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Biomedical subjects

R Klar

Publications and source records attributed to R Klar.

9 recordsLinked to original sources
PubMed1990

Medically inappropriate inpatient care in West Germany.

The extent of medically unnecessary hospital utilization in West German acute hospitals was measured by a representative study. A random sample of medical records was reviewed and assessed according to appropriateness by specially experienced physicians. This rating method was trained, standardized and evaluated. The study yields a mean length of stay of 13 days with 2.4 days (18.4%) of inappropriate use. Further analyses concern the influence of diagnoses, age, sex, hospital size etc. Prorated to all 461 300 West German acute hospital beds, 85,000 beds or 26.6 million patient days per year are affected by inappropriate use.

Adolescent↗
PubMed1990

Medical expert systems: design and applications in pulmonary medicine.

Expert systems are computer applications with a built-in knowledge of a special field to solve problems like a human expert on this subject. An expert system consists of an inference component for problem specification and solving, a knowledge base for storage of data, facts, rules and heuristics, an interface for knowledge acquisition, another for the interaction with the user, and a component for reasoning. Pulmonary expert systems are used for automatic interpretations of lung function data which are measured on-line and directly computed. There are also some expert systems for consultation in difficult pulmonary cases and for protection against overlooking rare diseases. Perhaps the most successful applications of pulmonary expert systems are for educational purposes and a large variety of teachware is available. Pulmonary expert systems are presently limited to small applications; often it is necessary to type in large amounts of data and to follow a deeply structured cumbersome dialog. Also, the problem of responsibility for computer decisions has to be mentioned. But pulmonary expert systems as integrated supplements of normal pulmonary measuring devices, as decision support, and as parts of pulmonary teachware will be helpful tools for the pneumological physician.

Artificial Intelligence↗
PubMed1990

Computer-assisted teaching and learning in medicine.

Induced mainly by the increased spreading of personal computers in the last few years computer-assisted instruction (CAI) systems for medicine have been developed on a large scale. Proven structure principles are above all the simulation of patient management in a problem-orientated approach, the mathematical simulation of (patho-) physiological functions independent of particular patients and the separation of educational mode and scoring mode. There exists already a large choice in programs dealing with topics of internal medicine--especially cardiology--while operative disciplines are less represented so far. Programs accredited in the US for continuing medical education (CME) are usually of high quality as to medical contents. Other important quality criteria to be mentioned concerning simulation programs are algorithms of medical decision making, completeness and refinement of the medical knowledge base, software design and user interface. CAI is a unique tool to enhance clinical problem solving skills although--of course--it can by no means replace bedside teaching.

Computer-Assisted Instruction↗
PubMed1990

[Discriminatory value of bronchoalveolar lavage parameters in differential diagnosis--exogenous allergic alveolitis, sarcoidosis and patients with healthy lungs].

For this study, the results of 487 BAL investigations involving 126 patients with sarcoidosis, 34 patients with exogenous-allergic alveolitis, 18 subjects with healthy lungs, and 309 patients with other pulmonary disorders, were analysed. The diagnoses had been established independently of the BAL results. After elimination of interdependent variables, the discriminatory usefulness of the BAL parameters: total number of cells, relative percentage of lymphocytes, natural killer cells, and T4/T8 ratio, was analysed with the aid of ROC curves and the Wilcoxon test. The ROC curves permit a rapid overview of the differential significance of the various BAL variables, and identify the relationship between sensitivity and specificity.

Alveolitis, Extrinsic Allergic↗
PubMed1989

[A representative study of the scope and structure of faulty admissions of acute hospital patients over 60 years of age].

The extent and the structure of inappropriate, i.e. medically unnecessary hospital utilisation by patients of 60 years of age and over, in German acute hospitals were assessed by reviewing a randomised sample of medical records judged by physicians. This rating method was tested, standardised and evaluated. The most important result of the study was that the mean length of story was 17.4 days of which 2.9 days (17%) were estimated to be inappropriately used. If this result is projected to all West German hospitals, 35,000 hospital beds are inappropriately occupied by patients over 60 years of age for a total of 10.5 million patient days per year.

Aged↗
PubMedDate not supplied

[The hospital service misuse problem in orthopedics].

In a representative study for all German acute hospitals the amount of inappropriate (medically not necessary) patient care was estimated. The data material, sampling design, weighting technic and the appropriateness expert rating (retrospective, consent judging) was controlled. An overall proportion of inappropriate days of care of 18.45% were found but for orthopedic diseases this rate was 31.9% and even 37.7% for the younger than 60 orthopedic patients. Similar high rates for orthopedic diseases were found in US hospital studies of inappropriateness and should lead to an analysis of their reasons.

Bed Occupancy↗