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Biomedical subjects

C Safran

Publications and source records attributed to C Safran.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

A computer-based outpatient medical record for a teaching hospital.

We developed a computer-based outpatient medical record system to facilitate direct physician interaction with the clinical computing system at the Beth Israel Hospital in Boston. During the 2 years since the medical record system was installed, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners have entered 15,121 active problems and 1996 inactive problems for 3524 patients, as well as 12,651 active medications and 1894 discontinued medications for 3430 patients. Another 20,321 items were entered on health-promotion and disease-prevention screening sheets, and with the help of automatic updating by the computer, an additional 21,897 entries on screening sheets were made for 8686 patients. Clinicians wrote 10.9 +/- 12.8 (mean +/- SD) words per problem when they were working at the computer, as compared with 4.3 +/- 2.5 words per problem when they were writing in the paper medical record. We conclude that physicians will readily enter data directly into a computing system when they are given appropriate tools, and that they consider the computer-based problem list to be a valuable improvement over its paper counterpart. Use of a computer-based medical record system has obvious benefits for data management and patient care.

Ambulatory Care Information Systems↗
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ClinQuery: searching a large clinical database.

We designed a user-friendly computer program that permits physicians to use clinical and demographic descriptors to search a hospital's clinical database for purposes of patient care, teaching, and research. For example, the user can identify all admissions in which diabetic ketoacidosis was diagnosed, the serum bicarbonate level was under 12 mmol/liter, and the length of stay exceeded 7 days. Once particular admissions have been identified, all data stored in the computerized record can be displayed. Authorized persons can also request the patient's complete medical record for further study. Over a 5-year period, 895 doctors, nurses, medical students, and hospital administrators used Clin-Query to search the clinical database of Boston's Beth Israel Hospital 3724 times. They displayed detailed information on 72,489 patients and requested the complete medical record 5477 times. Responses to a computer-based questionnaire indicated that 16% of the searches were performed for patient care, 38% for clinical research, 16% for teaching and education, 12% for hospital administration, and 18% for general exploration. We conclude that physicians and allied personnel will repeatedly examine and analyze aggregate clinical information when they are provided with the appropriate tools.

Hospital Information Systems↗
PubMedDate not supplied

Computer-based support for clinical decision making.

Although computers are now commonly used for financial purposes in hospitals and physicians' offices, most physicians do not routinely use them in patient care. And in hospitals where laboratory data are provided on computer terminals, the displays are often difficult to use and programs that offer assistance in interpreting the data are usually unavailable. We have developed decision support programs that are widely used with the clinical computing system at our hospital. This paper describes the programs and how the clinicians use them.

Boston↗
PubMedDate not supplied

Role of computing in patient care in two hospitals.

This report describes two hospital-wide clinical computing systems that assist physicians, nurses, medical students, and other clinicians in the care of their patients. From any of the video-display terminals located throughout the hospitals (666 at Beth Israel Hospital and 1250 at Brigham and Women's Hospital, both in Boston), clinicians can obtain results from the clinical laboratories; read diagnostic reports from the clinical departments; view lists of medications used during hospitalization and prescriptions filled in the outpatient pharmacy; request delivery of a patient's chart; request consultation on approaches to therapy; perform bibliographic retrieval of the MEDLINE database; and read, write, retract, edit, and forward electronic mail. During a one-week study period, 1737 clinicians at Beth Israel Hospital used one or more of the options in the clinical information system 58,757 times. During the same week, 2262 clinicians at Brigham and Women's Hospital used one or more of their options 89,101 times. The large amount of use by clinicians, who could, if they so desired, rely on printed reports or telephone calls to obtain their clinical information, suggests that a reliable, comprehensive, and easy-to-use computer system can contribute substantially to the quality of patient care.

Attitude to Computers↗
PubMedDate not supplied

Departmental and laboratory computing in two hospitals.

This report describes the departmental and laboratory use of integrated, hospital-wide computing systems at Beth Israel and Brigham and Women's hospitals in Boston. The systems have an important role in the admitting, outpatient, and medical records departments; in the clinical departments (blood bank, cardiology, neurophysiology, pathology, radiology, and pharmacy); in the clinical laboratories; and at Brigham and Women's Hospital, in the financial departments. Information that is collected in the computers from these departments and laboratories is available for viewing by clinicians at terminals located throughout each hospital and is used in compiling charges for each patient's account. The programs are heavily used. During a one-week study period, 742 departmental and laboratory workers at Beth Israel Hospital filed or edited information in patients' computerized records 137,526 times. During the same week, 984 departmental and laboratory workers at Brigham and Women's Hospital filed or edited information 293,367 times. After the computing systems were introduced, the time required to collect unpaid bills decreased substantially at both hospitals.

Boston↗
PubMedDate not supplied

[Pharmacokinetic study of cefotaxime in newborn infants and infants].

The serum kinetics of intravenous cefotaxime was studied in 13 neonates and 5 infants presenting with bacterial infections in order to establish the dosage and route of administration. Average dosage was 66.6 mg/kg/day in neonates and 62 mg/kg/day in infants. Cefotaxime was given intravenously in 3 daily bolus injections in infants and 2 bolus injections in neonates under 8 days of age. In infants the average serum peak was 173 mcg/ml at 15 min. Serum half-life was between 0.45 and 0.50 hr (T 1/2 beta) close to the one found in adults. In neonates the average serum peak was 106.2 mcg/ml at 35 min. Serum half-life was 1.71 hr (T 1/2 beta). It is prolonged in neonates who are younger, more premature and have a lower weight. In full term neonates, during the first 8 days, the desirable dose seems to be 75 to 150 mg/kg/day in 3 injections, according to the severity of the infection. In premature neonates under 8 days of age, the interval between injections should be increased up to 12 hrs. Finally, in full term neonates older than 8 days and in infants, one injection every 6 hours seems to be advisable.

Bacterial Infections↗
PubMedDate not supplied

Protection of confidentiality in the computer-based patient record.

To evaluate the confidentiality of the patients' data in the electronic patient records designed by members of the Center for Clinical Computing in Boston, we examined the accessibility of the computer-stored medical records of two groups of patients at Boston's Beth Israel Hospital: celebrities, hospital employees, and their relatives (VIPs) and other patients (non-VIPs). We studied how often authorized clinicians gained access to computer-stored data on the two types of patients and whether look-up patterns differed if the data concerned a VIP. Our results suggest that the measures used to maintain data confidentiality at Beth Israel Hospital are adequate.

Boston↗
PubMedDate not supplied

A computer-administered health screening interview for hospital personnel.

We developed a computer-administered health screening interview for the employees of an urban teaching hospital. The interview is part of the integrated Center for Clinical Computing (CCC) clinical information system used throughout the hospital, and is available on any of 2000 terminals. Conducted in private and with protection of confidentiality, the interview seeks information on medical problems and patterns of living for which behavioral change is considered desirable. In a four-year period ending in May 1994, 1937 employees completed the interview. The results showed that stress and unhappiness were common: 57% of the employees reported high levels of stress, and 42% reported feeling sad, discouraged, or hopeless in the previous month; 6% indicated that life sometimes did not seem worth living. Eighty-six percent of the employees expressed an interest in the health-related programs offered by the hospital: 72% were interested in the fitness center, and 37% in the stress-reduction program. We conclude that if interactive health-promotion programs are easily available, they will be used and appreciated in the work place. The programs can be written to reveal the employees' health concerns and stimulate their interest in promoting their own health.

Boston↗
PubMedDate not supplied

Computer interview for screening blood donors for risk of HIV transmission.

To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors, and to determine donor reactions to the use of the computer, we compared the rate of detection of HIV-related factors elicited by the computer interview with the rate elicited by standard American Red Cross procedures (written questionnaires and face-to-face interviews) for assessment of donor suitability. The study was performed at a Red Cross blood donor center and a hospital. A consecutive sample of 294 male and female blood donors 18 to 75 years of age participated in a randomized crossover trial in which the order of the two methods was reversed. Among 272 prospective donors who provided complete data, the computer identified 12 who reported either behavior associated with a risk of acquiring HIV or symptoms compatible with AIDS. None of these 12 was so identified by face-to-face interviews or written questionnaires. Only one used the confidential unit exclusion procedure to prevent use of his donated blood. Tests for antibody to HIV were negative in blood from all 272 subjects. The subjects enjoyed the computer interview and judged it to be more private than the standard method for donor assessment.

AIDS Serodiagnosis↗