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We approach the need of representing by powerful graphical user-interface the granularity of the temporal clinical information. In this work we present some contributions, to suitably display such temporal clinical information. The graphical representation relies on a temporal clinical data model able to manage data having different granularities.
An Internet healthcare information resources Gopher server is described as a part of a state-wide medical information network. The development of the server and its design and operation are presented. The potential impact of this technology on the healthcare delivery process and issues associated with the use of public domain information resources are discussed.
FELIX is an front-end application processor, with an open systems back-end, that provides a uniform and intuitive interface to clinical and administrative information. It consists of an information browser, three clinical applications, and three management applications. FELIX was developed in a community hospital environment, but has conceptual and technical roots in medical informatics and the Internet.
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Students who had completed a post-RN university nursing course by computer mediated conferencing participated in a qualitative study examining their experience with this mode of delivery of distance education. All seven students reported that great difficulties with the technology at the beginning of the course caused them extreme frustration. However, despite the lack of user-friendliness of the technology, the students participated actively, functioned as a group, developed strong personal ties, and mastered the required content via the computer. These multiple-role women appreciated the ability to participate in discussion without the requirement of being at a specific place at a particular time. Having overcome the initial difficulties with the technology, all the students were enthusiastic about the method and would sign up for another computer mediated course.
Electronic patient records have been the subject of research by academic and business organizations for at least 25 years. Despite a notable lack of progress, the time for broad acceptance of the concept may well be near. Important driving forces include 1) the external pressures being placed on the health care industry to lower costs and to provide standardized care with measures of outcome; and 2) new computer and communications technologies that can support the evolving "continuum of care," including the needs of even the most highly mobile clinicians. Home care nurses are ideal candidates to be early adapters of electronic patient records because of the high degree of mobility in their profession, their front-line role in the new health care system, their lack of a support structure at the point of care, and the excessive nursing time spent on documentation. Successful systems will be based on consideration of the clinician's working environment and computer skills, the interaction between the patient and the clinician, and the need for a record capable of supporting the sophisticated requirements of managed care.
We evaluated medical student reaction to a computer-assisted interactive tutorial on malignant melanoma, a pigmented skin cancer. The tutorial was programmed for use with IBM Infowindow Touchscreen systems which integrate full-color video images from laser videodisc with text and graphics from a personal computer. Second-year medical students at the Medical College of Virginia responded to a questionnaire and rated both the content and the process of learning with this method more highly than presentation of similar content from textbooks.
Highly interactive multimedia electronic documents pose unique graphic information design problems. This paper is a discussion of some of the graphic design considerations that are unique to electronic documents, including the challenges of adapting existing graphic design skills to electronic documents that are displayed and read from computer screens.
We present a new multiprocessor architecture for medical image compression using digital signal processors. The system has been designed to be used in a NuBus-based workstation and to apply different image compression algorithms to medical images. The system has been tested with a full-frame cosine transform and bit allocation table on several imaging modalities ranging from ultrasound to magnetic resonance imaging. Results show that image quality is acceptable when the allocation tables are calculated for each specific image modality. Implementation of algorithms such as wavelet transforms and vector quantization which respond to the characteristics of each type of image is in progress.
Psychologists have recently identified "situated cognition" as an important issue for educators across disciplines. Accordingly, instructional technologists have been working on ways to make classroom materials more true-to-life and affectively engaging. In this article I review a study designed to investigate the ways in which differing realism conditions (delivered through interactive video) influenced users' understanding of the issue of euthanasia and the case of Dax Cowart. Based on the study's findings, I raise the issue of a possible trade-off between traditional values of objectivity and authenticity.
A computer interaction session conducted during the 14th Annual Peritoneal Dialysis Conference in Orlando, Florida, on January 24, 1994, revealed the preferences and practices of 650-690 respondents voting on questions related to peritoneal catheters. Compared to the surveys conducted in 1987 and 1989, the most striking change was an increase in the use of catheters with the bent intramural segment, particularly the Swan neck catheter, and an increase in the use of catheters with the coiled intraperitoneal segment. The Tenckhoff catheter continued to be the most popular, although its use was decreasing. The remaining catheters were used in small numbers. The vast majority of nephrologists remain convinced of the superiority of double cuff catheters over single cuff ones, and the use of the former continued to exceed 70%. Essentially no change occurred in the method of catheter placement; surgical dissection (72.7%) remained the most popular implantation method. Surgeons were primarily responsible for catheter implantations (87.4% of votes). The use of prophylactic antibiotics prior to catheter implantation seems to be increasing. The majority of respondents did not consider a Staphylococcus aureus nasal carrier status as important in the development of catheter-related infections, as indicated by the small number of centers where routine culture of nares was performed. The majority of institutions delayed ambulatory peritoneal dialysis after catheter implantation, but ambulatory peritoneal dialysis was started in some centers (5.7% of votes) in the immediate postimplantation period.
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Over 700 people attending the Opening Session of the Fourteenth Annual Peritoneal Dialysis Conference participated in the computer interaction exercise as keyboard responders. Responders were 50.5% nurses and 40.4% physicians. Of these, 70.4% were from North America and 19.6% were from Europe. Only 9.5% had been involved in chronic peritoneal dialysis for less than one year. Over half (56%) worked in programs with more than 30 chronic peritoneal dialysis patients. Their own personal choice of dialysis therapy was a form of chronic peritoneal dialysis in 82%. Serum albumin concentration was indicated as the main monitor of nutritional status by 79.1%. Dietary protein intake ranging from 1-1.2 was considered the preferred goal by 84.4% of responders, even though the majority of chronic peritoneal dialysis patients probably do not achieve dietary protein intake in this range. A minimum weekly KT/V urea of 1.7 was chosen as a minimum target by 53.4%. An increase in exchange volume was the most frequently chosen approach to the large, anuric, low-peritoneal transporter. Numerous other questions dealing with adequacy and nutrition were posed to the audience, and the findings are summarized herein.
This communication is to announce the availability of a network server for biological sequence database entries which will allow scientists to fetch entries in a desired format directly into their file store. This server will use TCP/IP protocols allowing any user with an Internet connection to participate. FarFetch will allow users to obtain sequence entries in a directly usable form as opposed to conventional e-mail based sequence retrievers. This server also differs from Gopher and WAIS servers in that the sequence entry is written into the user's file store in a format that is immediately usable. Clients for the OpenVMS, Unix and Macintosh operating systems have been written and are available via anonymous ftp. Development of MS-DOS and Windows clients is planned. There will be no usage fees associated with the server.
The paper describes the knowledge-base of the expert system OLT 1, developed to support medical decision-making in patients referred for liver transplantation. The paper goes through the real clinical problems, and describes both structural (organization of the domain knowledge) and functional aspects (reasoning algorithm and strategies for clinical decision). According to the programme, patients referred to Liver Transplant Centres may be enrolled and ranked in the waiting list, included in a stand-by list for treatment and re-evaluation, or discharged. All decisions are made on the basis of well-assessed and objective criteria.
An interactive videodisc instruction module on therapeutic communication in nursing was evaluated to assess its impact on learning and retention. A pre-test, post-test, re-test, control group design was used on two comparison groups. Results showed that the intervention group met therapeutic communication course objectives more efficiently than the control group. Although all 65 student study participants met therapeutic communication course objectives equally well and at a high level by the end of the semester, the intervention group had achieved these objectives at a higher level than the control group within the first month of the semester. The results support the use of computer assisted instruction, and more specifically, interactive videodisc instruction for teaching therapeutic communication skills and permitting an increase in the student-faculty ratio, with no loss in quality.
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