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Prediction of choledocholithiasis using a pocket microcomputer.

A computerized method, using a small pocket computer, has been used to predict the presence of choledocholithiasis in a prospective series of 239 patients undergoing cholecystectomy. From an initial data base of 424 patients 36 factors were evaluated and the most important 2 of these were determined by multivariate analysis for use in the prospective analysis. Satisfactory operative cholangiograms were a prerequisite to evaluation of the statistical method and were obtained in 90.4 per cent of cases. Using the computerized method a common bile duct stone would have been overlooked in only 1 patient but 17 unnecessary explorations would have been carried out. The overall accuracy of the computerized method was 92.5 per cent. When the method was applied to a further study of 97 patients from a separate centre the overall accuracy was 85.6 per cent. If the method was used to aid selective use of operative cholangiography, cholangiograms would be performed in 20 per cent and stones would be overlooked in less than 1 per cent.

Cholangiography↗

A microcomputer program for the generation of random grid squares in quantitative analysis.

Subjectivity in selecting random grid squares for routine quantitative analysis can be circumvented through a combination of finder grids and a computer program. The simple BASIC program described in this paper generates a list of random grid-square numbers, which are sequentially analyzed. The concept was applied in the quantitation of asbestos and other microparticles in environmental samples. The use of finder grids and this program can also be useful in quality-control programs and in cross-referencing analyses, as well as in the study of biological specimens.

Asbestos↗

A microcomputer program for the design and analysis of phase II cancer clinical trials with two group sequential methods, the sequential probability ratio test, and the triangular test.

We developed an interactive and menu-driven computer program to help investigators design and analyze phase II cancer clinical trials with a group sequential method, namely the sequential probability ratio test or the triangular test. Based on the values selected for the parameters of the trial, the "Design" option allows one to obtain, using simulations, the statistical properties (type I and II error rates and the probability that the test accepts the hypothesis of inefficacy under 21 different assumptions) and the average sample size (under the same assumptions) of the selected test. The "Analysis" option (i) computes, at each analysis, the two statistics V and Z on which the sequential method is based and plots the sample path from the number of successes observed, and (ii), using asymptotic properties, gives the significance level of the test and a point estimate (with its 95% confidence interval) of the parameter of interest at the last analysis.

Algorithms↗

Microcomputer-based recording system for clinical electrophysiology.

We developed a personal computer-based system for clinical electrophysiologic measurements. The computer interfaced with a commercially available A/D converter, a low-noise isolation preamplifier, filter circuits, pattern and Ganzfeld stimulators, and a hardcopy unit. Separate programs were developed for electroretinography (ERG), pattern ERG and simultaneous visual evoked potential (VEP), flash and pattern-shift VEP, and electro-oculographic measurements. The complete control of the applied hardware (eg, stimulus control, automatic gain, and filter selection) is a common feature of the computer programs. These programs provide oscilloscopic functions, overload protection, artifact elimination, averaging, automatic peak latency and amplitude determination, baseline correction, smoothing, and digital filtering. The results can be presented on matrix, laser printers, or digital plotters. The hardware components and the features of the driver software are demonstrated on normal and pathologic signals.

Electrooculography↗

The Computerized Notation System (CNS). A microcomputer system for rapid entry of notes by physicians and nurses.

A computerized notation system has been developed to produce a digital medical data base. Use of a separate physical record for every 1-4 patients allows several years of accumulated data to be easily accessible for patient "summaries" or admission "histories and physicals." To facilitate entry of data in the system, the physician is provided with a portable, complete computer system (HP-85, or Epson HX-20), a user-defined two-letter dictionary, and a program that produces all elements of the manual paper charting system. "Overview" and research data bases are developed from the digital medical data base records. In this paper, we report the efficiency of use of this computerized notation system in private outpatient and inpatient practice.

Computers↗

A new microcomputer software system evaluation paradigm: the medical perspective.

The new fourth-generation software has enormously eased the burden of computing for users, but they have also created a confusing, difficult problem in software evaluation and selection. Therefore it is argued that a sound and complete evaluation paradigm is a key element in an efficient and effective software system design and use process. While much has been written about software evaluation in general, in the medical field, the guidances and recommendations previously provided are too general to be of practical use. Considering also the other weaknesses of conventional evaluation paradigms we have decided to develop a more adequate one which will have a solid theoretical framework, specific guidances, strict and well-defined taxonomic space, and a fair ranking approach. In the present paper we will therefore introduce our new evaluation paradigm and show its applicability in evaluation and selection of medical software systems according to their usability.

Classification↗

A microcomputer data base system for an in vitro fertilization clinic programmed in BASIC.

A computer program was developed for the IBM personal computer to be used for in vitro fertilization and gamete intrafallopian transfer clinics. This program, written in BASIC, allows input, editing, updating, sorting, and printing of patient data. Statistical functions permit summation of patient data based on various combinations of user-defined treatment cycles, diagnoses, and protocols, thus making possible comparison of pregnancy and other patient data between and among various treatment groups and diagnoses. The statistical information can be continually updated and revised when new data become available on patients (such as confirmation of pregnancy by ultrasound or live births) and at the end of each cycle. The formats used are useful in assimilating individual clinic data for various surveys and other reporting requirements. The program can be easily modified by anyone with minimal training in the BASIC programming language.

Ambulatory Care Facilities↗

Interactive microcomputer for acquisition of patient information.

Written records and first-generation hospital information systems do not meet their primary purpose to assist physicians in solving patients' problems. Simply automating the present chart formats is not the answer. An example of the concept needed for charting is the intensive care unit chart. Anesthesiology charts provide little useful information for the continued care of the patient postoperatively. They serve principally as legal archival documents. Automation of the anesthesia record should free the anesthesiologist of the need to search for preoperative information and to manually record most information intraoperatively. Decisions about how much data to archive and how to extract the data pertinent to continuing care are the challenges for physicians. The technologic tools are available for the design and implementation of a software system that focuses on effective communication of the patient's problems throughout the perioperative period as the patient moves from ward to operating room, through the recovery room and intensive care unit, and to the ward and home.

Anesthesiology↗