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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↗
PubMed1990

Improving access to computer-based library and drug information services in patient-care areas.

A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.

Computer Communication Networks↗
PubMedDate not supplied

MEDLINE, cancer-CD, SCI-CD addition on CD-ROM.

Compact Disc Read-Only-Memory, CD-ROM, is a powerful resource which combines the best features of both online and print access to the literature: multiple access points and leisurely browsing (online accessibility without a modem or without its cost). Applied to the MEDLINE database, this technology has created a brand new market, one which is increasingly competitive and therefore evolving rapidly. Five MEDLINE and two non-MEDLINE products are reviewed. The MEDLINE products include: BRS/COLLEAGUE DISC, Compact Cambridge, Ebsco's Core MEDLINE, Online Research System's Compact Med-Base, and SilverPlatter's MEDLINE on CD-ROM. The two other products include: Institute for Scientific Information's SCI CD Edition and SilverPlatter's CANCER-CD. The market is still wide open and the buyer is wise to try before he buys. However, there are great differences between the various packagings of a rather familiar product. In our view, in terms of ease of use, SilverPlatter was the clear winner. Ebsco's product is attractive because of its containment on one CD. Med-Base is the most original and offers special features not found elsewhere. Finally, personal preference is a strong consideration and should not be overlooked.

MEDLARS↗
PubMed1989

Accessing the biomedical literature: the South Dakota Med-Fax Network.

Librarians developed a plan for a medical information network based upon the needs of South Dakota physicians as revealed in a 1984 survey. The South Dakota Med-Fax Network received private funding in 1987 and became operational in 1988. The Network incorporates interactive simultaneous remote on-line database searching (ISRS) and telefacsimile transmission to expedite the identification and delivery of medical literature to South Dakota physicians. At present, the Network is composed of sixteen institutional sites. Individual physicians may establish their own sites if they provide an IBM compatible personal computer with a modem and purchase a telecommunications software package. The Network will provide training and follow-up support. Use patterns to date demonstrate that telefacsimile transmission is instrumental in reducing significantly the time necessary to deliver journal literature and that ISRS searching is the method of choice in the Network's remote sites.

Humans↗
PubMedDate not supplied

Computer-based patient monitoring systems. Use in research and clinical practice.

The use of new technologies, such as computers, in the management of diabetes has changed dramatically over the past decade. The development of the memory-based reflectance meter, telephone modems for the transmission of self-monitored blood glucose, and computer programs to aggregate and analyze data have significantly altered approaches to diabetes care. The clinical application of these systems is just now being evaluated. Initial data suggest that these systems enhance treatment, improve patient performance, assist in collection and representation of accurate and reliable data, and may be associated with improved metabolic control.

Blood Glucose↗
PubMed1988

Using microcomputer telecommunications.

The field of computers and communication is rapidly growing. Microcomputer telecommunications is a fairly simple new tool that can increase productivity and improve work skills. For those who have access to a microcomputer, the cost to add telecommunication capability is minimal while the payoff is unlimited. The next time you need an article about a particular topic or try to remember where you read a particular article, make travel plans or write a letter to a colleague in another state, think how easy it would be with your microcomputer and a modem.

Computer Communication Networks↗
PubMed1988

[Participation in a simple large-scale randomized trial organized by EORTC through an international computer network].

Case registration and treatment allocation was achieved in a "Simple large-scale trial against colorectal cancer" designed by the European Organization for Research and Treatment of Cancer (EORTC) using an international computer network system VENUS-P. The access to the central computer "EuroCODE" was obtained by simple equipment including ordinary microcomputer, modem and telephone line. Subscription to the KDD data network VENUS-P using a Packet Assembler/Disassembler (PAD) was necessary to connect to the EuroCODE. Intraoperative patient registration and allocation of treatment were possible through this system regardless of the time difference between countries. To organize a large-scale trial as a means to detect moderate but medically worthwhile treatment differences, this method proved to be particularly effective especially for international cooperative studies.

Colonic Neoplasms↗
PubMed1986

Computer-assisted instruction: a library service for the community teaching hospital.

This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.

Computer-Assisted Instruction↗
PubMed1986

Bringing the medical literature to physicians. Self-service computerized bibliographic retrieval.

Seven years ago physicians at the Beth Israel Hospital in Boston began doing their own searches of the medical literature. They used PaperChase, a computer program written especially for end users rather than for search librarians. The data base was initially limited to the journals shelved in the library of the Beth Israel Hospital, but it has since been expanded to include the entire MEDLINE collection of the National Library of Medicine-nearly 5 million references published in 3,400 biomedical journals dating back to 1966.PaperChase is now available throughout the United States and Canada to anyone who has a computer terminal or personal computer and a modem. No special training is needed for a successful search and there is no user's manual. Users can search by title word, "medical subject heading," author's name, journal title, year of publication, language of publication or any combination of the above. They can read abstracts on line, and they can request that a photocopy of the full text of any article be mailed to them.

Canada↗
PubMed1985

Outpatient computer-based 32-hour esophageal pH studies teletransmitted to a central esophageal laboratory.

Using a computer-based 32-hour esophageal pH system with a small patient-worn digital recording computer, outpatient studies are performed in the physiologic environment of the patient's workplace and home. Samples are taken at 15-s intervals, and the pH data stored in this computer are then fed into the main computer in the Central Esophageal Laboratory for analysis, scoring, printing out, and storage. Satellite esophageal laboratories located in regional hospitals, clinics, and physicians' offices conduct pH studies by telecommunication, using antimony electrodes, a recording computer, and a modem to transmit data to the main computer for high-quality computer analysis. One main computer and associated personnel serve multiple satellite stations. This maintains patient-physician relationships and is highly cost-effective.

Computers↗
PubMed1984

Transtelephonic electrocardiographic monitoring: reliability in detecting the ischemic ST segment response during exercise.

The ECG detection of ST segment depression during maximal treadmill exercise has diagnostic and prognostic significance in coronary artery disease. This study of 200 consecutive patients undergoing Bruce exercise testing for chest pain documents the ability of a transtelephonic ECG system, capable of storing segments of ECG memory during exercise, to reliably record ST segment depression detected during simultaneous exercise testing (sensitivity 79%; specificity 99.6%). Of the three transtelephonic ECG systems tested, the modified precordial V5 snap-on lead most accurately reflected ST segment amplitude and morphology with no "false positives" (specificity 100%) and few "false negatives" (sensitivity 78%). Therefore, this system is a potentially important clinical tool for accurately and conveniently monitoring coronary patients during exercise outside the hospital (e.g., following myocardial infarction) as well as for providing useful clinical information for ambulatory patients with undiagnosed sporadic chest pain.

Adult↗
PubMed1975

Clinical application of a second generation electrocardiographic computer program.

An electrocardiographic computer program based on multivariate analysis of orthogonal leads (Frank) was applied to records transmitted daily by telephone from the Veterans Administration Hospital, West Roxbury, Mass., to the Veterans Administration Hospital, Washington, D. C. A Bayesian classification procedure was used to compute probabilities for all diagnostic categories that might be encountered in a given record. Computer results were compared with interpretations of conventional 12 lead tracings. Of 1,663 records transmitted, 1,192 were selected for the study because the clinical diagnosis in these cases could be firmly established on the basis of independent, nonelectrocardiographic information. Twenty-one percent of the records were obtained from patients without evidence of cardiac disease and 79 percent from patients with various cardiovascular illnesses. Diagnostic electrocardiographic classifications were considered correct when in agreement with documented clinical diagnoses. Of the total sample of 1,192 recordings, 86 percent were classified correctly by computer as compared with 68 percent by conventional 12 lead electrocardiographic analysis. Improvement in diagnostic recognition by computer was most striking in patients with hypertensive cardiovascular disease or chronic obstructive lung disease. The multivariate classification scheme functioned most efficiently when a problem-oriented approach to diagnosis was simulated. This was accomplished by a simple method of adjusting prior probabilities according to the diagnostic problem under consideration.

Analysis of Variance↗