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Biomedical subjects

R M Gardner

Publications and source records attributed to R M Gardner.

At least 73 records · Page 4Linked to original sources
PubMed1991

The impact of the HELP computer system on the LDS Hospital paper medical record.

This study sought to answer the question: What percentage of an LDS Hospital patient's chart is contained in the HELP system? Using the number of pages in the record as the criteria, the answer is about 26 percent overall, but between 35 percent and 40 percent for patients in nursing divisions where computerized nurse charting is used. Although this fraction is likely to rise in the near future, the critical factor driving computerization is the desire for data usable in computerized decision making rather than the need to computerize the entire chart per se. The medical record at LDS Hospital will probably be a hybrid of computerized and paper data for some time to come.

Clinical Medicine↗
PubMed1991

Innovations and research review: the impact of the HELP computer system on the LDS Hospital paper medical record.

This study sought to answer the question: What percentage of an LDS Hospital patient's chart is contained in the HELP system? Using the number of pages in the record as the criteria, the answer is about 26 percent overall, but between 35 percent and 40 percent for patients in nursing divisions where computerized nurse charting is used. Although this fraction is likely to rise in the near future, the critical factor driving computerization is the desire for data usable in computerized decision making rather than the need to computerize the entire chart per se. The medical record at LDS Hospital will probably be a hybrid of computerized and paper data for some time to come.

Documentation↗
PubMed1991

Development of a computerized adverse drug event monitor.

Adverse events during drug therapy are receiving renewed attention. Some adverse drug events (ADEs) are identified only after the widespread clinical use of a drug. The Food and Drug Administration advocates post-marketing surveillance systems to provide early warnings of previously undetected ADEs. The identification of ADEs by U.S. hospitals is now required by the Joint Commission on Accreditation of Healthcare Organizations. We developed a series of computer programs and data files on the HELP System to help identify ADEs. The HELP System monitors laboratory test results, drug orders, and data entered through a computerized ADE reporting program. A nurse or pharmacist verifies computer alerts of possible ADEs. The computerized system identified 401 ADEs during the first year of use compared to 9 by voluntary reporting methods during the previous year (p less than 0.001). This paper describes the development and early use of the computerized ADE surveillance system.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Assessing the effectiveness of a computerized blood order "consultation" system.

To optimize blood ordering and accurately assess transfusion practice, in 1987, an "on line" computerized, knowledge-based, blood order critiquing system was integrated into the HELP Hospital Information System (HIS) at LDS Hospital. Evaluations of the computerized ordering system demonstrated its benefits and limitations on transfusion practice. Based on this experience, a second generation blood ordering system using a consultation mode was developed. A pilot test of this blood order consultant system, using historical data in the HELP system's database, was performed. This pilot test demonstrated that the consultation system provided accurate recommendations for red blood cell (RBC) and platelet orders. Comparing the appropriateness of blood orders with the recommendations made by the director of the blood bank, the orders recommended by the computer "consultant" agreed 95.5% of the time. The computer consultation system also recommended fewer RBC units for transfusion. Preliminary results obtained using the consultant approach suggest that we may be able to simplify blood ordering practice and also reduce the number of units of blood products ordered. Based on these findings we are now preparing to compare the "critiquing" and "consultation" approaches using a clinical trial.

Artificial Intelligence↗
PubMed1991

Real time data acquisition: experience with the Medical Information Bus (MIB).

Care of the acutely ill patient requires rapid acquisition, recording and communications of data. In the modern hospital it is not unusual for a patient to be connected to several monitoring and recording devices simultaneously. Each of these devices is typically made by a different manufacturer who may specialize in one sort of measurement, for example, pulse oximetry. Most of the modern monitoring and recording devices are micro-processor based and have communications capabilities. Unfortunately, there is no operable standard communications technology available from all devices. In addition different clinical staff (physicians, nurses, or respiratory therapists) may be responsible for collecting data. As a result there is a need to develop methods, standards, and strategies for timely and automatic collection of data from these monitoring and recording devices. We report on more than 5 years of clinical experience of automated ICU data collection using a prototype of the Medical Information Bus (MIB).

Computer Communication Networks↗
PubMed1990

Clinical evaluation of computer-based respiratory care algorithms.

A collection of computer-based respiratory care algorithms were implemented as a prototype computer-based patient advice system (COMPAS) within the existing HELP hospital information system. Detailed medical logic recommended ventilator adjustments for 5 different modes of ventilation: assist/control (A/C), intermittent mandatory ventilation (IMV), continuous positive airway pressure (CPAP), pressure controlled inverted ratio ventilation (PC-IRV), and extracorporeal carbon dioxide removal (ECCO2R). Suggestions for adjusting the mode of ventilation, fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), peak inspiratory pressure, and several other therapeutic measures related to the treatment of severe arterial hypoxemia in adult respiratory distress syndrome (ARDS) patients were automatically presented to the clinical staff via bedside computer terminals. COMPAS was clinically evaluated for 624 hours of patient care on the first 5 ARDS patients in a randomized clinical trial. The clinical staff carried out 84% (320/379) of the computerized therapy suggestions. In response to a questionnaire distributed to clinical users of the system, 86% judged the system to be potentially valuable. Through implementation of COMPAS, a computer-based ventilatory therapy advice system, we have laid the groundwork for standardization of ventilator management of arterial hypoxemia in critically ill ARDS patients.

Algorithms↗
PubMed1990

Therapeutic antibiotic monitoring: surveillance using a computerized expert system.

STUDY OBJECTIVE: To develop and evaluate a computerized system to monitor therapeutic antibiotics in a hospital setting. MATERIAL AND METHODS: From November 1986 through October 1987, we prospectively monitored 1,632 hospitalized patients who had 2,157 microbiology specimens sent for culture and sensitivity testing. During the study period, computer algorithms were used to identify patients whose antibiotic therapy was inappropriate in relation to microbiology culture and sensitivity data. When inconsistencies occurred between antibiotic therapy and in vitro sensitivity data, computer algorithms generated therapeutic antibiotic monitor (TAM) alerts. A clinical pharmacist then notified the attending physician of the alert. RESULTS: Antibiotic therapy was identified by the computer as inappropriate in 696 instances (32%). After we eliminated false-positive alerts, 420 evaluable TAM alerts remained. Physicians responded to the TAM alerts by either changing or starting antimicrobial therapy in 125 cases (30%). Moreover, physicians were previously unaware of the relevant susceptibility test results in 49% of the alerts. CONCLUSION: Computer-assisted monitoring is an efficient and promising method to identify and correct errors in antimicrobial prescribing and to assure the appropriate use of therapeutic antibiotics.

Algorithms↗
PubMed1990

Computer-critiqued blood ordering using the HELP system.

Recently the medical risk of blood transfusions has emphasized the need to improve the safe use of blood products. For the past 2 1/2 years at LDS Hospital we have used the HELP computer system to assist and critique ordering of blood products "on-line" by physicians and nurses. This report details the computer methods used to order blood products and to critique the appropriateness of those orders. Physicians personally enter the orders for more than 45% of the blood products using computer terminals, whereas 7% are from physician standing orders. Nurses enter the remaining orders from written orders (26%), verbal orders (14%), and phone orders (8%). There were 3396 blood orders for 1043 patients generated by 273 physicians during the fourth quarter of 1989. Each order is justified at the time it is entered by selecting from a menu of physician-approved criteria. The criteria are linked to supportive data in the data base, i.e., laboratory results and clinical data. The computer verified that 82% of these orders met criteria. Quality Assurance nurses verified the remaining 18%. Of these 18% only one in eight required manual chart review. After computer and Quality Assurance review, only eight (0.24%) of the orders were found to be true exceptions to established criteria. Physicians and nurses have accepted the computerized critiquing system. Through use of the computer we provide "on-line" critiquing and improve the use of scarce blood product resources.

Blood Banks↗
PubMed1990

Body image of sexually and physically abused children.

Body size perception was measured in 41 children aged 6-10 who had been either sexually or physically abused, or had no history of abuse. Two psychophysical methods were used, including the staircase method and a signal detection method. In the staircase methodology, children adjusted the direction of distortion of their continuously changing body size. In the signal detection method, children made judgments about the presence or absence of size distortion in presented images. Results using the staircase method indicated children overestimated their body sizes, with no differences between abuse conditions, gender, or age. For the signal detection methodology, no difference in ability to detect the presence/absence of size distortion (d') was found between abuse conditions, although females were less accurate than males. All groups were better able to detect distortion when the image was distorted too wide. Measures of response bias (Ln beta) indicated that sexually abused children had a greater bias to report size distortion as present, as compared with the physically abused children.

Body Image↗
PubMed1990

Reducing the duration of prophylactic antibiotic use through computer monitoring of surgical patients.

The use of antibiotic prophylaxis for unnecessarily prolonged periods after surgical procedures can contribute to increased health care costs and adverse drug reactions as well as the development of antibiotic-resistant infections. Hospitals are under economic pressures to develop methods to control the excessive use of these drugs. We expanded the capabilities of our hospital information system to monitor the duration of surgical antibiotic prophylaxis. For six months during one year we used the computer system to monitor antibiotics received by every surgical patient and to identify patients receiving antibiotic prophylaxis longer than was deemed necessary according to generally accepted guidelines. For six months in the following year we used the system to monitor and identify the same types of patients and clinical pharmacists placed antibiotic "stop orders" in the charts of the patients identified by the computer. Surgical patients received an average of 19 doses of antibiotics in the first year compared with 13 doses in the second year (p less than 0.001). The average cost of antibiotics received more than 48 hours after the operation was $42 less per patient in year 2 than in year 1, resulting in a potential cost savings of $44,562 in six months. The computer system was found to be an efficient tool for monitoring all antibiotics given to surgical patients and identifying patients receiving antibiotic prophylaxis longer than necessary. Clinical use of this system appears to have resulted in improved usage of antibiotic prophylaxis.

Anti-Bacterial Agents↗
PubMed1990

Performance evaluation of contemporary spirometers.

A comprehensive evaluation of 62 spirometers from 37 different sources was performed using a two-part protocol: calibrated syringe, and dynamic waveform testing. All testing was done with ambient air. Calibrated syringe testing examined the ability of the spirometers to accurately measure the output of a 3 L calibrating syringe under varying conditions. The accuracy, FVC volume linearity, and stability of each spirometer was determined from these data. All but five of 42 spirometers accurately measured a 3 L calibrating syringe to within +/- 3 percent. Dynamic waveform testing consisted of introducing 24 standard waveforms into the spirometer from a computer-controlled air pump. The values of FVC, FEV1, and FEF25-75% were compared to the actual values for each waveform to determine a performance rating. Only 35 (56.5 percent) of the spirometers performed acceptably when measuring the 24 standard waveforms. Nine (14.5 percent) were marginal and 18 (29.0 percent) were unacceptable. Fifty-nine (95 percent) of the 62 spirometers were computerized. Software errors were found in 25 percent of the computerized systems evaluated. Although using a 3 L syringe for quality control purposes is essential, simple testing of spirometers with a 3 L calibrating syringe for validation purposes was inadequate to assess spirometer performance when compared to dynamic waveform testing. Dynamic waveform testing is essential to accurately measure and validate acceptability of spirometer system performance.

Calibration↗
PubMed1990

Somatization tendencies and ability to detect internal body cues.

39 subjects performed a task in which they were required to detect the presence of a resistive load during the inhalation phase of breathing. Subjects were also measured on somatization tendencies, using the SCL-90-R test. A signal-detection analysis indicated an inverse relationship between ability to detect the resistive load during breathing and somatization score. Results are discussed relative to possible ramifications for somatoform disorders.

Adult↗
PubMed1990

Optimizing medical practice using a computerized hospital information system. Example of blood transfusions.

The recent focus on medical risks and dollar cost of blood transfusion has resulted in the need to define guidelines for transfusion of blood products. In 1987, a computerized knowledge-based system was implemented at LDS Hospital to screen transfusion requests and flag those not justified by criteria defined by the medical staff. The use of red blood cells (RBC) for the 9 month period from July 1, 1988 was reviewed. The number of units ordered that met the criteria used by LDS Hospital was 90%. Our results showed there was a need to refine knowledge about transfusion therapy to help physicians optimize the use of blood products.

Blood Transfusion↗
PubMed1990

Medical impact analysis for the space station.

Since the Space Station Health Maintenance Facility can house only a relatively limited quantity of supplies and equipment, the decisions about what should be included must be based on documented research. In this study, Space Station medical care priorities were determined by a medical impact analysis of two analog populations, U.S. Army and U.S. Navy personnel. Diseases and injuries in the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) were ranked, using a Medical Impact Score (MIS) combining modified incidence rate and a function of disease outcome. The validity of the analysis method was tested by measuring rank order correlation between the two analog populations. Despite virtually identical age and sex distributions, Army and Navy incidence rates differed significantly for half of the ICD-9-CM categories, p less than 0.05. Disability rates differed for 76%, p less than 0.05. Nevertheless, Army and Navy MIS rank orders for categories and sections were not significantly different, p less than 0.001. In critical ways, the Space Station will be a safer environment than Earth. Cardiac events, musculoskeletal injuries, affective psychoses, and renal calculi were among the highest scoring categories.

Accidents, Occupational↗
PubMed1990

Cardiac self-perception in obese and normal persons.

Cardiac self-perception was measured in obese and normal weight subjects. Subjects had to judge whether a tone was coincident with their own heartbeat or slightly mismatched. A signal-detection analysis was used to measure sensory sensitivity to the heartbeat separate from nonsensory, response-bias factors. Subjects were able to perform the heartbeat-detection task, with an average sensory sensitivity d' of .58. No significant differences in sensory sensitivity were found between obese and normal-weight subjects, nor were any sex differences noted. Measurement of response bias (Ln beta) indicated that obese subjects had a significantly more lax response criterion than normal-weight subjects. Results are discussed in terms of Schachter's (1971) internality-externality theory of obesity and ramifications for weight control are discussed.

Adult↗