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PubMed1995

A citation analysis of medical informatics journals.

Citation analysis is an unbiased, quantitative method for evaluating the usefulness of a particular scientific article, or the journal containing that article, based on the number of citations it receives. We performed a citation analysis of the medical informatics journals and compared them to several general medical and science journals. There was no clear-cut "best" medical informatics journal based on these rankings. Comparison with the general medical and science journals showed that our field is at least an order of magnitude smaller than these fields.

Bibliometrics↗
PubMed1994

[Informatics education in undergraduate study at the 1st Medical School of Charles University].

History of medical informatics at the 1st Medical Faculty goes to 25 years back. Currently curriculum is divided in two parts. In the first year of studies and obligatory course of computer technique is organized including: computer functions, communications with computers, database systems and text editors. In the 4th year of studies a course in clinical informatics is realized including: principles of computer science, statistical software, artificial intelligence, computer in pedagogy, scientific information, classification in medicine, biological signal and picture analysis, hospital information systems, computer in outpatient ward, clinical decision support, computer simulation in clinical medicine, computers in pharmacology, computer in metabolic care, computers in medical devices. In this way medical students are prepared to be able to use technical means in scientific information management.

Czech Republic↗
PubMed1996

Medical informatics, artefacts or science?

Successful and productive medical informatics research is evidently a combination of luck, creative art, and science, but some researchers focus too much on building computer artefacts and writing anecdotal reports of their experience. They need to adopt a less technology-fixated approach, be willing to evaluate their systems and publish failures as well as successes, and attempt to generalise their results as hypotheses for others to test. It does appear that medical informatics is a distinct discipline, and one based on scientific principles, but it is less clear whether these principles originate within the discipline or elsewhere. If elsewhere, it is usually unclear whether their validity has been tested with the atypical information, decisions and context that medicine represents. This article has presented some criteria for judging such scientific principles, and described a process which would lead to such principles, if they exist, being uncovered more rapidly. If our discipline is to thrive and take root in firm ground, such activities need to be taken seriously by all, otherwise we could end up building edifices on sand.

Delivery of Health Care↗
PubMed1997

Informatics: a physician's view.

From bedside to boardroom, physicians are coming on-line to use automated information systems. Physicians are increasingly able to scroll through computer screens to scan images and lab summaries. But they will obtain their most critical data by listening to, observing, and examining patients. Practitioners will be driven in two diagnostic realms by informatics: acute care and chronic care. Training of both internists and surgeons will be enhanced. Nurses will be able to take on more of doctors' work. Telemedicine may eventually reduce patient visits to the office and doctors' trips to the emergency department. Health care system management is strengthened and network message traffic smoothed by informatics, but lack of trust will slow acceptance.

Acute Disease↗
PubMed1997

Health informatics: handle with caution.

The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the choice of applications of such data. These possibilities for data management must be well understood and, related to this, two major dangers must be emphasized. One concerns data security, and the other concerns the processing of these data. This paper discusses these items and warns of the inappropriate use of medical informatics.

Computer Security↗
PubMed1997

Medical informatics in perinatology project AGUSTINA in Argentina.

This paper reviews the development of the field of medical informatics in Latin America. It also describes the preliminary results of a computer-based data management system, named AGUSTINA, which is comprised of maternal and infant data on 6195 deliveries that occurred between June 1990 and December 1995 in a hospital in the surroundings of Buenos Aires, Argentina. These data were fundamental for the instrumentation of preventive community-oriented activities in the area. Finally, this paper describes recommendations for future actions in the area of medical informatics in Latin America.

Adolescent↗
PubMed1998

Informatics methodologies for evaluation research in the practice setting.

A continuing challenge in health informatics and health evaluation is to enable access to the practice of health care so that the determinants of successful care and good health outcomes can be measured, evaluated and analysed. Furthermore the results of the analysis should be available to the health care practitioner or to the patient as might be appropriate, so that he or she can use this information for continual improvement of practice and optimisation of outcomes. In this paper we review two experiences, one in primary care, the FAMUS project, and the other in hospital care, the Autocontrol project. Each project demonstrates an informatics approach for evaluation research in the clinical setting and indicates ways in which useful information can be obtained which with appropriate feed-back and education can be used towards the achievement of better health. Emphasis is given to data collection methods compatible with practice and to high quality information feedback, particularly in the team context, to enable the formulation of strategies for practice improvement.

Cross-Sectional Studies↗
PubMed1998

[Trends in genome informatics].

Genome Informatics is not only a new area of computer science for genome projects but also a new approach of life science. As the genome projects proceed, genome informatics is becoming more important to bio-industry as well as life science. The major subjects are as follows; Database technologies for integration of various kinds of biological data Knowledge discovery from the integrated databases Interpretation and analysis of DNA sequence data with the databases Computer technologies for simulating life system with knowledge extracted from the databases in order to check the validity of the knowledge In this article, the history and trend of development of computer technologies for the subjects are described except for computer simulation.

Animals↗
PubMed1998

The next generation Internet and health care: a civics lesson for the informatics community.

The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to medical informatics and to the nation's health-care system. Current national research programs are summarized and the need for more involvement by the informatics community and by federal health-care agencies is emphasized.

Computing Methodologies↗
PubMed2002

The human cadaver in the age of biomedical informatics.

Major national and international critiques of the medical curriculum in the 1980s noted the following significant flaws: (1) over-reliance on learning by rote memory, (2) insufficient exercise in analysis and synthesis/conceptualization, and (3) failure to connect the basic and clinical aspects of training. It was argued that the invention of computers and related imaging techniques called to question the traditional instruction based on the faculty-centered didactic lecture. In the ensuing reform, which adopted case-based, small group, problem-based learning, time allotted to anatomical instruction was severely truncated. Many programs replaced dissection with prosections and computer-based learning. We argue that cadaver dissection is still necessary for (1) establishing the primacy of the patient, (2) apprehension of the multidimensional body, (3) touch-mediated perception of the cadaver/patient, (4) anatomical variability, (5) learning the basic language of medicine, (6) competence in diagnostic imaging, (7) cadaver/patient-centered computer-assisted learning, (8) peer group learning, (9) training for the medical specialties. Cadaver-based anatomical education is a prerequisite of optimal training for the use of biomedical informatics. When connected to dissection, medical informatics can expedite and enhance preparation for a patient-based medical profession. Actual dissection is equally necessary for acquisition of scientific skills and for a communicative, moral, ethical, and humanistic approach to patient care. Anat Rec (New Anat) 269:20-32, 2002.

Anatomy↗
PubMed2001

Wavelets and imaging informatics: a review of the literature.

Modern medicine is a field that has been revolutionized by the emergence of computer and imaging technology. It is increasingly difficult, however, to manage the ever-growing enormous amount of medical imaging information available in digital formats. Numerous techniques have been developed to make the imaging information more easily accessible and to perform analysis automatically. Among these techniques, wavelet transforms have proven prominently useful not only for biomedical imaging but also for signal and image processing in general. Wavelet transforms decompose a signal into frequency bands, the width of which are determined by a dyadic scheme. This particular way of dividing frequency bands matches the statistical properties of most images very well. During the past decade, there has been active research in applying wavelets to various aspects of imaging informatics, including compression, enhancements, analysis, classification, and retrieval. This review represents a survey of the most significant practical and theoretical advances in the field of wavelet-based imaging informatics.

Algorithms↗
PubMed1996

Endophrenology: new statistical techniques for studies of brain form. Life on the hyphen in neuro-informatics.

The interweaving here of statistics, image analysis, and neuroscience is a fine example of how neuro-informatics is more than the concentration of its constituent disciplines. Each of the component tools of the morphometric synthesis--the deformation model, Procrustes shape coordinates, the thin-plate spline--gains greatly in power in the context of the others, and enhances, too, great recent strides in the instrumentation leading to the raw image data itself (MR scanner physics, multiple stains, new contrast agents). The modern morphometric tool kit seems better matched to the description of gross brain variation than we had any reason to expect. Now the new tools can be exploited to produce remarkably sharper new findings. At the same time, the demands of neuro-informatics will press the toolmakers to provide equivalently powerful new techniques in areas presently less developed, such as cortical form or correlations of images with parametric experimental designs or with clinical histories.

Animals↗
PubMed1994

Applications of medical informatics in antibiotic therapy.

The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the computer provided information. Thus, the computer will assist but not replace physicians in providing medical care.

Anti-Bacterial Agents↗
PubMed1997

Implementing an informatics system in a perioperative environment.

This article identifies and describes strategies for successful implementation of an informatics system in a perioperative environment. With the trend toward managed care, perioperative nurses must address the challenge of instituting advanced technology in organizations with limited staffing and other resources. Planning methods of the past no longer are relevant in today's health care systems; therefore, innovative planning approaches are important. Five key elements in implementation of an informatics system are: a collaborative planning process, education and involvement of staff members regarding the systems design, development of a timetable, selection of a focus group, and assessment of staff members' training requirements. Methods are described for using a focus group process, including recommendations for structuring the focus group and establishing responsibilities of core group members.

Computer User Training↗
PubMed2003

Global cardiac function: mechano-energetico-informatics.

This review on the global cardiac function covers cardiac mechanics, energetics, and informatics that I have developed with my collaborators over the last 30 years in Japan and USA. We first established E(max) (end-systolic maximum elastance or pressure/volume ratio) as a new index of ventricular contractility using canine hearts. We then expanded the E(max) concept to PVA (systolic pressure-volume area consisting of external mechanical work and mechanical potential energy) as an innovative measure of total mechanical energy of ventricular contraction and discovered it to be a reliable determinant of ventricular energetics or O(2) consumption (V(O(2))). We have discovered that E(max) shifts the V(O(2))-PVA relation and the E(max) dependency (O(2) cost of E(max)) varies among different pathophysiological hearts. We also searched for the basis of E(max) in crossbridge behavior information contained in an X-ray diffraction of papillary muscle. Recently, we established a new integrative analysis to estimate total Ca(2+) recruited for excitation-contraction coupling in a beating heart using the E(max)-PVA-V(O(2)) information. These global, mechano-energetico-informatic approaches seem to facilitate better understanding of cardiac function, as required in the present post-genomic era when more physiomic knowledge is required not only in cardiac function but also in all other physiologic functions.

Animals↗
PubMed2003

Cluster analysis of human autoantibody reactivities in health and in type 1 diabetes mellitus: a bio-informatic approach to immune complexity.

Informatic methodologies are being applied successfully to analyze the complexity of the genome. But beyond the genome, the immune system reflects the state of the body in health and disease. Traditionally, immunologists have reduced the immune system, where possible, to one-to-one relationships between particular antigens and particular antibodies or T-cell clones. Autoimmune diseases, caused by an immune attack against a body component, are usually investigated by following the response to single self-antigens. In this study, we apply informatics to analyze patterns of autoantibodies rather than single species of autoantibodies. This study was designed not to replace traditional approaches to immune diagnosis, but to test whether meaningful patterns of autoantibodies might exist. Using an unbiased solid-phase ELISA antibody test, we detected serum IgG and IgM antibodies in the sera of 20 healthy persons and 20 persons with type 1 diabetes mellitus binding to an array of 87 different antigens, mostly self-antigens. The healthy subjects manifested autoantibodies to a variety of self-antigens, many known to be associated with autoimmune diseases. We investigated the patterns of these autoantibodies using a coupled two-way clustering algorithm developed for analyzing data from gene arrays. We now report that the reactivity patterns of autoantibodies to particular subsets of self-antigens exhibited non-trivial structure, which significantly discriminated between healthy persons and persons with type 1 diabetes. The results show that despite the wide prevalence of autoantibodies, the patterns of reactivity to defined subsets of self-antigens can provide information about the state of the body.

Autoantibodies↗
PubMed2001

Evaluating informatics applications--some alternative approaches: theory, social interactionism, and call for methodological pluralism.

A review of evaluation literature concerning CDSSs indicates that randomized controlled clinical trials (RCTs) are the 'gold standard' for evaluation. While this approach is excellent for studying system or clinical performance, it is not well suited to answering questions concerning whether systems will be used or how they will be used. Because lack of use of CDSS has been of concern for some years, other evaluation research designs are needed to address those issues. This paper critiques RCT and experimental evaluation approaches and presents alternative approaches to evaluation that address questions outside the scope of the usual RCT and experimental designs. A wide range of literature is summarized to illustrate the value of evaluations that take into account social, organizational, professional, and other contextual considerations. Many of these studies go beyond the usual measures of systems performance or physicians' behavior by focusing on 'fit' of the system with other aspects of professional and organizational life. Because there is little explicit theory that informs many evaluations, the paper then reviews CDSS evaluations informed by social science theories. Lastly, it proposes a theoretical social science base of social interactionism. An example of such an approach is given. It involves a CDSS in psychiatry and is based on Kaplan's 4Cs, which focus on communication, control, care, and context. Although the example is a CDSS, the evaluation approach also is useful for clinical guideline implementation and other medical informatics applications. Similarly, although the discussion is about social interactionism, the more important point is the need to broaden evaluation through a variety of methods and approaches that investigate social, cultural, organizational, cognitive, and other contextual concerns. Methodological pluralism and a variety of research questions can increase understanding of many influences concerning informatics applications development and deployment.

Attitude↗
PubMed1998

Standardization in health informatics in Canada.

Around the world, informatics has been cited as a key enabler of health sector reform. Recent reform programs in Canada, reflecting this global consensus, have emphasized the importance of quality information and information technology in meeting their goals. Standards are an important building block for achieving the required comprehensive and integrated health information infrastructure. This paper describes the current status of, and future plans for, health informatics and related standards in Canada.

Canada↗