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Moving toward an electronic record is both challenging and rewarding. The implementation of a computerized scheduling and management system for the operating room is evaluated. Components of the system include Scheduling, Personnel, Supply, Intraoperative, and InSight modules.
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Video imaging can simulate combined orthodontic-orthognathic surgical treatment to assist in treatment planning and patient education. Video imaging predictions were compared with actual posttreatment results for 18 patients who received orthodontic and mandibular orthognathic surgical treatments. Three untreated control subjects were also studied. The locations of 13 soft tissue landmarks relative to horizontal and vertical reference planes were compared between predictions and posttreatment photographs, and significant variation (+/- 5 mm) was found for many of the landmarks. Comparisons of various steps repeated during the prediction process were also completed to test for reproducibility. Relatively small differences, generally less than +/- 2 mm, were attributed to the process of linking the cephalogram and photograph and to the manual steps to create surgical treatment objectives. The largest proportion of the total variation, about 80%, was estimated to arise from inaccuracy inherent in the software program. Other contributions to the total variation likely came from physiologic facial changes over time and nonstandardized head positions in the photographs.
This retrospective study analyzes the accuracy of a prediction algorithm from Quick Ceph Image. Pre- and postsurgical lateral cephalograms of 35 adult patients were computer imaged and specific landmarks digitized. Digitization error was assessed from duplicate digitizations. Sixteen measurements of the predicted and actual postsurgical hard and soft tissue landmarks were compared using Student's t test, one- and two-way analysis of variance, and a modified Bradley-Blackwood test. Results showed a good correlation between repeated digitization of all variables except soft tissue point B and E-plane. Comparison of the predicted and actual changes found that all differences were less than 1.8 mm or 3.1 degrees. Student's t test showed 10 of the 16 measurements did not differ significantly, and interclass correlation demonstrated moderate to good correlations for 13 of 16 variables. Overall the results of this study suggest that the magnitude of the differences were within clinically acceptable limits.
The purpose of this study was to test and compare the accuracy and reliability of soft tissue profile predictions generated from two computer software programs. The presurgical and postsurgical cephalometric radiographs of 28 patients were digitized onto each computer program. A customized analysis was created to determine the amount of surgical movement, as well as to compare the actual postsurgical soft tissue profile with the computer-generated prediction. The results demonstrated that, on the average, the predictions were not significantly different from the actual postsurgical profile changes. While each program generated statistically similar prediction results, marked variability was noted. There was no significant difference found in the prediction errors between patients who had one-jaw surgery and those who had two-jaw surgery. This study found that a linear relationship existed between the surgical movement and the prediction error. In general, the greater the magnitude of the surgical movement, the larger the prediction error.
We studied the accuracy of left ventricular (LV) volumes and ejection fraction (EF) derived from ECG gated 99mTc-sestamibi myocardial perfusion SPECT (G-SPECT) and the software for automatic data analysis (QGS program described by Germano G et al.). G-SPECT was performed in 29 patients with various cardiac diseases. LV end-diastolic and end-systolic volumes (LVEDV and LVESV), and LVEF determined by QGS program were compared to those by Simpson method in biplane left ventriculography (LVG). Interobserver reproducibility in measuring the G-SPECT parameters was excellent (LVEDV: r = 0.99, LVESV: r = 0.99, LVEF: r = 0.97). There was a good correlation between the values obtained from G-SPECT and LVG (LVEDV: r = 0.92, LVESV: r = 0.94, LVEF: r = 0.85), but G-SPECT tended to underestimate LVEDV and LVEF. In 17 patients with moderate to severe myocardial perfusion defects selected from the subjects, the correlation was maintained fairly high (LVEDV: r = 0.90, LVESV: r = 0.92, LVEF: r = 0.77). In conclusion, QGS program provides high accuracy and reproducibility in determining LV volumes and LVEF from G-SPECT.
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OBJECTIVE: To test the accuracy of the PD ADEQUEST kinetic model in calculating peritoneal transport parameters and to quantify the differences between the results of software simulations and direct measurements in order to assess the reliability of this tool in chronic peritoneal dialysis (PD) pediatric patients. PATIENTS: Twenty-nine patients (mean age: 10 +/- 4 years; range: 4-17), 5 on continuous ambulatory PD, 4 on continuous cycling PD, 19 on nocturnal intermittent PD and 1 in nocturnal tidal PD, all free from peritonitis in the previous 2 months. Fourteen patients were anuric and 15 had a mean glomerular filtration rate of 1.79 +/- 1.23 mL/min, range 0.25-4.82. METHODS: In all patients, 24-hour dialysate and urine collections associated to standard peritoneal equilibration test (PET) were performed using their usual dialytic regimen and fill volume (1023 +/- 159 mL/m2 BSA, range 614-1361). PD ADEQUEST kinetic parameters were compared with pediatric and adult data from literature. The measured weekly normalized total creatinine clearance (CRCL), weekly total Kt/V, and daily net ultrafiltration (UF) were compared with corresponding mathematically modeled values. RESULTS: Kinetic parameters calculated by the PD ADEQUEST program were comparable to adult and pediatric values from previous studies after normalization for BSA. Measured and modeled CRCL and Kt/V showed a good agreement [concordance correlation (rc) 0.937 and 0.768, respectively] with limited median percentage absolute errors (11.6% and 10.2%, respectively). Ultrafiltration showed less favorable results (rc = 0.600 and median percentage absolute error 45%) probably owing to the wide variability of this parameter. When the analysis was restricted to the peritoneal component, the rc coefficients results were 0.745 for CRCL and 0.512 for Kt/V (median absolute error: 11.6% and 15.2%, respectively). CONCLUSIONS: The overall findings of our study show that the PD ADEQUEST kinetic model can be used in pediatric patients for the calculation of kinetic indexes and for mathematical simulation of the various regimens. We also feel that the results yielded by the PD ADEQUEST program are reliable enough for this computerized mathematical model to be used in the prescription management of pediatric patients. Only UF prediction needs to be used with a certain caution on account of the marked variability of this parameter.
The American Heritage dictionary defines the word "web" as "something intricately contrived, especially something that ensnares or entangles." The wealth of medical resources on the World Wide Web is now so extensive, yet disorganized and unmonitored, that such a definition seems fitting. In emergency medicine, for example, a field in which accurate and complete information, including patients' records, is urgently needed, more than 5000 Web pages are available today, whereas fewer than 50 were available in December 1994. Most sites are static Web pages using the Internet to publish textbook material, but new technology is extending the scope of the Internet to include online medical education and secure exchange of clinical information. This article lists some of the best Web sites for use in emergency medicine and then describes a project in which the Web is used for transmission and protection of electronic medical records.
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UNLABELLED: Automatic speech recognition systems are already being used in spheres employing a restricted vocabulary. OBJECTIVE: Our aim was to investigate whether low-cost speech recognition software for PC is capable of being usefully employed in the sphere of sociomedicine. MATERIALS AND METHODS: To this end 34 representative pages of text (a total of 11,000 words) taken from expertises on cases of suspected medical malpractice (many different subspecialties) were dictated using IBM's "Voice Type Simply Speaking" software. Having completed a page, the resulting error rate was recorded, and the text was corrected before we proceeded with the dictation. Finally, 3 pages of text were re-dictated and the resulting error rate determined. RESULTS: The error rate in the previously unknown text ranged between 10 and 23 per cent (mean 15.9%) without any significant reduction during the training phase, while that in the re-dictated text was drastically reduced to less than 3 per cent. It became evident that once a word was corrected the system hardly ever repeated that particular mistake. CONCLUSION: The system's poor performance on unknown text and the missing reduction in the error rate during the training phase are obviously not due to any incompetence of the system but to the huge amount of technical jargon in the scope of medical writing. To attain an acceptable performance we suggest to either extend the training phase, or, preferably, to confine the application to a single medical subspecialty. Its overwhelming learning ability makes the system a serious candidate typist in the sphere of sociomedicine.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
As demonstrated in several validation studies, the dermal phototoxic potential of chemicals in humans can be effectively assessed by in vitro methods. The core of these methods is to monitor dose-response curves of a chemical in the absence and presence of light, to quantify the difference between these two curves by appropriate measures (either the photo-irritancy factor [PIF], or the mean photo effect [MPE]), and to use these measures as predictors of in vivo phototoxicity. We present new concentration-response analysis software for in vitro phototoxicity testing, which runs on current personal computers, and takes into account all the limitations identified when using a former program. We also demonstrate the validity and robustness of this new software by applying it retrospectively to all data available from two phases of the EU/COLIPA validation trial for the 3T3 neutral red update in vitro phototoxicity test. Some frequently raised questions pertaining to the use of prediction models in phototoxicity testing are addressed, including: the necessity of using prediction models based on a cut-off; whether it is justifiable to use sharp prediction cut-off values; whether there is a biostatistical justification for the highest concentration of the test chemical; and whether repeated testing of a chemical is required.