1 inhibited DISC formation and caspase-3/9 activation in CSE-treated epithelial cells, diminished the expression of Beclin 1, and partially inhibited the processing of LC3B-I to LC3B-II. Conversely, transfection of Beas-2b with ho-1 siRNA augmented CSE-induced DISC formation and increased intracellular reactive oxygen species formation. HO-1 expression augmented CSE-induced phosphorylation of NFkappaB p65 in Beas-2b cells. Consistently, expression of IkappaB, the inhibitor of NFkappaB, increased CSE-induced DISC formation. LC3B siRNA also enhanced p65 phosphorylation. In fibroblasts from beclin 1 heterozygous knockout mice, p65 phosphorylation was dramatically upregulated, while CSE-induced DISC formation was inhibited, consistent with an anti-apoptotic role for NFkappaB and a pro-apoptotic role for Beclin 1. These studies demonstrated an interdependence of autophagic and apoptogenic signaling in CSE-induced cell death, and their coordinated downregulation by HO-1. An understanding of the regulation of cell death pathways during smoke exposure may provide therapeutic strategies in smoke-related illness.

PurposeTo compare the selling orientation (SO) versus customer orientation (CO) selling behavior of a service employee and examine the impacts of SO versus CO behavior on customer relationship quality and retention in financial services selling. Specifically, this research hypothesizes that a salesperson's SO is negatively related to relationship quality while salesperson's CO is positively related to relationship quality.Design/methodology/approachA conceptual framework is proposed that considers customer retention as a consequence, and a service employees' SOCO behavior as an antecedent of, relationship quality. Structural equation modeling techniques are applied to data collected from customers in the two important financial services (insurance and banking) in Taiwan to test the framework.FindingsA service employee with CO approach increases relationship quality while a SO approach decreases relationship quality with customers. Furthermore, relationship quality is verified to positively affect customers' future retention.Research limitations/implicationsAlthough the sample may be representative of the financial industry in general, it is possible that results may vary for specific service industries. Also, the fact that data were collected in Taiwan raises the question of its transferability into other cultural regions.Practical implicationsThe results should lead managers to consider the importance of emphasizing a CO approach when service employees are selling services. This study suggests that service employee training emphasizing CO can add additional value to a company's service offering and influence future retention of the service firms.Originality/valueThis is the first study to completely compare the CO approach with SO approach in a service selling.

This study examined consumer risk perceptions and knowledge of avian influenza and its linkage to behavioral changes in chicken consumption. A consumer survey was administered in 3 metropolitan areas in Taiwan in 2007. Multivariate analyses were utilized in this study to analyze data. Findings in this study indicated that respondents who were more knowledgeable of avian influenza with relatively high levels of risk perceptions would be likely to stay away from birds and the crowd. Respondents with relatively low levels of avian influenza knowledge were likely to prefer not eating chicken at all under a possible threat of avian influenza outbreaks. Respondents with low risk perception levels would be more likely to maintain usual chicken consumption than those with high risk perception levels if outbreaks of avian influenza occurred. Contributions of this study are to provide new insights into knowledge and risk perceptions of avian influenza and to reveal behavioral changes in chicken consumption in an area that a pandemic situation like avian influenza has not occurred but under a possible threat. Findings in this study would be beneficial to government administration and industry managers in designing effective information communication for educational purposes to ease possible effect on the industry as well as the consumer market if outbreaks had occurred in Taiwan.

An Almost Ideal Demand System model is developed and used to estimate price elasticities for US cheese sold at retail. Growing consumption of cheese coupled with fierce competition between private labels and national brands serves as motivating factors for this study. Per capita consumption of cheese grew by 75% during 1980–2004 and private labels captured a rising share of this growth. Private labels today account for 35% of market share; national brands, for the remaining 65%. Kraft accounts for 45% of national brands, but price increases for Kraft brands led to a sizeable price gap between its brands and private labels. This gap helped to stimulate growth of private labels. Marketing managers seek to capitalize on both growing cheese sales and price gaps for brands. Relevant information for marketing managers is consumer sensitivity to price changes. This study uses 69 weeks of scanner data, with consumers segmented by income levels to derive price elasticities for both lower-and higher-income consumer...

This study examines the impacts of a service employees’ selling orientation/customer orientation (SOCO) behavior on customer relationship quality in financial services selling. Results indicate that a service employee with a customer orientated approach increases customer relationship quality while a selling orientated approach decreases the customer relationship quality.

It is important to check the position of the endotracheal tube on the portable chest radiography for patients in the intensive care units. The position of carina is not easy to identify on portable chest radiography due to the low image contrast and abundant noise at this region of interest. In this paper, a novel method is proposed to identify the position of carina. The proposed method is integrated with the rule-based image segmentation, contrast enhancement, selective thresholding, and morphological image processing. Experimental results show that the proposed method is robust and the success rate is 85.9%. It can be used to enhance patient safety by early detection and prompt correction of improper position of the endotracheal tube.