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PubMed1996

Validation of Automated Border Detection in Intravascular Ultrasound Images.

Intravascular ultrasound (IVUS) imaging provides cross-sectional views of the vessel lumen; however, lumen measurements still rely on operator-dependent border delineation and time-consuming lumen tracings. We tested a new system for automated lumen border detection in IVUS images based on acoustic quantification of blood and vessel wall. In 10 rabbits, 29 segments of the aorta were imaged in vivo using a 2.9-Fr IVUS catheter. IVUS images were obtained during motorized pullbacks of aortic segments of 18 mm length. Automated measurements of lumen dimensions were compared to automated measurements of a second pullback through the same segment, lumen measurements derived from visual border tracings in IVUS images, and to quantitative angiography. The automated system showed good reproducibility: Correlations for repeated measurements of lumen area, maximal and minimal lumen diameters were r = 0.97, r = 0.91, and r = 0.93, respectively. Automated measurements also correlated well to visual image analysis (lumen area, r = 0.97; maximal lumen diameter, r = 0.89; minimal lumen diameter, r = 0.89) and to angiographic measurements (lumen area, r = 0.93; lumen diameter, r = 0.95). In 12% of the images, the automated system overestimated lumen dimensions because of weak wall signals in the presence of echolucent structures next to the wall. Signal artifacts from the IVUS catheter itself or strong blood backscatter resulted in lumen underestimation in 6% of the images. Over- and underestimation of lumen by the border detection system were often associated with eccentric catheter position. Thus, lumen measurements in vivo IVUS images can be performed using an automated border detection system based on acoustic quantification of blood and vessel wall. The system allows reproducible and accurate measurements of lumen area and diameters. (ECHOCARDIOGRAPHY, Volume 13, November 1996)

Journal Article↗
PubMed2003

Validation of automated blood cell counter for the determination of polymorphonuclear cell count in the ascitic fluid of cirrhotic patients with or without spontaneous bacterial peritonitis.

OBJECTIVES: Polymorphonuclear (PMN) cell count in ascitic fluid is the most useful test for the diagnosis of spontaneous bacterial peritonitis (SBP). We evaluated the validity of an automated blood cell counter for the PMN determination in ascitic fluid by comparing it with the traditional hematologic method with a light microscope in a manual counting chamber. METHODS: A total of 130 ascitic fluid samples were collected from 74 consecutive cirrhotics. The agreement between the two techniques was assessed according to Bland and Altman's method. The sensitivity, specificity, and positive and negative predictive values of the automated blood cell counter were calculated by considering the diagnosis of SBP as a PMN count > or = 250 cells/mm(3), determined by the manual method as the "gold standard." RESULTS: The mean PMN counts assessed by the manual method and the automated blood cell counter were 124 +/- 301 cells/mm(3) and 130 +/- 339 cells/mm(3), respectively (p = 0.89, ns). The mean +/- SD of the difference between manual and automated measurements was 6 +/- 61 cells/mm(3), whereas the limits of agreement were +127 cells/mm(3) (95% CI = +108 to +147) and -115 cells/mm(3) (95%CI = -96 to -135). SBP was diagnosed in 11 patients. All but one were correctly identified with the automated blood cell counter, with a sensitivity of 94% and a specificity of 100%; positive and negative predictive values were 100% and 99.1%, respectively. CONCLUSIONS: The manual method and the automated blood cell counter have a good agreement in the PMN determination in ascitic fluid, and the automated blood cell counter is a reliable tool for rapid diagnosis of SBP.

Aged↗
PubMedDate not supplied

Lessons from evaluating an automated patient severity index.

OBJECTIVE: To report lessons learned from evaluation of an automated interface between a hospital clinical information system and a severity of illness index. DESIGN: A system was developed to convert coded electronic patient findings from the HELP System at LDS Hospital into the attributes used by the Computerized Severity Index (CSI) to calculate a severity of illness score. Performance was assessed by comparing the automated CSI score with the manual CSI score (from paper chart review) and by evaluating changes introduced by augmenting the manual CSI score with verified patient data discovered by the automated CSI method. MEASUREMENTS: The strengths and weaknesses of each method are presented. RESULTS: The automated CSI score matched the manual CSI score in 61% of the cases. Sources of errors were analyzed. When the automated score was in error, two-thirds of the time it was due to the lack of codes in the HELP system representing CSI concepts; one-third of the time it was due to nurses not using established HELP system codes. Surprisingly, significant problems were also discovered in the manual system, making it difficult to define a "gold standard". CONCLUSIONS: Automated computerized severity indices have great potential for future applicability once their performance exceeds that of the time-consuming manual chart review method. Neither automated nor manual methods are adequate at the present time. This area remains a fertile ground for future research.

Electronic Data Processing↗
PubMedDate not supplied

Automated RIBA HCV strip immunoblot assay: a novel tool for the diagnosis of hepatitis C virus infection in hemodialysis patients.

Hemodialysis (HD) patients remain a high-risk group for hepatitis C virus (HCV) infection. Serological assays (enzyme-linked immunosorbent assays, ELISAs) are the only tests currently approved by the Food and Drug Administration in the United States for the diagnosis of HCV. The RIBA HCV Strip Immunoblot Assay (SIA) is an established method for supplemental testing of repeat reactive hepatitis C ELISA patients on HD. However, the current manual procedure is labor intensive, requiring subjective band scoring and result interpretation. Recently, the automated CHIRON RIBA HCV Processor System has been designed to perform RIBA supplemental testing. The CHIRON RIBA HCV Processor System consists of a bench-top instrument that provides objective evaluation of the RIBA immunoblot strips, by measuring the light differentially reflected from the developed bands and white background, creating a density of reflectance. The CHIRON RIBA HCV Processor System assesses the intensity of each of the reactive bands in relation to the intensity of the internal control bands on each RIBA HCV strip. Comparison between processor and manual protocols was performed using a large (n = 200) cohort of ELISA 3.0 HCV negative and positive patients on maintenance HD. The test characteristics of RIBA HCV 3.0 SIA were identical with manual and automated runs. The relative intensity values of antigenic bands by the CHIRON RIBA HCV 3.0 Processor System between anti-HCV positive and negative patients were significantly different; only 15 of 784 (1.9%) antigenic bands had borderline reactivities. The correlation of test results between manual and automated runs was very high (kappa value 0.989). Among positive results by RIBA HCV 3.0 SIA, there was a strong concordance between manual and automated runs with regard to the pattern of reactivity (kappa value 0.943). The discordant results between manual and automated protocols were attributable to increased variability of antigen scores close to the cutoff value for both tests. In conclusion, the CHIRON RIBA HCV 3.0 Processor System is capable of performing RIBA HCV 3.0 SIA in the HD population accurately with minimal operator involvement. The test characteristics of RIBA HCV 3.0 SIA were identical by manual and automated runs. There was a strong correlation between the results of the manual and automated runs; the few discordant results between the two procedures were mostly due to increased variability of antigen scores close to the cutoff value for both tests. The Centers for Disease Control and Prevention in the USA have recently included chronic HD patients among those persons for whom routine HCV testing is recommended; HCV-infected patients on HD often have a high rate of indeterminate results by manual RIBA technology which is operator dependent for band scoring and result interpretation. The CHIRON RIBA HCV 3.0 Processor System may be very useful for supplemental anti-HCV testing of ELISA repeat reactive specimens in clinical practice within dialysis units.

Hepatitis C, Chronic↗
PubMed2003

Fully automated assessment of inflammatory cell counts and cytokine expression in bronchial tissue.

Automated image analysis of bronchial tissue offers the opportunity to quantify stained area and staining intensity in a standardized way to obtain robust estimates of inflammatory cell counts and cytokine expression from multiple large areas of histopathologic sections. We compared fully automated digital image analysis with interactive digital cell counting and semiquantitative scoring of cytokine expression in terms of repeatability and agreement in bronchial biopsies in 52 patients with mild to moderate atopic asthma. Immunohistochemistry with antibodies against CD3, interleukin (IL)-4, IL-5, and interferon-gamma protein was performed on frozen tissue sections, using 3-amino-9-ethylcarbazole as chromogen and hematoxylin as counterstaining. IL-4 and IL-5 messenger RNAs were localized by in situ hybridization without hematoxylin staining. Separation of 3-amino-9-ethylcarbazole and hematoxylin-stained pixels was achieved by linear combination of red- and blue-filtered gray-scale images. Using baseline biopsy specimens, fully automated CD3+ cell counts showed perfect repeatability (r = 1.0) and a strong linear relationship with the interactive procedure (r = 0.98). Automated densitometry showed perfect repeatability (1.0) and a moderate to strong relationship with semiquantitative scoring of protein and messenger RNA expression (r = 0.43-0.89). Relationships between automated and semiquantitative assessments of changes in cytokine expression during 2 years of follow-up were moderate to strong (r = 0.40-0.84). We conclude that fully automated cell counts and automated densitometric analyses in bronchial tissue of patients with asthma are unbiased and help to reduce variability in inflammatory outcomes.

Adult↗
PubMed2003

Automated detection of diabetic retinopathy in a fundus photographic screening population.

PURPOSE: To evaluate the performance of an automated fundus photographic image-analysis algorithm in high-sensitivity and/or high-specificity segregation of patients with diabetes with untreated diabetic retinopathy from those without retinopathy. METHODS: This was a retrospective cross-sectional study of 260 consecutive nonphotocoagulated eyes in 137 diabetic patients attending routine photographic retinopathy screening. Mydriatic 60 degrees fundus photography on 35-mm color transparency film was used, with a single fovea-centered field. Routine grading was based on visual examination of slide-mounted transparencies. Reference grading was performed with specific emphasis on achieving high sensitivity. Computer-assisted automated red lesion detection was performed on digitized transparencies. RESULTS: When applied in a screening population comprising patients with diabetes with untreated diabetic retinopathy in any eye and patients with diabetes without retinopathy, the automated lesion detection correctly identified 90.1% of patients with retinopathy and 81.3% of patients without retinopathy. A per-eye analysis for methodological purposes demonstrated that the automated lesion detection could be adapted to simulate various visual evaluation strategies. When adapted at high sensitivity, the automated system demonstrated sensitivity at 93.1% and specificity at 71.6%. When adapted at high specificity the automated system demonstrated sensitivity at 76.4% and specificity at 96.6%, closely matching routine visual grading at sensitivity 76.4% and specificity 98.3%. CONCLUSIONS: Automated detection of untreated diabetic retinopathy in fundus photographs from a screening population of patients with diabetes can be made with adjustable priority settings, emphasizing high-sensitivity identification of diabetic retinopathy or high-specificity identification of absence of retinopathy, covering opposing extremes of visual evaluation strategies demonstrated by human observers.

Aneurysm↗
PubMed2003

Automated detection of fundus photographic red lesions in diabetic retinopathy.

PURPOSE: To compare a fundus image-analysis algorithm for automated detection of hemorrhages and microaneurysms with visual detection of retinopathy in patients with diabetes. METHODS: Four hundred fundus photographs (35-mm color transparencies) were obtained in 200 eyes of 100 patients with diabetes who were randomly selected from the Welsh Community Diabetic Retinopathy Study. A gold standard reference was defined by classifying each patient as having or not having diabetic retinopathy based on overall visual grading of the digitized transparencies. A single-lesion visual grading was made independently, comprising meticulous outlining of all single lesions in all photographs and used to develop the automated red lesion detection system. A comparison of visual and automated single-lesion detection in replicating the overall visual grading was then performed. RESULTS: Automated red lesion detection demonstrated a specificity of 71.4% and a resulting sensitivity of 96.7% in detecting diabetic retinopathy when applied at a tentative threshold setting for use in diabetic retinopathy screening. The accuracy of 79% could be raised to 85% by adjustment of a single user-supplied parameter determining the balance between the screening priorities, for which a considerable range of options was demonstrated by the receiver-operating characteristic (area under the curve 90.3%). The agreement of automated lesion detection with overall visual grading (0.659) was comparable to the mean agreement of six ophthalmologists (0.648). CONCLUSIONS: Detection of diabetic retinopathy by automated detection of single fundus lesions can be achieved with a performance comparable to that of experienced ophthalmologists. The results warrant further investigation of automated fundus image analysis as a tool for diabetic retinopathy screening.

Algorithms↗
PubMed2002

The perceived utility of human and automated aids in a visual detection task.

Although increases in the use of automation have occurred across society, research has found that human operators often underutilize (disuse) and overly rely on (misuse) automated aids (R. Parasuraman & V. Riley, 1997). Nearly 275 Cameron University students participated in 1 of 3 experiments performed to examine the effects of perceived utility (M. T. Dzindolet, H. P. Beck, L. G. Pierce, & L. A. Dawe, 2001) on automation use in a visual detection task and to compare reliance on automated aids with reliance on humans. Results revealed a bias for human operators to rely on themselves. Although self-report data indicate a bias toward automated aids over human aids, performance data revealed that participants were more likely to disuse automated aids than to disuse human aids. This discrepancy was accounted for by assuming human operators have a "perfect automation" schema. Actual or potential applications of this research include the design of future automateddecision aids and training procedures for operators relying on such aids.

Adult↗
PubMed2003

Short-term effect of transition from conventional to automated milking on teat skin and teat end condition.

A higher milking frequency, as a consequence of milking with an automated milking system, incorporates a threat to teat condition. To study the effect of transition from conventional to automated milking on teat skin and teat end condition, 40 lactating Holstein-Friesian cows and heifers from a high yielding dairy herd were randomly allocated to either a conventional or an automated milking system group. In the latter group, automated milking was initiated during the study period, while conventional milking was continued in the control group. Teat skin and teat end condition were evaluated weekly on quarter level for all animals from 5 wk before until 8 wk after transition. A high emollient iodine teat dip was used on all cows during the study period. Teat skin condition of the animals in the automated milking system group was consistent from before and during milking with the automated milking system. Rear teats had a better skin and end condition than front teats. Evolution of teat end condition over time between the automated and conventional milking groups was not statistically different. Heifers, however, seemed to be more sensitive to the change than multiparous cows, as their teat end condition slightly decreased.

Animals↗
PubMedDate not supplied

Recent trends in clinical laboratory automation.

A convergence of concepts has allowed clinical laboratory automation to proceed in a greater number of laboratories: developing automation control interfaces, direct track sampling, and adopting a universal interface. The laboratory automation system (LAS) must interface to the laboratory information system (LIS), which provides the information necessary for routing and scheduling and for future rules-based processing, an important component of the LAS. The automation system also must operate in a real-time or near real-time environment and use the single tube per carrier paradigm. LAS capabilities should span the clinical laboratory and run parallel to the LIS with respect to information flow. The laboratory automation software will control the automated technology and the transportation system that binds clinical laboratory instruments together. It must be able to both drive the hardware components and interface with patient information sources, and it should further the goals of the health-care delivery system by supporting outcomes optimization and utilization management of laboratory resources. The development of workcells based on disciplines such as chemistry or hematology is having and will continue to have a significant effect on the acceptance of clinical laboratory automation technologies.

Autoanalysis↗
PubMed1998

Vision of an 'automated' hospital information system.

This paper tries to describe a coherent vision of a possible next generation of HIS that rethinks how and what for computing is used in hospitals. Current systems, organized mainly around the 'database' and the 'communication' paradigm help the data processing to a great extent. At the same time they cannot be accepted as 'automated' systems, as handling of information is done mostly by end-users, i.e. by human actors. Emerging methods enabling automated information handling are the following: integrated handling of different media, seamless communication among different systems, alternative input-output devices, tools for pro-active information handling. These technologies should be grouped to two main branches: technical advances in data handling and theoretical advances in knowledge handling. The advances in knowledge handling are really important: tools based on that can take over routine information handling tasks from human end users. To discuss automation in HIS it is useful to understand the process of information handling in general within the hospital. A suggested multidimensional information space, where information objects are gathered mainly along two axes, the 'patient axis' and the 'management' axis might be of help. Combinations of selected dimensions resulted in a space of an estimated 2,294,082 possible information handling situation types in an earlier publication. Automation of information handling tasks can be derived from this model. The authors suggest to automate certain tasks done usually by active actors of the information handling situation space. Software agents working 'on their own' are known entities in HIS systems. Two components are needed for automation: an organized data base where its content can be 'understood' and interpreted by an algorithm, with other words a knowledge base an algorithm, that covers a certain routine information handling task. Data bases of HIS should be re-thought in a way that enables automated processing to a greater extent. The development of data base technologies clearly point to this direction. If most of the data bases of a HIS will be like that, new generation of applications might be launched to use them. E.g. a software agent called 'patient assistant' could collect data from different sources and build a coherent and updated patient file. The results of a knowledge based, agent operated HIS should be the following: significantly less direct human involvement significantly less paper to be produced enhanced speed of data flow in general enhanced reliability by widespread watchdog functions

Algorithms↗
PubMed2000

[An automated electronic anesthesia record using a hospital LAN (local area network)].

We have developed an automated electronic anesthesia record system using a hospital LAN. As the number of monitors we can use in the operating room is increasing, it is impossible to record all physiologic parameters in a handwritten anesthesia record. Physiologic parameters are recorded every 10 seconds from the anesthesia monitor. An operation ordering system by a hospital LAN has been completed and the patient's data are stored in a host computer, and we can use its data for the automated electronic anesthesia record preoperatively. The advantages of the automated electronic anesthesia record are continuous high quality, more data collection than the handwritten anesthesia record, and the electronic database. During a critical period, the anesthesiologist is too busy to plot physiologic parameters but the automated electronic anesthesia record is reliable and accurate. Disadvantage of the automated electronic anesthesia record is some practice required to input clinical events such as drug administration. The handwritten anesthesia record is easy to use and economical. Ergonomic problems still remain to be solved for wider acceptance of the automated electronic anesthesia record in clinical practice. At the end of the operation, intraoperative data are sent to a host computer and the anesthesia record is printed. We can use this database for clinical research and retrospective case reviews. The implementation of the automated electronic anesthesia record in anesthesia practice will improve quality of patient care.

Anesthesia↗
PubMed2002

[Automated analyser of organ cultured corneal endothelial mosaic].

PURPOSE: Until now, organ-cultured corneal endothelial mosaic has been assessed in France by cell counting using a calibrated graticule, or by drawing cells on a computerized image. The former method is unsatisfactory because it is characterized by a lack of objective evaluation of the cell surface and hexagonality and it requires an experienced technician. The latter method is time-consuming and requires careful attention. We aimed to make an efficient, fast and easy to use, automated digital analyzer of video images of the corneal endothelium. METHODS: The hardware included a PC Pentium III ((R)) 800 MHz-Ram 256, a Data Translation 3155 acquisition card, a Sony SC 75 CE CCD camera, and a 22-inch screen. Special functions for automated cell boundary determination consisted of Plug-in programs included in the ImageTool software. Calibration was performed using a calibrated micrometer. Cell densities of 40 organ-cultured corneas measured by both manual and automated counting were compared using parametric tests (Student's t test for paired variables and the Pearson correlation coefficient). RESULTS: All steps were considered more ergonomic i.e., endothelial image capture, image selection, thresholding of multiple areas of interest, automated cell count, automated detection of errors in cell boundary drawing, presentation of the results in an HTML file including the number of counted cells, cell density, coefficient of variation of cell area, cell surface histogram and cell hexagonality. The device was efficient because the global process lasted on average 7 minutes and did not require an experienced technician. The correlation between cell densities obtained with both methods was high (r=+0.84, p<0.001). The results showed an under-estimation using manual counting (2191+/-322 vs. 2273+/-457 cell/mm(2), p=0.046), compared with the automated method. CONCLUSIONS: Our automated endothelial cell analyzer is efficient and gives reliable results quickly and easily. A multicentric validation would allow us to standardize cell counts among cornea banks in our country.

Aged↗
PubMed2004

Flow cytometric validation of automated differentials in pediatric patients.

Manual differential white blood cell (WBC) counting has been considered the gold standard and is routinely used to validate differentials obtained with other methodologies. To validate the accuracy of automated lymphocyte counts, we compared 2-part differentials using a Coulter HmX hematology analyzer and a Coulter XL flow cytometer to analyze 57 pediatric samples with WBC counts ranging from 0.7 k to 33.4 k. These data were compared with manual differential counts. We found excellent correlation between the two automated lymphocyte and monocyte counting methods that surpassed the manual correlations, indicating manual lymphocyte or monocyte counts are unnecessary in the setting of quality scatterplots. To evaluate the use of automated differentials for our most labor-intensive cases (low WBCs, which frequently require manual differentials) we then compared 3-part differentials using the HmX hematology analyzer and flow cytometer for 51 samples with total WBC < or = 1.1 x 10(9)/L. Manual differentials (< or = 100-cell counts) were available on 27 samples. Although the correlations for manual versus automated or flow differentials were good for all cell types, the correlation between the two automated methods was better, irrespective of the hematology analyzer scatterplot quality. Preliminary data provide additional evidence that automated differentials in samples with WBC of < or = 1.1 x 10(9)/L are acceptable for reporting, thus saving technologist time and improving patient care by decreasing the resulting turnaround time. These studies suggest that comparison with a standardized procedure like flow cytometry would be a better method for validation of automated differentials than comparison with the less precise, more laborious manual differential.

Autoanalysis↗
PubMed1992

Four radionuclide methods for left ventricular volume determination: comparison of a manual and an automated technique.

This study compared the accuracy and reproducibility of three previously described and one new radionuclide method of measuring left ventricular volumes in 19 subjects using contrast ventriculographic volumes (n = 38, mean volume = 126.6 ml) as the gold standard. The four methods were compared using both manual and automated ROIs. For manual ROIs, the Links (189.7 ml, r = 0.85), Starling (183.2 ml, r = 0.77) and the new count ratio method (141.4 ml, r = 0.90) overestimated contrast volumes, while the Massardo method (122.5 ml, r = 0.91) provided accurate volumes. For the automated ROIs, we performed an interpolative background subtraction and used a 50% threshold of the highest count pixel to define the ventricular regions. The automated Massardo method severely underestimated the contrast volume (59.5 ml, r = 0.90), while the other automated methods yielded accurate volumes: Links (122.4 ml, r = 0.89), Starling (118.1 ml, r = 0.81) and the new count ratio method (125.0 ml, r = 0.90). The interobserver reproducibility of the automated methods was excellent (mean difference = 1%-4%) compared to the manual methods (2%-8%). Because no additional images, blood counting, attenuation, or decay correction were necessary, the manual Massardo method and the automated count ratio method are the simplest to perform. We conclude that automated determination of left ventricular volumes using the new count ratio method is rapid, accurate, reproducible and could readily be incorporated into routine clinical use.

Algorithms↗
PubMedDate not supplied

Quality assurance responsibilities as defined by the EPA Good Automated Laboratory Practices (GALPs).

In December 1990, the Environmental Protection Agency's (EPA) Office of Information Resources Management (OIRM) issued a draft of the Good Automated Laboratory Practices (GALP). The GALPs developed from a union of existing Federal and EPA regulations and policies, including: the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) & Toxic Substance Control Act (TSCA), Good Laboratory Practices (GLP), the EPA Information Resources Management Policy (IRMP), and the Computer Security Act of 1987. The GALPs consolidate the regulations and policies to provide a single source of reference, and sever as an extension of the GLP standards (40 CFR 160 & 792). Whereas the GLPs describe acceptable laboratory management practices, the GALPs describe acceptable automated data management practices, and give guidance for standardizing and implementing procedures to ensure the quality and integrity of automated data collection and storage. The GALPs have been formatted to parallel the structure of the GLPs. Just as the GLPs define the responsibilities of the Quality Assurance Unit (QAU) in maintaining good laboratory practices, the GALPs define the responsibilities of the QAU in maintaining good automated data practices. The QAU is charged with (i) maintaining copies of written procedures for the automated data collection system, (ii) performing inspections of laboratory operations utilizing the automated data collection system and reporting findings, (iii) ensuring authorization and documentation of deviations from written procedures, (iv) auditing data and reports from the automated data collection system to ensure they accurately represent the raw data, and (v) maintaining records of the above-defined QAU functions.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Laboratory Information Systems↗
PubMed1993

Validation of automated sleep stage and apnoea analysis in suspected obstructive sleep apnoea.

Full-night polysomnography is necessary for the diagnosis of obstructive sleep apnoea (OSA). However, analysis of the sleep stages and apnoeas is time-consuming. Computer systems for automated analysis have, thus, been developed to alleviate this task. We investigated 27 consecutive patients referred to our sleep laboratory with suspected OSA. The analysis of sleep stages and apnoeas was performed by visual scoring, according to Rechtschaffen and Kales, and by commercially available automated analysis device. The mean difference between visual scoring and automated analysis was -1, 111, -140, -3, 1 and 27 min, for sleep stages awake, I, II, III, IV and rapid eye movement (REM) respectively. For the apnoea index, the automated analysis rated a lower figure (mean difference 7.h-1, 95% confidence interval 2-12.h-1). The diagnosis of OSA was performed with a sensitivity of 85% and a specificity of 93% by automated analysis. Comparison of two independent handscores showed good agreement, with a mean difference of 6, 4, 3, -7, 1 and -1 min, for sleep stages awake, I, II, III, IV and REM, respectively. In conclusion, the automated analysis underestimates stage I sleep and the apnoea index. Visual scoring is advisable for control of the results. Automated analysis should only be used by those who are able to perform a visual analysis.

Aged↗
PubMed1996

Automated perimetry. American Academy of Ophthalmology.

Automated perimetry is one product of the computer revolution that has had a dramatic impact on the practice of ophthalmology, affecting the quality of both the perimetric test (perimetric technique) and the interpretation of the test results. Before automation, the quality of visual field technique in many practices was poor, partly because perimetrists lacked the volume of patients requiring the test to provide training sufficient to maintain a high level of experience and expertise. At first, automated perimetry was developed simply to make available to all practitioners visual field testing that was nearly as good as the most skilled manual perimetry. The data provided by first-generation automated perimeters lacked the accuracy, sensitivity, and reproducibility obtainable from a highly skilled manual perimetrist. As automated perimeters evolved, perimetric techniques and the software that analyzes data for clinical significance were improved. The use of automated perimetry to evaluate routinely various visual disorders that require testing of the visual field has increased significantly. Statistical analysis of the test results aids interpretation, both to determine if the field is abnormal and if there is change in the field from one occasion to another, especially in the context of glaucoma. The test is excellent; it is now standardized, with better test algorithms, and in many cases it achieves better results than the best manual perimetrist. However, attention to detail and skill in administering the automated test are still essential. The future will hold further improvements. Nevertheless, as each manufacturer enhances computerized perimetry, it may become more difficult to compare the test results among instruments or even between two test algorithms on the same instrument. In addition, clinical knowledge and experience will still be necessary to reach accurate diagnostic conclusions.

Guidelines as Topic↗