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PubMed2001

Neural network in communication with medical computer system.

The paper presents a concept of an experimental module designed to recognize spoken utterances that cover a limited range of words indispensable in dialogs with computer medical systems. Research into the recognition of spoken words by a module based on artificial neural network is described. Usefulness of the obtained results for surgery-assisting multimedia systems and for a patient simulator supporting medical education of students in case history-taking and diagnosing is also discussed.

Computer Systems↗
PubMedDate not supplied

Medical outreach after hurricane Marilyn.

INTRODUCTION: Many geographical areas are subject to devastating disasters that leave the citizens not only without homes, but also without their local medical systems. Now medical-aid stations consisting of personnel, supplies, and equipment quickly can be deployed when needed to such areas under the aegis of the National Disaster Medical System (NDMS). Such teams can provide emergent medical care as well as daily medical care. However, these aid stations are of no help for the home-bound or nursing home patients too infirm to reach them. Thus, these citizens only can obtain medical care if medical teams make planned outreach excursions to reach them. OBJECTIVE: To describe a planned outreach program that was implemented for such patients on St. Thomas Island after it was devastated by Hurricane Marilyn in 1995. RESULTS: Over a five-day period, the outreach team provided medical care for 67 patients ranging in age from 11 days to 90 years. Play and art therapy was provided for non-injured children. The most common needs in the elderly were anti-hypertensive medications and insulin-loaded syringes. CONCLUSIONS: For outreach efforts of this nature, membership of the team should include a registered nurse, a paramedic, a respiratory therapist, a public health specialist, and a local authority familiar both with the area and its inhabitants. A physician does not need to be assigned to the team, but should be available by radio.

Adolescent↗
PubMed2005

[A research on healthcare integrating model of medical information system].

System integration is inevitable since there are lots of heterogeneous medical information systems in the complicated medical environment. The current medical communication standards often focus on one aspect of the integration and do not provide a general scheme. Based on the analysis of the application of medical integration, the medical integration model HIM (Healthcare integrating model) is put forward, and the dataflow integration framework, function integration framework and interface integration framework in the HIM are designed subsequently. HIM provides a 3-D scheme for the integration of medical information systems, which not only contains the three aspects of integration application vertically, but covers the whole medical area horizontally.

Database Management Systems↗
PubMed1990

Towards validation of expert systems as medical decision aids.

Expert system evaluation is an important step in knowledge engineering development and is clearly not a simple process. The aim of this paper is to introduce methodological aspects of medical knowledge base validation. We distinguish two components of the evaluation: verification and validation. In the first part, the difficulties of evaluation are analysed, problems with some techniques used in the evaluation process are discussed. In the second part, our experiment gives guidelines to present these aspects and underline what and when to evaluate.

Decision Making, Computer-Assisted↗
PubMed1995

How to monitor the effectiveness of an emergency medical dispatch system: the Houston model.

The use of priority dispatch systems for emergency medical services (EMS) is widespread throughout the United States and in several other countries. It is essential that any such system be monitored to prove that it is safe and effective. A study of the EMS system in Houston, Texas, USA, has previously reported that the priority dispatch system can safely and reliably identify EMS incidents requiring only basic life support; the methods by which this was achieved are outlined here. In addition, the current and pending revisions to the Houston Fire Department Dispatch Quality Management Programme are discussed.

Emergency Medical Service Communication Systems↗
PubMed1999

Bacterial antibiotic efflux systems of medical importance.

Multidrug efflux systems endow on bacterial cells the ability to limit the access of antimicrobial agents to their targets. By actively pumping out antibiotic molecules, these systems prevent the intracellular accumulation necessary for antibiotics to exert their lethal activity. Drug efflux appears to be one of the most widespread antibiotic resistance mechanisms among microorganisms, since it has been demonstrated to occur in many Gram-positive and Gram-negative bacteria including medically important species like staphylococci, streptococci, enterobacteria and opportunistic pathogens like Pseudomonas aeruginosa. Efflux pumps can be specific for only one substrate or accommodate a more or less wide range of noxious products. Export of structurally unrelated compounds confers a multidrug-resistance phenotype on bacterial cells. Therapeutically critical levels of resistance can be achieved by overexpression of efflux systems, especially in those species such as P. aeruginosa which possess a low outer membrane permeability. It is suspected that the dual physiological function of active efflux systems is both the secretion of intracellular metabolites and the protection against a variety of harmful substances that the microorganism may encounter in its natural environment.

Bacteria↗
PubMed1989

[Medical expert systems. What are they and how should we organize our efforts?].

Medical expert systems have been developed for more than 20 years, in particular in the United States. Most existing systems are prototypes, and only a few commercial systems are available. The prototypes are generally limited in scope or functions (and have not been transferred to other users). However, in the near future we can expect useful applications to appear in special areas of medicine. In Norway we probably do not have the resources required to develop large commercial medical expert systems. If we want to develop medical expert systems, we should concentrate on limited areas. We must prepare the ground for future use of such systems in Norway. An important first step is to give health personnel basic education in the use of computers.

Expert Systems↗
PubMed1989

Automatic speech recognition--can it improve the man-machine interface in medical expert systems?

Computer-aided medical diagnosis has existed for two decades, but has not yet attained widespread acceptance among physicians. It is proposed that automatic speech recognition may be a significant factor in the eventual acceptance of the technology by the medical profession. The current state-of-the-art of automatic speech recognition is briefly surveyed, and problems with the technology are discussed. A potential natural language interface with DIAG, an expert system for aiding in dermatologic diagnosis, is described. A system that has been developed for accepting input of body parts in freestyle format is presented as a prototype for a natural language interface with an automatic speech recognition device.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Anglo-American vs. Franco-German emergency medical services system.

It has been stated that the Franco-German Emergency Medical Services System (FGS) has considerable drawbacks compared to the Anglo-American Emergency Medical Services System (AAS): 1. The key differences between the AAS and the FGS are that in the AAS, the patients is brought to the doctor, while in the FGS, the doctor is brought to the patient. 2. In the FGS, patients with urgent conditions usually are evaluated and treated by general practitioners in their offices or at the patient's home; initially, very few approach an emergency department. 3. Emergency patients with life-threatening trauma or disease are treated by emergency physicians at the scene and during transport. Paramedics often are first to arrive at the scene, and until the emergency physician arrives at the scene, are allowed to defibrillate, to intubate endotracheally, and to administer life-saving drugs (epinephrine endotracheally, glucose intravenously, etc.). 4. Prehospital emergency physicians treat patients at the scene and during transport. 5. Emergency patients are guaranteed to be reached by an appropriate emergency vehicle and a respective crew within 10 minutes in 80% of the responses and within 15 minutes in 95% of cases. 6. The FGS deploys qualified emergency physicians assisted by qualified paramedics as prehospital intensive care providers; extended immediate care is standard. Total Prehospital Times (TPT) and scene times only are minimally longer than in the AAS. 7. Emergency Medicine is recognized as a supra-specialty to the base specialties. Specific training programs exist for emergency physicians, medical directors of emergency medical services systems (EMSS), and chief emergency physicians (CEP). 8. Resuscitation attempts are carried out not only by anesthesiologists, but also by internists, surgeons, pediatricians, etc. Emergency medicine encompasses cardiopulmonary resuscitation (CPR) and shock cases, and patients with an acute myocardial infarction, stroke, poly-trauma, status asthmaticus, etc. Emergency patients are admitted directly to emergency departments of the hospitals, which, depending upon the size of the hospital. 9. The incidence of life-threatening trauma victims has decreased to <10% in the FGS. Of a total of 830,000 deaths/year, fatal trauma cases ranked the lowest at 4%. 10. Survival figures on cardiac arrest (asystole, ventricular fibrillation/ventricular tachycardia (VF/VT), pulseless electrical activity (PEA, etc.) reported in the German EMSS correspond to those in Europe and the United States. 11. Paramedic training is characterized by a two-year program followed by a theoretical and a practical examination. 12. Paramedics and emergency physicians-in-training are supervised at the scene and during transport. Quality assurance (Q/A) constitutes an integral and legally compulsory part of the EMSS. 13. In the majority of cases, the emergency patients are evaluated and treated by the respective specialties without delays caused by patient transfer to other hospitals. 14. The FGS does not require a greater number of ambulances and/or personnel than does the AAS. 15. The German healthcare system creates less expenses/capita than the does the U.S. system at a similar level of quality of care. 16. Emergency procedures are carried out by anesthesiologists, emergency physicians, surgeons, internists, and other specialists.

Cardiopulmonary Resuscitation↗
PubMed1987

Applications of the MEGADATS database system in medical genetics.

The MEGADATS relational database system has many useful applications in the field of medical genetics. Some of these applications include storage, retrieval, and display of pedigree information; retrieval of sets of individuals, sibships, or families who meet given criteria; storage of necessary information for mailing lists, clinic data, etc; and combination of pedigree information and genotype information into the format needed for linkage analysis packages.

Genetics, Medical↗
PubMed2001

Evaluating medical information systems: ethnomethodological and interactionist approaches.

This paper examines how qualitative research can contribute to the evaluation of medical information systems. Most qualitative studies of the use of medical computer systems adopt either an interactionist or, less commonly, an ethnomethodological perspective. The paper compares and contrasts the two approaches through the detailed discussion of two case studies, one rooted in each tradition. It identifies the implications of using these different analytical approaches and assesses their strengths and weaknessess. The paper argues that the preference for interactionism has led qualitative researchers to overlook important aspects of the social processess which surround the use of computer systems and that, consequently, a shift in emphasis towards ethnomethodological research is necessary. Nonetheless, it concludes by asserting that both strands of qualitative research can illuminate the organizational impact of medical computer systems.

Attitude of Health Personnel↗
PubMedDate not supplied

A novel standard-compliant audience response system for medical education.

Audience response systems (ARSs) have been suggested as a means to improve the effectiveness of didactic lectures, but their widespread use has been limited because of cost and complexity. The authors developed a simple, cost-effective ARS that relies completely on standard networking technology, is embedded easily into a PowerPoint presentation, and operates without the need for extensive server setup and configuration. A PowerPoint Add-in that capitalizes on WiFi (wireless fidelity) technology was created that allows lecturers to easily add interactive question and response slides to an existing PowerPoint presentation. In the system, audience members can submit responses by using any wireless network-enabled device (eg, laptop computer, cell phone). The system was designed to be easy to use, to be standard compliant, and to eliminate the high operating costs associated with current interactive ARSs.

Communication↗
PubMed2004

The Unified Medical Language System (UMLS): integrating biomedical terminology.

The Unified Medical Language System (http://umlsks.nlm.nih.gov) is a repository of biomedical vocabularies developed by the US National Library of Medicine. The UMLS integrates over 2 million names for some 900,000 concepts from more than 60 families of biomedical vocabularies, as well as 12 million relations among these concepts. Vocabularies integrated in the UMLS Metathesaurus include the NCBI taxonomy, Gene Ontology, the Medical Subject Headings (MeSH), OMIM and the Digital Anatomist Symbolic Knowledge Base. UMLS concepts are not only inter-related, but may also be linked to external resources such as GenBank. In addition to data, the UMLS includes tools for customizing the Metathesaurus (MetamorphoSys), for generating lexical variants of concept names (lvg) and for extracting UMLS concepts from text (MetaMap). The UMLS knowledge sources are updated quarterly. All vocabularies are available at no fee for research purposes within an institution, but UMLS users are required to sign a license agreement. The UMLS knowledge sources are distributed on CD-ROM and by FTP.

Animals↗
PubMedDate not supplied

Evaluation of alarm systems for medical equipment.

The provision of automatic alarm systems on medical equipment is generally designed to supplement the user's ability to monitor a variety of device and patient variables simultaneously. The potential value of such systems in improving the safety and efficacy of medical care is accompanied by the potential for false reliance on or other misuse of the alarm systems. Therefore the alarm provisions become an important aspect of clinical engineering assessment of equipment with respect to selection, user training, hazard analysis, and the provision of effective and appropriate preventive maintenance programs.

Biomedical Engineering↗
PubMed2002

[The application and development of artificial intelligence in medical diagnosis systems].

This paper has reviewed the development of artificial intelligence in medical practice and medical diagnostic expert systems, and has summarized the application of artificial neural network. It explains that a source of difficulty in medical diagnostic system is the co-existence of multiple diseases--the potentially inter-related diseases. However, the difficulty of image expert systems is inherent in high-level vision. And it increases the complexity of expert system in medical image. At last, the prospect for the development of artificial intelligence in medical image expert systems is made.

Artificial Intelligence↗
PubMedDate not supplied

Effects of a medical expert system on differential diagnosis of renal masses: a prospective study.

A medical expert system, RMDS, was used to prospectively evaluate patients undergoing nephrectomy for suspected renal masses. The effects of a medical expert system on differential diagnosis of renal masses were investigated. After RMDS consultation, three chief residents and one junior attending physician changed their preoperative diagnosis and significantly increased their diagnostic accuracy. The results indicate that the medical expert system may have an useful role in preoperative diagnosis of renal masses.

Bayes Theorem↗
PubMed2002

[Health economics analysis of prospective payment systems in medical rehabilitation].

The forthcoming introduction of the DRG-system as a new hospital funding system in Germany reinforced the discussion about a reform of the already existing funding system in medical rehabilitation. Experience and concepts from acute medicine, however, cannot be transferred directly to rehabilitation. The development of a patient classification system is a presupposition for prospective payment systems. Initial attempts in rehabilitation-specific patient classification systems already exist, even though a comprehensive approach is not yet noticeable. International patient classification systems scarcely seem to be transferable due to the specific German case-mix. The specific differences between acute medicine and medical rehabilitation relevant for the valuation of funding systems are analyzed. Particularly a reduction of the length of stay as a primary aim for the introduction of the DRG-system does not seem appropriate for medical rehabilitation. The existing funding system in medical rehabilitation is analyzed from an economic point of view. The cost management of the German pension insurance, being one of the rehabilitation providers in Germany, has achieved high quality standard of treatment as well as cost restriction. This funding system has been further developed during the last couple of years. Future developments are shown.

Chronic Disease↗
PubMed1998

[A study on medical educational system in North Korea].

Medical education in North Korea began with 2 medical colleges established during the 1930s and 1940s, and each Province came to have one medical college by the 1970s. It is presumed to exist 14 medical colleges in 1992. Apart from medical colleges, there are several kinds of medical schools. the number of medical practitioners has increased as the number of educational institutes for medicine increased. In 1996, there was 29.7 medical practitioners for 10,000 persons. They have several kinds of academic degrees in North Korea. They include: Wonsa, candidate Wonsa, doctor, vice-doctor, candidate doctor. In the university they have professor, associate professor, associate professor, lecturer, and research assistant. Academic degrees and positions are given not by the university nor research institute, but by the Government Board for Awarding Academic Degree and Position. Concerning research institutes, there is Chosen Institute for Medical Science that once was a medical research center under the Central Science Academy, and became an independent institute in 1963. Besides this institute, universities have their own research institutes, and there are also some other independent institutes.

Education, Medical↗