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Computerized radiation therapy data.

A computer data system by which data from radiation therapy records are stored, corrected, and up-dated continuously as information becomes available is described. Two main programs are involved. A data storage and retrieval system called TAXIR uses a high-level language similar to English and allows display of information in alphabetic or numerical fashion. The other program, MIDAS, is a statistical package designed to perform multiple statistical analyses on the data accumulated on the former program. Both of these programs utilize a logical syntax permitting easy identification and partition of a data set. In addition, several smaller program have been developed to advance survival information in a rapid and reliable way and to obtain information directly from computerized data available at the University of Michigan Cancer Follow-Up Unit. Programs to obtain life tables or graphs on survival or reactivation of neoplasms have been developed. Stress is placed on the development of a strategy to obtain the maximum accurate information with a minimum input. The development of suitable coding sheets including appropriate diagnoses and tumor classifications is discussed. The importance of keeping a continuous up-to-date flow of information is stressed.

Computers↗

[Electronic data processing system for clinical microbiology].

A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.

Accounting↗

Computerized medical record in a private neurotology practice.

OBJECTIVE: To develop a computerized medical record for a private neurotology practice using a relational database with templates. BACKGROUND: Computers have been used in the medicine many years for billing, scheduling appointments, and word processing. Neurotology represents a relatively narrow field of medicine, which is particularly suited to a computerized record. A computerized medical record should allow for better data storage and retrieval as well as better documentation of the patient care given. METHODS: Using a commercially available, record-keeping software in a local area computer network. templates were developed for several common neurotologic problems. A template for a neurotologic examination was also developed. These were adapted from templates developed by a group otolaryngology practice in a neighboring city. Data entry templates for vestibular and audiologic tests were also developed. Implementation of the computerized record was accomplished in phases, allowing elimination of the paper record. RESULTS: A fully computerized medical record has been developed and maintained in a private neurotology practice over the past year. Patient response to the computerized record system has been favorable. Office personnel have adapted well to a paperless record, and referring physicians have welcomed the documents generated by the computer. CONCLUSION: Computerizing the medical records of a neurotology practice is possible and allows for improved documentation, ongoing assessment of treatment results, and improved efficiency among office staff.

Humans↗

The retrieval, storage, numerical and graphical trending of data from an Ohmeda 3700e pulse oximeter by personal computer.

A suite of computer programs are described to facilitate the transfer, disc storage, graphical trending and statistical analysis of data from an Ohmeda 3700e pulse oximeter. The programs are written in GWBASIC and designed to operate on a low cost IBM PC or compatible personal computer. The programs have been proved to be clinically useful in determining response to therapy as discerned from the long-term monitoring of arterial oxygen saturation. The computerised system is superior to analogue display system, such as a chart recorder, since it provides a logical method of presentation and analysis of data from long term monitoring.

Computer Graphics↗

Dealing with large data sets.

Collection, storage and retrieval of large amounts of data from multiple experiments for subsequent reduction, graphing and statistical analysis need not be a burdensome task. Although turnkey systems may offer significant economies for single well-defined and repetitive tasks, they may not permit sufficient flexibility to achieve the diverse aims required by many research programs. Using popular microcomputers to run one or a few experimental subjects may confront the investigator not only with significant bookkeeping problems, but also with an allocation of labor resources to computer maintenance and support that might be better invested in research effort. By using networked minicomputers, economies of scale emerge both in data collection, transfer, reduction, and analysis, as well as in maintenance, support, and scientific effort.

Data Collection↗

Storage and retrieval of coded patient diagnoses and data on a clinical laboratory computer system.

A system has been developed which allows for easy storage and retrieval of patient diagnoses using ICD-9-CM codes. Entered codes are automatically interpreted by the computer and then both the code and the interpretation are stored as in integral part of the patient record. Teaching clinicians may use an automated, keyword-search algorithm to display the code for a diagnosis of interest and then use that code to find any hospitalized patient with such a primary or secondary diagnosis. Entered diagnoses automatically appear on worksheets in the clinical laboratory. Retrospective studies also may be performed whenever a pathologist wants to compare diagnoses with laboratory results.

Clinical Laboratory Techniques↗

Why is epiluminescence microscopy important?

The new morphological information provided by epiluminescence microscopy (ELM) requires a fresh approach to the analysis of pigmented lesions. It necessitates a learning process that pertains to the recognition of hitherto unknown morphological features and is based on the discrimination of these features and their combination into two different patterns. ELM has been shown to improve the sensitivity and specificity of the diagnosis of melanoma and other pigmented lesions by 25-30%. Digitized ELM (DELM) provides an unlimited capacity for data storage and retrieval. It is a computerized imaging method, objective and noninvasive; it provides objective evidence of lesional changes on follow-up; documents growth and any changes in the structure and shape of lesions; and thus helps in decisions on whether to excise them or not. It provides for quality control by means of the aforementioned documentation, which may also serve as back-up in the case of medico-legal problems. In addition, the spectrum is widened by the dimension of teledermatology and cybernet computer-assisted diagnosis, which holds great promise for the future. ELM and DELM are thus the most important single development of the past three decades in the early diagnosis of melanoma.

Humans↗

The outcome index and system outcome score: a method of quality assurance through outcome analysis in the special care area.

A scoring system intended to assess mortality risk and permit surveillance, evaluation and comparison of medical care was developed in our Surgical Intensive Care Unit. Five simple clinical components were identified and assigned scores according to their statistically validated relationship to mortality and the summation of the component scores resulted in a daily System Outcome Score (SOS). Cluster analysis was used to divide the creation data set of 2,777 patients into suitable groupings of scores to predict mortality and the clustering was confirmed for reproducibility with a validation set of an additional 2,860 patients. Two patient care surveillance techniques were then developed. The first involved the definition of three unfavourable SOS patterns evolving during the course of a patient's admission and detection of one or more of these patterns permits identification of specific patients for whom review of care delivered may be appropriate. The second involves a global assessment of care utilizing the Outcome Index (OI) which relates overall mortality risk in the unit to the actual mortality rate over a given time period. The effectiveness of care can then be compared between different time periods within the one unit or between different units with similar patient mix. A simple menu driven program has been developed for the IBM personal computer and clones that facilitates data storage and retrieval, production of outcome reports and customization of the scoring ranges to meet local standards of performance.

Adolescent↗

New approaches to drug discovery and development: a mechanism-based approach to pharmaceutical research and its application to BNP7787, a novel chemoprotective agent.

Any approach applied to drug discovery and development by the medical community and pharmaceutical industry has a direct impact on the future availability of improved, novel, and curative therapies for patients with cancer. By definition, drug discovery is a complex learning process whereby research efforts are directed toward uncovering and assimilating new knowledge to create and develop a drug for the purpose of providing benefit to a defined patient population. Accordingly, a highly desirable technology or approach to drug discovery should facilitate both effective learning and the application of newly discovered observations that can be exploited for therapeutic benefit. However, some believe that drug discovery is largely accomplished by serendipity and therefore appropriately addressed by screening a large number of compounds. Clearly, this approach has not generated an abundance of new drugs for cancer patients and suggests that a tangibly different approach in drug discovery is warranted. We employ an alternative approach to drug discovery, which is based on the elucidation and exploitation of biological, pharmacological, and biochemical mechanisms that have not been previously recognized or fully understood. Mechanism-based drug discovery involves the combined application of physics-based computer simulations and laboratory experimentation. There is increasing evidence that agreement between simulations based on the laws of physics and experimental observations results in a higher probability that such observations are more accurate and better understood as compared with either approach used alone. Physics-based computer simulation applied to drug discovery is now considered by experts in the field to be one of the ultimate methodologies for drug discovery. However, the ability to perform truly comprehensive physics-based molecular simulations remains limited by several factors, including the enormous computer-processing power that is required to perform the formidable mathematical operations and data processing (e.g. memory bandwidth, data storage and retrieval). Another major consideration is the development of software that can generate an appropriate and increasingly complex physical representation of the atomic arrangements of biological systems. During the past 17 years, we have made tremendous progress in addressing some of these obstacles by developing and optimizing physics-based computer programs for the purpose of obtaining increasingly accurate and precise information and by improving the speed of computation. To perform physics-based simulations that involve complex systems of biological and pharmaceutical interest, we have developed methods that enable us to exceed Moore's law. This has been accomplished by parallel processing as well as other methods that have enabled us to study more complex and relevant molecular systems of interest. This paper provides an overview of our approach to drug discovery and describes a novel drug, currently in clinical development, which has directly resulted from the application of this approach.

Animals↗

Ambulatory electrocardiography and computer technology--practical advantages.

Ambulatory electrocardiography has employed computer technology for more than two decades. This review pertains to current state-of-the-art interaction between ambulatory electrocardiography and computer technology with regard to data analysis, quantitation and standardization, data formatting, data storage and retrieval, and comparative interpretation of ambulatory ECGs. This report also addresses evolving techniques expected in the near future.

Computers↗

A program for handling data obtained by 'blind' histopathological evaluations.

An interactive data input, storage, retrieval and treatment system (LAMES) is described for use in histopathological studies where pathologists evaluate tissues without any identification (termed evaluations which are 'blind'). The system produces the mean values of individual groups within an experiment, and results of statistical comparisons between the groups. The system was implemented on a Hewlett-Packard (HP) 1000-F minicomputer operating under RTE-6/VM, and was written using FORTRAN IV.

Computers↗

Computer-assisted mapping with the light microscope.

With the system described specific features in a histological section such as neuronal degeneration, specific cell types, or the silver grains of autoradiography can be accurately localized. It is simple to operate, and allows for data storage and retrieval. The system consists of a Zeiss Universal microscope equipped with stepping motor drives on the X and Y axes and interfaced to a PDP-12 computer equipped with a printer/plotter. The user controls the system through a joystick control box and teletype. In spite of magnification changes all points in the field remain constant relative to a point of origin selected at the beginning of the mapping sequence. Therefore, the outline and major features of a section are entered at low magnification while the detail of neuronal degeneration, for example, is added in its precise location at a higher magnification. The plotting of points can be done in either random fashion or in a systemized series of horizontal or vertical scans. A graphic display is available throughout the procedure and all maps are both printed on a Versatec printer/plotter and stored on a disk for future recall and analysis. Use of the system in plotting neuronal degeneration is described.

Animals↗

Using a personal digital assistant to streamline the OR workload.

PERSONAL DIGITAL ASSISTANTS (PDAs), are handheld minicomputers used for tasks such as referencing, documentation, and data storage and retrieval. THESE DEVICES can help perioperative nurses solve problems associated with updating, maintaining, and retrieving surgical preference cards and accessing treatment and medication references. CHOOSING A PDA and accessories, finding basic software, and writing a perioperative nursing program can be painless, even for a novice. NURSING DOCUMENTATION can be accelerated and streamlined with the use of PDAs, which leaves perioperative nurses more time for quality patient care.

Computers, Handheld↗

Temporal reasoning and temporal data maintenance in medicine: issues and challenges.

We present a brief, nonexhaustive overview of research efforts in designing and developing time-oriented systems in medicine. The growing volume of research on time-oriented systems in medicine can be viewed from either an application point of view, focusing on different generic tasks (e.g. diagnosis) and clinical areas (e.g. cardiology), or from a methodological point of view, distinguishing between different theoretical approaches. In this overview, we focus on highlighting methodological and theoretical choices, and conclude with suggestions for new research directions. Two main research directions can be noted: temporal reasoning, which supports various temporal inference tasks (e.g. temporal abstraction, time-oriented decision support, forecasting, data validation), and temporal data maintenance, which deals with storage and retrieval of data that have heterogeneous temporal dimensions. Efforts common to both research areas include the modeling of time, of temporal entities, and of temporal queries. We suggest that tasks such as abstraction of time-oriented data and the handling of different temporal-granularity levels should provide common ground for collaboration between the two research directions and fruitful areas for future research.

Artificial Intelligence↗

Schizophrenia: pathophysiological mechanisms--a synthesis.

A Nobel Symposium, 'Schizophrenia: Pathophysiological Mechanisms' was held in Stockholm, October 1-3, 1998. The topics ranged from etiology, genetics, neuropathology, neurotransmitter, brain imaging, to integrative aspects including cognition and language. The collective amount of information is already enormous and will rapidly increase with advances in molecular pathology, gene transcript profiling and non-invasive imaging techniques. Probably reflecting the complexity is the absence of a disease model that can accommodate the data and explain its roots. In the process of moving from simplistic mechanisms involving single or a few interacting neurotransmitters or circuits and turning to more complex interactive models, there is a need for improved data storage and retrieval. Stochastic search in chemical libraries for potential new drug candidates coupled with rational approaches in their final design may improve therapeutic efficacy.

Animals↗

A computer assisted follow up system for spinal cord injury patients.

The comprehensive care of patients with traumatic spinal cord injuries (SCI) necessitates, among other things, a structured, life-long follow up. The high consumption of medical care in chronic SCI patients, often a result of diseases affecting many different organ systems, soon causes the cumulated medical documentation to be extensive and therefore hard to survey. The possibilities for rational patient management, adequate quality assurance, and clinical research may improve considerably by computerisation of medical records. A computerised medical records system for SCI has recently been developed, using a semistructured medical record format for data input and a medical entity dictionary for facilitated data storage and retrieval. The principles for developing this computer-assisted follow up system are described.

Humans↗