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Development of a robotic near patient testing laboratory.

Many laboratories have centralized critical care services to conserve resources, but centralization has often been at the expense of providing optimized patient care. We have created a remotely controlled clinical laboratory that provides whole blood analysis of blood gases (PCO2, PO2), pH, electrolytes (Na+, K+, Cl-), glucose, and hemoglobin near the patient's beside, while maintaining the distinct advantage of central laboratory control. The automated remote laboratory provides extremely rapid turnaround times, eliminates the cost of labor for specimen processing, reduces the risk from contaminated specimens, reduces staff training, and results in improved patient care.

Centralized Hospital Services↗

Visual design for the user interface, Part 1: Design fundamentals.

Digital audiovisual media and computer-based documents will be the dominant forms of professional communication in both clinical medicine and the biomedical sciences. The design of highly interactive multimedia systems will shortly become a major activity for biocommunications professionals. The problems of human-computer interface design are intimately linked with graphic design for multimedia presentations and on-line document systems. This article outlines the history of graphic interface design and the theories that have influenced the development of today's major graphic user interfaces.

Audiovisual Aids↗

[SOPHOCLE (Ophthalmologic Simulator of Laser PHOtocoagulation): contribution to virtual reality].

PURPOSE: This study was undertaken to teach laser retinal photocoagulation in different disorders using a "virtual eye". Most ophthalmologists routinely use laser photocoagulator. Both indications and laser effects are well-known. However, in various diseases (diabetic retinopathy, age-related-macular degeneration, myopia...) complications rate increase or at least does not decrease. The main reasons are: - ignorance of risk factors, - misuse of the instrument. METHODS: We developed a new automated device stimulating a real laser photocoagulator. Only slit-lamp exists. The three-mirror lens, the fundus and the retinal photocoagulation impacts are "virtual". CONCLUSION: The aim of the simulator is to help practitioners to recognize various pathologies almost as in real conditions and to be familiar with different technics of photocoagulation. By using computer assisted learning, a constant evaluation determines the level and the progress of practitioners.

Computer Simulation↗

The medical information superhighway.

Commercial and private use of the Internet has grown exponentially over the last few years. Its estimated size increases by more than 10% per month. Medical information and resources are now available to aid physicians in practice and in research. Users can utilize email to communicate with other medical professionals around the world. The newest and possibly most significant development on the Internet is the World Wide Web. Through it, physicians may access multimedia resources such as databases of medical information, recent news and research, atlases, and electronic journals using an intuitive graphics interface. Medically related software can be obtained from the vast archives on the Internet via the FTP function. As the Internet expands and becomes more ubiquitious, its uses will multiply and become an important mode of medical information dissemination and acquisition.

Computer Communication Networks↗

A complex cerebrovascular screening system (CERBERUS).

Stroke is unique among neurological diseases since it has a high incidence rate, severe burden of illness, high economic cost, and it may be preventable [1]. Described here is a system for screening the cerebral and vascular status of individuals to detect the initial stages of vascular disorders. The computer based polygraphic system (CERBERUS) questions subjects about risk factors, stresses, neurologic symptoms and monitors impedance pulse waves of the head and extremities, EEG, and ECG. The system has been tested in 691 cases. Doppler control studies were carried out on approximately 300 of these cases. Additional somatic measures and psychological tests related to stroke risk factors were carried out for wide biological basis of possible correlation of CERBERUS data base. The high incidence of cerebrovascular disturbance was established by CERBERUS data, further confirmed by additional data gathered, and moreover was compared by traditional medical records. The polygraphic system is more sensitive at detecting physiological asymmetries of blood flow than even a Doppler measurements. This suggests that it may be a significantly improved means for the differential diagnosis of neurological disease and the screening of subjects for arteriosclerosis, transient ischemic attack and stroke prevention to be offered at the lowest level of medical service.

Adolescent↗

End-user search behaviors and their relationship to search effectiveness.

One hundred sixty-one MEDLINE searches conducted by third-year medical students were analyzed and evaluated to determine which search moves were used, whether those individual moves were effective, and whether there was a relationship between specific search behaviors and the effectiveness of the search strategy as a whole. The typical search included fourteen search statements, used seven terms or "limit" commands, and resulted in the display of eleven citations. The most common moves were selection of a database, entering single-word terms and free-text term phrases, and combining sets of terms. Syntactic errors were also common. Overall, librarians judged the searches to be adequate, and students were quite satisfied with their own searches. However, librarians also identified many missed opportunities in the search strategies, including underutilization of the controlled vocabulary, subheadings, and synonyms for search concepts. No strong relationships were found between specific search behaviors and search effectiveness (as measured by the librarians' or students' evaluations). Implications of these findings for system design and user education are discussed.

Computer Literacy↗

Prediction of primate splice junction gene sequences with a cooperative knowledge acquisition system.

We propose a cooperative conceptual modelling environment in which two agents interact: the machine and the human expert. The former is able to extract knowledge from data using a symbolic-numeric machine learning system, and the latter is able to control the learning process by accepting and validating the machine results, or by criticizing those results or the explanation that the system produces on them. The improvement of the conceptual modelling relies on the cooperation between the two agents. Results obtained with our method on prediction of primate splice junctions sites in genetic sequences are far better than those reported in the literature with other symbolic machine learning systems, and are as better as those obtained with some artificial neural networks methods reported at present. But in opposite to neural networks which lack of argumentation, our system provides the user a plausible explanation of its prediction.

Algorithms↗

Protein structure prediction system based on artificial neural networks.

Methods based on the neural network techniques are among the most accurate in the secondary structure prediction of globular proteins. Here the same principles have been used for the tertiary structure prediction problem. The map of dihedral phi and psi angles is divided into 10 by 10 squares each spanning 36 by 36 degrees. By predicting the classification of each residue in the protein chain in this map a rough tertiary structure can be deduced. A complete prediction system running on a cluster of workstations and a graphical user interface was developed.

Amino Acid Sequence↗

Using interactive video to add physical assessment data to computer-based patient simulations in nursing.

The use of computer-based simulations can enhance problem-based learning in nursing education. Adding interactive video allows students to "see" the patient they are interviewing and to "examine" the patient rather than having the examination findings described by the software developer. These features both increase the realism of the simulations and challenge the learner to interpret the physical examination findings. The use of interactive videotape has proved to be a medium that lends itself to in-house production of interactive video.

Computer Simulation↗

Three-dimensional reconstruction of a bullet path: validation by computed radiography.

Three-dimensional visualization is an important tool in the evaluation and demonstration of injury. Creating convincing graphics, however, requires strict distinction between illustrative and reconstructive visualizations and a method of validation. We present a case in which we used a radiation-planning tool to provide a 3-dimensional illustrative visualization of a contact gunshot wound to the head, and validated the result by comparing computed radiographs with radiographs taken at autopsy. We discuss the use of visualization tools for data exploration in forensic pathology.

Adult↗

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Blue Cross Blue Shield Insurance Plans↗

An Internet-based nuclear medicine teaching file.

UNLABELLED: Teaching file cases play an important role in the training of nuclear medicine residents; however, film-based teaching files have limitations, such as difficulty in accessing cases in a department with several remote clinical sites. The goal of this project was to develop a digital teaching file with the capability for local and remote (Internet) network access, with the additional requirements that viewing existing cases and addition of new cases be easy and simple. METHODS: The teaching file software (TF-Web) utilizes applications developed for the World-Wide-Web in combination with locally developed programs for importing images, entering case information, indexing, searching, case selection and case editing. The time required to add cases to the TF-Web and to access existing cases from local and remote network sites as well as computer storage requirements were assessed. RESULTS: Cases entered in TF-Web may be viewed either with or without diagnoses and may be accessed with acceptable speed (2-14 sec) from both local and remote network sites. A relatively complex case required 1.2 megabytes of storage, with lesser storage requirements for simpler cases. CONCLUSION: A digital teaching file has been developed that allows easy access from computers located both locally and elsewhere on the Internet. Digital storage requirements are reasonable, and, because of the unique nature of TF-Web, case storage may be distributed among multiple institutions.

Computer Communication Networks↗

User interface reengineering. Innovative applications of bar coding in a clinical microbiology laboratory.

Some clinical laboratory departments (such as microbiology) provide extensive reporting of text and other data not generated by instruments that can be interfaced to a laboratory information system. These data are usually entered into the laboratory information system manually by keyboard data entry, which can be cumbersome and time consuming. Bar codes, which are already used in laboratories to facilitate rapid entry of sample-identifying information, have the potential to be used much more broadly as a generalizable data entry technique. We developed a comprehensive system that takes advantage of several applications of bar coding to facilitate the work of our Clinical Microbiology Laboratory. Central to our system is the use of bar code "scripts" to meet many of our complex data entry requirements. Use of these scripts is transparent to the laboratory information system (ie, no special "drivers" are needed) because data are received as if they had been generated by typing the characters on the keyboard. The scripts consist of bar codes that encode the series of keystrokes needed to give the appropriate response at the series of prompts offered by the laboratory information system. Both alphanumeric and other keys, including carriage returns and special characters, can be converted into bar codes and incorporated into scripts. By creating and printing these scripts in the laboratory using standard wordprocessing software and bar code fonts for personal computers, laboratorians without specialized computer training have the tools to substantially improve the data entry efficiency of existing data entry terminals for a variety of laboratory information systems.

Clinical Laboratory Information Systems↗

[Ergonomics of computer programs].

There are many different factors to be taken into account while planning, designing and implementing user interface to a new programme. The most important factors are price, quality, documentation, installation and ergonomic properties of software. Ergonomic aspects are classified into two groups. One group deals with problems of direct human-computer interaction e.g. sort of dialogues, screen layout, response time. The other deals with problems of flexibility, consistency, structuring. Out of a number of ergonomic factors, some of the most important are listed in this paper.

Ergonomics↗