A magnetic tape database for a real-time medical information system.
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Appointments and Schedules↗
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Results for “Medication Systems”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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A measured dose of safety. Addressing adverse drug events is among first steps prescribed as Trinity health installs an electronic medical record system.
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Adverse Drug Reaction Reporting Systems↗
Automated medication order system.
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Computers↗
A framework for evaluation of medical information systems.
The evaluation of information systems, especially in the health care field, is a complex task. While in the general information system science field there have been several attempts to build frameworks and models to understand better the evaluation of information systems, in health care such models have been non-existent. Unfortunately general frameworks cannot be exactly applied for the evaluation of medical information systems, because they do not recognise the specific nature of the medicine. This article represents an attempt at formulating conceptual models to understand the evaluation of the different impacts of medical information systems.
Decision Support Systems, Clinical↗
Automated medication dispensing systems.
Threefold pressures to control hospital costs, improve professional staff performance and maximize medical quality motivate health systems managers to continually reassess the potential role of automated medication dispensing systems. Nurse managers become intimately involved in this assessment and reassessment process and must understand both the varied performance variables and the total health system implementation challenges presented by each of the available systems.
Automation↗
Advanced patient information systems and medical concept representation.
With ubiquitous networked computer based patient information systems, the conventional technology reaches a sound barrier: problems of recall and precision curtail the efficiency gains in data retrieval as the number of data sources and the amount of data in them increases; concerns for privacy protection meet the limits of conventional means as the entropy of the data collections and the number of persons implicated by them increases. We propose that these shortcomings will require additional features for advanced patient information systems, and that medical concept representation has a key role in overcoming these deficiencies. After substantiating the evidence for the need, we outline a means for improvement through medical concept representation. We conclude by discussing the current state of alternatives for medical concept representation and propose that the methodology for resolution of the identified impediments is available.
Ethics, Medical↗
Controlling for chance agreement in the validation of medical expert systems with no gold standard: PNEUMON-IA and RENOIR revisited.
In the validation of medical expert systems, agreement among different human specialists on a random sample of cases may be taken as a substitute to a missing gold standard. Distance measures between pairs of experts, extensively described in previous studies, do not take into account the influence of chance-expected agreement. A weighted kappa index, with three different weighting schemes, is proposed as an alternative to be applied in the general situation of N cases assessed by E experts about K possible diagnoses, each of them qualified with one of G ordinal categories. A hierarchical cluster analysis, applied to the kappa matrices generated, allows for the classification of the expert system among clinical specialists, providing a relative assessment of its diagnostic ability. The above methodology is applied to the validation of two medical expert systems, PNEUMON-IA and RENOIR.
Cluster Analysis↗
Emergency medical service systems in Japan: past, present, and future.
Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.
Advanced Cardiac Life Support↗
An investigation of a spread energy method for medical ultrasound systems. Part two: proposed system and possible problems.
A medical ultrasound device using a Golay code is proposed and investigated theoretically. The code enables the spread energy method to be used to help overcome the restraints of the parameters of resolution, peak power and penetration.
Medical Laboratory Science↗
Incorporating drugs and devices into emergency medical services systems.
The proliferation of new medical technology and pharmacology forces the medical community to ensure the efficacy and safety of new drugs and devices before their use in patient care. Although traditional medical practices have a fairly consistent means to achieve this end, prehospital medical practice often does not. In addition, it often appears that the emergency medical services marketplace does not always follow conventional supply/demand and cost/quality paradigms. This article describes a process implemented in Pennsylvania to standardize the mechanism by which new drugs and devices are introduced into prehospital medical practice.
Device Approval↗
UMLS-based access to CPR data. Unified Medical Language Systems.
This paper describes the results of a project that explores the use the Unified Medical Language System (UMLS) for knowledge-driven tasks, such as browsing a computer-based patient record (CPR). The project consisted of a number of steps: the mapping between CPR terms and UMLS concepts, the development of an algorithm that explores the CPR data using this mapping and the implementation of a first prototype browser that visualizes 'found' data. A second task addressed in this project has been the direct access to online medical literature (MEDLINE) using the UMLS concepts found in the CPR data. In this project, we used a preliminary version of the Open Records for Patient Care (ORCA) CPR that consisted only of the history and physical examination data of patient suffering from heart failure.
Algorithms↗
Auditing the Unified Medical Language System with semantic methods.
OBJECTIVE: The National Library of Medicine's (NLM) Unified Medical Language System (UMLS) includes a Metathesaurus (Meta), which is a compilation of medical terms drawn from over 30 controlled vocabularies, and a Semantic Net, which contains the semantic types used to categorize Meta concepts and the semantic relations to connect them. Meta has been constructed through lexical matching techniques and human review. The purpose of this study was to audit the Meta using semantic techniques to identify possible inconsistencies. METHODS: Five different techniques were applied: (1) detection of ambiguity in Meta concepts with two or more semantic types, (2) detection of interchangeable keyword synonyms, (3) detection of redundant pairs of Meta concepts (using lexical matching combined with keyword synonyms), (4) detection of inconsistent parent-child relationships in Meta (based on the semantic type information), and (5) discovery of pairs of semantic types for which relations could be added to the Semantic Net, based on "other" relationships between Meta concepts. RESULTS: Of 57,592 concepts with multiple semantic types, 1817 (3.2%) were judged to be ambiguous. Keyword analysis showed 7121 pairs of interchangeable words. Using the keyword pairs, 5031 pairs of potentially redundant concepts were suggested, of which 3274 (65.1%) were judged to actually be redundant. Review of the 100,586 parent-child relationships revealed 544 (0.54%) that were incorrect. Review of the 219,664 "Other" relationships suggested 1299 places in the Semantic Net where relations between pairs of semantic types could be added. CONCLUSION: Semantic techniques, alone or in combination, can be used to audit the UMLS to detect inconsistencies that are not detectable through lexical techniques alone. Use of these methods to augment the UMLS maintenance process will lead to improvement in the UMLS.
Algorithms↗
The Tokyo Medical Examiner's Office. Introduction of the medical examiner system in Tokyo and statistical observation over four decades.
The medical examiner system was introduced to Japan by the general headquarters of the Allied powers after World War II; however, as of now, this system serves only four regions (23 wards in Tokyo, Yokohama, Osaka, and Kobe). The Tokyo Medical Examiner's Office is the largest of the four, and this report presents its activities.
Accidents↗
RAPID: An Electronic Medical Records System for Radiation Oncology.
A electronic text-based medical record system used in a radiation oncology department since 1990 is described. The database is composed of a group of subfiles linked with a powerful relational database. The clinically relevant subfile structures are described and the hardware and software requirements for the system are itemized. Data entry is accomplished primarily by transcriptionists with some additional input by physicians at the time a dictation is reviewed. The database has been the exclusive source of radiation oncology notes since 1990. The flow of information from the dictaphone to the printed copy is described. Compared with a standard transcription service, addition clinical information is collected at the time of the patient encounter, and this information can be abstracted in reports. While not entirely replacing the paper record, the easy and rapid access to text-based digital information from any computer within the department has been invaluable.
Journal Article↗
Pharmacists in the Omaha Metropolitan Medical Response System.
PURPOSE: The role of pharmacists in the Metropolitan Medical Response System (MMRS) for Omaha, Nebraska, is described. SUMMARY: Pharmacists have been involved in the Omaha MMRS since its inception in 2000. The Omaha MMRS has a pharmacy committee composed of pharmacists from local hospitals, community pharmacies, and two pharmacy schools. The pharmacy committee oversees the stock of pharmaceuticals available to Omaha in an emergency by continuously monitoring hospital inventories and working with state and federal planners. Pharmacists are responsible for planning for the receiving, staging, storing, distributing, and dispensing of the large quantities of pharmaceuticals that might be required in a disaster. Pharmacists also educate other health care professionals and the public about threats. CONCLUSION: Pharmacists play a major role in emergency preparedness in the Omaha metropolitan area and would be active participants in the community's response to a disaster.
Cities↗
Accuracy and time requirements of a bar-code inventory system for medical supplies.
The effects of implementing a bar-code system for issuing medical supplies to nursing units at a university teaching hospital were evaluated. Data on the time required to issue medical supplies to three nursing units at a 480-bed, tertiary-care teaching hospital were collected (1) before the bar-code system was implemented (i.e., when the manual system was in use), (2) one month after implementation, and (3) four months after implementation. At the same times, the accuracy of the central supply perpetual inventory was monitored using 15 selected items. One-way analysis of variance tests were done to determine any significant differences between the bar-code and manual systems. Using the bar-code system took longer than using the manual system because of a significant difference in the time required for order entry into the computer. Multiple-use requirements of the central supply computer system made entering bar-code data a much slower process. There was, however, a significant improvement in the accuracy of the perpetual inventory. Using the bar-code system for issuing medical supplies to the nursing units takes longer than using the manual system. However, the accuracy of the perpetual inventory was significantly improved with the implementation of the bar-code system.
Data Collection↗
A computerized data base system for medical diagnostic studies (Diastu).
A computerized database system (DIASTU) has been developed for the storage and selective retrieval of the results of medical diagnostic studies. The system is being used to analyze the disease process and the efficacy and yield of selected diagnostic studies. The system runs on a DEC PDP-11/60 computer. It consists of three FORTRAN IV programs linked to a general-purpose assembly language database handler. One program, DSENT, interactively modifies the information in the database. The second, DSLIST, prints all or portions of the database. The third program, DSTAT, interactively assembles the parameters for selective searches of the database and executes them. A query language is used that allows the use of time and size specifications and Boolean operators in nested loops.
Computers↗
An enriched unified medical language system semantic network with a multiple subsumption hierarchy.
OBJECTIVE: The Unified Medical Language System's (UMLS's) Semantic Network's (SN's) two-tree structure is restrictive because it does not allow a semantic type to be a specialization of several other semantic types. In this article, the SN is expanded into a multiple subsumption structure with a directed acyclic graph (DAG) IS-A hierarchy, allowing a semantic type to have multiple parents. New viable IS-A links are added as warranted. DESIGN: Two methodologies are presented to identify and add new viable IS-A links. The first methodology is based on imposing the characteristic of connectivity on a previously presented partition of the SN. Four transformations are provided to find viable IS-A links in the process of converting the partition's disconnected groups into connected ones. The second methodology identifies new IS-A links through a string matching process involving names and definitions of various semantic types in the SN. A domain expert is needed to review all the results to determine the validity of the new IS-A links. RESULTS: Nineteen new IS-A links are added to the SN, and four new semantic types are also created to support the multiple subsumption framework. The resulting network, called the Enriched Semantic Network (ESN), exhibits a DAG-structured hierarchy. A partition of the ESN containing 19 connected groups is also derived. CONCLUSION: The ESN is an expanded abstraction of the UMLS compared with the original SN. Its multiple subsumption hierarchy can accommodate semantic types with multiple parents. Its representation thus provides direct access to a broader range of subsumption knowledge.
Algorithms↗