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At least 973 records · Page 54Linked to original sources
PubMed1993

Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care.

STUDY OBJECTIVE: To develop and validate a new time interval model for evaluating operational and patient care issues in emergency medical service (EMS) systems. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective analysis of 300 EMS responses among 20 advanced life support agencies throughout an entire state by direct, in-field observation. RESULTS: Mean times (minutes) were response, 6.8; patient access, 1.0; initial assessment, 3.3; scene treatment, 4.4; patient removal, 5.5; transport, 11.7; delivery, 3.5; and recovery, 22.9. The largest component of the on-scene interval was patient removal. Scene treatment accounted for only 31.0% of the on-scene interval, whereas accessing and removing patients took nearly half of the on-scene interval (45.8%). Operational problems (eg, communications, equipment, uncooperative patient) increased patient removal (6.4 versus 4.5; P = .004), recovery (25.4 versus 20.2; P = .03), and out-of-service (43.0 versus 30.1; P = .007) intervals. Rural agencies had longer response (9.9 versus 6.4; P = .014), transport (21.9 versus 10.3; P < .0005), and recovery (29.8 versus 22.1; P = .049) interval than nonrural. The total on-scene interval was longer if an IV line was attempted at the scene (17.2 versus 12.2; P < .0001). This reflected an increase in scene treatment (9.2 versus 2.8; P < .0001), while patient access and patient removal remained unchanged. However, the time spent attempting IV lines at the scene accounted for only a small part of scene treatment (1.3 minutes; 14.1%) and an even smaller portion of the overall on-scene interval (7.6%). Most of the increase in scene treatment was accounted for by other activities than the IV line attempts. CONCLUSION: A new model reported and studied prospectively is useful as an evaluative research tool for EMS systems and is broadly applicable to many settings in a demographically diverse state. This model can provide accurate information to system researchers, medical directors, and administrators for altering and improving EMS systems.

Arizona↗
PubMed1996

Ambulance use, misuse, and unmet needs in a developing emergency medical services system.

Ambulances in Taiwan have always been viewed by medical personnel and the population at large purely as transport vehicles. The emergency medical services (EMS) system upgrading will require a change of concept. Following emergency medical technicians (EMT) training in Keelung, a 400000-inhabitant mid-sized port city in northern Taiwan, we began prospective data collection to evaluate the patterns of ambulance use, misuse and potential needs within the community. Over a 3-month period, 1035 calls, 572 fully documented patient transfers and 17703 emergency department (ED) visits at the city's largest hospital were collected and analysed. The daily call volume was 0.32 per 10000 population with 31.7% of all ambulances dispatched resulting in no patient being transferred. The majority of patient transports were for trauma (61.2%), with almost all of the no patient transfers also following trauma, having been called in by someone passing by or witnessing the accident. Of those transported, 27.6% did not require even basic EMT care and so were considered misuse. Conversely, the majority of critically ill patients presenting to the hospital ED did not arrive by EMS ambulance, giving a conservatively projected unmet need of 86%. Despite low call volumes, misuse and non-transport, rates appear high. This is because the majority of accidents are called-in by passers-by who have no first aid training and a cultural aversion to becoming involved. At the same time unmet needs are also high, with education required to get the public to change their practice, and further study needed to see if this will, in fact, improve outcomes.

Ambulances↗
PubMed2002

Crossing the "digital divide:" implementing an electronic medical record system in a rural Kenyan health center to support clinical care and research.

To improve care, one must measure it. In the US, electronic medical record systems have been installed in many institutions to support health care management, quality improvement, and research. Developing countries lack such systems and thus have difficulties managing scarce resources and investigating means of improving health care delivery and outcomes. We describe the implementation and use of the first documented electronic medical record system in ambulatory care in sub-Saharan Africa. After one year, it has captured data for more than 13,000 patients making more than 26,000 visits. We present lessons learned and modifications made to this system to improve its capture of data and ability to support a comprehensive clinical care and research agenda.

Ambulatory Care↗
PubMed2001

A missing data treatment for data mining applications in medical information systems.

To apply user-friendly, easily operated and accessible tools to handle missing data resulting from an auto-stored medical information system, these tools are applied to satisfy general users from different disciplines (i.e. statistics and machine-learning), followed by medical information system development. This study attempts to develop a new logic separation inference method applied to a database with a format like most real-world medical records containing many missing data and miscellaneous variables. It is expected that this method should have better performance than currently accessible methods. The newly developed logic separation inference method shows a classification power of 0.997 (elimination method is 1), which is better than the simple replacing method (replaced by mode shows 0.974). Both inference methods (mode and mean) have superior classification power to the simple replacing method. The missing data treatment processes introduced in this study can be completed on a MS Excel spreadsheet without any complicated calculation; therefore, they can satisfy general users. This new missing data treatment method is only applied up to 60% of the missing data (missing at random). However, when there is large amount of data, it is expected that this method also can be applied to a database missing more than 60%.

Humans↗
PubMed2002

The Defense Medical Surveillance System and the Department of Defense serum repository: glimpses of the future of public health surveillance.

The Defense Medical Surveillance System (DMSS) is the central repository of medical surveillance data for the US armed forces. The DMSS integrates data from sources worldwide in a continuously expanding relational database that documents the military and medical experiences of service members throughout their careers. The Department of Defense Serum Repository (DoDSR) is a central archive of sera drawn from service members for medical surveillance purposes. Currently, the DMSS contains data relevant to more than 7 million individuals who have served in the armed forces since 1990, and the DoDSR contains more than 27 million specimens that are linkable to data in the DMSS. Recent applications of the DMSS and DoDSR provide glimpses of the capabilities and uses of comprehensive public health surveillance systems.

Confidentiality↗
PubMedDate not supplied

Methodology for a medical expert system on fuzzy analog ganglionar lattices. Non-approximate reasoning with multiple antecendents of different relative importance and limited uncertainty.

This work presents an Expert System based on fuzzy analog ganglionar lattices. Its reasoning scheme is designed analogously to the expert's mental organization and it is realized on an (analog) operator called the ganglionar lattice. It is a connectionist system that uses the medical knowledge to define its architecture. The operator evokes some similarities to higher order neural networks and performs as the knowledge base and inference engine of the expert system, in a unified manner. A main feature of this operator is that it exhibits the variables corresponding to all intermediate concepts identified by the expert; this characteristic is shown to be most valuable for assessing, explicating and prospecting in medical applications. Further, it is capable of (i) evaluating a consequent for a variety of non-approximate reasonings with multiple antecendents of different relative importance under limited uncertainty; (ii) explicating the conclusions at different levels of abstraction to suit the user; and (iii) prospecting for the best 'a priori' sequence of unevaluated antecedents, from which to choose following tests. These procedures are based on the objective criterion of the consequent's uncertainty decrease (entropy). All results are produced in numerical form and may be translated into restricted natural language. A simple example of this technology is fully developed. Finally the method's potentials are discussed for future applications.

Artificial Intelligence↗
PubMed2007

Effects of technological interventions on the safety of a medication-use system.

PURPOSE: A study was conducted to assess the effects and outcomes of implementing new technology into the medication-use process. METHODS: A pharmacy computer system, automated dispensing cabinets, and point-of-care products were implemented. The hypotheses of the study were that system errors in each phase of the medication-use process would decrease with the implementation of each technological application and that workload measures, such as staffing and inventory levels, would increase. Using a scripted questionnaire, interviews of participating staff (registered nurses, licensed practical nurses, nursing-unit clerks, pharmacists, pharmacy technicians, physicians, and physician assistants) were conducted to determine their impressions of the safety of the medication-use system before and after the implementation of technology. All hospitalwide errors were reported monthly between November 2002 and July 2005 by the number of errors per 1000 patient days and were categorized by error type. The accuracy of the medication administration record was examined; the pharmacy dispensing process was evaluated for accuracy, timeliness, and system changes; the accuracy of medication administration was observed; and staffing changes were also evaluated. RESULTS: Because of the technology implementation, the accuracy of patient identification was introduced, process changes and technological design identified potential failure modes in the medication administration process, inventory increased, turn-around time to process medication doses in the pharmacy decreased, accuracy of medication administration increased, and the staffing of nurses and pharmacists increased. CONCLUSION: Implementation of new technology into the medication management system standardized the medication administration processes, decreased turnaround time for processing medication orders, and increased accuracy of medication administration to patients.

Diffusion of Innovation↗
PubMedDate not supplied

Errors in a computerized medical records system (CLINICS).

The accuracy of computer-held medical information can be of critical importance in patient care, therefore it is important not only to know the error rate in the stored data but also to know the effectiveness of error checking and correction programs. This paper reports on the errors which were detected by checking the consistency between stored data and incoming data (context checks), in Southampton University Primary Medical Care computer system (CLINICS). The majority of detected errors were traced either to the registration of new patients or to the doctors failing to pay adequate attention to detail in their record keeping (or to their legibility). 7% of incoming data had errors detected by the context checking program and subsequently corrected; we calculate that the stored data contains less than 1% in error.

Computers↗
PubMed1991

Extensions to the time-oriented database model to support temporal reasoning in medical expert systems.

Physicians faced with diagnostic and therapeutic decisions must reason about clinical features that change over time. Database-management systems (DBMS) can increase access to patient data, but most systems are limited in their ability to store and retrieve complex temporal information. The Time-Oriented Databank (TOD) model, the most widely used data model for medical database systems, associates a single time stamp with each observation. The proper analysis of most clinical data requires accounting for multiple concurrent clinical events that may alter the interpretation of the raw data. Most medical DBMSs cannot retrieve patient data indexed by multiple clinical events. We describe two logical extensions to TOD-based databases that solve a set of temporal reasoning problems we encountered in constructing medical expert systems. A key feature of both extensions is that stored data are partitioned into groupings, such as sequential clinical visits, clinical exacerbations, or other abstract events that have clinical decision-making relevance. The temporal network (TNET) is an object-oriented database that extends the temporal reasoning capabilities of ONCOCIN, a medical expert system that provides chemotherapy advice. TNET uses persistent objects to associate observations with intervals of time during which "an event of clinical interest" occurred. A second object-oriented system called the extended temporal network (ETNET), is both an extension and a simplification of TNET. Like TNET, ETNET uses persistent objects to represent relevant intervals; unlike the first system, however, ETNET contains reasoning methods (rules) that can be executed when an event "begins", and that are withdrawn when that event "concludes". TNET and ETNET capture temporal relationships among recorded information that are not represented in TOD-based databases. Although they do not solve all temporal reasoning problems found in medical decision making, these new structures enable patient database systems to encode complex temporal relationships, to store and retrieve patient data based on multiple clinical contexts and, in ETNET, to modify the reasoning methods available to an expert system based on the onset or conclusion of specific clinical events.

Diagnosis, Computer-Assisted↗
PubMed1993

Electronic medical record systems as a basis for computer-based patient records.

In summation, some document imaging systems offer the capability to form what may be called electronic medical record (EMR) systems. These systems are adaptations of current paper-based record management systems into the digital environment, but they offer far more capabilities than strictly archival, historical functions. Some of the capabilities that create EMR systems will also be necessary for development of CPRs, these capabilities are listed as follows: mass storage and image management; direct capture, storage, and retrieval of digital information (native format); large volume, high-speed, client-server networks; multi-media information management; high-power, flexible database tools; workflow process software; flexible, full function security; user customizable features; and alerts and reminders. Selection and implementation of document imaging systems should, at present, be undertaken with great care to insure that the platform may be utilized to form an electronic medical record with a clear migration path to the CPR.

Database Management Systems↗
PubMed2005

Improving the reliability of medical software by predicting the dangerous software modules.

Software reliability analysis is inevitable for modern medical systems, since a large amount of medical system functionality is now dependent on software, and software does contribute to system failures. Most software reliability models are based on software failure data collected from the project. This creates a problem for the designers since, during the early stage, software failure data are not available. However, a valuable knowledge can be learned from the analysis of previous projects and applied to the new ones. This paper presents the approach that predicts the potentially dangerous software modules under development based on the analysis of the already finished modules using the machine-learning techniques. On the basis of the prediction given by our method software designers are able to devote more testing effort to the dangerous parts of the system, which results in a more reliable medical software system.

Algorithms↗
PubMed1994

[The Medical Information System Program in urology: what should be considered?].

Medical data processing, introduced in France in 1985 has been compulsory for public hospitals since 1989 and has been tested in private institutions since 1991. A trial is currently underway in the Languedoc-Roussillon region to determine whether medical data processing can be used to modulate the global budget for hospitals and to define a new fees scheme for private clinics. The objective of the first part of this paper is to explain the origins of medical data processing and to understand its mechanisms and limitations. The second part situates medical data processing in the more general context of medicalization of information systems and emphasises the importance of an individual discipline approach for urology.

Budgets↗
PubMed2006

Correlation between estimates of tumor perfusion from microbubble contrast-enhanced sonography and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: We compared measurements of tumor perfusion from microbubble contrast-enhanced sonography (MCES) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in an animal tumor model. METHODS: Seven mice were implanted with Lewis lung carcinoma cells on their hind limbs and imaged 14 days later with a Philips 5- to 7-MHz sonography system (Philips Medical Systems, Andover, MA) and a Varian 7.0-T MRI system (Varian, Inc, Palo Alto, CA). For sonographic imaging 100 microL of a perfluoropropane microbubble contrast agent (Definity; Bristol-Myers Squibb Medical Imaging, Billerica, MA) was injected and allowed to reach a pseudo steady state, after which a high-mechanical index pulse was delivered to destroy the microbubbles within the field of view, and the replenishment of the microbubbles was imaged for 30 to 60 seconds. The MRI included acquisition of a T(10) map and 35 serial T(1)-weighted images (repetition time, 100 milliseconds; echo time, 3.1 milliseconds; alpha, 30 degrees ) after the injection of 100 microL of 0.2-mmol/kg gadopentetate dimeglumine (Magnevist; Berlex, Wayne, NJ). Region-of-interest and voxel-by-voxel analyses of both data sets were performed; microbubble contrast-enhanced sonography returned estimates of microvessel cross-sectional area, microbubble velocity, and mean blood flow, whereas DCE-MRI returned estimates of a perfusion-permeability index and the extravascular extracellular volume fraction. RESULTS: Comparing similar regions of tumor tissue seen on sonography and MRI, region-of-interest analyses revealed a strong (r(2) = 0.57) and significant relationship (P < .002) between the estimates of perfusion obtained by the two modalities. CONCLUSIONS: Microbubble contrast-enhanced sonography can effectively depict intratumoral heterogeneity in preclinical xenograft models when voxel-by-voxel analysis is performed, and this analysis correlates with similar DCE-MRI measurements.

Animals↗
PubMed2005

[The need for creating a patient medication record system and characteristics of its application in community pharmacies].

UNLABELLED: The objectives of this study were to explore the need for an information system of patient's medication record in pharmacies, where pharmacists could find all information about patient's condition, diseases and used medicines; to find out internet and information technologies usage in pharmacies. METHODS: In order to evaluate the demand for a specialized information system the method of a questionnaire-based survey was used. RESULTS: Obtained answers indicated that an information system could be useful in pharmacies and information technologies would facilitate information exchange among different institutions directly responsible for the treatment of patients.

Data Interpretation, Statistical↗
PubMed1988

Assessing the quality of data entry in a computerized medical records system.

A primary care university clinic discovered major errors in its medical records after instituting a computerized medical records system. A quality assessment tool was devised to measure the error rate and provide clues to the sources of these errors. During the implementation of this tool a marked reduction in data entry errors occurred suggesting its use had a positive impact on our medical record quality.

Arizona↗
PubMedDate not supplied

[Trends in the improvement of the medical documentation system].

The paper reports on the general and specific functions of medical records, as well as on the need to improve medical recording and the circulation of medical records in health units. The economic medical and social advantages of keeping accurate records are highlighted. Recent breakthroughs in information science permit unifying and standardizing medical records, making them more problem-oriented, developing technical equipment and extending its use in archives, expanding the role of the computer in clinical recording.

Documentation↗