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PubMed1989

Automated spinal cord monitoring for spinal surgery.

A microcomputer-based automated spinal cord monitoring system was developed and 56 spinal operations have been carried out with it since 1986. The system comprises an electrodiagnostic system (Dantec 2000M), an FM tape recorder, a channel selector, an electrical relay, a Modem and a microcomputer which controls all of the elements. The program allowed for automated recording and analysis of evoked potentials during spinal surgery and alarm signals were generated according to the criteria of amplitude decrease and latency delay. It was demonstrated that automated spinal cord monitoring in the operating room was performed easily, reliably and safely allowing the surgeon to react quickly to possible compromise of the spinal cord. The design and usefulness of the system is described in this report.

Diagnosis, Computer-Assisted↗

PubMed1989

Remote monitoring of free flaps with telephonic transmission of photoplethysmograph waveforms.

Analog waveforms from bedside photoplethysmograph flap-monitoring devices have been transmitted via telephone lines to remote monitoring stations. Two methods for data transfer have been successfully used in clinical practice. One employs equipment similar to that used for transmission of EKG signals; the second uses paired microcomputers linked with telephone modems. These readily available technologies enable remote evaluation of the adequacy of perfusion of free tissue transfers.

Humans↗

PubMed1986

An integrated perinatal information system and telecommunications networking.

The integrated perinatal information system in Albany Medical Center has two significant features: that of a flexible user-definable database and ease of networking both locally and regionally. The unified perinatal record is structured in Ansi standard MUMPS and resides on the College Vax 750. A special set of program tools ensures effective multi-split screen display, moving pointers, and corresponding multiple choice entries. Because it is self contained, it has the ability to create complex data structures without programming. A powerful math/statistical library has been incorporated. In house, the use of existing PABX wire allows for simultaneous voice/data traffic. Linkage to the regional system is made by modem connection. The system is compatible with the demands of both clinical and regional management.

Computers↗

PubMedDate not supplied

[Medical applications of electronic data processing in surgery, trauma surgery and orthopedics. Results of a survey of 1,450 clinics].

With a standardized questionnaire we evaluated 1450 orthopedic and general surgery departments. The response rate was 57.2%, 52% of the departments were using computers for different purposes. The favoured system was the MS-DOS system (73%). The computers were mainly used for word processing (58%), statistics (50%), and graphics (39%). For clinical routine the leading use was patient documentation (70%) followed by patient report generation (43%). Other applications (e.g. online use of administrative data (19.4%) or the use of other patient information like blood parameters (10%)) were relatively rarely used. However, most of the users have plans to incorporate these applications in the nearest future. For the out patients care the leading application is private billing (42.5%) and statistics (30%). The majority of the departments (42.6%) only have one PC. Most of the departments use the printer for hard copies and as hard disc a the standard storage medium. The average storage capacity of the used hard discs is 40 to 80 MB. Other peripheral tools like a laser printer, a scanner, or modems are rarely used. Most of the departments invested between 5000 and 15,000,--DM. 33.3% financed the computers only with the official budget of the department. However, 25.8% only used private funds to buy the hard- and software. The distribution according to zip codes showed a slight accommodation in Bavaria and NRW. The amount of new installations showed an almost constant increase from 1975 until 1981. Between 1981 and 1990 there was a significant increase with a small drop in 1986.

Computer Systems↗

PubMed1989

Data source automation: new technology for the management of patient-generated test results.

Self-monitoring of blood glucose is widely accepted by patients today, but its usefulness to clinicians has been seriously limited by our inability to interpret the patient-generated data. It is difficult or impossible to make optimal use of hand-kept diaries, no matter how compulsively kept. Patterns elude us, summaries are inaccurate, and large blocks of data are almost entirely ignored. To remedy these problems, data source automation--the automatic recording of data at their site of origin--is being applied to diabetes. Meters will measure blood glucose and memorize the result, date, and time of day. One system even allows the patient to record insulin dosage, exercise, and diet. The advantage of these systems lies in their potential for data management. Recognition of patterns of blood glucose concentration, easy longitudinal comparison of data, and aggregation of large data bases are all facilitated by computerized manipulation of the stored data. In-hospital use of glucose meters can have better documented quality control. It is possible to communicate data to physicians by telephone modem. Effective use of these systems, though, requires convenient software; and their acceptance in actual clinical practice must be demonstrated. But data management capabilities, as they are refined and brought into common use, could significantly improve diabetic management.

Autoanalysis↗

PubMed1992

An overview of networking for physicians and problems of network consulting in remote areas.

For computer networking the most suitable operating systems are UNIX or MS-DOS. As networking software UUCP and TCP/IP are most common. Hardware requirements are derived from the operating system and from the networking software. Low-cost solutions, for example, uuPC, a public domain version of UUCP, require only an 8088 processor and a 2400-baud modem. TCP/IP fares better with more powerful processors and requires permanent lines between the connecting computers. In developing countries the introduction of computer networks is hampered by several factors: lack of foreign exchange, price of hardware and software, unreliable electricity and telephone lines, lack of hardware and software support, large distances to the nearest center, and incompatibilities between existing systems and the network. Important aspects for clinical networking in developing countries include appointment scheduling in the referral hospitals, access to laboratory and pathology results from the central laboratory, and primary health care information such as epidemiologic data. Advanced systems, for example, for image processing, are not yet feasible in developing countries.

Computer Communication Networks↗

PubMed1992

Improved care of patients with diabetes through telecommunications.

This project tested the importance of enhanced information transfer of home monitoring results to health care providers. The study tested whether computer-assisted communication of medical information between the chronic care patient and the physician can result in health care benefit. The information tools were constructed/adapted as a test of this hypothesis for diabetes mellitus. Patients connected a glucometer to an intelligent modem weekly for six to nine months. Graphical and mathematical tools extracted and emphasized the information content of the home monitoring data arriving at the central site. Data smoothing, trend analysis, and calculation of quality control statistics were incorporated into a graphical time series oriented report that was used by the health care provider during an outpatient visit. The integrated home monitoring system was tested on 20 patients with diabetes in a double cross-over design over a 15-month period. A significant improvement in serum glucose control as measured by glycated hemoglobin was shown in the study group, but not in the control group.

Algorithms↗

PubMed1991

Computerisation of primary care in Wales.

OBJECTIVE: To obtain information about the computerisation of general practice in Wales, and to enable more effective planning of educational provision for doctors and other primary health care workers. DESIGN: Postal questionnaire sent to all general practices in Wales. SUBJECTS: 553 general practices, of which 401 (73% replied). RESULTS: The level of computerisation varied from 11 (85%) of practices in Powys Family Health Services Authority to 22 (40%) in Mid Glamorgan. Less than half of practices had a computer in only two authorities. The commonest uses of the computer were for patient registration (208 practices), repeat prescribing (180), call and recall of patients (165), and partial clinical records (122). The main suppliers were VAMP (78 practices), AAH Meditel (46), and AMC (23). 102 of 226 practices with a computer had a terminal on each doctor's desk. Just 33 practices had full patient notes on computer and 51 had modems for electronic communication. CONCLUSION: Mechanisms to encourage greater and more sophisticated use of computers and information technology need to be explored.

Ambulatory Care Information Systems↗

PubMed1988

NeuroSIG: the computer network of the Congress of Neurological Surgeons.

A sophisticated computer network has been developed specifically for use by the Congress of Neurological Surgeons. This network provides a variety of communication and information features. These include public and private message transmission, teleconferencing, numerous data libraries, programs that may be downloaded and executed on the user's own computer, high resolution color graphics image transmission, an extensive neurosurgical database, and extensive on-line "help" features. The system can be accessed using almost any personal computer and a telephone modem.

Computer Communication Networks↗

PubMed1986

Transmitting deaf sign language over the telecommunications network.

An experimental investigation is reported into the use of moving cartoon images for two-way communication by the deaf. The images are derived by special signal-processing operations on the output of a conventional television camera, according to a new theory of perceptually important human features. Calculations show that, using facsimile-type coding and digital modems, the images are capable of transmission over the Public Switched Telephone Network; in enhanced form (with more resolution and optional voice accompaniment) they could be carried on the emerging Integrated Services Digital Network or transmitted over teletext.

Communication Devices for People with Disabilities↗

PubMedDate not supplied

A fast communication aid for non-verbal subjects with severe motor handicaps.

A computer-based communication system for non-verbal persons with severely deficient coordination of the upper extremities is described. The device doubles as an environmental control unit. Modular design is chosen throughout. Commercially available subunits are used to reduce cost. Input is by a 3 x 3 keyboard, when the user has some command over his hands. Otherwise a binary 'autoscan' access mode is used, which is controlled by repeated closures of a single binary switch. Output is in written form on a display or acoustical by synthesized speech. Hard-copy output can also be provided. Remote communication is possible by modem or by synthesized speech. Speed of message generation is increased by establishing a vocabulary, which contains, in addition to signs and letters of the alphabet, whole words and stereotyped phrases. The data blocks of the latter are accessed by a single input cycle similar to that used for the selection of isolated letters, symbols, etc.

Communication Devices for People with Disabilities↗

PubMed1992

Increases in knowledge and use of information technology by entering medical students at McMaster University in successive annual surveys.

OBJECTIVE: To determine self-reported microcomputer and information technology competency, access, and usage by entering medical students and their perceptions of the need for training in additional applications. DESIGN: Cross-sectional surveys of successive classes. SETTING: McMaster University Faculty of Health Sciences Medical Undergraduate Program, which has a 33-month, problem-based, self-directed learning curriculum and a high applicant-to-student ratio. PARTICIPANTS: Medical school classes entering in 1987, 1988, and 1989. Response rates were 80%, 90%, and 86% respectively. MEASURES: A self-report questionnaire was sent to each student, with up to two follow-up letters to prompt a response. RESULTS: There was a progressive rise in reported information technology access and use for the three years. For the classes starting in 1987, '88, and '89 respectively, computer access was 29%, 49%, and 49% (P < 0.002 for linear trend), and, among those with computer access, modem access was 17%, 29% and 50% (P = 0.012). Self-service MEDLINE use on CD-ROM at the Health Sciences Library was 65%, 75%, and 89% respectively (P < 0.001) for all respondents within the first few months of starting medical school. Over 50% of each class stated they would take courses, if available, on clinical applications software, office management, online searching, filing, and CD-ROM searching. CONCLUSIONS: Half of the most recent entering students already had access to a personal computer and most wished to learn computer applications that would assist them with patient management, and with information access and organization. Medical schools need to address which applications they will teach or make available and how to bring all students to acceptable competency in their use.

Computer Literacy↗

PubMed1992

Can teledialysis help in the clinical management of patients on remote hemodialysis?

This study investigated whether transmission of the parameters monitored from a remote center to the main center could improve the control of a dialysis session. The parameters of the computer connection module Monitral SC in remote and main centers, were transmitted by means of the Hospal data collection software (Demoplus) by modem, to the host computer. Each remote center can be temporarily disconnected, if necessary, from the telephone line and linked directly to a local computer. We checked 101 hemodialyses. The dialysis was monitored from filter washing to disconnection of the patients and the following parameters were selected: backfiltration during washing and hemodialysis: ultrafiltration, conductivity and temperature. From the sessions recorded (93%) we observed that backfiltration during the filter preparation phase was high (30%) in 28 sessions. Backfiltration during the preparatory phase is the major problem for correct management of dialysis sessions. The high percentage in which ultrafiltration had to be stopped shows that control of this parameter is still not ideal. Finally, the collection of monitor parameters and the comparative analysis of clinical data is useful for improving dialytic management.

Adult↗

PubMed1992

CAD/CAM in dentistry: a historical perspective and view of the future.

What can we look forward too? Lots of fun with new CAD/CAM systems that will enhance dentistry, providing quality restorations quickly. The evolution of an array of new versions of already available systems as well as altogether new systems will provide improved quality, expanded capabilities, and increasing user friendliness. And new materials will be more esthetic, wear more nearly like enamel, and strong enough for full crowns and bridges. We can also look forward to lots of change. Because of the cost of CAD/CAM systems, many clinicians are likely to collaborate by sharing a single system. Laboratories and clinicians may collaborate as well, with data being gathered in the operatory and sent to a laboratory via modem. The fabrication would then be done by the laboratory. Other changes that we cannot even predict are likely to occur in dentistry. Exciting times are here. Automation through dental CAD/CAM systems will, most certainly, change the profession. The impact of that change will only be known in the future. But as the future approaches, the systems and materials available to us will continue to evolve, improve, and enhance dentistry.

Artificial Intelligence↗

PubMed1992

[Computer-assisted ENT medical literature search and literature management--a report of experiences].

The increasing number of medical articles calls for a computer-aided system for literature database programs, literature retrieval and bibliography systems. We report an assessment of a dedicated modem line to DIMDI of Cologne (an institute offering a variety of biomedical, psychological and other literature databases), Medline on Silverplatter, Current Contents on disk and the Papyrus bibliography system. The databases with retrieval software are installed on a IBM-compatible PC (386 with an 80MB hard disc) and 4 CD-ROM players. Medline contains bibliographic citations and abstracts of biomedical literature; Current Contents on disk with its weekly update provides citations of articles published very recently; and the Papyrus bibliography system maintains a permanent collection of reference citations. When linked to a word processor, Papyrus can automatically read the manuscript, create a bibliography and produce a new copy of the manuscript in which the citations have been appropriately edited, and the references can be printed in any desired format. Although not without drawbacks, the configuration described here proved to be a valuable, time-saving tool to access citations precisely.

Computer Systems↗

PubMed1991

Personal computer access to MEDLINE: an introduction.

Physicians can personally search MEDLINE to answer clinical questions or to update their knowledge base. The components required, each of which is discussed in the text, are a personal computer, a communications software program, a modem, the literature database, and an information vendor. Physicians can assemble and use these components with a minimum of expense and computer knowledge. For the novice searcher who does not want to make a large initial investment, obtaining a low-cost personal computer and using an information vendor such as GRATEFUL MED or PaperChase may be the most suitable alternative. For searchers without access to a medical library or for more experienced searchers, an information vendor such as BRS, MEDIS, or DIALOG may be more appropriate.

Computers↗

PubMed1990

PaperChase: a user-friendly program for searching the biomedical literature.

PaperChase is a computer program which provides an efficient interface to the National Library of Medicine's MEDLINE database of references to the biomedical literature. The database includes references (citations) and abstracts compiled from Index Medicus, the International Nursing Index and the Index to Dental Literature. PaperChase may be accessed using any computer terminal or personal computer with modem. No special knowledge of computers or biomedical terms is necessary. Simple menus enable the novice to search the biomedical literature without training. A command language speeds searching for the experienced user. PaperChase does not require the user to know the database's indexing terminology, called Medical Subject Headings. Everyday language may be used and PaperChase will translate, or "map", the user's search term into the required Medical Subject Heading. PaperChase monitors a search in progress and suggests additional Medical Subject Headings which can be used to broaden or narrow a search. The searcher can order a full-text photocopy of any reference found in PaperChase. Support documentation and a subscriber newsletter are provided at no charge. Trained search specialists are available to offer assistance and to answer questions.

MEDLARS↗

PubMedDate not supplied

Communicating in the 1990s: a technology update.

With the variety of available technologies, choosing among them will be difficult at best. Waiting for integration and standardization among technologies may effectively eliminate a competitive edge and productivity improvements for health care organizations. Also, selecting which one communication technology is needed may not be the issue since several technologies likely are needed to solve different communication needs in organizations. One might begin to sort out options by performing an assessment of current communication patterns and deficiencies. Ideally, the assessment should be completed by someone who is able to assess needs over an entire organization, not just one service or one organizational level. The assessment should focus at least on some of the following questions. Are three major problems with staff or client communications? If staff-related, are primary needs interactive with routine communication needs? If they are interactive, time-sensitive, and inter-organizational then a form of video-conferencing may help. Short-term interactive needs might be met by leasing video-conferencing rooms. Long-term, time sensitive interactive needs might require PC-based video-conferencing, Non-time-sensitive, interactive, inter-organizational needs might be met with voice mail or e-mail, which allow some time-delayed but single-mode interactions. If communication needs are routine, one might examine how e-mail, or fax could help. If text-based paper traffic through the mail room is enormous or slow, e-mail may help. If communication among persons at any level of geographically separate organizations is needed, modem-based or public e-mail may be the answer.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗