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PubMed2002

Healthcare telematic applications in Cyprus.

OBJECTIVES: a) To present a review of ongoing health telematic applications in Cyprus. b) To promote the use of these health telematic applications in the Cyprus region. c) To help in the spin off of other health telematic applications thus enabling the offering of a better health service to the citizens. METHODS AND RESULTS: The health telematics applications include a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a system for the evaluation of the risk of stroke by telemedicine (EROS), a diagnostic telepathology network in gynaecological cancer (TELEGYN), a collaborative virtual medical team for home healthcare of cancer patients (DITIS), and a health telematics training network (HEALTHNET). The paper refers to the set-up and characteristics of these applications and tries to relate them with the health policies that should be applied in Cyprus. CONCLUSIONS: It is anticipated that this paper will promote the importance of health telematics applications for Cyprus and increase the awareness on the possibilities that these applications offer for health policies in all levels of health related human resources.

Ambulances↗

PubMed2004

The LifeShirt: a multi-function ambulatory system monitoring health, disease, and medical intervention in the real world.

Despite advances made in health-related ambulatory monitoring, medical practitioners and researchers have remained seriously constrained in their ability to acquire concurrent assessments of multiple physiological systems, as well as patient reports of symptoms and well being in daily life: Almost all past and current applications have been limited to the registration of a single variable (e.g. the electrocardiogram or blood pressure), and this has resulted in incomplete information about other relevant physiological and environmental factors likely to contribute to disease or its amelioration. Monitoring of multiple physiological functions has been too complicated to achieve and has required special measurement devices that have been unavailable, too expensive, or too cumbersome to effectively employ. Concurrent assessment of pertinent information about patient activities during monitoring has remained difficult to accomplish, although such information is likely to be crucial for the interpretation of physiological findings and patients' perceptions of improvement. The LifeShirt (Vivometrics, Inc., Ventura, CA, U.S.A.) is a multi-function ambulatory device capable of simultaneously monitoring several physiological signals and patient reports of symptoms and well being. The LifeShirt system is an extensible data acquisition and processing platform consisting of a garment, a data recorder, and PC-based analysis software. Sensors in the LifeShirt garment continuously monitor respiration, the electrocardiogram, activity and posture. Other functions are easily plugged into the system, including pulse oximetry, EEG/ EOG measurement, blood pressure, temperature, capnometry and acoustic monitoring. Subjective patient data may also be entered into the LifeShirt recorder, and all data are encrypted and written to a flash memory card. Vivologic(TM) analysis software provides full-disclosure analysis and display of high-resolution waveforms and over 30 derived parameters; the software also produces summary reports for clinical diagnostic purposes. The LifeShirt has been rigorously tested for more than 38,000 hours in 90 studies with 1,750 subjects. The device has received all necessary regulatory approvals and is currently used in leading research institutions throughout the United States, Canada and Europe. Clinical applications include sleep diagnostics, heart disease, pulmonary disorders, cardiopulmonary rehabilitation, early hospital discharge and pre- and post-operative monitoring, human-factors in ergonomics and behavioral medicine.

Cardiovascular Diseases↗

PubMed1997

Electronic communication with patients. Evaluation of distance medicine technology.

OBJECTIVE: To evaluate controlled evidence on the efficacy of distance medicine technologies in clinical practice and health care outcome. DATA SOURCES: Systematic electronic database and manual searches (1966-1996) were conducted to identify clinical trial reports on distance medicine applications. STUDY SELECTION: Three eligibility criteria were applied: prospective, contemporaneously controlled clinical trial with random assignment of the intervention; electronic distance technology application in the intervention group and no similar intervention in the control group; and measurement of the intervention effect on process or outcome of care. DATA EXTRACTION: Data were abstracted by independent reviewers using a standardized abstraction form and the quality of methodology was scored. Distance technology applications were described in 6 categories: computerized communication, telephone follow-up and counseling, telephone reminders, interactive telephone systems, after-hours telephone access, and telephone screening. DATA SYNTHESIS: Of 80 eligible clinical trials, 61 (76%) analyzed provider-initiated communication with patients and 50 (63%) reported positive outcome, improved performance, or significant benefits, including studies of computerized communication (7 of 7), telephone follow-up and counseling (20 of 37), telephone reminders (14 of 23), interactive telephone systems (5 of 6), telephone access (3 of 4), and telephone screening (1 of 3). Significantly improved outcomes were demonstrated in studies of preventive care, management of osteoarthritis, cardiac rehabilitation, and diabetes care. CONCLUSIONS: Distance medicine technology enables greater continuity of care by improving access and supporting the coordination of activities by a clinician. The benefits of distance technologies in facilitating communication between clinicians and patients indicate that application of telemedicine should not be limited to physician-to-physician communication.

Communication↗

PubMed1997

Computerized education in a multi hospital university medical center.

The advantages of using authoring, instructional, and informational computer applications in a university-based multi-hospital medical teaching center are vast. Software applications are used by the staff development educators at The Presbyterian Hospital, Columbia University Medical Center (CPMC) for test construction and administration, information processing, instruction, assessment, and evaluation. The media formats include Windows and DOS based CAI programs, CD ROM, IVD, INTERNET sites, and other on-line resources. This presentation will focus on how nurse educators use the various types of software applications available on the CPMC network and in the multimedia center, and on the benefits experienced by learners, educators, and nursing management and administration.

Academic Medical Centers↗

PubMed1999

Economic studies and 'technical' evaluation of telemedicine: the case of telemonitored polysomnography.

Information and communication technology (ICT) is not yet integrated into current medical practice and frequently, organizational patterns of health care production are held responsible for this situation. However, and quite paradoxically, measures recently taken in France indicate that a preferential role is granted to ICT in order to promote the development of healthcare networks. In this context, one should carefully examine which factors, other than organizational ones, can explain the very slow diffusion of telemedicine. Actually, medical assessment of telemedicine is very seldom and the medical community is unable to appreciate the extent that this technology would modify the quality of care provided. Furthermore, and as a consequence of the former, there is no economic evaluation of telemedicine applications and its effects, in terms of productivity, remain virtual. In this article, based on an early evaluation of telemonitored polysomnography to diagnose sleep apnea syndrome, we show that it is possible, even at an experimental stage, to produce appropriate and convincing clinical results stating the true technological effectiveness (choice of an adequate clinical trial, selection of appropriate endpoints). Specific attention is given to the technical conditions in which the technology is assessed, we also provide most of the data that should be taken into account to foresee the major organizational transformations of the production processes. Our results show that early clinical ad hoc evaluations of telemedicine applications can be conducted promptly, providing strong clinical results and useful data for any forthcoming economic evaluation.

Adult↗

PubMed1998

Neural networks: a new technique for development of decision support systems in dentistry.

OBJECTIVES: To outline the key concepts of neural network based systems and to evaluate the potential applications of such systems in dentistry. DATA SOURCES: Published work on neural networks. CONCLUSIONS: Neural networks may initially seem complex and computer intensive, but actually integrate well with a clinical environment. Neural network expert systems may be trained with only clinical data and as such can be used where 'rule based' decision making is not possible. This is the case in many clinical situations. Neural networks may therefore become important decision making tools within dentistry and have applications both in improving clinical care and in maximizing the cost benefit of care.

Algorithms↗

PubMed1996

Reaping the benefits of medical information systems.

Increasingly, external forces affect and constrain physicians' clinical decision making and consequently their practice of medicine. Physicians are expected to achieve optimal patient outcomes at the lowest possible cost, which requires that they have quick and convenient access to comprehensive clinical information from different sources. Considerable experience to date has shown that computers can improve physicians' problem solving and decision making by presenting pertinent data, information, and knowledge when it is needed, where it is needed, and in an appropriate format. The authors advocate the use of medical information systems in the daily practice of medicine. They identify critical information-related issues affecting clinicians, provide a brief overview of computer applications in medical care, and discuss studies that indicate how medical information systems can assist physicians in the delivery of cost-effective, high-quality care. Finally they discuss how individual institutions can best reap the benefits of medical information systems.

Efficiency, Organizational↗

PubMed2003

Open, flexible and portable secure web-based health applications.

This paper presents a totally generic client-server model for accessing legacy and new databases according to the three tier architecture principles. It is based on an integrated environment that eases the dynamic creation and instantiation of secure web applications that access multiple database management systems. Emphasis is placed on the ability to query almost any type of relational database and queries can simultaneously address a multitude of data sources. The information is collected, assembled and presented to users depending on a possible set of user profiles. These profiles originate from work on securing the conduct of clinical studies. This has been achieved in the context of the EU funded project HARP (Harmonisation for the Security of Web Technologies and Applications). The generic character of the model is exploited through an accompanying set of development tools. This permits efficient and effective creation and maintenance of applications in several domains of health telematics and beyond. Main merit is the lightweight character of the resulting platform, whereby all necessary instantiations are accomplished through a set of related XML documents.

Computer Security↗

PubMed1995

Collaborative health care information system development through sharable infrastructure, services, and paradigms.

The Decision Systems Group has focused for several years on software architectures and software engineering approaches to support collaborative development for health care information systems. The goal is to be able to more readily develop complex applications that require integration of a variety of information resources. Our efforts are aimed at four primary capabilities: (1) a software environment, Arachne, for developing applications by incorporation of components created by disparate developers, developing component classes, for providing cross-platform graphical user interface support with remote rendering, and incorporating evolving software engineering standards; (2) a library of domain-specific components for medical applications; (3) a user interaction paradigm that provides a framework for applications that integrate both clinical data and other information resources for education and decision support; and (4) improved understanding of the collaborative process per se and the development of methodologies to support it.

Information Systems↗

PubMed1997

SAM: speech-aware applications in medicine to support structured data entry.

In the last two years, improvement in speech recognition technology has directed the medical community's interest to porting and using such innovations in clinical systems. The acceptance of speech recognition systems in clinical domains increases with recognition speed, large medical vocabulary, high accuracy, continuous speech recognition, and speaker independence. Although some commercial speech engines approach these requirements, the greatest benefit can be achieved in adapting a speech recognizer to a specific medical application. The goals of our work are first, to develop a speech-aware core component which is able to establish connections to speech recognition engines of different vendors. This is realized in SAM. Second, with applications based on SAM we want to support the physician in his/her routine clinical care activities. Within the STAMP project (STAndardized Multimedia report generator in Pathology), we extend SAM by combining a structured data entry approach with speech recognition technology. Another speech-aware application in the field of Diabetes care is connected to a terminology server. The server delivers a controlled vocabulary which can be used for speech recognition.

Cell Biology↗

PubMedDate not supplied

[Informatics and parenteral and enteral nutrition: the state of the art].

A review was performed of the progress made with the assistance of computers in the parenteral and enteral nutrition field as one more of the many uses made today of the computer industry. Detailed analysis is presented by the authors of the different types of hardware used, as well as the main characteristics and content of the programmes and applications existing in this field, both restricted to small working groups and in management. A comparative study was also made of the management programmes distributed free of charge by some laboratories. Finally, an evaluation was made of the advantages and disadvantages of using computers in parenteral and enteral nutrition at present.

Computers↗

PubMed1998

Convincing cases: important component of user acceptance.

This paper is presenting the rational that lead to the organisation of the European workshop on Acceptance of Telematics Applications by Healthcare Professionals "Looking for the convincing cases," that took place in Thesaloniki 12-13 December, 1997. A brief overview is presented of the health telematics sector, the current situation of the usage of some applications, and major challenges towards wide implementation of health telematics applications. It focuses on user acceptance as one of the critical challenges towards wider implementation. It concludes that the support and promotion "Convincing cases" are important components contributing to user acceptance.

Attitude of Health Personnel↗

PubMed1999

[Telemedicine--technology, application, evaluation and prospect].

With the information society drawing near, the pattern of medical treatment is changing. Telemedicine is now carrying out many purposes such as family health care, first aid, expert consultation, long-distance intervene and learning communication in it's particular mode. This article will enter into some engineering-technology methods of medical information transmission (including data, sound and image), introduce several application field of telemedicine , evaluate the potential benefit, virtue and some problems which are likely to arise in the implement of telemedicine, and forecast the development of telemedicine in the future.

Aerospace Medicine↗

PubMedDate not supplied

Automated computer interviews to elicit utilities: potential applications in the treatment of deep venous thrombosis.

OBJECTIVE: To assess the practicality of an automated computer interview as a method to assess preferences for use in decision making. To assess preferences for outcomes of deep vein thrombosis (DVT) and its treatment. STUDY DESIGN: A multimedia program was developed to train subjects in the use of different preference assessment methods, presented descriptions of mild post-thrombotic syndrome (PTS), severe PTS and stroke and elicited subject preferences for these health states. This instrument was used to measure preferences in 30 community volunteers and 30 internal medicine physicians. We then assessed the validity of subject responses and calculated the number of quality-adjusted life years (QALYs) for each individual for each alternative. RESULTS: All subjects completed the computerized survey instrument without assistance. Subjects generally responded positively to the program, with volunteers and physicians reporting similar preferences. Approximately 26.5% of volunteers and physicians had preferences that would be consistent with the use of thrombolysis. Individualization of therapy would lead to the most QALYs. CONCLUSIONS: Utilization of computerized survey instruments to elicit patient preferences appears to be a practical and valid approach to individualize therapy. Application of this method suggests that there may be many patients with DVT for whom treatment with a thrombolytic drug would be optimal.

Adult↗

PubMed1993

Automated translation between medical vocabularies using a frame-based interlingua.

The integration of clinical systems almost always requires a translation phase, where vocabularies are compared and the similar concepts are matched. The lack of standards in the area of medical concept representation makes this task very difficult. The authors describe the development of a frame-based application that automatically translates terms found in one vocabulary to another. The application implements an innovative scoring algorithm that ranks the best matches using an exponential scale. Preliminary results and the comparison against a manual process in the same domain are also discussed.

Electronic Data Processing↗

PubMed2002

A rapid usability assessment methodology to support the choice of clinical information systems: a case study.

We present here an adapted methodology integrating usability engineering and early evaluation procedures to support the choice of a Clinical Information System in the context of a standard Call for Tender. We illustrate the application of this methodology with a case study. We integrated a standard 'contextual task and activity analysis' into the choice process and then drew up usability recommendations for the choice of an application. We organized a one-week on-site exhibition and test for each candidate company. During the test sessions, we performed a rapid usability assessment. The final choice of the application is strongly and positively influenced by the results of the usability assessment.

Consumer Behavior↗

PubMed1990

Applications of computer technology in dentistry.

Technological advances in industrial manufacturing have contributed to improvement in productivity and quality of dental care. However, computer technology has also been exploited but not to the same extent as other forms of technology. This paper examines computer applications that have been utilised by various groups of dental professionals in the provision of dental care and in dental education. The benefits derived from existing applications and future possibilities are seen in the following fields. In practice management, besides the usual collecting, sorting and searching of data, productivity and efficiency are greatly increased through computer appointments, recall and practice analysis programmes. In patient education, the use of computer graphics has enabled simulation of cosmetic changes to be presented to the patient with before and after possibilities. Dental education and communications have moved forward with the introduction of Computer Assisted Instruction programmes, and bibliographic databases including electronic transmission of Continuing Dental Education which are now easily available. In the field of Diagnostics and Treatment planning, the advent of CAD-CAM has made possible the use of cutting devices which mills a 3-dimensional model of the designed restoration from solid blocks of gold. Computer applications has also been used in forensic dentistry where identification systems describe tooth conditions and other oral characteristics besides automated screening and matching of antemortem databases.

Computer-Assisted Instruction↗

PubMed2000

Towards a health telematics infrastructure in the European Union.

Over the last decade information and communication technologies--telematics technologies--have demonstrated their potential to improve the quality, access and efficiency of health care. Health telematics applications are presently revolutionizing the developments not only in diagnosis, treatment, surveillance and rehabilitation of patients, but also on the side of the more collective aspects of health care and health prevention such as clinical trials, epidemiology and health education. Moreover, for the first time in the history of health care the emerging Health Information Infrastructure (HII), i.e. telematics networks together with a set of technologies, health telematics applications and services, is making possible the rapid dissemination and sharing of health information and research results. This is leading to knowledge creation and to promotion of innovative approaches based on evidence collected in medical practice all over the world.

Biotechnology↗