Medical education system in Czechoslovakia: achievements and perspectives of medical informatics education.
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Attitude to Computers↗
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[Medical care system for a wide area and ME(medical electronics)].
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Community Health Services↗
Approach to a hospital-based application of a medical expert system.
CADIAG-2 is a data-driven fuzzy medical expert system built for computer-based consultation in internal medicine. It has been integrated into the medical information system WAMIS of the Vienna General Hospital. Through the integration, CADIAG-2 is able to access patient data and laboratory test results already collected in the central patient database of WAMIS. CADIAG-2 operates in two subsequent phases: (1) as an automatic screening procedure for detecting pathological states in the patient, for generating diagnostic hypotheses, and for proposing further useful examinations; and (2) as an on-line consultation system for the clinician to assist him in clarifying patients' disorders completely and in great detail. At present, CADIAG-2 is subject to extended clinical trials. There are four application areas: rheumatic diseases, pancreatic diseases, gall bladder and bile duct diseases and colon diseases. First results on the performance of CADIAG-2 based on the evaluation of about 500 cases were obtained. In this paper, the principal goals, main components and concepts of CADIAG-2, and the experience gained until now are discussed.
Artificial Intelligence↗
Two tools for well-being: health systems and communities.
Medical systems are tools of limited power to improve health status in modern societies. The associational tools of local communities are now the most important health-giving resources. Health professionals must learn the nature of these tools and understand their relation to and support of them.
Community Health Planning↗
A pediatric survey for the National Highway Traffic Safety Administration: emergency medical services system re-assessments.
Emergency medical services for children, or EMSC, is still a relatively underdeveloped component of most state and local EMS systems. Advocacy and funding for EMSC from the federal EMSC Program, availability of many useful EMSC products, and the rapidly enlarging literature in EMSC have created heightened awareness and interest in improving systems for pediatric emergency, trauma, and critical care. The new National Highway Traffic Safety Administration (NHTSA) EMS Technical Assistance (TA) re-assessment program, the second version of the successful original TA Program from 1988 to 1996, provides an ideal opportunity for state EMS professionals to evaluate EMSC capabilities and to integrate new EMSC products and services. The history of the TA Program reflects the evolution of EMS itself and indicates a historical inattention to children's issues, but re-assessment TA teams now have much useful intervening EMSC history to draw upon and a clear philosophical mandate to integrate children more fully in EMS system planning and management. In order to facilitate state-of-theart reviews of EMSC within state EMS systems, a pediatric survey for the NHTSA re-assessments is presented. The survey, developed with the input of EMS administrators and physicians and approved by the National Association of State EMS Directors, follows the original ten-component model for EMS system review. It is intended for optional use within the overall EMS review process.
Child↗
The Unified Medical Language System (UMLS) of the National Library of Medicine.
This article describes the rationale for a Unified Medical Language System (UMLS) being developed by the National Library of Medicine and relates the usefulness of the System for medical record practitioners.
Information Systems↗
Rheumatoid arthritis in a medical information system: how valid is the diagnosis?
In order to validate the Stockholm County Medical Information System with regard to rheumatoid arthritis (RA) we have studied the medical records of 276 cases coded as RA in the medical information system. We searched information on the criteria for RA from (1961) and New York (1966). 18% of the medical records lacked information to the extent that an assessment of the number of criteria fulfilled was not possible. 9% fulfilled only one New York criterion and 7% fewer than three Rome criteria. 47% fulfilled four New York criteria and 35% at least seven Rome criteria. The most complete information on criteria was found in medical records from departments of rheumatology and these had also the highest degree of criteria fulfillment. A comparison is also presented between this sample of cases and a sample of RA persons selected from the general population with regard to fulfillment of criteria.
Adolescent↗
Decision support systems for the outpatient office. Two examples of medical expert systems.
Although definitive decision-making systems remain beyond the scope of present-day applications available on the market, effective and efficient decision support systems have been developed and are entering the market place. These systems focus on very specific tasks in limited domains and can be valuable adjuncts in primary care settings. There are also a few large-scale applications with well-defined goals that have proved themselves. It is imperative to validate the organizational support and expertise underlying any expert decision support system.
Ambulatory Care↗
A characterization of major salivary gland flow rates in the presence of medications and systemic diseases.
The purpose of this study was to characterize the effects of medications and systemic diseases on major salivary gland flow rates. Unstimulated and 2% citrate-stimulated parotid and submandibular salivas were collected from 293 subjects of the oral physiology component of the Baltimore Longitudinal Study of Aging. The influence of the number of medications and diseases on salivary flow rates was determined by separate one-way ANOVA tests. There was an overall decrease in both parotid and submandibular flow rates with increasing numbers of medications and systemic diseases. However, this was significant (p < 0.05) only for unstimulated submandibular flow rates (with increasing numbers of systemic diseases) and stimulated submandibular flow rates (with increasing numbers of systemic diseases and medications). Unstimulated flow rates rapidly approached zero with increasing numbers of medications and diseases. These results suggest that the submandibular gland may be more sensitive to physiologic permutations than the parotid gland. In addition, individuals being treated for multiple systemic diseases and taking numerous medications may be more susceptible to salivary hypofunction.
Adult↗
Electronic medical record systems in Israel's public hospitals.
BACKGROUND: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems. OBJECTIVES: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use. METHODS: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues. RESULTS: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%. CONCLUSIONS: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations.
Adolescent↗
Q-Pro: a quality control management system for medical equipment.
Q-Pro is an application for quality control (QC) and inspection of medical equipment. The system has been designed on the basis of a broad requirements analysis, contributed by clinical engineers from several European countries and with a focus on current and forthcoming regulatory requirements concerning the quality control and risk management for medical equipment. Q-Pro comprises a generalized application, providing the necessary flexibility to accommodate the different degrees of difficulty and specialization in creating or customizing QC protocols, carrying out inspections and managing collected data. The system incorporates a tool library for QC protocol design, widely used multimedia as well as a local database for protocol and inventory data archiving. The paper presents a detailed account of the system context of use, design and functionality.
Equipment and Supplies↗
Image integrity verification in medical information systems.
In nowadays it is a major objective to protect healthcare information against unauthorized access. Comparing conventional and electronic management of medical images the later one demands much more complex security measures. We propose a new scenario for watermark data buildup and embedding which is independent from the applied watermarking technology. In our proposed method the embedded watermark data is dependant on image and patient information too. The proposed watermark buildup method provides watermark information where it is small in size and represents a unique digest of the image and image related data. The embedded data can be considered unique with high probability even if the same algorithm was used in different medical information systems. Described procedures ensure new, more secure links between image and related data, offering further perspectives in smartcard implementations.
Authorship↗
A new and cheap medical examination system with artificial intelligence.
This is a medical examination system with artificial intelligence. It is used to find persons who want to obtain higher professional posts in the medical field, including doctors, dentists, nurses, pharmaceutists, etc. It has a question bank of 536,000 multiple choice questions (MCQs), of which 59,500 have pictures. Ten percent of the MCQs is updated every year; the old MCQs in the question bank are used as exercises for the persons who want to obtain higher professional posts. The system, with three distinctive degrees of difficulty, is applicable to three different professional posts: the assistant physician, the resident, and the attending physician. It ensures the general level of assessment for the same professional post, regardless of when one wants to take the system. In addition, the system also guarantees the consistency of the following three factors: the constituent of sub-professions, the classification of MCQs, and the degree of difficulty of each MCQ. Another feature of the system is that the passing score need not be the traditional standard passing score of 60. The passing score is determined by the system according to the requirements of the different professional posts and the degree of difficulty of the MCQs in the system. Therefore, the new method for passing the system is more rational than the traditional one. Moreover, the final score given by the system will be standardized to eliminate sampling errors. The reliability of the system will also be tested after each examination. If the coefficient of reliability is lower than 0.85, the scores will be canceled and examination will be repeated. The system can accept 96 persons simultaneously taking the examination with on-line computers. The people who work in remote places can take examination in their hospital with a personal computer linked via telephone. The system has already been approved by the relevant authoritative departments in China. It has been running successfully for more than six years. During this period of time, 125,645 candidates have taken the exam; 64,078 have passed the examination and have been promoted to higher professional posts. The system runs on local area network and uses a program written in PROLOG and FoxPro. It is estimated that the total cost of developing the system is less than $46,000 (US).
Artificial Intelligence↗
Additional Essential Criteria for Quality Systems of Medical Laboratories. European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation.
Essential Criteria for Quality Systems of Medical Laboratories have been published recently by the European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation. The Essential Criteria address the majority of critical aspects of quality management in the medical laboratory. They have been accepted by the EC4 General Assembly and are endorsed by the Forum of European Societies for Clinical Chemistry (FESCC). However, a supplement to the Essential Criteria was necessary, addressing two aspects, which are only partly covered by the Essential Criteria: the management of resources and point of care testing. Thus, the EC4 Working Group on Harmonisation of Quality Systems and Accreditation has decided to formulate Additional Essential Criteria for Quality Systems of Medical Laboratories, directed at the issues of management of resources and point of care testing. Criteria on management of resources address financial aspects, information logistics and acceptance by clients. Criteria on point of care testing address responsibilities, education of non-laboratory staff and operational aspects. The Additional Criteria are supplementary to the previously published Essential Criteria and should be read as an integral part of these.
Accreditation↗
A general purpose neural network simulator system for medical data processing.
We developed a general purpose neural network simulator system for medical data processing. This system has a flexible network definition language. Users can define arbitrary hierarchical neural networks using the definition language to analyze medical data that contains some complex patterns. The learning algorithm used in this system is back propagation. Learning curves are displayed on multiple windows. This is a general purpose system, so it can be used for various kinds of medical data processing such as one dimensional signal processing or two dimensional image processing. The system can run on a standard UNIX workstation, which is faster and more powerful than most personal computers. The system needs an X window system/Motif and C compiler. These are standard system programs already available on most UNIX workstations. The source code of the system can be retrieved from our anonymous ftp site via Internet.
Algorithms↗
Is it time for a computer in your practice? III: Types of computer systems for medical offices.
The three basic types of medical-office computer systems have been described along with their basic advantages and disadvantages. A fourth option, that of keeping your current manual office system, may be a valid alternative. The next article of this series will discuss a method for evaluating the suitability of any computer system for your needs and will describe how to select the "best" one for you.
Computers↗
[The use of the medical expert system in the diagnosis and treatment of myocardial infarct patients].
The authors consider it essential and expedient for patients with myocardial infarction that an expert medical system be created to diagnose and treat this condition. The presented structure of the created expert system incorporates data base, information base, and control system. Placed in the system as separate blocks are those of optimization and minimization securing clear cut medical recommendations in the output of the system. A variety of potential applications of the expert system are described together with expected results.
Cardiotonic Agents↗
Resource allocation in multifacility emergency medical service systems.
As instruments of public policy, Emergency Medical Service Systems must not only make effective use of the available resources but also ensure that those resources are shared equitably by the systems' facilities. This paper develops a multifacility EMS system resource allocation model that enables its user to evaluate the equitability of resource allocation schemes. Recognizing and objectively defining the relationships between the consumption of system resources and the provision of EMS System services, this model is appropriate for use in both prospective and retrospective EMS System resource allocation analyses.
Cost Allocation↗