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PubMedDate not supplied

Treatment patterns for otitis externa.

BACKGROUND: Although otitis externa is a common and painful infection of the outer ear canal, there is little specific information available regarding current treatment patterns in the United States. We wanted to examine treatment patterns for otitis externa. METHODS: Data were analyzed from the 1993 National Ambulatory Medical Care Survey (NAMCS) and the 1993 National Hospital Ambulatory Medical Care Survey (NHAMCS) for adults and children treated for otitis externa. Data analyses included the reasons for physician visits, concomitant diagnoses, types of physicians seen, sources of payment, medical procedures administered, drugs prescribed, and patient disposition following a physician visit. RESULTS: Study results suggested that treatment patterns differ substantially for adults and children, as well as by physician specialty. Although otitis externa is frequently painful, few cases are classified as severe, and the data indicated that less than 20 percent of patients have concomitant diagnoses treatable by medication. Nevertheless, 40 percent of patients received both topical and systemic medication, and many of the oral antibiotics prescribed are not active against Staphylococcus aureus or Pseudomonas aeruginosa, the most common bacterial pathogens in otitis externa. CONCLUSIONS: Appropriate treatment of localized otitis externa with topical antibiotics should eliminate the need for systemic medications. Addition of systemic medications can unnecessarily increase treatment costs and the likelihood of side effects, and could reduce the likelihood of patient compliance.

Administration, Topical↗
PubMedDate not supplied

The Unified Medical Language System: an informatics research collaboration.

In 1986, the National Library of Medicine (NLM) assembled a large multidisciplinary, multisite team to work on the Unified Medical Language System (UMLS), a collaborative research project aimed at reducing fundamental barriers to the application of computers to medicine. Beyond its tangible products, the UMLS Knowledge Sources, and its influence on the field of informatics, the UMLS project is an interesting case study in collaborative research and development. It illustrates the strengths and challenges of substantive collaboration among widely distributed research groups. Over the past decade, advances in computing and communications have minimized the technical difficulties associated with UMLS collaboration and also facilitated the development, dissemination, and use of the UMLS Knowledge Sources. The spread of the World Wide Web has increased the visibility of the information access problems caused by multiple vocabularies and many information sources which are the focus of UMLS work. The time is propitious for building on UMLS accomplishments and making more progress on the informatics research issues first highlighted by the UMLS project more than 10 years ago.

Computer Communication Networks↗
PubMed2006

Naturopathic medicine and type 2 diabetes: a retrospective analysis from an academic clinic.

UNLABELLED: Accurate descriptions of naturopathic medicine as a whole system of medical practice are rare in the literature and non-existent for type 2 diabetes. METHODS: Using retrospective analysis of medical records at an academic naturopathic outpatient clinic, data was abstracted to investigate patterns of patient status, details of treatment recommendations, and levels of evidence. RESULTS: Most naturopathic medical care for type 2 diabetes is adjunctive, although naturopathic physicians are qualified to fill the role of primary care providers. Glycemic control and other vital statistics in patients receiving naturopathic care are comparable to published national averages. Naturopathic physicians prescribe comprehensive therapeutic lifestyle change recommendations supported by a high level of evidence - 100 percent received dietary counseling, 69 percent were taught stress reduction techniques, and 94 percent were prescribed exercise. Patients additionally received prescriptions for botanical and nutritional supplementation, often in combination with conventional medication. Analysis of individual supplement effects was not performed due to inadequate records. Components of treatment recommendations are often evidence-based, with varying evidence quality. CONCLUSION: Naturopathic medicine as a whole medical system supplies evidence-based lifestyle recommendations as suggested in management guidelines for diabetes, hypertension, and hyperlipidemia set forth by the respective national organizations - the American Diabetes Association (ADA), the Joint National Committee on Hypertension (JNC-7), and the National Cholesterol Education Program results of the third Adult Treatment Panel (NCEP ATP-III). Increased research effort to determine the safety and efficacy of combinations of supplements or medications and supplements is warranted. Education of other health care providers, patients, and health policy makers regarding the value of the naturopathic approach in the treatment and prevention of type 2 diabetes is warranted, yet prospective data on efficacy must be collected.

Blood Glucose↗
PubMed1989

Performance evaluation of medical expert systems using ROC curves.

This paper presents a performance evaluation of the diagnostic accuracy of the medical expert system CADIAG-2/PANCREAS. The study included 47 clinical cases from a university hospital with 51 diagnosis of pancreatic diseases (four patients had two pancreatic diseases). As gold standard, the histologically or clinically confirmed diagnoses were assumed. Performance was studied along three lines: (a) each case was evaluated twice, first, by restricting patient data to history, physical examination, and basic laboratory tests and, second, by utilizing the complete set of data including also special laboratory tests. US. X ray, CT-scan, ECG, and biopsy, if available: (b) considering CADIAG-2's hypotheses generation, each evaluation series was also carried out twice, first, by testing whether the gold standard was the first diagnosis in the ranked list of hypothesis and, second, whether the gold standard was among the hypotheses: (c) receiver operating characteristic (ROC) curves were determined by varying an internal threshold which determined the extent of CADIAG-2's diagnostic hypotheses generation. The evaluation showed that CADIAG-2's initial list of diagnostic hypotheses, based on patient history, physical examination, and basic laboratory tests usually has already included the gold standard diagnosis and thus an application of CADIAG-2 at a very early stage of the diagnostic process seems achievable. Moreover, it turned out that given the complete set of patient's medical data the gold standard is usually ranked at the first place in the list of hypotheses. except for patients with chronic diseases where only unspecific findings are available. The last test series showed that ROC curves do not only allow optimal adjustment of the expert system's internal ad hoc decision criteria such as thresholds, weights, and scores but also provide a basis for better comparing the performance of different medical expert systems.

Diagnosis, Computer-Assisted↗
PubMed1983

Effect of a computerized ambulatory medical record system on the validity of claims data.

Relationships were compared between claims data and charts data in a medical practice when a paper chart and manually prepared claims forms were used and after implementation of a computerized medical record system (COSTAR) in which claims data were derived automatically from the medical database. Claims data and chart data resembled each other more closely when the computer system was used, suggesting that claims data derived in this manner may have particular value in health care planning and research.

Ambulatory Care↗
PubMedDate not supplied

[An integrated emergency medical care system at the University of Leuven].

There are three motives to start an organized medical emergency care system: to provide a systematic approach to all admitted medical emergencies in a specific structure in the hospital. to decrease mortality and morbidity by immediate evaluation and treatment of vital functions. to supply adequate emergency care for the region. These motives can only be realized through well-known options: the system must be multidisciplinary. excellence in critical care medicine must be available at all times. a system of mobile medical emergency care must be developed. all available regional emergency care facilities must be integrated. Only this way can the emergency service evolve as the central link of critical care medicine.

Ambulances↗
PubMed1979

A hospital medication monitoring system.

Hospitals need to process large quantities of scattered information to properly screen medication orders. The data includes complex relationships involving drugs, diseases, and other drugs that determine whether a particular drug is contraindicated for a patient. Hospitals would therefore benefit from a flexible system for storing complex medical data relationships. We have used GPLAN, a CODASYL-like data management system, to construct a functioning model of a hospital pharmacy medication monitoring system. the patients' histories, drug-drug contraindications, disease-drug contraindications, and recommended dosages are stored in the data base in a network structure defined by the Data Description Language. Each drug order is checked for dose, allergies, current diseases, and current medications.

Computers↗
PubMed2003

Modeling an emergency medical services system using computer simulation.

STUDY OBJECTIVES: In the emergency medical services (EMS) system, appropriate prehospital care can substantially decrease casualty mortality and morbidity. This study designed a simulation model, evaluated the existing EMS system, and suggested improvements. METHODS: The study focused on 23 networked EMS hospitals affiliated with 36 emergency response units (subgroups) to perform two-tier rescues (advanced life support [ALS] in addition to basic life support [BLS] services) in Taipei, Taiwan. Using the existing EMS model as a base, this research constructed a computer simulation model and explored several model alternatives to achieve the study's objectives. The virtual models varied with staffing level, number of assigned emergency network hospitals, and various two-tier rescue probabilities. RESULTS: Increasing the staffing to two teams for Hospital 22 lessened the call waiting probability (delay between rescue call and ambulance dispatch) by 50%, even if the dispatch rate of the two-tier rescue increased from the empirical 2% to a simulated 10 and 20%. Changing the two-tier rescue pattern so each EMS subgroup cooperated with two specific, preassigned network hospitals lowered the probability of patients having to wait for rescue dispatch to under 1%. CONCLUSION: The following alternatives provided the greatest combination of effectiveness, quality patient care, and cost-efficiency: (1) because of its unique location, increase Hospital 22's staffing level to two ALS teams. (2) Establish a specific rescue protocol for the two-tier system that preassigns two network hospitals to each of the 36 EMS subgroups along with a prearranged calling sequence. If implemented, this will improve EMS performance, streamline the system, reduce randomness, and enhance efficiency.

Computer Simulation↗
PubMed1994

Anthropological issues in medical ethnobotany.

While ethnobotany has emerged as an important discipline in the search for new drugs, this economic impetus should in no way distract from a more ethnobiological and equally critical goal--the codification and promotion of indigenous medical systems as a major factor in the conservation of biocultural diversity. Codification of indigenous medical systems requires a holistic view which entails (1) in-depth understanding of the recognized health conditions in the native system and how they might be described in terms of Western biomedicine; (2) comprehensive inventories of medicinal species employed in the native system, descriptions of their modes of preparation and administration and giving priority to those species most likely to merit pharmacological testing; and (3) identification of the pharmacological properties of these species with the goal of discovering how they might be effective in the treatment of the health conditions for which they are employed. Promotion of indigenous medical systems requires the development of local training programmes aimed at the active conservation and enhancement of traditional herbal medicinal therapies that have been shown to be pharmacologically effective in the treatment of symptoms of recognized health conditions. The establishment of such programmes is critical at a time when traditional medical systems are often disparaged as worthless by the national societies in which indigenous peoples live, as well as by younger members of the native populations themselves.

Anthropology↗
PubMedDate not supplied

Baylor University Medical Center system.

In today's health care environment, the hospital's relationship to its medical staff can mean the difference between success and failure. As opposed to the current system, the medical staff of the future must be organized and strong, yet flexible enough to undergo the changes necessary for "venturing." This article describes how one University Medical Center organized its physicians and medical staff to meet the changing needs of the surrounding Texas community and the organization itself. Focusing on today's health care environment and the concept of venturing, this article unveils the special relationship between a medical center and its medical staff.

Academic Medical Centers↗
PubMed1976

The medical care system under national health insurance: four models.

This paper presents a critical evaluation of four national health insurance models in light of their ability to counteract incentives in the present system that are dysfunctional in terms of costs and quality of care. The feasible models are labelled as: major risk insurance, alternative delivery systems under universal coverage; the public utility allocation model (alias the British system); and the public utility hospital model. It is concluded that substantial changes in the existing structure of the medical care system will be very difficult to achieve politically. Further, those models most politically feasible, the present medical care system with universal third party financing, and public utility process controls with universal third party financing, are the ones most likely to aggravate present cost-quality difficulties. Therefore, the recommended procedure for implementing national health insurance is unabashedly incremental: i.e.; to experiment with cost-sharing, alternative delivery systems, other provider incentive mechanisms and public utility regulation-budget allocation approaches, before wholesale adoption of national health insurance is entertained.

Delivery of Health Care↗
PubMed2002

[Medicine and orientalism in the late nineteenth century Korea].

The paper investigates medical missionaries that exerted a significant role in establishing Western medicine in the late nineteenth century Chosun, in relation to orientalism, an academically popularized concept introduced by Edward Said. Historical analysis is focused on several important medical missionaries such as Horace N. Allen, William B. Scranton, John W. Heron, C. C. Vinton, and Oliver R. Avison to explain how their activism as medical missionary contributed to the formation of medical orientalism in which Western medicine was 'taught, studied, administered, and judged' in that period. In addition, I explore into how medical orientalism was in service of Japanese imperialism by showing that medical missionaries had to be under imperial surveillance by Japanese colonizers. The article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of social recognition of medical care and a view of public policy.

Colonialism↗
PubMed1995

[MEDRISK--an expert system for medical risk assessment].

The Munich Reinsurance Company has developed a rule-based expert system for assessing substandard risk in life, disability and accidental death benefit. It is one of the most comprehensive medical expert systems yet conceived and currently includes entries for over 7500 impairment terms. Based on the most up-to-date insurance medical knowledge MEDRISK allows underwriters, irrespective of their level of experience, to process both simple and highly complex cases. The system which takes account of the interactive effect that can exist between different impairments as well as the influence which occupational factors can exert, always produces consistent and case-specific decisions. The number of impairments and types of insurance included in MEDRISK can be expanded. After tests at Munich Re and at a number of insurance companies, the system ist now ready to be launched in German speaking markets.

Artificial Intelligence↗
PubMed1977

Utilization of medical information systems in American occupational medicine. A committee report.

In an attempt to define the nature of medical programs and the extent of utilization of information systems in occupational medicine, a questionnaire was directed to 230 corporate medical directors of the largest employers in the USA. Responses were received from 163 (nearly 70%) of those contacted. While industrial injury data and sickness absence statistics are the principal areas of present computer analysis, respondents indicated that future plans called for a shift in emphasis to the analysis and correlation of human medical data with work exposure data. Nearly three-quarters of the respondents are planning more extensive medical information systems. It is concluded that there is an apparent need for both trained personnel to develop appropriate systems and enhanced communication between the users and suppliers of the required computer technology.

Computers↗
PubMedDate not supplied

The development of personal computer-based medical consultation system for diagnosis of congenital malformation syndromes using MUMPS.

This paper describes a medical consultation system for diagnosis of congenital malformation syndromes. The system consists of a personal computer, NEC PC-98XL (MS-DOS), using SP-MUMPS for the retrieval of knowledge data, and BASIC for the input/output of image data. This system displays pictorial knowledge and is designed so users can build up the knowledge base, as needed, by adding knowledge from medical literature and records of patients actually treated.

Congenital Abnormalities↗