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[Computer controlled brain death documentation in the intensive care unit].

An interactive, knowledge-based computer system for brain death documentation is presented. The specific exponents BRAINDEX R and G were realised by the software tool Personal Consultant Plus and the programming language Clipper, respectively. The strategies of conclusion were forward chaining for approximate evaluation of coma stages and backward chaining for analysing the brain death syndrome. BRAINDEX was developed for use with an IBM personal computer or compatible equipment. Systemic analyses were compared retrospectively with the data from clinical brain death protocols (n = 132) of 128 comatose patients (mean age 35.1 +/- 15.8 years) with a Glasgow Coma Score of 3. Identical classifications (system vs physician) were found in all patients without diagnosis of brain death (n = 35). Differences related to the findings of the physician were evaluated in lower numbers of the systemic positive diagnosis of brain death (82 vs 89) and higher numbers of impossibility of systemic evaluation (11 vs 2). These results were obtained by conclusions of the computer system drawn by restrictive systemic mechanisms to avoid false-negative diagnoses. The system therefore seems to be useful for documentation, consultation, and as a teaching instrument and data bank in brain death.

Adult↗

[Assessment of the accuracy of position in breast irradiation with isocentric technique using an electronic system to acquire portal images].

This study investigated the accuracy of daily patient positioning in an isocentric set-up for breast irradiation. This was achieved through the assessment of both systematic and random errors measured as discrepancies between reference simulation images and portal images obtained with an on-line electronic portal imaging device (EPID). To this end, 10 portal images for each of the tangential fields were obtained in 12 consecutive patients and the images were compared to reference simulation films with dedicated software tools provided with the EPID. The discrepancies measured for each set of images were analyzed statistically. Most variations in each series both in terms of cranio-caudal and of lateral displacement appeared to be random, with mean standard deviations of 2.3 and 2.8 mm, respectively. Such variations between reference fields and portal images tend to counteract one another and do not usually play a significant role in the overall accuracy of patient set-up. In some cases, however, the distribution of the variations occurred in a well-defined pattern indicating a systematic error in patient positioning. This study shows that our set-up technique for breast irradiation is relatively accurate and reproducible, and most of the observed errors were below the 5 mm cut-off level, but it stresses the need of accurate quality assurance programs in radiotherapy. Electronic portal imaging devices are excellent tools for fast portal image acquisition, and permit the accurate assessment of discrepancies with respect to reference images.

Breast Neoplasms↗

SGML and XML as interchange formats for HL7 messages.

OBJECTIVE: To report on the use of SGML and XML (a proper subset of SGML) as transfer syntaxes for HL7 Version 2.3 and Version 3.0 messages. METHODS: The methodology has focused largely on two questions: Can it be done? How best to do it? The first question is addressed by attempting to build an SGML/XML representation of HL7 messages. The second question requires a consideration of several metrics: message length, speed of message creation and parsing, interversion compatibility, local customization, conformance determination, and the availability of software tools and skill on the format. RESULTS: Detailed specifications for expressing HL7 in SGML and XML have been developed. Some HL7 requirements are not readily expressed, while some ambiguous areas of the HL7 standard are made explicit in the SGML/XML representation. With the current design, an SGML/XML parser can extract any component of any data type from a message. CONCLUSIONS: SGML and XML can both serve as implementable message specifications for HL7 Version 2.3 and Version 3.0 messages. The ability to explicitly represent an HL7 requirement in SGML/XML confers the ability to validate that requirement with an SGML parser. The optimal message representation will be a balance of functional, technical, and practical requirements.

Algorithms↗

The "X-Ray RheumaCoach" software: a novel tool for enhancing the efficacy and accelerating radiological quantification in rheumatoid arthritis.

BACKGROUND: Precise diagnosis and follow up treatment of rheumatoid arthritis (RA) requires objective quantification, which is still lacking. For this purpose, radiological analyses are considered to be the most appropriate method. OBJECTIVE: To develop computer assisted quantification software that is particularly applicable to joint scoring in rheumatic disorders. METHODS: 3914 radiographs from hands and feet of 190 patients with RA were collected, expertly examined, analysed, and statistically evaluated. Radiographs were quantified using the conventional Larsen score and the "X-Ray RheumaCoach" (XRRC) software. The XRRC is a Java stand alone application which can support and accelerate, but not fully automate, the scoring procedure in RA. The scorer can apply both the Larsen and the Ratingen-Rau scores. RESULTS: Compared with conventional scoring procedures, the XRRC software accelerated quantification time by approximately 25%. The program, which is now available on the internet free of charge, ran stably and proved to be a consistently valuable tool. CONCLUSIONS: Compared with conventional scoring methods, the XRRC software offers several advantages: (a) structured data analysis and input that minimises variance by standardisation; (b) faster and more precise calculation of sum scores and indices; (c) permanent data storing and fast access to the software's database; (d) the possibility of cross calculation to other scores; (e) "user friendly" technology and a dedicated help program; (f) fast access and data transfer through the internet if desired; and (g) reliable documentation of results in a specially designed printout.

Arthritis, Rheumatoid↗

Biodosimety Assessment Tool: a post-exposure software application for management of radiation accidents.

The Biodosimetry Assessment Tool software application under development will equip health care providers with diagnostic information (clinical signs and symptoms, physical dosimetry, etc.) germane to the management of human radiation casualties. Designed primarily for prompt use after a radiation incident, the user-friendly program facilitates collection, integration, and archiving of data obtained from exposed persons. Data collected in templates are compared with established radiation dose responses obtained from the literature to provide multiparameter dose assessments. The program archives clinical information (e.g., extent of contamination, wounds, infection, etc.) useful for casualty management, displays relevant diagnostic information in a concise format, and can be used to manage both military and civilian radiation accidents. In addition, monitoring of diagnostic information of individuals using this program could potentially minimize the severity of psychological casualties by making a marked impact on the way that both radiation casualties and the worried well view their exposure, dose, and future risk for the development of disease.

Humans↗

Assistant programming software: a new tool for an improved programming of pacemakers.

Programming the new DDD pacemakers is becoming increasingly difficult. One must take into account the pacemaker's complexity, the fact that some parameters are linked to others, and the clinical profile of the patient. This difficult problem will lead to the design of software to assist programming, which will help the implanting physicians in choosing adequate programmed settings adapted to the functioning of the device and to the physiology and pathology of the patient. These programming aides should meet certain basic requirements to make them safe, efficient, and easy to use. One such system designed by ELA Médical, "Programming Assistant" is herein described. The preliminary results of an initial study on the acceptance of this programming aide among physicians involved in cardiac pacing are given and discussed.

Adult↗

Next generation software systems provide tools for handling complexity of billing codes.

Medical practice staff members, intent on assuring accurate and prompt reimbursement by an increasing number of payers for services rendered to the practice's patients, face what often feels like an insurmountable challenge. Ever-changing and differing reimbursement rules create a frustrating environment in which it is difficult, if not impossible, to comply with payers' requirements. This article provides an overview of a new generation of automated systems that offers physicians the ability to submit bills that more precisely comply with payers' expectations. It describes how claims editing software systems work and capabilities staff should consider before choosing a system.

Efficiency, Organizational↗

TIGR Gene Indices clustering tools (TGICL): a software system for fast clustering of large EST datasets.

TGICL is a pipeline for analysis of large Expressed Sequence Tags (EST) and mRNA databases in which the sequences are first clustered based on pairwise sequence similarity, and then assembled by individual clusters (optionally with quality values) to produce longer, more complete consensus sequences. The system can run on multi-CPU architectures including SMP and PVM.

Cluster Analysis↗

[Assesing the GRDOSIS Software program as a tool to analyse drug usase by DRGs].

OBJECTIVE: To validate the GRDOSIS software program as a tool to calculate Spanish drug weights within diagnosis-related groups (DRGs), and to analyse information used in this calculation. MATERIAL AND METHODS: Information corresponding to a 7-hospital sample is analysed after exchanging data between the minimum basic data set processed by the DRG-grouping program Estación Clínica -3M and unit-dose drug consumption. Data are purged by eliminating cases with an unusual (either long or short) length of stay in each DRG, and both weights and pondered weights are calculated. Data from the 5 most prevalent DRGs are analysed by using the different options provided by the software program, with the aim of detecting intervention points in order to improve results. RESULTS: Extreme case elimination noticeably reduces mean cost per DRG. A reduced group of DRGs represents a high percentage of total cost. Similarly, a reduced number of drugs may represent a high percentage of cost within a given DRG. The use of specific therapeutic groups for specific DRGs is demonstrated, as is the correct use of first-choice drugs versus other therapeutic options within therapeutic groups. An unwarranted variability regarding drug administration dosing and frequency is, however, observed. CONCLUSIONS: The GRDOSIS software program proves itself a powerful tool for both the qualitative (drug usage profiles, dosage) and quantitative (costs) analysis of information originating in a Pharmacy Department

Diagnosis-Related Groups↗

Refinement of the HEPAR expert system: tools and techniques.

Methods and tools for the static and dynamic verification and validation of software systems are commonplace in the field of software engineering. In the field of expert systems, where it is more difficult to ensure that a system meets the specifications and expectations than in traditional software engineering, such tools are generally not available. In this paper, the need for more support of the development process by methods and tools is illustrated by the approach taken in building the HEPAR system, a rule-based expert system that can be used as a supportive tool in the diagnosis of disorders of the liver and biliary tract. At a certain stage in the development of this system an incremental development methodology has been adopted, in which implementation of parts of the expert system was followed by dynamic validation. For this purpose, a collection of software tools were implemented as extensions to a rule-based expert-system shell. These tools provide valuable information about the effects of modification of the HEPAR knowledge base, and indicate places in the knowledge base for refinement. It is believed that similar software tools may prove helpful in the development of other expert systems as well.

Artificial Intelligence↗

(PLOT79): a comprehensive portable Fortran scientific line graphics system, as applied to biomedical research.

Scientific results are often most succinctly presented in graphical form. We describe a system for computer-generated scientific line graphics known as (PLOT79), named to commemorate the SIGGRAPH CORE graphics standard proposal of 1979. (PLOT79) is a widely used and actively evolving graphics system, written primarily in SFTRAN3, a structured procedural computer language which can be translated readily into Fortran. The package embodies concepts of sound software engineering, having been designed from the outset to be portable, maintainable and hardware-independent; much of the effort required to implement the system was directed toward the development of software engineering tools to ensure these goals. A modular design strategy has allowed a wide variety of graphics output devices to be supported. (PLOT79) has been installed under numerous operating systems, and software tools provided by UNIX have allowed particularly efficient installation and use of the system. Access to (PLOT79) is available through three avenues: (1) linking (PLOT79) routines with a user-written high-level program; (2) use of pre-written high-level applications programs which perform certain frequently-required tasks such as the plotting of simple two or three-dimensional data; or (3) the use of an interactive graphics command parser known as slides. (PLOT79) has proven popular among workers in the physical sciences and engineering both for its easy availability, openness (all source code is provided), and powerful capability. The system presents an equally important (though lesser known) resource for biomedical research, as demonstrated by examples from ongoing biomedical research projects. It also provides a focus for discussion of the practical limitations inherent in existing graphics standards and programming languages.

Computer Graphics↗

PRIST-2: a Graphic User Interface based tool for the development of medical software.

A 4th generation tool, called PRIST-2, is presented that has been designed as an interactive environment for the rapid prototyping of clinical applications in a large-scale Hospital Information System project. We adopted an SQL-based commercial Relational Data Base Management Systems (RDBMS) to guarantee portability on different hardware and operating systems. Relational databases, however, are characterized by a simple data structure and do not incorporate the application semantics required to ensure a high degree of data independence. To reach this goal, we propose an extension to the relational model, adding some of the main characteristics of the Object Oriented Data Base Management Systems (OODBMS) approach, such as "types" and "encapsulation".

Clinical Protocols↗

A simulation model for small-area cancer incidence rates.

OBJECTIVES: Cancer epidemiologists are often asked by members of the interested public about possible associations between suspected carcinogens and apparently increased small-area cancer incidence rates. Frequently, no systematic incidence differences can be demonstrated. Nevertheless, it is necessary to address public concerns about suspected cancer clusters. To facilitate explanations about the large random variation of small-area tumor incidence, we implemented a software simulation tool in R. METHODS: Under the assumption of no cancer causes other than chance, the tool simulates a small village population with an average number of five inhabitants per house and allows graphical visualisation of ten streets with 100 houses. Published age-specific incidence and mortality data are used for event sampling based on the binomial distribution. Program parameters include sample size, age distribution, cancer incidence, and mortality rates. RESULTS: On average, 22 percent (2.2/10) of all houses per street have been inhabited by at least one cancer patient during the last five years in our simulated small village. A situation where all (10) houses in a street have been inhabited by at least one cancer patient during the last five years appears to be very rare (less than one in a million streets). CONCLUSIONS: Our software tool can be used effectively for numerical and graphical visualisation of small-area tumour incidence and prevalence rates due to chance alone. The explanation of basic epidemiological concepts to members of the public can help to increase public motivation and support for population-based cancer registration. Our simulation tool can be used to support this goal.

Adolescent↗

Self-test software for PowerPoint: a tool for self-learning.

RATIONALE AND OBJECTIVES: We developed self-test software to improve self-learning efficiency using Microsoft PowerPoint data files. CONCLUSION: This tool can be run on IBM-compatible computer under Microsoft Windows. It is a new useful and interactive tool for self-learning. This tool allows users to do view the cases in the PowerPoint data files by random or sequentially. Goal-oriented effective self-learning is possible from methods that conjecture the possible differential diagnosis without promptly seeing correct diagnosis. Thus effective and interactive self-learning is possible.

Computer Graphics↗

A software application that answers the need for an enterprise budgeting tool.

A prototype software application developed for the Vanderbilt University School of Medicine answered our need for an enterprise budgeting tool--one that has application across the entire organization. This application, built on Microsoft Access, provides a flexible user interface without requiring sophisticated technical support.

Academic Medical Centers↗