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PubMed1989

[A trial of digitization and digital analysis from analogue clinical images of the renal cancer].

The advancement in image diagnostic methods has been great in recent years and image diagnosis has become indispensable for the diagnosis of renal and other cancers. However, the clinical images are fixed and recorded on film as analog images for storage and the expansion of storage space, the poor efficiency in arrangement and control and the inconvenience of transfer have become big problems. Digitization of the clinical images offers the advantages of solving these problems and of allowing a variety of image analyses to be made easily. The tendency is for the digitization of all images for medical use in the near future. We applied a handy image analysis system (Shonic GA) using a personal computer as the mainframe and tried to digitize the analog images of a pyelogram, DSA, ultrasonogram, and X-ray CT of renal carcinoma for digital analysis. The results were displayed. This system is handy and easy to operate and thus is useful for the purposes of understanding and gaining experience in digitization and digital analyses of images for medical use.

Analog-Digital Conversion↗
PubMed2002

From mainframe to Web-based: 30 years of experience in computer-aided instruction of pharmacology.

This review describes 30 years of experience at the University of Kansas Medical Center in using computers in the teaching of pharmacology to medical students and other health professionals. The Computer-Assisted Teaching System contains both Computer-Assisted Instruction (CAI) and Computer-Managed Instruction (CMI). The system has evolved from mainframe to microprocessors to the current World Wide Web system. The greatest challenge has been to meet the changes in technologies and teaching approaches. The system has been well received by students and has provided the faculty with the means of providing a novel approach to teaching pharmacology.

Academic Medical Centers↗
PubMed1993

Calculating the probability of rare events: why settle for an approximation?

OBJECTIVE: Health services researchers often need to compute the probability of observing a certain number of events when only a few such events are expected. Our objective is to show that the standard approaches (Poisson, binomial, and normal approximations) are inappropriate in such instances, and to suggest an alternative. DATA SOURCES: Patients undergoing cholecystectomy (34,234) in 465 California hospitals in 1983 are used to demonstrate the biases arising from various methods of calculating the probability of observing a given number of deaths in each hospital. Similar data from other procedures and diagnoses with lower and higher mortality rates are also used for illustration. STUDY DESIGN: The computational methods to derive probabilities using the Poisson, normal, simulation, and exact probabilities are discussed. Using a previously developed risk factor model, the probability of observing the actual number of deaths (or more) is calculated given the expectation of death for each patient in each hospital. Results for the four methods are compared, showing the types of random and systematic errors in the Poisson, normal, and simulation approaches. DATA COLLECTION: Routinely collected hospital discharge abstract data were provided by the California Office of Statewide Planning and Development. PRINCIPAL FINDINGS: The Poisson and normal approximations are often biased substantially in calculating upper-tail p-values, especially when the expected number of adverse outcomes is less than five. Simulations allow unbiased calculations, and the degree of random error can be made arbitrarily small given enough trials. Exact calculations using a simple recursive algorithm can be done very efficiently on either a mainframe or personal computer. For example, the whole set of cholecystectomy patients can be assessed in less than 90 seconds on a Macintosh. CONCLUSIONS: Calculating the probability of observing a small number of events using standard approaches may result in substantial errors. The availability of a simple and inexpensive method of calculating these probabilities exactly can avoid these errors.

Bias↗
PubMed1996

Remote instrument telemaintenance.

In the past decade, great technological progress has been made in telemaintenance of mainframe and mini computers. As hardware technology is now available at an acceptable cost, computer aided trouble-shooting can be adapted to laboratory instrumentation in order to significantly improve repair time, avoid instrument downtime by taking advantage of predictive methods, and provide general diagnostic assistance. Depending on the size of the instrument, the telemaintenance facility can be dedicated to a single instrument or alternatively a telemaintenance server can manage multiple distributed small instruments through a Local Area Network. As complex failures can occur, the local diagnosis capabilities may be exceeded and automatic dialing for connection to computerized Remote Maintenance Centers is needed. The main advantages of such a centre, as compared to local diagnosis systems, are the increased access to more information and experience of failures from instrument installations, and consequently the provision of training data updates for Artificial Neural Networks and Knowledge Based Systems in general. When an abnormal situation is detected or anticipated by a diagnosis module, an automatic alert is given to the user, local diagnosis is activated, and for simple solutions, instructions are given to the operator. In the last resort, a human expert can be alerted who, with remote control tools, can attend to the failures. For both local and remote trouble-shooting, the data provided by the instrument and connected workstation is of paramount importance for the efficiency and accuracy of the diagnosis. Equally, the importance of standardization of telemaintenance communication protocols is addressed.

Clinical Laboratory Information Systems↗
PubMed1996

Restructuring VA ambulatory care and medical education: the PACE model of primary care.

The Veterans Health Administration (VHA) Western Region and associated medical schools formulated a set of recommendations for an improved ambulatory health care delivery system during a 1988 strategic planning conference. As a result, the Department of Veterans Affairs (VA) Medical Center in Sepulveda, California, initiated the Pilot (now Primary) Ambulatory Care and Education (PACE) program in 1990 to implement and evaluate a model program. The PACE program represents a significant departure from traditional VA and non-VA academic medical center care, shifting the focus of care from the inpatient to the outpatient setting. From its inception, the PACE program has used an interdisciplinary team approach with three independent global care firms. Each firm is interdisciplinary in composition, with a matrix management structure that expands role function and empowers team members. Emphasis is on managed primary care, stressing a biopsychosocial approach and cost-effective comprehensive care emphasizing prevention and health maintenance. Information management is provided through a network of personal computers that serve as a front end to the VHA Decentralized Hospital Computer Program (DHCP) mainframe. In addition to providing comprehensive and cost-effective care, the PACE program educates trainees in all health care disciplines, conducts research, and disseminates information about important procedures and outcomes. Undergraduate and graduate trainees from 11 health care disciplines rotate through the PACE program to learn an integrated approach to managed ambulatory care delivery. All trainees are involved in a problem-based approach to learning that emphasizes shared training experiences among health care disciplines. This paper describes the transitional phases of the PACE program (strategic planning, reorganization, and quality improvement) that are relevant for other institutions that are shifting to training programs emphasizing primary and ambulatory care.

Ambulatory Care↗
PubMed1991

Derivative-free restricted maximum likelihood estimation in animal models with a sparse matrix solver.

Estimation of (co)variance components by derivative-free REML requires repeated evaluation of the log-likelihood function of the data. Gaussian elimination of the augmented mixed model coefficient matrix is often used to evaluate the likelihood function, but it can be costly for animal models with large coefficient matrices. This study investigated the use of a direct sparse matrix solver to obtain the log-likelihood function. The sparse matrix package SPARSPAK was used to reorder the mixed model equations once and then repeatedly to solve the equations by Cholesky factorization to generate the terms required to calculate the likelihood. The animal model used for comparison contained 19 fixed levels, 470 maternal permanent environmental effects, and 1586 direct and 1586 maternal genetic effects, resulting in a coefficient matrix of order 3661 with .3% nonzero elements after including numerator relationships. Compared with estimation via Gaussian elimination of the unordered system, utilization of SPARSPAK required 605 and 240 times less central processing unit time on mainframes and personal computers, respectively. The SPARSPAK package also required less memory and provided solutions for all effects in the model.

Algorithms↗
PubMed1986

Computer technology in institutional foodservice.

A survey research study profiled foodservices and foodservice managers in health care and educational institutions that applied computer technology to their operations. The survey also examined the extent to which computers were applied to management and client service functions. Both the size and the type of institution were found to be significantly related to computer usage. The larger the institution, the greater the extent of indicated usage. Educational institutions used computers more than all types of health care institutions. Mainframe systems (time shared internally or externally) were the predominant computers used. Internal mainframe systems and minicomputers were used significantly more by educational institutions than by health care institutions. The manager most likely to use computers was a man of any age with at least a bachelor's degree who was employed full-time within the institution. He had taken at least six business management courses and had at least some understanding of and ability to apply systems management concepts to his daily management practices. Applications were categorized into five functional areas: menu, purchasing/storage, production, client service, and managerial information. Managerial information applications were most frequently reported by all respondents, with large institutions and elementary/secondary schools reporting the greatest usage for those applications. Several purchase/storage and production applications were significantly related to type or to size or to both, with large institutions and college/university foodservices reporting the greatest usage. Menu precosting was the only significant menu function, and that was significant only relative to institutional type. No client service functions were significantly related to either type or size.

Adult↗
PubMed1984

The pharmacy computer system at The Ohio State University hospitals.

The pharmacy computer system designed, developed, and implemented at The Ohio State University Hospitals is described. The computer system was developed to make more efficient use of hospital facilities and professional staff time. The pharmacy system operates on the mainframe hospital system using computer terminals with light-pen and keyboard access. Current online applications include order entry, patient profiles, pharmacokinetic calculations, and preparation of unit dose cart fill lists. Batch processing functions include drug-use review, drug-drug interactions, and financial management reports. Approximately 95% of unit dose orders and 20% of i.v. orders are conditionally entered by pharmacy technicians for subsequent verification by pharmacists. The system saves considerable staff time in the i.v. admixture and billing areas and has relieved pharmacists from performing many clerical and repetitive tasks. Disadvantages of the system include (1) its dependence on another department for patient admission, transfer, and discharge information and (2) delays in obtaining approval for program modifications and new applications. The advantages of the pharmacy computer system lie in its ability to access information from other computerized databases in the hospital. Future modifications and enhancements to the system are discussed.

Computers↗
PubMed1994

An automated Computerized Severity Index.

The Computerized Severity Index (CSI) is a commercially available scoring system for hospital inpatients. Trained abstractors review the patient's paper medical record and enter the diagnoses and relevant physiological attributes. The HELP (Health Evaluation through Logical Processing) System at LDS Hospital stores patient data in discrete codes. This paper describes the development of an automatic interface between the standalone, personal-computer-based severity system and the mainframe-based hospital information system. The interface scores patient severity without the need for manual chart review. Severity scores from the automated and manual methods were identical for 70% of 222 general medical patients scored retrospectively. An evaluation of the causes for differing scores between the two methods is presented.

Computers, Mainframe↗
PubMed1991

PC development gives Baptist Medical Center mainframe power.

Sophisticated distributed applications are easier to develop and maintain when prototyped using personal computer (PC) technology. Baptist Medical System, the largest hospital system in Arkansas, is using PC technology to prototype and then develop mainframe-based applications that augment mission-critical, distributed systems.

Arkansas↗
PubMed1984

Personal information tools (personal computers): the changing environment and its management.

The potential of the personal computer as a universal information tool for professional and managerial work is explained and illustrated. Forms of implementation, as desktop computer systems (hardware and software) and as virtual personal computers in the context of online mainframe systems, are differentiated. Reasons are given why personal computers are becoming essential for various major types of information work. The need for planned and coordinated introduction of personal computers to prevent the negative effects of uncoordinated applications without attention to compatibility and redundancy is stressed.

Computers↗
PubMed1986

A voice-entry data management system: application in monoclonal antibody research.

A computerized system for the management of hybridoma cell growth data using voice input is described. The system permits the storage, retrieval, and analysis of data for hybridoma cells secreting monoclonal antibodies. It consists of a local system residing on a professional computer interfaced to a mainframe processing system. The local system uses voice-input to facilitate data entry while data flagged for retention is stored on the mainframe. The system permits the investigator to monitor thousands of candidate cell lines until selection for specific antibody production is completed. All record-keeping aspects of hybridoma cell culture from establishment through freezing and storage of selected cell lines can be accomplished by personnel without computer expertise.

Antibodies, Monoclonal↗
PubMed1994

Computer program for connection and data management of an automated coagulation system: the KC 10.

In Europe, the KC 10, manufactured by Amelung Germany, is one of the instruments most commonly found in coagulation laboratories. For facilitating the work of technical validation, we wrote a software adapted to any IBM or compatible PC running under MS-DOS, to manage the analyser performance. Data are automatically collected via the BCD interface from the analyser or keyed in for the other techniques. The software deals with 64 different analyses entirely 'user defined'. An 'electronic worksheet' presents the results, by page of ten patients. This enables the laboratory technician to assess the coherence of the various data and to perform verifications or complementary tests if necessary. As an option, a blinking asterisk can signal all results outside predetermined range. By moving the cursor through the table, a test result can be deleted, modified or added. A function displays the patient's previous files in a window because the data are recorded in long-term archives at the end of the day. This long-term recording allows a search of previous files to decide additional tests if the patient is unknown. A daily archive function classifies and prints the whole day's work in alphabetical order. A protocol of communication allows connection to a mainframe Bayer-Technicon computer. This program and the user's manual are free, available on request from address above.

Blood Coagulation Tests↗
PubMed1991

Making the transition from information systems of the 1970s to medical information systems of the 1990s: the role of the physician's workstation.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these systems are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development of a Physician's Workstation which integrates information from multiple existing information systems and discuss how the workstation makes it possible to move from the departmental systems of the present to the computer-based medical record system of the future.

Computer Communication Networks↗
PubMed1991

The Physician's Workstation: an example of end user integration of information systems.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Computer Communication Networks↗
PubMed1991

Using Monte Carlo simulations in public health risk assessments: estimating and presenting full distributions of risk.

With desktop computers as powerful as mainframes were just a few years ago, analysts can now use commercial software to estimate full probability distributions for--not just point estimates of--health risks experienced by people chronically exposed to toxic chemicals at or near hazardous waste sites. Even though probability is the central concept in risk assessment, and even though probabilistic methods offer strong advantages and insights as compared to the "deterministic" methods now required by U.S. Environmental Protection Agency's guidance manuals, analysts have only begun to use probabilistic methods at Superfund sites. In this paper, we examine a simplified case study using Monte Carlo methods to estimate full distributions of public health risk. We demonstrate the use of "toggles" to isolate the contributions of different inputs, and we also offer new graphical methods to communicate the results to risk managers and concerned citizens.

Child↗