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PubMed1996

Security standards for medical information systems.

This paper has provided an overview of some of the aspects of medical information systems security and the standards that are available to implement security solutions. There is a need to address a complete solution for the security of medical information systems: technical, procedural and legal protection of medical records, databases, applications, hardware and software, networks and the management of the system. The existing standards cover some of these topics but not all. There is still room for further work and the development of standardised technological solutions supported by legal and procedural measures.

Computer Security↗
PubMed1994

A case-mix classification system for medical rehabilitation.

Dissatisfaction with Medicare's current system of paying for rehabilitation care has led to proposals for a rehabilitation prospective payment system, but first a classification system for rehabilitation patients must be created. Data for 36,980 patients admitted to and discharged from 125 rehabilitation facilities between January 1, 1990, and April 19, 1991, were provided by the Uniform Data System for Medical Rehabilitation. Classification rules were formed using clinical judgment and a recursive partitioning algorithm. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) uses four predictor variables: diagnosis leading to disability, admission scores for motor and cognitive functional status subscales as measured by the Functional Independence Measure, and patient age. The system contains 53 FRGs and explains 31.3% of the variance in the natural logarithm length of stay for patients in a validation sample. The FIM-FRG classification system is conceptually simple and stable when tested on a validation sample. The classification system contains a manageable number of groups, and may represent a solution to the problem of classifying medical rehabilitation patients for payment, facility planning, and research on the outcomes, quality, and cost of rehabilitation.

Activities of Daily Living↗
PubMed1999

Intelligent systems in medical diagnosis.

From an intelligent system for a computer supported medical diagnosis it is expected to achieve high accuracy and ability to draw conclusions from a small data sets. Medical practice could takes many years to generate a large database. A new mathematical method that is able to learn on a small data set is presented.

Algorithms↗
PubMed1982

Remote Medical Diagnosis System (RMDS) concept.

The goal of the Remote Medical Diagnosis System (RMDS) is to provide assistance to medical personnel on navy ships and at remote locations by providing an adequate consulting link with a physician at some other site. The RMDS utilizes navy communication links and commercial telephone lines for the exchange of patient physiological information and diagnostic/treatment advice. Narrow band-width (3 kHz) hf and uhf radio and satellite communication channels are utilized. The RMDS terminals perform the function of processing analogue physiological information (images, electrocardiograms, (ECG), auscultation, and voice) into a digital format suitable for transmission over the communication links. These terminals also perform the inverse operation of processing the received digital bit streams into analogue information for visual display. The digital data are transmitted at a rate of 2,400 bps.

Diagnosis↗
PubMed1994

Induction of medical expert system rules based on rough sets and resampling methods.

Automated knowledge acquisition is an important research issue in improving the efficiency of medical expert systems. Rules for medical expert systems consists of two parts: one is a proposition part, which represent a if-then rule, and the other is probabilistic measures, which represents reliability of that rule. Therefore, acquisition of both knowledge is very important for application of machine learning methods to medical domains. Extending concepts of rough set theory to probabilistic domain, we introduce a new approach to knowledge acquisition, which induces probabilistic rules based on rough set theory (PRIMEROSE) and develop a program that extracts rules for an expert system from clinical database, using this method. The results show that the derived rules almost correspond to those of medical experts.

Artificial Intelligence↗
PubMed1996

Mapping medical vocabularies to the Unified Medical Language System.

This paper presents our work in automated mapping of medical vocabularies to the National Library of Medicine's Unified Medical Language System (UMLS). We used the UMLS Knowledge Source (KS) tool to map terms from several sources to UMLS Metathesaurus concepts. We compared performance of the KS tools with our own Minimal Representable Units Method (MRUM). The KS tools were able to map terms from 13% to 54% of the time, depending on the term set and the KS options used. Our MRUM method mapped between 96% and 99% of the terms. Based on our experience, we believe that questions remain about the best method by which the UMLS can be used to achieve automated term translation.

Algorithms↗
PubMed1989

Influence of emergency medical services systems and prehospital defibrillation on survival of sudden cardiac death victims.

This article reviews the influence of emergency medical systems and prehospital defibrillation on survival of sudden cardiac death. The historical perspective and epidemiologic considerations of prehospital sudden cardiac death are highlighted. Factors predictive of successful resuscitation and impact of community activity on sudden death are discussed. Influences of emergency medical services on outcome of prehospital cardiac arrest are reviewed, with emphasis on the role of dispatchers, emergency medical technicians, and paramedics. The recent emergence of prehospital automatic defibrillation by emergency medical technicians, first responders, and lay persons is discussed in depth, as it has great potential to positively influence outcome of prehospital sudden cardiac death.

Death, Sudden↗
PubMed1980

Medical librarianship: a systems perspective.

Medical or health sciences librarianship is viewed as a system whose components are the professional school, the professional group, and the professional association. As an open system it imports energy from these components, or subsystems, and transforms this energy into professionally identifiable products. The subsystems, in influencing the character of the medical and health sciences library profession, are interdependent and interrelated. However, linkages between the subsystems are becoming defective due primarily to lack of communication, information, and feedback. Stronger and more vigorous interaction among the subsystems is needed.

Libraries, Medical↗
PubMed1991

[Medical care system in 21st century].

In a rapidly aging society, the role of medical services to ensure the Japanese people's health has become more and more important. Although it is not easy to forecast precisely 21st century medical services, the existing medical delivery system must be reorganized and improved, recognizing the changes in relative occurrences of diseases, the progress of medical technology, and changes in patient need. It is also necessary to pay adequate attention to the need for medical services in different regions and establish a medical care delivery system based on the need. It is also important to systematize the provision of medical services. The future of the medical care system in the 21st century depends on these approaches.

Adult↗
PubMed2004

The use of an aSi-based EPID for routine absolute dosimetric pre-treatment verification of dynamic IMRT fields.

BACKGROUND AND PURPOSE: In parallel with the increased use of intensity modulated radiation treatment (IMRT) fields in radiation therapy, flat panel amorphous silicon (aSi) detectors are becoming the standard for online portal imaging at the linear accelerator. In order to minimise the workload related to the quality assurance of the IMRT fields, we have explored the possibility of using a commercially available aSi portal imager for absolute dosimetric verification of the delivery of dynamic IMRT fields. PATIENTS AND METHODS: We investigated the basic dosimetric characteristics of an aSi portal imager (aS500, Varian Medical Systems), using an acquisition mode especially developed for portal dose (PD) integration during delivery of a-static or dynamic-radiation field. Secondly, the dose calculation algorithm of a commercially available treatment planning system (Cadplan, Varian Medical Systems) was modified to allow prediction of the PD image, i.e. to compare the intended fluence distribution with the fluence distribution as actually delivered by the dynamic multileaf collimator. Absolute rather than relative dose prediction was applied. The PD image prediction was compared to the corresponding acquisition for several clinical IMRT fields by means of the gamma evaluation method. RESULTS AND CONCLUSIONS: The acquisition mode is accurate in integrating all PD over a wide range of monitor units, provided detector saturation is avoided. Although the dose deposition behaviour in the portal image detector is not equivalent to the dose to water measurements, it is reproducible and self-consistent, lending itself to quality assurance measurements. Gamma evaluations of the predicted versus measured PD distribution were within the pre-defined acceptance criteria for all clinical IMRT fields, i.e. allowing a dose difference of 3% of the local field dose in combination with a distance to agreement of 3 mm.

Algorithms↗
PubMed2002

[A 3D-rendering system for medical images based on COM].

This paper introduces a 3D medical image rendering system. The system uses the technology of COM with a fine upgradable and maintainable performances. Its main functions include image filtering, enhancement, image classification & segmentation, image registration, image interpolation and 3D display. The system can run on PC, so it owns a good practical value.

Algorithms↗
PubMedDate not supplied

A comprehensive microcomputer-based medical records system with sophisticated preventive services features for the family physician.

BACKGROUND: Computer-based medical records systems improve the provision of preventive services in the offices of family physicians. Until recently, these systems were either not commercially available for use by practicing physicians or were very expensive. METHODS: A commercially available, microcomputer-based medical records system is currently used at the Department of Family Medicine at the Medical University of South Carolina. This system is used as a fully electronic medical record and has sophisticated health maintenance tracking and reminder features. These features track the provision of preventive services, provide physician reminders at the time of patient visits, permit generation of mailed patient reminders, and provide reference to relevant patient education resources. RESULTS AND CONCLUSION: The system described in this paper can be used by practicing physicians to improve their delivery of preventive services.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Medical information system, health records, and knowledge banks.

A medical decision system with the capability to answer questions in an interactive mode to assist clinical decisions is described. The system consists of four modules: (a) clinical case history bank, (b) pooled clinical experience bank, (c) clinical knowledge band, and (d) biomedical research bank. At the human/machine interface, an encoder transforms input natural language into codes and retransforms output into natural language. If properly authorized, the physician can request his patient's files, ask for clinical experience in similar cases, ask for related textbook knowledge, or browse among related research findings or speculations. All four modules have been tested as prototypes. Multidisciplinary cooperation is needed for the implementation of a national medical information network and for the reorientation of clinical and academic medicine.

Computers↗
PubMed1999

Automatic enrichment of the unified medical language system starting from the ADM knowledge base.

The Unified Medical Language System (UMLS) project aims to provide a repository of terms, concepts and relationships from several medical classifications. This work describes the possibility to enrich automatically with meaningful links the UMLS database by using description of diseases from another knowledge base, in our case ADM (Aide au Diagnostic Medical). In spite of the constraints and the difficulties to qualify the interconcept links, the results show that it is possible to find and create new links from a french knowledge database to the UMLS one. One of the interests of this work is that the automated learning of the connections could be used with others knowledge databases like expert system databases.

Algorithms↗
PubMed1994

New medical record system in Queen Elizabeth Hospital, Hong Kong.

During the 1980's, the medical record problems had been identified and it was not until 1991 that Queen Elizabeth Hospital was chosen to be the pilot hospital for the development of a new medical record management system for the Hospital Authority hospitals. The new medical records system was implemented in Queen Elizabeth Hospital in December, 1993. Six month after implementation, a pre-implementation and post-implementation review of the medical record services were conducted to compare the results of the new and old system. The results showed that there were significant improvements in the record retrieval and record integrity in the new system. New medical record services such as the delivery of readmission records to the ward, filing of medical records forms in pre-defined order and filing of loose sheets in the relevant hospital notes are able to facilitate the efficient, effective and complete access to patient information. The support and cooperation of the hospital staff are crucial to the success of the new system. Continuous review and improvement of the new system is essential in order to obtain the best results.

Disease↗
PubMed2002

Dental concepts in the Unified Medical Language System.

OBJECTIVE: Currently, no comprehensive, controlled vocabulary for dentistry is available. The objective of this study was to determine how well the Unified Medical Language System, the largest repository of concepts and terms in biomedicine, represents dental concepts. METHOD AND MATERIALS: The dental subset of concepts was extracted from Unified Medical Language System using the software program APEX (APplication for the EXtraction of domain-specific concepts). The relationships contained in the Unified Medical Language System Metathesaurus were used to locate the concepts related to 12 seed terms. The Encyclopédie Médico-Chirurgicale (513 dental terms) and the Diagnostic Codes developed by Leake et al (124 terms) were compared to the dental subset. Terms were classified as exact match, related term, or no match. The resultant matching characteristics were compared to those determined by the National Library of Medicine/Agency for Health Care Policy and Research Large Scale Vocabulary Test. RESULTS: The dental subset of Unified Medical Language System contained 948 concepts. The Encyclopédie Médico-Chirurgicale and the Diagnostic Codes exhibited similar matching characteristics for exact match (61.6% and 58.9%, respectively) and related term (38.0% and 32.2%, respectively). For no match, the matching frequencies were significantly different (P < .001). CONCLUSION: The Unified Medical Language System may be a comprehensive source of terms suitable for various representation requirements in dentistry.

Chi-Square Distribution↗
PubMed1996

Systemic retinoid medication and periodontal health in patients with Papillon-Lefèvre syndrome.

Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefèvre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.

Adolescent↗