Computer-aided medical decision making.
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Computers↗
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Computer based assistance for medical decision making.
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Computers↗
Computer-aided diagnosis of acute abdominal pain. The British experience.
This presentation reviews the U.K. experience of computer-aided diagnosis of acute abdominal pain--which now relates to over 30,000 cases seen in more than 10 hospitals during a 13 years period. Following a discussion of the philosophy, construction and mode of usage of the systems employed, results of this experience are presented. Computer-aided diagnosis in this area has been shown to be feasible and (if correctly utilised) leads to improvements in patient care, diagnosis, and decision making by the doctors involved. In this context, the computer is simply one element of an integrated package reaffirming the importance of traditional clinical medicine.
Abdomen↗
[Perspectives in the use of computers in anesthesia].
The remarkable development of computer technology and the early experiments into its clinical use give us cause ot define useful spheres of application and task areas in anaesthesia for this valuable machine. Parallel to this followed the development of computer use in anaesthesia. Here, there are essentially four main areas of application: administration of data, monitoring, teaching, process of decision making. Next to a quite uniform definition of the task areas of a computer, the question of the selection of the suitable computer for the respective requirement cannot be answered in the same uniform way. For the application of computer technology in the practice of anesthesiology it is essential to guarantee not only sufficient safety of data but also a protection from misuse and manipulation. On the whole it is probable that computer technology will take over more and more medical technical tasks especially of the anaesthesia apparatus and evaluate them. An automatic registration of records with combined off-line and on-line recording of measured values represents the logical development of this technology.
Anesthesia↗
[Computer assistance in diagnosis and therapeutic decision-making].
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Computers↗
[Algorithms of medical decision making].
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Computers↗
[Animals, data and diagnosis (author's transl)].
The development of the 'chip' tends to make data-processing apparatus increasingly smaller, reliable and cheaper. The question is in which fields they will be of practical use to the veterinarian. In the present paper, a brief technical introduction is followed by a description of the functional potentialities and limitations of computers. The use for administrative purposes and recording as well as for interaction in processes of decision is discussed and illustrated by examples. The principles which are of importance in Information Retrieval and diagnosis are discussed. Finally, a data-processing system designed for veterinary practitioners is described in broad outline.
Animal Diseases↗
In-basket exercise to teach computer-assisted food systems management.
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Competency-Based Education↗
Dietitians use computer assistance to contain costs.
To determine if a computer-assisted food management system is cost effective, the manager sould compare the cost of personnel to produce records manually with the cost of computer time and supporting personnel. Current reports, which the computer produces, enable managers to react to spiraling food cost immediately by changing recipes, menus, and making other pertinent decisions. This has proved to be cost effective. Another factor that makes computer application cost effective is the release time which results when cooks, clerks, and other personnel are relieved of repetitive routine tasks. Although it is possible to identify many specific savings, there is significant value in the quality of decision-making potential which cannot be quantified but is unquestionable.
Computers↗
[Trans-thoracic 3D echocardiography reconstruction for left ventricular volume determination].
2D-echocardiography is a safe and inexpensive method for accurate left ventricular volume quantification. However, accuracy of measurements is limited by the requirement of geometric assumptions and volume computation algorithms. Reproducibility is diminished by erroneous image plane positioning, which is due to the necessity of standardized reference images. The degree of variation can influence clinical decision making. 3D-echocardiography has overcome those problems. Volume quantitation is performed without the need of geometric assumptions, computation algorithms or reference images. The shape of a ventricle is defined by acquired data, not by calculated data. Since the recent development of sophisticated hardware- and software techniques the method can be utilized under clinical circumstances. For data acquisition tomographic planes are acquired either in a random or in a sequential order. For random acquisition the transducer is positioned at various acoustic windows at the thoracic wall and spatial orientation of the corresponding plane is localized by a spark gap device. By this way various, non-parallel cross-sectional images of the left ventricle are acquired. The spatial position of the planes is displayed by lines in a parasternal longitudinal view, each representing a "line of intersection". When tomographic planes are acquired in a sequential manner, mostly rotational scanning is utilized. Here, multiple apical views of the left ventricle are acquired during ECG- and respiration gated rotation of the transducer over a span of 180 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)
Algorithms↗
Development of a computer program for teaching periodontal diagnosis based on clinical epidemiological principles.
Multimedia teaching tools in dental education are still rare. This paper describes the development of an inexpensive yet powerful computer program for instruction in the principles of clinical epidemiology. The application was developed in the context of periodontal diagnostic methodologies at the third year D.D.S. level. Principles of probabilistic thinking are invoked as the student is guided from the application of raw research data to the derivation of likelihood ratios and how they affect clinical decision making. A questionnaire was used to evaluate student satisfaction with the program and the responses indicated good acceptance of the concepts presented in the program and an interest in further computer-aided instruction.
Computer-Assisted Instruction↗
Biomedical image processing in pathology: a review.
Pathologists make a diagnostic decision by viewing a specimen and measuring various diagnostically important attributes of an isolated object such as size, shape, darkness, colour and texture. This is a complex process. In recent years, computer-aided image processing and analysis systems have played a significant role in quantitative pathology. This paper summarises basic image processing and analysis techniques and reviews related work in pathology and cytology based on computational image processing since 1987. Firstly, we present a general introduction to image enhancement, segmentation, morphometry and visualisation for those medical colleagues who may not have the necessary background in this area. (The mathematical treatment is kept to minimum and appropriate references are cited to satisfy the more mathematically oriented readers. Selected examples are provided to demonstrate the effects of various basic image processing algorithms on a MRI scan. It should be emphasised that the reviewed techniques are generally used as preprocessing steps in analysing microscopic images and powerful algorithms are more sophisticated and problem-specific.) Secondly, we review image cytometric and histometric methods, standards, calibration and applications. Finally, we touch upon three dimensional confocal image processing and analysis, applications of artificial neural networks, and optical disk database management for recording and retrieving a large number of digitised high resolution images. The development of integrated optical microscope and computer, systems is also briefly described.
Artificial Intelligence↗
[Image analysis of ECG rhythm].
The paper deals with ECG rhythmic structure presentation oriented on image thinking of the specialist making diagnostic decisions in interactive interaction with computer. Rhythmogram complex for personal computer is designed.
Electrocardiography↗
Computer-based consultation in "care" of the critically ill patient.
Despite far-reaching progress in all areas of surgery, methods of medical data analysis and communication have not kept pace with the increased rate of data acquisition. The needs to organize and communicate these data and to provide a medium for continuing education are great in critical-care areas where the amount and the diversity of data collected are enormous, and the number of surgical team members involved in patient care has grown proportionately. The computer-based Clinical Assessment, Research, and Education System (CARE) is a time-shared computer system now available on a national basis designed to provide a management and education aid for the treatment of critically ill surgical patients. An initial clinical assessment and operative note are entered by the surgeon from which an estimation of the initial fluid, blood, and electrolyte deficits are calculated. Daily doctor's progress notes, shift nurses' summaries of vital signs, clinical information, intake and output data, and drug administration, biochemical, cardiovascular, blood gas, and respiratory information are entered for each shift. From these, a metabolic balance is calculated; fluid, electrolyte, and caloric requirements are determined; cardiorespiratory parameters are computed; and various therapuetic suggestions and cautions are given to alert the physician to problems that may be arising. The surgeon-user is assisted in making the best critical-care decisions through computer-directed, interactive prompting which focuses on the most important clinical conditions and correlations and metabolic considerations and relates the important problem to the relevant literature.
Acute Disease↗
Quantitative echocardiography: a comparison with ultrafast computed tomography in patients with chronic aortic regurgitation.
Chronic aortic regurgitation leads to progressive left ventricular dilatation and hypertrophy. It is important to be able to measure these variables for clinical decision making on the timing of aortic valve replacement. M-mode and two-dimensional echocardiography are widely utilized in clinical practice for a qualitative assessment of left ventricular size and function. Recent recommendations have been proposed for the use of quantitative assessment by left ventricular size and left ventricular mass by two-dimensional echocardiography; there has been no study examining the validity of these measurements in patients with aortic regurgitation. The purpose of this study was to prospectively examine the various geometric models of echocardiographically determined left ventricular mass and volumes in patients with chronic aortic regurgitation compared with cine-computed tomographic scanning. Twenty-two patients with chronic aortic regurgitation were prospectively identified and underwent two-dimensional echocardiographic and cine-computed tomographic scanning. M-mode and two-dimensional echocardiographic images were analyzed on an off-line measurement digital system. Seven previously described geometric models were used in this study for quantitative analysis. Both left ventricular mass and left ventricular volume were calculated from real-time ultrafast tomographic scans. Left ventricular mass determinations by two-dimensional echocardiography correlated more than M-mode determinations (r = 0.84 vs. r = 0.75, standard error of the estimate (SEE) = 38 g vs. 139 g). Biplane two-dimensional echocardiography formulas using Simpson's rule construct yielded more accurate values for left ventricular end-diastolic volumes (r = 0.92, SEE = 24 ml) than either the single-plane Simpson's rule (r = 0.58, SEE = 73 mL) or methods using predetermined models of left ventricular shape (r = 0.80, SEE = 38 ml).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Expert systems.
The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.
Drug Interactions↗
Creating care plans via modems: using a hospital information system in nursing education.
Preparing nursing students for the demands of high technology in health professions is a challenge for everyone involved in nursing education today. Advancements in technology have changed the health care delivery system resulting in computerization that affects all areas of patient care. Nursing education programs must assure that all graduates can effectively use computer technology. To address this need, the Wright State University-Miami Valley School of Nursing was one of the first schools in the nation to provide connectivity via computers in the school's student computer lab to a real hospital information system. This connectivity allows the nursing students to create care plans for their assigned patients, plans which after discussion with the instructor and the patients' nurse, are entered into the patients' records. This real-life application allows the students to see not only the results of their decision-making, but the overall process of patient care. The benefits of having students use a nursing information management system include enhanced student motivation, professional socialization, the ability to understand the "whole clinical picture," and decreased fear of computer technology. The computers in the student computer lab play an invaluable role in the education of the nursing students. They give the students the opportunity to experience a real-life application in the nursing profession and prepare them for the world of technology they will encounter after graduation.
Computer Security↗
[Imaging science and technology in diagnostic radiology: expectations in the second century of Roentgen's discovery of X-rays].
During the first century since the discovery of X-rays by Roentgen in 1885, imaging technology has contributed significantly to the progress of diagnostic radiology, mainly by providing various methods and techniques for production of diagnostic images. In the next century, it is expected that imaging science and technology will contribute to the most important process of diagnostic decision makings by radiologists and physicians by providing quantitative analyses of medical images using high-speed computers. The computer output may be used as a "second opinion" to assist radiologists' interpretation of images. This concept has been investigated as computer-aided diagnosis (CAD) during the last ten years in chest radiography and mammography for detection of lesions and characterization of normal and abnormal patterns. The aim of CAD is to improve the accuracy and the consistency of radiologic diagnoses. In this article, recent results are presented on the detection of lung nodules and pneumothoraces as well as quantitative analyses of interstitial infiltrates and cardiomegaly in chest radiographs. In mammography, CAD schemes are being developed for detection of clustered microcalcifications and masses. Recently, the prototype mammography intelligent workstation has been implemented in the clinical section of our department and initial clinical results from screening cases appear promising.
Diagnosis, Computer-Assisted↗