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At least 1,135 records · Page 63Linked to original sources
PubMed2003

Accuracy of computer diagnosis of melanoma: a quantitative meta-analysis.

BACKGROUND: Recent developments in computer technology have raised expectations that fully automated diagnostic instruments will become available to diagnose cutaneous melanoma without the need of human expertise. OBJECTIVES: To critically review the contemporary literature on computer diagnosis of melanoma, evaluate the accuracy of such computer diagnosis, analyze the influence of study characteristics, and compare the accuracy of computer diagnosis of melanoma with human diagnosis. METHODS: Quantitative meta-analysis of published reports. DATA SOURCES: Eligible studies were identified by a MEDLINE search covering the period from January 1991 to March 2002, by manual searches of the reference lists of retrieved articles, and by direct communication with experts. RESULTS: Thirty studies with substantial differences in methodological quality were deemed eligible for meta-analysis. Five of these complied with the predetermined list of "good quality" requirements, but none met all methodological quality requirements. Ten of these studies compared the performance of computer diagnosis with human diagnosis. The diagnostic accuracy achieved with computer diagnosis was statistically not different from that of human diagnosis (log odds ratios, 3.36 vs 3.51; P =.80). The diagnostic performance of the computer diagnosis was better for studies that used dermoscopic images than for studies that used clinical images (log odds ratios, 4.2 vs 3.4; P =.08). Other study characteristics did not significantly influence the accuracy of the computer diagnosis. CONCLUSIONS: The computer diagnosis of melanoma is accurate under experimental conditions, but the practical value of automated diagnostic instruments under real-world conditions is currently unknown. We suggest minimum requirements for methodological quality in future experimental studies or, ideally, randomized controlled trials.

Clinical Trials as Topic↗
PubMed1994

Computer-based vs manual health maintenance tracking. A controlled trial.

OBJECTIVE: To compare computer-based with manual health maintenance tracking systems to determine whether (1) a computer-based system will result in better provider compliance with the practice health maintenance protocol, (2) the incremental cost of operating a computer-based vs a manual health maintenance tracking system differs, and (3) inactive patients will respond to health maintenance reminders. DESIGN: Two-year prospective, randomized, controlled trial. SETTING: Rural, multiple-office, nonprofit, fee-for-service family practice. PATIENTS: Adult members of families in which at least one member had been seen by the practice within the past 2 years. INTERVENTION: A computer-based health maintenance tracking system that generated annual provider and patient reminders for all patients regardless of appointment status compared with a manual flowchart-based tracking system in which patient reminders were triggered by provider request. OUTCOME MEASURES: Provider compliance with the health maintenance protocol determined by preintervention and postintervention chart audits, costs of computer-based tracking, and response of inactive patients to health maintenance reminders. RESULTS: Overall provider compliance with the health maintenance protocol increased 15 percentage points in the computer-based tracking group and four percentage points in the manual group. The computer-based tracking group had significantly higher provider compliance than the manual group for eight of 11 procedures. The computer-based tracking system cost 78 cents per patient per year to operate. It was not associated with increased office visits or patient billings. CONCLUSIONS: Computer-based health maintenance tracking improved provider health maintenance compliance compared with a manual system. The finding that health maintenance compliance improved without a significant increase in patient visits or billings requires confirmation in other settings but suggests that considerable health maintenance can be incorporated into ongoing patient care.

Adult↗
PubMed1995

Diagnostic accuracy of ultrasound and computed tomography in the staging of Hodgkin's disease. Verification by laparotomy in 100 cases.

BACKGROUND: A staging laparotomy still is considered the gold standard to detect occult abdominal involvement in Hodgkin's disease. Computed tomography and ultrasound are routinely available for diagnostic imaging. To the authors' knowledge, the exact contribution of ultrasound for the staging of Hodgkin's disease has not been reported in a large series of patients before this study. METHODS: The diagnostic accuracy of abdominal ultrasound was compared with that of computed tomography and laparotomy in 100 patients with biopsy-proven Hodgkin's disease. Liver, spleen, paraaortic, and iliac lymph nodes were evaluated separately. RESULTS: Seventeen patients had a higher disease stage after surgery (17%). Considering only patients without known abdominal disease (supradiaphragmatic involvement), 14/79 (18%) had a positive staging laparotomy. Ultrasound had superior sensitivity for detecting splenic involvement with Hodgkin's disease (sensitivity, 63% compared with 37% for computed tomography). The specificity of both methods for detecting splenic disease was identical (99% vs. 96%). Inhomogeneities of structure or small nodular infiltrates were detected preferentially by ultrasound. Hepatic involvement also was visualized better by ultrasound than by computed tomography. Lymph nodes at the splenic hilus were recognized by both methods with identical sensitivity (64% vs. 62%). Paraaortic and iliac lymph nodes were recognized with greater sensitivity by computed tomography than by ultrasound (sensitivity, 93% and 100% vs. 77% and 67%, respectively). CONCLUSIONS: These results indicate that ultrasound and computed tomography each have their weaknesses and strengths and therefore should be combined, if possible. Ultrasound is the fastest and least invasive method and has particular accuracy for detecting splenic involvement, whereas computed tomography is more accurate in detecting involvement of paraaortic or iliac lymph node. If cost is important in the staging of Hodgkin's disease and if computed tomography is considered the standard, patients whose results are negative by computed tomography should be examined by ultrasound, focusing on splenic texture and size. Even in the era of combined modality treatment, surgical staging may be necessary to detect occult abdominal disease in a certain number of cases.

Abdominal Neoplasms↗
PubMed2001

Computed tomographic features of colorectal carcinoma liver metastases predict posthepatectomy patient survival.

PURPOSE: The gross appearance of colorectal carcinoma liver metastases reflects the biologic behavior of the tumor, yielding prognostic information. The aims of this retrospective study were to determine whether preoperative computed tomographic features of colorectal carcinoma liver metastases reflect the gross appearance of resected specimens and whether these computed tomographic hepatic features predict survival after hepatectomy. METHODS: Eighty-five patients underwent curative partial hepatectomy for colorectal carcinoma liver metastases. Preoperative computed tomographic features of the largest hepatic deposit were classified by the contour of advancing margin of the tumor into two types: lobular tumors with indentations with an acute angle and nonlobular tumors without such indentations. The correlation between computed tomographic features and 18 other clinicopathologic factors was examined. RESULTS: The overall five-year survival rate was 34.1 percent. Of 85 hepatic tumors examined, 49 were lobular and 36 were nonlobular. Computed tomographic features correlated significantly with gross appearance (P = 0.007). Univariate analysis revealed that computed tomographic features (P < 0.0001), gross appearance (P = 0.0063), size of the largest hepatic deposit (P = 0.0075), age (P = 0.0140), and satellite lesions (P = 0.0443) were significant prognosticators. The five-year survival rates in patients with lobular and nonlobular tumors were 10.4 and 66.1 percent, respectively. By multivariate analysis, computed tomographic features (P < 0.0001) and size of the largest hepatic deposit (P = 0.0419) were independently significant. CONCLUSIONS: Computed tomographic features of colorectal carcinoma liver metastases correlate with their gross appearance. The computed tomographic characterization of liver metastases is the most important independent prognostic factor in patients undergoing curative hepatectomy.

Adenocarcinoma↗
PubMed1998

Timing of computed tomography in acute diverticulitis.

PURPOSE: The purpose of this study was to evaluate the use and timing of computed tomography in the treatment of patients with acute left-sided diverticulitis. METHODS: We reviewed our four-year experience of 47 patients with the diagnosis of acute diverticulitis. We have evaluated the benefits of admission vs. delayed computed tomography in patients with this diagnosis. RESULTS: Of the 47 patients, 17 were diagnosed on clinical grounds alone, treated, and released. Thirty patients had their clinical diagnoses of diverticulitis evaluated with either computed tomographic scan (26) or laparotomy (4). Eleven of those 30 (36 percent) patients were found to have normal computed tomographic scans, indicating inaccurate clinical diagnosis, and all patients who underwent laparotomy had the pathologic diagnosis of diverticulitis. Six of the 47 patients had abscesses, but only 2 were identified at the time of admission. The remaining four abscesses were identified on delayed computed tomographic scans after failure of medical therapy. Thirty-seven hospital days were used by patients with inaccurate diagnoses before their computed tomographic scans. Analysis of cost revealed that a computed tomographic scan for all 47 patients would have cost less than the expense of admission for just the 11 patients who had normal computed tomographic scans. CONCLUSION: Routine admission computed tomographic scan for patients with acute diverticulitis leads to more accurate diagnosis, earlier identification of complications, and possible decreased hospital costs.

Acute Disease↗
PubMed1985

Application of computers in renal units. A question of time?

The application of computers for day-to-day patient care in renal units is still in its infancy, but the renal unit seems to be well suited for automation, because a computer may carry out functions that are often done badly or inefficiently or not at all. A data base system allows better access to information about patients and may improve the organisation of a center. Kinetic modelling can help to optimize treatment schedules and regimens. Computer-monitoring may improve the safety of dialysis, particularly home dialysis. The introduction of computers into the renal unit has been slow and hesitant. Responsible for this is the difficulty of defining exactly what data are necessary to treat renal patients. Economic benefit and improvement in patient care are also difficult to indicate. Lack of communication between computers and people still has its impact. However, those physicians and nurses who fully understand and master the area of nephrology and dialysis may appreciate the help of a computer. Finally, it can be concluded that interest for computers is more or less omnipresent. Realizing that the entire field of computer technology is continuously in motion, it can be speculated that the broad application of computers in renal units is just a question of time.

Belgium↗
PubMedDate not supplied

Significance of the computed tomography finding of subcapsular hepatic necrosis in liver transplantation.

BACKGROUND: To evaluate the clinical significance of the computed tomographic finding of subcapsular hepatic necrosis following liver transplantation. METHODS: 105 computed tomography scans performed in 50 allografts, 6 days to 4 years following transplantation, were retrospectively reviewed and divided into two groups: those with and those without the computed tomographic finding of subcapsular hepatic necrosis. Extrahepatic fluid, biliary dilatation, circumcaval rings, periportal collar, biochemistry, and random biopsies were correlated with the computed tomographic finding of subcapsular hepatic necrosis. RESULTS: Computed tomographic finding of subcapsular hepatic necrosis was demonstrated at some point in 21 (42%) patients and was never demonstrated in 29 (58%) patients. The association of periportal collar with the computed tomographic finding of subcapsular hepatic necrosis was significant; there was no significant association with other computed tomographic findings. There was no significant difference in serum transaminases between the two groups. There was no significant difference in necrosis on biopsy between the two groups; however, the association of acute cellular rejection with the computed tomographic finding of subcapsular hepatic necrosis was significant. CONCLUSIONS: Computed tomographic finding of subcapsular hepatic necrosis is a common finding following liver transplantation, which has little clinical prognostic significance.

Biopsy, Needle↗
PubMed2003

The Strengths and Difficulties Questionnaire: a pilot study of a new computer version of the self-report scale.

A computer-based version of the self-report Strengths and Difficulties Questionnaire (SDQ) was developed with colourful graphics illustrating each question. One hundred and two children referred to child and adolescent mental health services were recruited and randomly allocated to complete either the new computer-based version or the paper original. A further 112 children from local schools were recruited and completed the computer-based version of the scale. All children who took part in the study were aged between 8 and 15 years. The paper version of the SDQ is recommended for use in children aged 11 and over and, in this age group, the computer-based questionnaire was able to discriminate between the clinical and community sample (ROC = 0.761, 95 % CI 0.676-0.846). Comparison of the paper-based SDQ and computer-based SDQ within the clinic sample found trends towards better test-retest reliability, inter-rater reliability and significantly better user satisfaction in the computer version compared to the paper-based version. The computer-based SDQ has the added advantage of results being automatically added to a spreadsheet out of view from the user reducing the chance of operator error in coding and entering the data. These preliminary results suggest that the computer-based version of the SDQ may represent a further improvement on the paper SDQ. All versions of the SDQ, including the computer-based version, can be downloaded from the Strengths and Difficulties website address www.sdqinfo.com.

Adolescent↗
PubMed2005

How do connectionist networks compute?

Although connectionism is advocated by its proponents as an alternative to the classical computational theory of mind, doubts persist about its computational credentials. Our aim is to dispel these doubts by explaining how connectionist networks compute. We first develop a generic account of computation-no easy task, because computation, like almost every other foundational concept in cognitive science, has resisted canonical definition. We opt for a characterisation that does justice to the explanatory role of computation in cognitive science. Next we examine what might be regarded as the "conventional" account of connectionist computation. We show why this account is inadequate and hence fosters the suspicion that connectionist networks are not genuinely computational. Lastly, we turn to the principal task of the paper: the development of a more robust portrait of connectionist computation. The basis of this portrait is an explanation of the representational capacities of connection weights, supported by an analysis of the weight configurations of a series of simulated neural networks.

Cognitive Science↗
PubMed2005

Impact of multi-detector row computed tomography on the tactics of cardiovascular surgery: from qualitative evaluation to quantitative assessment.

OBJECTIVE: We assessed the role of multi-detector row computed tomography in cardiovascular surgery. METHODS: The efficacy of multi-detector row computed tomography was assessed concerning the graft patency of coronary artery bypass, arterial atheromatous degeneration, small vessel imaging, and left ventricular volume measurement. Images were reconstructed using both the volume-rendering and the maximum-intensity-profile methods. Arterial atherosclerotic degeneration was assessed by aortic wall volume and aortic calcification volume. RESULTS: In the assessment of bypass graft patency, multi-detector row computed tomography showed a 98% correct positive ratio with sensitivity and specificity of 98% and 100%, respectively. Atheromatous degeneration showed matching results in more than 70% of cases compared with intraoperative findings. More than 92% of arterial branches with diameters of 3 mm or greater were detected by preoperative multi-detector row computed tomography images, though only 6% of branches with diameters of 2 mm or less could be visualized. There was a positive linear correlation between left ventricular volumes determined by multi-detector row computed tomography and those calculated from cine angiography. CONCLUSION: Multi-detector row computed tomography clearly visualized coronary bypass grafts and aortic arterial branches, providing detailed vascular images. Atheromatous degeneration assessed by multi-detector row computed tomography was equivalent with intraoperative findings in more than 70% of cases. Left ventricular volumes measured by multi-detector row computed tomography correlated closely with those determined by cine-angiography. Multi-detector row computed tomography is an efficient and promising modality in cardiovascular surgery.

Cardiac Volume↗
PubMed1981

Evaluation of aortocoronary bypass graft status by computed tomography.

The efficacy of contrast-enhanced computed tomography to define graft patency status was studied in 42 patients with 100 aortocoronary vein grafts. The status of each graft had been determined earlier by angiography. A rotary fan beam whole body scanner with a 2 second scan duration was used. Initial scans determined the optimal level for study of the graft; patency was assessed by computed tomographic enhancement of the graft after intravenous bolus injection of 30 ml meglumine and sodium diatriazoate. The computed tomographic studies were evaluated without knowledge of the angiographic findings; graft status by computed tomography was interpreted as patent, occluded or equivocal. Overall, computed tomography correctly defined graft patency status in 79 of the 100 grafts and incorrectly identified it in 9; in 12 grafts, the computed tomographic diagnosis was equivocal. Computed tomography correctly identified 61 of 74 patent grafts and 18 of 26 occluded grafts. Patency status was correctly defined by computed tomography in 35 of 37 grafts to the left anterior descending artery, 23 of 30 grafts to circumflex branches and 19 of 31 grafts to the right coronary artery. These data indicate that computed tomography is a promising noninvasive method of determining patency of aortocoronary bypass grafts, especially of grafts to the left anterior descending artery.

Coronary Angiography↗
PubMed1987

A comparative study of computed tomography and ERCP in pancreaticobiliary disease.

Fifty-seven patients with suspected pancreaticobiliary pathology constituting a clinical subset in whom the diagnosis was problematic or nonspecific were evaluated with computed tomography and ERCP. The relative sensitivities, specificities, and accuracies of the two tests were compared. Computed tomography was successful in obtaining a diagnostic examination in 100% and ERCP was technically successful in 75%. Both tests were equally accurate in detecting an abnormality (computed tomography 95.7%; ERCP 95.3%) and offering a correct diagnosis (computed tomography 72%; ERCP 70%). Sensitivity and specificity of the two tests for detection of an abnormality was computed tomography 100% and 91.3%; ERCP 91.7% and 100%. Sensitivity and specificity for the correct diagnosis was computed tomography 59% and 91.3%; ERCP 46% and 100%. Computed tomography was also superior to ERCP in making a correct diagnosis in pancreatic carcinoma (80% versus 63%) and pancreatitis (75% versus 50%). Based on these results we conclude that computed tomography utilizing high doses of intravenous contrast material and thin collimation is the preferred screening examination for pancreaticobiliary disease. ERCP should be reserved for those cases where the pancreaticobiliary disease. ERCP should be reserved for those cases where the diagnosis on computed tomography is obscure or uncertain and/or the pancreatic or biliary ductal anatomy requires direct contrast imaging.

Biliary Tract Diseases↗
PubMed1986

Detecting and preventing adverse drug interactions: the potential contribution of computers in pharmacies.

For patients taking two or more medications concurrently, interactions among the drugs can cause undesirable effects or negate desired responses. In modern pharmacy practice, an important role of the pharmacist is to detect potentially harmful interactions and take appropriate action to prevent their occurrence. Pharmacy computer systems offer potential for improving pharmacists' effectiveness in the detection and followup of drug interactions. Based on a survey of southern Michigan pharmacists, relationships between computer use and pharmacists' attitudes and activities in drug interaction monitoring were investigated. Respondents included users of two major computer systems as well as pharmacists who do not use computers. Results suggest that general statements cannot be made about the effect of computer use on drug interaction detection. Users of one of the two computer systems detected and followed up on interactions more frequently and were more likely to report improved knowledge of drug interactions than non-users. Frequencies of drug interaction detection and other related measures reported by users of the second computer system were similar to those for pharmacists not using computers. Computer system characteristics which might lead to these differences are discussed.

Computers↗
PubMed2006

Use of tissue Doppler imaging to guide tube current modulation in cardiac multidetector computed tomographic angiography.

In multidetector computed tomographic coronary angiography, strategies to minimize effective radiation dose (ERD) are urgently needed. Prospective tube current modulation (TCM) allows a decrease in ERD, although it may limit reconstruction options. We sought to determine if tissue Doppler imaging (TDI) by echocardiography could predict an optimal phase for multidetector computed tomography and be used to guide TCM. Echocardiographic studies were performed in 94 patients immediately before multidetector computed tomography (83% men; mean 60 +/- 11 years of age, mean body mass index 27.7+/-4.1 kg/m2) and identified the most quiescent phase of the cardiac cycle within the atrioventricular groove. In 40 patients, prospective TCM was programmed according to TDI (TCM(TDI) group); 54 patients underwent multidetector computed tomography without TCM (no-TCM). In 25 patients assigned to the TCM(TDI) group, multidetector computed tomograms were correlated with invasive quantitative coronary angiograms to ensure maintenance of diagnostic accuracy. Optimal phase determined by TDI was 71 +/- 11%, with a distinct bi-modal distribution. Compared with no-TCM, effective radiation dose was decreased by 42% in the TCM(TDI) group (6.6 +/- 1.2 vs 11.4 +/- 2.2 mSv, p < 0.0001). Only 8 segments (3%) were unevaluable due to motion artifact. In 296 segments, sensitivity, specificity, and positive and negative predictive values to detect lesions > 50% by multidetector computed tomography were 92%, 94%, 65%, and 99%, respectively. There was good correlation between quantitative coronary angiography and multidetector computed tomography for absolute degree of stenosis (r = 0.70, p < 0.0001). In conclusion, TDI is a useful tool to guide prospective TCM in multidetector computed tomography. ERD in multidetector computed tomography may be significantly decreased using this technique while maintaining excellent image quality.

Cardiac Catheterization↗
PubMed2005

Computer skills in patients with movement disorders.

BACKGROUND: Electronic communication is important in healthcare, but the level of computer proficiency among patients with neurological disorders is unknown. OBJECTIVE: This study sought to determine the proportion of a movement disorder clinic population that was able to perform basic computer skills, and the effect of specific cognitive and motor features on computer proficiency. METHODS: One hundred and four movement disorder patients participated. Seventy-four completed both paper and computerized questionnaires to evaluate data entry skills and thirty subjects completed paper questionnaires only. Basic e-mail messaging and Internet skills were evaluated. Demographic information, Mini-Mental Status Examination (MMSE) score, and Hoehn and Yahr stage were assessed. RESULTS: Ninety-six percent of subjects successfully completed computerized data entry tasks, and over 70% completed e-mail and Internet tasks. Computer data entry had an average accuracy of nearly 95% when compared to paper data entry. Poorer performance on computer tasks was associated with older age, less education, and cognitive impairment. Computer performance was reduced in subjects with a history of parkinsonism and when both tremor and dyskinesia were present during task performance. Nearly three-quarters of subjects have access to a computer. Subjects who completed the paper questionnaire but refused to complete the computer questionnaire were older, less educated and more cognitively impaired. CONCLUSION: The majority of patients visiting a tertiary movement disorders center were able to perform computer data entry, e-mail messaging and Internet usage. These results reinforce the potential value of electronic communication and information systems in neurology practice.

Aged↗
PubMed1985

Use of the personal computer in clinical research.

Personal computers are quickly becoming items of everyday use. More physicians' offices are using computers for billing and patients' records. Others have purchased computers for their word processing capabilities. These computers can be used for archives of medical case records or to collect and collate data for clinical research. This article focuses on how we use a personal computer for organization and management of clinical research projects. Included is a description of how we organize a research project, gather data, write computer programs, enter data into the computer, and generate and display reports. The use of a template program and a personal computer permits creation of individual programs without the aid of a professional programmer. When a single data-management program is used, five or six research projects can be carried out at a cost comparable to that of one project using a large computer and professional programmers.

Computers↗
PubMed2002

Computer assisted screw insertion into real 3D rapid prototyping pelvis models.

OBJECTIVE: Show the use of computer navigation in exact screw positioning in the different pelvic bones. BACKGROUND: Computer assisted pedicle screw insertion in the spine is an established procedure. Screw fixation is also used in highly difficult pelvic and hip surgery (arthroplasty revision surgery and tumor surgery). DESIGN: Insert as long screws as possible with computer navigation into the different bones of the pelvis and compare these results with a non-computer controlled method. METHODS: The computer navigation was done with the system of Medivision (Oberdorf, Switzerland), the software was SurgiGATE 2.1. Optically controlled spine instruments and a special calibrated drill were used. The screw insertion with and without computer navigation took place in seven real rapid prototyping pelvis models matched by pairs. Three screws were inserted into the Os ileum, one into the Os pubis and one into the Os ischium. The length of the inserted screws were measured and compared using routine statistic methods. RESULTS: The mean screw length with vs. without computer navigation was 8.9 vs. 5.7 cm in the Os ileum (P=0.0001), 6.0 vs. 4.2 cm in the Os pubis (P=0.01) and 4.3 vs. 3.9 cm in the Os ischium (not significant). CONCLUSIONS: The use of computer navigation allows for the insertion of longer screws into the bones of the pelvis (more exact positioning), which requires a more precise original point of entry and direction of the drill (vector). RELEVANCE: The insertion of fixation screws in highly difficult pelvic and hip surgery (revision arthroplasty, tumor surgery) are another field for the use of computer navigation.

Arthroplasty, Replacement, Hip↗
PubMed1998

Computers in the Faculty of Health Science--5 years on.

In 1989, the Faculty of Health Science at Central Queensland University (CQU) committed itself to a major instructional development project for its nursing education program. Partially supported by a National Priority (Reserve) Fund (NPRF) grant, the Faculty undertook a multi-year project to develop computer-based learning materials. The success of that project was mixed. However, by 1993 staff and students within the Faculty were using computers regularly, many of the staff were involved in developing computer-based instructional materials, and some staff were using available computer-based tools to extend the scope of the standard Health Science materials developed under the project. As well, the Faculty was committed to using Faculty funds for technical support staff to maintain its computer infrastructure and to assist both staff and students in using that infrastructure. The authors review the original NPRF project, then explore the Faculty's continued development and use of computer-based learning materials through an examination of student and staff evaluations, personal recollections, and subsequent projects. This paper demonstrates that the NPRF project spawned a number of other computer-based developments, including the offering of health informatics degree programs at the undergraduate and postgraduate levels, the development of the Faculty's current Internet site and a CD-ROM based interactive multimedia project for diabetes education. It also demonstrates that moderate levels of funding can maintain a computer-literate Faculty which views computers as essential tools for learning.

Australia↗