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PubMed1991

A new microcomputer software system evaluation paradigm: the medical perspective.

The new fourth-generation software has enormously eased the burden of computing for users, but they have also created a confusing, difficult problem in software evaluation and selection. Therefore it is argued that a sound and complete evaluation paradigm is a key element in an efficient and effective software system design and use process. While much has been written about software evaluation in general, in the medical field, the guidances and recommendations previously provided are too general to be of practical use. Considering also the other weaknesses of conventional evaluation paradigms we have decided to develop a more adequate one which will have a solid theoretical framework, specific guidances, strict and well-defined taxonomic space, and a fair ranking approach. In the present paper we will therefore introduce our new evaluation paradigm and show its applicability in evaluation and selection of medical software systems according to their usability.

Classification↗
PubMed1991

An assessment of the radiological module of NEONATE as an aid in interpreting chest X-ray findings by nonradiologists.

NEONATE is a prototype of an expert system for the Newborn Intensive Care Unit developed at the Primary Children's Medical Center in Salt Lake City, Utah. A pilot study was undertaken to see if the addition of radiological frames to the NEONATE software could aid attending Neonatologists to interpret chest X-ray films. A set of radiological frames was created from rules generated by a radiologist. The performance of these radiological frames was compared to the performance of other radiologists using the Kappa statistic to measure agreement. There is a good agreement between the computer's decisions and the radiologists' decisions. The radiological frames were also tested to see if they help physicians who are not trained in radiology. A system that compares the residents' interpretation and the computer's interpretation to a gold standard interpretation was developed. It shows that the computer helps the first and second year residents, but not the third year residents. This article suggests that NEONATE's interpretation of chest X-ray findings are close to the radiologists' interpretations. While NEONATE's radiological frames help novice physicians in reaching better chest X-ray interpretation, the current study suggests that they are not likely to help a Neonatologist.

Evaluation Studies as Topic↗
PubMed1991

A distributed approach to integrated inquiry and display for radiology.

Picture archive and communications (PACS) systems should be flexible and modular in design so that new advances in storage, computation, and display technology can be introduced into the system without a significant redesign of existing software. The acquisition, storage, and management of radiologic images must be carefully integrated with a radiology information system. Our architecture is based on a four-level data model: (1) patient information, (2) examination information and reports, (3) image information, and (4) instances of images. The PACS being developed at the Mallinckrodt Institute of Radiology within the Electronic Radiology Laboratory consists of three primary components: application clients, database servers and image servers. One type of application client is an image-capable workstation that supports a radiology image viewing application. The application client queries the database server for information regarding patient and examination data in response to user-level requests. The database server responds to the request by retrieving the appropriate patient demographics and examination information, along with a pointer to the image/instance data from a central database. The client then uses the image data pointer to query the image server for the actual pixel data. The image server responds by transmitting the pixel data to the requesting application client or a designated auxiliary display device. Other clients act as image data acquisition nodes. Queries to the database servers are made via a library of callable subroutines. Software integrity is maintained throughout the system by dynamically loading software from a code-control database. Inquiry and display transactions, supported on a local-area network (Ethernet), have been measured and analyzed. Results and observations are presented.

Computer Communication Networks↗
PubMed1992

Development of a diagnostic and therapeutic simulation system based on patient data and specialist's knowledge. I. Simulation of diagnostic process.

A new simulation system of diagnostic and therapeutic processes is developed. The aim is to train medical students for the practical use of their knowledge, utilizing patient data in a total hospital information system. The knowledge in the system is presented by the specialists for every case. In medical school there are many specialists in various fields. With their cooperation the system can grow up to a comprehensive CAI system for clinical education. The system is designed to work on the mainframe for easiness of development, maintenance and extensions of the system. The present framework has been applied to the simulation of diagnostic process. The usefulness of the present system has been confirmed by specialists and students.

Computer-Assisted Instruction↗
PubMedDate not supplied

Performance of computerized protocols for the management of arterial oxygenation in an intensive care unit.

Computerized protocols were created to direct the management of arterial oxygenation in critically ill ICU patients and have now been applied routinely, 24 hours a day, in the care of 80 such patients. The protocols used routine clinical information to generate specific instructions for therapy. We evaluated 21,347 instructions by measuring how many were correct and how often they were followed by the clinical staff. Instructions were followed 63.9% of the time in the first 8 patients and 92.3% in the subsequent 72 patients. Instruction accuracy improved after the initial 8 patients, increasing from 71.5% of total instructions to 92.8%. Instruction inaccuracy was primarily caused by software errors and inaccurate and untimely entry of clinical data into the computer. Software errors decreased from 7.2% in the first 8 patients to 0.8% in subsequent patients, while data entry problems decreased from 7.5% to 4.2%. We also assessed compliance with the protocols in a subset of 12 patients (2637 instructions) as a function of 1) the mode of ventilatory support, 2) whether the instruction was to increase or decrease the intensity of therapy or to wait for an interval of time and 3) whether the instruction was 'correct' or 'incorrect'. The mode of ventilatory support did not affect compliance with protocol instructions. Instructions to wait were more likely to be followed than instructions to change therapy. Ninety-seven percent of the correct instructions were followed and 27% of the incorrect instructions were followed.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Analysis↗
PubMedDate not supplied

Development of an expert system for haemodynamic monitoring: computerized symbolization of on-line monitoring data.

The development of intelligent alarm systems for intensive care benefits from the transformation of data from a quantitative to a qualitative mode. We constructed a computerized algorithm for the symbolization of on-line monitoring data of heart rate, systemic arterial, pulmonary arterial and central venous pressures, as well as central and peripheral temperatures. We tested the ability of the algorithm to symbolize the levels of the parameters and to detect significant long-term trends in ten adult patients admitted to the intensive care unit after cardiac surgery. The estimations of an experienced clinician were taken as the 'gold standard'. The symbolization of the levels of the monitored parameters was in agreement with the clinician in 99.4% of the estimations. The algorithm detected 93.0% of the trends correctly and also estimated their reliability. The clinician considered its estimations to be accurate in 96.2% of cases. On the other hand, the clinician considered unreliable 2.4% of all the trends detected and classified as reliable by the algorithm. The computerized algorithm for the symbolization of real-time monitoring data performed efficiently enough for its further use in expert systems for intelligent monitoring.

Algorithms↗
PubMedDate not supplied

INFORM: development of information management and decision support systems for High Dependency Environments.

The long-term aim in the INFORM Project is to develop, evaluate and implement a new generation of Information Systems for hospital High Dependency Environments (HDE-Intensive Care Units, Neonatal Units, Burns Units. Operating and Recovery Rooms, and other specialised areas). The distinguishing feature of the HDE is the very large amount of data that is collected through monitors and paper records about the state of critically ill patients; this has made the role of the staff a technical one in addition to a caring one. The INFORM System will integrate Decision Support with on-line, off-line and observed patient data and, in addition, will incorporate and integrate unit management features. In the Exploratory Phase of the Project, functional requirements have been set out. These are based on four components: conceptual model of the HDE; evaluation of existing HDE Information Systems; development of a novel software architecture using a Knowledge-Based Systems (KBS) methodology, and based on a critical review of KBS applied to the HDE: monitoring of appropriate leading-edge technological developments. The conceptual model has two components: a patient-related information model, and a department-related cost model. The patient-related model is identifying key and difficult areas of decision making. A key aspect of INFORM is integration of clinical Decision Support for these areas into the Information System through a layered software architecture. The lower layers are concerned with monitoring and alarming and the higher levels with patient assessment and therapy planning. The functionality and interconnection of these layers are being determined.

Decision Support Systems, Management↗
PubMed1988

An expert system on the diagnosis of ascites.

We constructed an expert system on the diagnosis of ascites, using a combination of case reports and unpublished patient data. Rule production was by induction from examples, and the program operated on an algorithm which was a modification of Quinlan's ID3. The result was a small, but formally complete expert system. When tested against a new data set of patients, our expert system predicted the clinical diagnosis 82% of the time.

Ascites↗
PubMed1989

(PLOT79): a comprehensive portable Fortran scientific line graphics system, as applied to biomedical research.

Scientific results are often most succinctly presented in graphical form. We describe a system for computer-generated scientific line graphics known as (PLOT79), named to commemorate the SIGGRAPH CORE graphics standard proposal of 1979. (PLOT79) is a widely used and actively evolving graphics system, written primarily in SFTRAN3, a structured procedural computer language which can be translated readily into Fortran. The package embodies concepts of sound software engineering, having been designed from the outset to be portable, maintainable and hardware-independent; much of the effort required to implement the system was directed toward the development of software engineering tools to ensure these goals. A modular design strategy has allowed a wide variety of graphics output devices to be supported. (PLOT79) has been installed under numerous operating systems, and software tools provided by UNIX have allowed particularly efficient installation and use of the system. Access to (PLOT79) is available through three avenues: (1) linking (PLOT79) routines with a user-written high-level program; (2) use of pre-written high-level applications programs which perform certain frequently-required tasks such as the plotting of simple two or three-dimensional data; or (3) the use of an interactive graphics command parser known as slides. (PLOT79) has proven popular among workers in the physical sciences and engineering both for its easy availability, openness (all source code is provided), and powerful capability. The system presents an equally important (though lesser known) resource for biomedical research, as demonstrated by examples from ongoing biomedical research projects. It also provides a focus for discussion of the practical limitations inherent in existing graphics standards and programming languages.

Computer Graphics↗
PubMed1992

A PC program for growth prediction in the context of Rao's polynomial growth curve model.

We consider the problem of growth prediction in the context of Rao's [1] one-sample polynomial growth curve model and provide a PC program, written in GAUSS, to perform the associated computations. Specifically, the problem considered is that of estimating the value of the measurement under consideration for a "new" individual at the Tth time point given measurements on that individual at T-1 previous points in time and the values of the measurement on N "similar" individuals at all T time points. The times of measurement t1, t2, . . ., tT need not be equally spaced, but we assume that each of the N individuals comprising the normative sample were measured at these times. The method and the program are illustrated using the leave-one-out method on a sample of N = 12 male rhesus monkeys whose mandibular ramus height was measured five times at yearly intervals.

Animals↗
PubMed1992

EndoCyte, an interactive computer program for quantitative analysis of receptor-mediated endocytosis.

We present EndoCyte, a user friendly interactive program for quantitative analysis of receptor-mediated endocytosis. The data, comprised of time-dependent concentrations of the ligand at the cell surface and the ligand internalized by cells, are analyzed by the application of a set of nested mathematical models of endocytosis. EndoCyte reduces data to parameters conventional in description of receptor-mediated endocytosis and a parameter which describes the non-linear effects. The performance of EndoCyte is documented by the analysis of applications to synthetic data.

Computer Simulation↗
PubMed1992

Impact on the management and delivery of primary health care by a computer-based information system.

Timely and accurate information forms the basis for management to plan and for care providers to take appropriate action. We report from a developing country a research project aimed to strengthen the information infrastructure with a computer at a Primary Health Centre. The software (MCHS) was designed to assist the care providers in the information management for the Maternal and Child Health (MCH) programme activities. In Phase I, a baseline survey was conducted to identify the needs and target groups. In Phase II, the MCHS was integrated into routine delivery of MCH to monitor the target population and help in evaluation. The research project's impact is reflected in enhanced utilization of services and quality in care, as seen by reduction of dropouts from the immunization program. In economic terms, we see that the costs for a fully immunised child are reduced with reduction of dropouts; thus, the computer system contributes to quality assurance and cost effectiveness in delivery of care.

Adolescent↗
PubMedDate not supplied

Using the job-exposure matrix for elaborating job histories.

A first software (JHS) for the elaboration of job histories oriented toward risks was designed and results published In an article "A software for the elaboration of Job Histories". This article presents a second software (JES), based on the use of a job-exposure matrix designed for one company. The matrix is essentially a database, an organized gathering of information concerning the company. The two softwares are inter-faced and both run on a PC. When properly exploited, the two softwares can serve as an asset for epidemiological studies dealing with occupational health.

Database Management Systems↗
PubMedDate not supplied

Computer-assisted rheological evaluation of microsamples of mucus.

Dynamic viscoelasticity measurements are required in many studies on biological fluids and they can be performed by determining the corresponding strain when a sinusoidal shear stress is applied to a sample. In several circumstances the amount of fluid that can be obtained for analysis in physiological conditions does not exceed microliters. In this context, the microrheometer technique is a useful approach to determine the dynamic rheological profile of the samples. However, the manual calculation of the desired parameters is tedious and time-consuming. This paper describes a menu-oriented program in order to facilitate its use by non-experts. The comparison between manual and computer-aided calculations demonstrated that the program reduced the time of measurement, and reduced intra- and interobserver variations. The program was developed on an IBM compatible PC in Microsoft C 5.1, and tested in a blind study to check the advantages in terms of time and reproducibility of the system verified by the concordance of two independent observers (interobserver influence) in two different occasions (intraobserver influence).

Bronchi↗
PubMedDate not supplied

The determination of the absolute bioavailability for drug substances with long elimination half-lives (with PC-programs for the method of truncated areas).

A survey is given of the methods for the determination of the absolute bioavailability for drug substances with long elimination half-lives. All methods depend on the assumption of linear pharmacokinetics. Emphasis is laid on Urso and Aarons' regression method of truncated areas-under-the-curve (AUC) to obtain estimates of the absolute bioavailability, F, and the absorption rate constant, ka, without obeying the otherwise general rule of following blood or plasma levels for at least three times the terminal half-life. It is shown by simulation when the linear and when the logarithmic trapezoidal rule is to be used for the calculation of the AUC. Two PC-programs for the regression method of truncated areas are presented: one program (SIMF&KA.EXE) simulates, based on tentative pharmacokinetic parameters, whether a blood sampling scheme, together with the precision of the analytical assay, is adequate to obtain accurate and precise estimates of F and ka; the method is insensitive to large variations in the tentative value of the elimination half-life. The other program (ESTF&KA.EXE) provides estimates of F and ka, with standard deviations of the estimates, from empirical data.

Biological Availability↗
PubMedDate not supplied

A scanning system for digital analysis of cineangiography films.

A system for scanning and digital analysis of cinefilms is presented and its performance is compared with entirely digital radiographic equipment. Apart from the difference between logarithmic and linear gray-scale representation, a higher noise level was found in the scanning system. When its spatial resolution was assessed visually, it was comparable to that of the digital system, although lower than when the cinefilming and scanning steps were evaluated separately. Algorithms for the correction of varying exposure and geometric ("pin-cushion") distortion are also presented. It is concluded that digital analysis after scanning of cinefilms can be a useful alternative to completely digital cineradiographic studies.

Algorithms↗
PubMed1992

Computer quantitation of saturation impairment time as an index of oxygenation during sleep.

The measurement of oxygenation during sleep has become a standard procedure in the assessment of hypoxemia in patients with various disorders. However, an accepted method for quantitating this hypoxemia is not available. This study describes the development of computerized data acquisition and analysis programs to quantitate nocturnal hypoxemia in patients with sleep and breathing disorders. The acquisition program samples the voltage output from pulse oximeters used to measure oxyhemoglobin saturation (SpO2) and stores this on an IBM PC or compatible computer. The analysis program integrates the SpO2 over time below the patient's pretest baseline as well as the integral below 90, 80, 70, 60 and 50% saturation. We refer to each integral as Saturation Impairment Time or SIT. In order to compare these integrals between patients or between the same patient but different studies, the integral is divided by the total sleep study time. We refer to each of these integrals, corrected for sleep study time, as the SIT index. Evaluation of the SIT index in 10 consecutive patients referred for various sleep disorders revealed acquisition program detection and deletion of 48 of 57 (86%) oximeter probe artifacts (mean duration of 3 seconds for undetected artifacts). There were no significant artifacts in the analysis program calculation of the SIT index in these same patients. In conclusion, computer programs were developed to measure and quantitate oxygen saturation measured by oximeters. Preliminary results reveal an accuracy of measurement which should prove acceptable in further clinical evaluations.

Diagnosis, Computer-Assisted↗