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Recent advances in computer technology provide improved means for the collection of information for the perinatal database. They depend principally upon online entry via a computer terminal which allows immediate checking of the data input. The availability of such effective procedures for information gathering demands a careful review of the purposes, content, and structure of a computerized perinatal questionnaire.
A collection of computer-based respiratory care algorithms were implemented as a prototype computer-based patient advice system (COMPAS) within the existing HELP hospital information system. Detailed medical logic recommended ventilator adjustments for 5 different modes of ventilation: assist/control (A/C), intermittent mandatory ventilation (IMV), continuous positive airway pressure (CPAP), pressure controlled inverted ratio ventilation (PC-IRV), and extracorporeal carbon dioxide removal (ECCO2R). Suggestions for adjusting the mode of ventilation, fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), peak inspiratory pressure, and several other therapeutic measures related to the treatment of severe arterial hypoxemia in adult respiratory distress syndrome (ARDS) patients were automatically presented to the clinical staff via bedside computer terminals. COMPAS was clinically evaluated for 624 hours of patient care on the first 5 ARDS patients in a randomized clinical trial. The clinical staff carried out 84% (320/379) of the computerized therapy suggestions. In response to a questionnaire distributed to clinical users of the system, 86% judged the system to be potentially valuable. Through implementation of COMPAS, a computer-based ventilatory therapy advice system, we have laid the groundwork for standardization of ventilator management of arterial hypoxemia in critically ill ARDS patients.
A method of automatic recognition and quantification of inter-ictal epileptic activity in the human EEG had previously been developed and tested using short recordings from awake subjects. This paper describes the adaptation of the method for use during overnight recordings in free-moving unattended patients, in combination with the already existing seizure monitoring system. EEG s were recorded from scalp and sphenoidal electrodes, using cable telemetry and a PDP-12 computer. The spike and sharp wave recognition method allowed the on-line analysis of 16 channels. A section of the 16-channel EEG including 1 sec before and 1 sec after each detected spike was saved on digital magnetic tape. Upon completion of the monitoring session, the tape was played back on the EEG machine, giving a discontinuous tracing of spike sections; this constituted a highly concentrated view of the inter-ictal epileptic activity, in traditional paper form. The spike sections were further analyzed by computer to determine and display on the computer terminal the spatial and temporal distributions of the epileptic activity, providing a complete synopsis of the recording. Several examples of the type of information available from this anslysis are discussed in detail. False detection rates are given for 34 six hour recordings, indicating a high vari ability in the performance, mainly because of artefacts. It is concluded that the final computer displays could only be trusted after visual inspection of the EEG sections provided on paper. The variety of morphologies of artefacts appeared to preclude a total automatic elimination.
The authors describe a technique for automated analysis of lesions demonstrated by computed tomography. A seed circle may be superimposed on a lesion by an operator controlled program. By selecting density limits, the program will then automatically outline a particular area of abnormal density and calculate the statistics of the pixels within that area. The information may be viewed on the computer terminal or recorded on the printer. The system may be superimposed on first generation EMI scanners without additional hardware. The time for obtaining the information roughly approximates that of systems employing manually operated cursors.
Recently the medical risk of blood transfusions has emphasized the need to improve the safe use of blood products. For the past 2 1/2 years at LDS Hospital we have used the HELP computer system to assist and critique ordering of blood products "on-line" by physicians and nurses. This report details the computer methods used to order blood products and to critique the appropriateness of those orders. Physicians personally enter the orders for more than 45% of the blood products using computer terminals, whereas 7% are from physician standing orders. Nurses enter the remaining orders from written orders (26%), verbal orders (14%), and phone orders (8%). There were 3396 blood orders for 1043 patients generated by 273 physicians during the fourth quarter of 1989. Each order is justified at the time it is entered by selecting from a menu of physician-approved criteria. The criteria are linked to supportive data in the data base, i.e., laboratory results and clinical data. The computer verified that 82% of these orders met criteria. Quality Assurance nurses verified the remaining 18%. Of these 18% only one in eight required manual chart review. After computer and Quality Assurance review, only eight (0.24%) of the orders were found to be true exceptions to established criteria. Physicians and nurses have accepted the computerized critiquing system. Through use of the computer we provide "on-line" critiquing and improve the use of scarce blood product resources.
We describe a laboratory information system employing a virus and chlamydia database developed over seven years which is used by a regional laboratory, performing virus and chlamydia testing. The information system is implemented on a University mainframe computer and accessed by computer terminals in the laboratory. The database is used to identify patients, store patient test results, minimize clerical work and improve accuracy of reported results. The database also serves as a patient registry for use in education and research.
A simple 'fail-safe' system is described that produces microbiology reports on a computer teleprinter and stores results on the magnetic tapes and discs of a computer for instant retrieval and epidemiological analysis. The system, which has been in operation for over a year, involves the use of a modified conventional NCR request form. The top portion, which is completed manually by the laboratory staff, is coded by writing numbers in hatched boxes. The data thus written on to the bottom portion are transcribed by punch operators on to paper tape and this data input is verified by double punching. The reports are normally produced automatically by the computer terminal telprinter, but in case of mechanical failure the manually completed request forms can be returned to wards and outpatient departments. The system permits a wide choice of options for epidemiological analysis, and six programmes are described, one of which produces a digest of the overall percentage antibiotic sensitivities of organisms from various sites.
The Belgian Society for Medical Informatics (MIM) organized a survey in 1986 in order to assess the present state of development of medical informatics in Belgium. Questionnaires were sent to hospitals, laboratories, private practitioners and pharmacists, as well as to social security organizations and software industries. The response rate was higher in hospitals (93%) than in any other category. Results showed a large number of computerized hospitals (93% of general acute care hospitals and 91% of psychiatric hospitals). There has been a sharp increase (+ 15%) in computerization of the admission, accounting and billing procedures since 1985, most likely in relation with administrative rules issued by the Belgian Government. The same trend (+ 20%) has been observed for computer applications in clinical laboratories, between 1984 and 1985. There is almost one computer terminal for ten beds in the hospitals with more than 200 beds in 1986. This figure exemplifies the present trend to on-line access to data. Computerized instrumental aids to medicine such as text processing, imaging or computerized interpretation of signals have known a rapid extension during recent years, although less comprehensive than administrative applications in hospitals and in social security organizations. The present state of other applications in medicine (general practice, pharmacy, etc.) was more difficult to assess as those information systems remain more pinpointed. In all medical fields, there appears to be a new rise in computer programs offered by software companies.
A Computer-Assisted-Self-Evaluation (CASE) program in oncology is described. The program is based on motivation by immediate, informative feedback, and involves the computer-guided interaction of a student with a series of microfiche cards. The computer leads the student through a series of 16 questions and associated explanations and recommendations based on the answer choices. Since all textual materials are placed on microfiche cards, the computer is only required to print simple, prearranged sentences and comments. As a result four students, using different CASE topics, can time-share the same computer terminal. This time-sharing capability, together with the large but compact, low cost information storage afforded by the use of microfiche, makes the cost of this system comparable to that of conventional study aids. The use of the CASE system as an educational aid and self-tutoring mechanism has been well accepted by faculty and students.
Prescriptions in an outpatient setting were kept on file for immediate recall by computer terminals. Drugs with abuse potential were found to make up 33.6 percent of all prescriptions, and 12.4 percent of these prescriptions were for excessive quantities. An additional 2.6 percent of these prescriptions represented irrationally large quantities of drugs dispensed by multiple prescriptions. The physician was cooperative and willing to correct this situation when it was brought to his attention by the pharmacist.
Using the capabilities of the HELP medical information system at LDS Hospital, a Computerized Laboratory Alerting System (CLAS) was developed. CLAS monitors and alerts for the presence of life-threatening conditions in hospitalized patients which are indicated by laboratory test results. Alerts are posted on computer terminals on the hospital's nursing divisions, where they are reviewed and acknowledged by hospital staff so that appropriate treatment can be rapidly instituted. CLAS was evaluated to determine its effectiveness in relaying alerts to the clinical staff, and improvements were made to develop an effective user interface. Initial average alert response times on nursing divisions ranged from 5.1 to 58.2 hr. The average alert response time dropped to 3.6 hr when alert review was integrated with laboratory result review, and to 0.1 hr after installation of a flashing light to notify hospital staff of the presence of new alerts.
The EEGs of adult patients with suspected supratentorial brain lesions were recorded on paper and on magnetic tape, using a small computer. The spectra of 16 channels were computed on a 40 sec sample. For each channel, a ratio of the type (delta + theta)/(alpha + beta) was computed and displayed on the computer terminal, a measure of the asymmetry in slow wave activity between homologous areas of the head was also displayed. This display is called a canonogram. It is believed to be a meaningful representation of the important characteristics of the EEG in the presence of supratentorial lesions. In order to assess the clinical value of the canonogram, the presumed localization of the lesion obtained from the interpretation of the traditional EEG and from that of the canonogram were compared to the known location of the lesion is a group of 87 subjects. The comparison was made quantitative by the use of a structured report encoding the traditional interpretation and that of the canonogram as well as the reference data (unequivocal surgical, radiological and clinical localizing evidence). The results varied among the anatomical regions: whereas in the frontal and occipital regions the EEG was slightly more accurate than the canonogram, both methods were similar in the temporal areas and the canonogram seemed more accurate in the centro-parietal regions. An attempt was made to interpret these differences. Furthermore, three readers read the cononograms and gave very consistent interpretations. These results show the reliability and value of this simple computer display for the particular type of EEG studied.
Ontogenetic development of ocularity domains--stripes, patches and layers in cortex, colliculus superior and lateral geniculate nucleus--is the result of organization that may either be intrinsic to the postsynaptic structure or induced to it by the afferents. A specific type of axonal growth behaviour that was recently proposed as a basis for ontogenetic development of retinotopy is sufficient to account also for ocularity domains. No intrinsic organization in the postsynaptic structure is required. The latter merely serves as a propagating medium for markers carried by the presynaptic terminals. Computer simulations demonstrate the mechanism to be complete and consistent.
Computerized nurse charting programs have been used at LDS Hospital for over two years. These programs allow the nurse to create nurse care plans for the management of the patient, and chart on the computer actions and information which support the documentation of the management of the patient according to the care plan created for the patient. Computer terminals have been placed at the patient's bedside to facilitate the use of these programs. This paper describes the programs available at LDS Hospital and several evaluation studies which have been performed to measure the efficacy of the programs. The evaluation studies indicated an increase in the level of documentation completeness and accuracy by the nurse but at some minor expense to time available to the nurse for patient care. Evaluation of the need for bedside terminals versus centrally located terminals showed an overwhelming desire by the nurse in favor of the bedside terminal. It was also found that data was entered more timely with less waiting when bedside terminals were available. Physician acceptance of the nurse charting system was found to be favorable.
It is not enough to merely manage medical information. It is difficult to justify the cost of hospital information systems (HIS) or intensive care unit (ICU) patient data management systems (PDMS) on this basis alone. The real benefit of an integrated HIS or PDMS is in decision support. Although there are a variety of HIS and ICU PDMS systems available there are few that provide ICU decision support. The HELP system at the LDS Hospital is an example of a HIS which provides decision support on many different levels. In the ICU there are decision support tools for antibiotic therapy, nutritional management, and management of mechanical ventilation. Computer protocols for the management of mechanical ventilation (respiratory evaluation, ventilation, oxygenation, weaning and extubation) in patients with adult respiratory distress syndrome ((ARDS) have already been developed and clinically validated at the LDS Hospital. These protocols utilize the bedside intensive care unit (ICU) computer terminal to prompt the clinical care team with therapeutic and diagnostic suggestions. The protocols (in paper flow diagram and computerized form) have been used for over 40,000 hours in more than 125 adult respiratory distress syndrome (ARDS) patients. The protocols controlled care for 94% of the time. The remainder of the time patient care was not protocol controlled was a result of the patient being in states not covered by current protocol logic (e.g. hemodynamic instability, or transport for X-Ray studies). 52 of these ARDS patients met extra corporal membrane oxygenation (ECMO) criteria. The survival of the ECMO criteria ARDS patients was 41%, four times that expected (9%) from historical data (p less than 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)
In order to avoid some of the problems connected with the census of the population and with the intention of actualizing the latter and providing the Federal administration as a whole with a rational means to obtain the necessary information on living conditions in the country, the Swiss Federal Statistical Office is planning to introduce annual sample surveys. It has spent a two years experimental stage working out contents and solutions to methodical and organizational problems. The planned household survey will consist of two parts, a general programme with demographic and socioeconomic variables and a specific programme. Two sample sizes will be used to get representative national or cantonal results. Written and/or oral survey methods will be chosen in accordance with the subject; telephone interviews with the help of a computer terminal will be one of the favourite methods. Participation will be optional. Before the end of this year, the Government will decide whether this statistical instrument is to be adopted.
The authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; an order for the appropriate supplies; a patient charge based on the supplies required; and an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary. Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in-service education and surveillance efforts.
The proposition was tested that depressives make predictions about the future based on a pessimistic future-event schema. Participants varying in depression predicted whether positive and negative events would happen to them (or to an average person) in the future by pressing yes or no at a computer terminal as quickly as possible, either under a concurrent attentional load or under no such load. As hypothesized, depressives predicted more negative events and fewer positive events than did mild depressives or nondepressives and showed greater automaticity in their predictions. That is, the attentional load did not increase depressives' response latencies for either negative or positive events, even though it did so reliably for both mildly depressed and nondepressed individuals. Depressives may thus possess a highly developed future-event schema that operates efficiently in enabling future-event predictions.