[ENGINEERING IN MEDICINE. BIOLOGIC SYSTEMS THROUGH THE EYES OF THE ENGINEER].
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The organization of a new medical school library offered a unique opportunity to develop machine methods of bibliographic control and to use electronic data processing for library routines. The development of the program and an analysis of major problems is reported. The program uses IBM record unit, punched card equipment: the IBM 407 Model E8 Accounting Machine, the IBM 26 Printing Card Punch, the IBM 82 Sorter, and the IBM 85 Collator. The total machine rental. with educational discount, for the program is $506.50 per month. A specific report is given of the ordering. receiving, and processing (including cataloging) procedures.
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The microbiological information system ISM gives the possibility to collect data of patients and findings on punch strips, to transmit the findings to the senders and to store and evaluate the data according to medical points of view and for the purpose of performance statistics. The essential elements of the system are demonstrated and the basic principles of the data processing apparatus type R300 are described. Here the author particularly enters the calculator-internal testing processes for elimination of codation and punching errors. Finally the further development of the information system provided is briefly sketched. The advantages of the use of electronic data processing result from 1. the simplificstion and unification of the information relations, 2. the reduction of writing work, 3. the centralised transmission of findings, 4. the increased security of data and 5. the possibility of mathematico-statistical evaluations of the stored data material. According to its basic conception the information system ISM may be used universally and it is possible to enlarge it.
Information about the use of data processing systems in prehospital emergency medicine were collected, using a questionnaire sent to all German rescue helicopter bases. Twenty-seven of the 42 German rescue helicopter bases returned the questionnaire. At present, only 15 of them take advantage of electronic data processing. All of them enter their data manually by keyboard, automatic data transfer by means of a bar code reader is available at one base only. The stored data are used for statistical analysis (n = 15), quality assessment (n = 10), administration (n = 10), research (n = 9) and education (n = 7). Based on the data of this survey, one fifth of those who replied use their computer only for administrative purposes, the other also manage patient and mission data with their computer systems. Today, documentation of a rescue mission consists of patient data, vital data, mission data and information about the procedures carried out. The use of a computer system, however, requires more time and work than a handwritten record, when most of the data have to be entered manually using a keyboard. Future developments may include automated data transfer and digitization of handwritten documents to decrease the workload of the staff. For the automation of data transfer, configuration and synchronisation a standardized interface in all medical devices is required. There is a clear need for the use of data processing systems in emergency medicine.
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In cooperation with the Department of Electronic Data Processing Systems we have developed a data processing unit for the analysis of hemodynamic data at the Department of Internal Medicine I. The aim was to design a computer-system for the daily routine in heart-catheterizations as well as for the solution of scientific problems during hemodynamic studies. In the on-line-mode besides the ECG up to four pressures can be analysed simultaneously. Analog and digital tapes can also be processed off-line on demand. The concept of the whole system and the individual steps of computer-handling are adjusted to the problems of data-analysis in praxis from the viewpoint of the examining cardiologist. Since the system is interactive after each measurement and each given command the computer-results are displayed on the video-scope. Because of the modular structure of the program new medical criteria can easily be implemented at any time. Since the computer-system is not effectively used with only one cath-lab other units possibly of different hard-ware configuration can be connected simultaneously to the computer. Each cath-lab shares 16 K out of the total 32 K core-memory. The results are displayed graphically and alpha-numerically on video-scope, x-y-plotter and line printer. The sampling-rate for fluid-filled catheters is 200 Hz and for catheter-tip-manometers 400 Hz. Smothing and differentiation-procedures are adapted to the respective catheter-material. The computer-program calibrates the different pressure amplifiers automatically. After defining the catheter-position the pressure-signals are sampled for 10 s and immediately afterwards analyzed by the computer. The ECG and the corresponding pressure-curves are displayed on the video-scope. The automatically selected representative beat as well as each of the identified and numerated other beats of the sampling-phase can be displayed selectively together with its numerical results. The computer marks the positions within the pressure-curves, where the individual measurements were taken. Besides the systolic and diastolic pressures in valvular stenosis the maximal and mean systolic or diastolic gradients, ejection- or filling-period, valve-flow and valve-area are calculated autonomously. The calculation of cardiac-output, different volume-indices and stroke-work-index are based on Fick-method, thermo- or indicator-dilution technique. The contractility-parameters max dp/dt, t-max dp/dt, max dp/dt/DP, max dp/dt/P, VPM, V40, min dp/dt and the stiffness are computed for the left and on demand also for the right ventricle. Data of the patient and the operating-team, catheter-technique, complications and free comments are transmitted to the computer via terminal together with the actual time. The computer-system was drafted for permanent use. Therefore possible technical defects have been anticipated in the design of hard- and soft-ware. In cases of failure suitable steps allow the immediate restart of the system without loosing information...
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