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This thesis introduced a kind of computerized image analysis system of medical electrophoresis and DNA gel, which have a high performance/price ratio. Moreover, it gives a detailed presentation of how to eliminate the background obstruction by the conjunction of hardware and software.
Based on the integration of the advanced visualization toolkit (VTK) and the real-time rendering System (VolumePro), 4D View, a 3D real-time visualization system of medical image, which applies real-time 3D medical image (such as MR, CT image, etc.) visualization and interaction was developed. Firstly the VTK, VolumePro and their integration were introduced briefly; then the system design and function template of 4D View system was discussed in detail; finally some visualization results acquired through 4D View was illustrated. According to the results, 4D View system can effectively resolve the poor real-time characteristic of 3D medical image visualization and interaction, so it will have a wide application area of the clinical diagnosis, therapy and medical research, etc in future.
INTRODUCTION: In this article we begin by connecting the concept of simplicity of user interfaces of information systems with that of usability, and the concept of complexity of the problem-solving in information systems with the concept of usefulness. We continue by stating "the usability axiom" of medical information technology: information systems must be, at the same time, usable and useful. We then try to show why, given existing technology, the axiom is a paradox and we continue with analysing and reformulating it several times, from more fundamental information processing perspectives. DISCUSSION: We underline the importance of the concept of representation and demonstrate the need for context-dependent representations. By means of thought experiments and examples, we advocate the need for context-dependent information processing and argue for the relevance of algorithmic information theory and case-based reasoning in this context. Further, we introduce the notion of concept spaces and offer a pragmatic perspective on context-dependent representations. We conclude that the efficient management of concept spaces may help with the solution to the medical information technology paradox. Finally, we propose a view of informatics centred on the concepts of context-dependent information processing and management of concept spaces that aligns well with existing knowledge centric definitions of informatics in general and medical informatics in particular. In effect, our view extends M. Musen's proposal and proposes a definition of Medical Informatics as context-dependent medical information processing. SUMMARY: The axiom that medical information systems must be, at the same time, useful and usable, is a paradox and its investigation by means of examples and thought experiments leads to the recognition of the crucial importance of context-dependent information processing. On the premise that context-dependent information processing equates to knowledge processing, this view defines Medical Informatics as a context-dependent medical information processing which aligns well with existing knowledge centric definitions of our field.
Medically, as in many other ways, India is a pluralistic society. There are numerous different modes of healing in India, which are, as a group, not subject to any form of standardization or centralized control. While such a situation has demonstrable advantages, it may also be legitimate to ask, is medicine in India as fundamentally unordered as it seems? The present paper examines four different healing traditions practiced in Tamil Nadu in southern India. These traditions appear on the surface to be quite diverse, and not to be united into a single, internally consistent medical system. Yet a study of the mythical and philosophical bases of these traditions shows them to share some common premises, and to communicate to the patient or student who attends to all of them a common message concerning the nature of life.
Medical error is a leading cause of death in the United States. The root cause analysis (RCA) process provides the framework for analysis of sentinel events and other medical errors. A thorough understanding of this process is a key component in promoting safety within the health care setting. Risk reduction strategies are presented to make this process meaningful and efficient while promoting the ultimate goal of safer health care systems.
The UMLS is a complex collection of medical terms and relationships derived from standard classifications. Appreciating the scope and layout of these relations from text descriptions of relational schema is difficult. The graphical technique of Logical Data Structure (LDS) representation was employed to illustrate the UMLS schema as a data abstraction, affording additional insights that might otherwise escape notice. An LDS representation of the Metathesaurus offers the following advantages: 1) the separation of a viewpoint from physical data structures enables a global outline of the contents; 2) the graphical map makes the interrelation of data visible; and 3) the logical entities explicitly reflect the decision-making which was implicit or ambiguous in the relational scheme.
The perceptual linearization of video display systems should play a significant role in medical image presentation. It maximizes the faithfulness of information transfer to the human observer; it provides a method for standardizing the appearance of images across different display devices; and it allows for calculation of the inherent contrast resolution of different display devices. This paper provides insight into the process of perceptual linearization by decomposing it into the digital driving level-to-monitor luminance relationship, the monitor luminance-to-human brightness perception relationship, and the construction of a linearization function derived from these two relationships. A discussion of previous work in these areas is given. We then compare and contrast the results of previous work with recent experiments in our laboratory and related work in vision and computer science. We conclude that (1) sufficiently good visual models exist for agreeing on a standard method of calculating the perceptual linearization function; (2) improvements in the resolution and luminance distribution of the digital-to-analog circuitry in display systems are required for medical imaging; and (3), methods for calculating a linearization remapping from a perceptual linearization function currently have significant error and should be replaced with methods that minimize perceptual error.
BACKGROUND: Helicopter transport of pediatric trauma patients in an urban Emergency Medical Services system remains controversial. METHODS: A retrospective review of pediatric patients transported by helicopter to a pediatric trauma center in Los Angeles, California, was conducted over a 3-year period. Pediatric patients (age < 15 years) are transported by helicopter if ground transport to a pediatric trauma center would exceed 20 minutes. Emergency Medical Services reports and hospital records were reviewed for key prehospital and outcome indicators. RESULTS: One hundred eighty-nine patients met the study inclusion criteria. The median age was 5 years (range, 0-14 years). The most common mechanisms of injury were falls and automobile versus pedestrian crashes. Eighty-two percent of patients had a Revised Trauma Score > 7. Of the 175 (93%) patients whose hospital records were available, 24 (14%) were intubated in the emergency department, 32 (18%) were admitted to the intensive care unit, and 7 (4%) were taken directly to the operating room. Injury Severity Scores (ISSs) were as follows: ISS 0 to 15, 146 (83%); ISS 16 to 30, 26 (15%); and ISS > 30, 3 (2%). Fifty-seven (33%) patients were discharged home from the emergency department. CONCLUSION: The majority of pediatric trauma patients transported by helicopter in our study sustained minor injuries. A revised policy to better identify pediatric patients who might benefit from helicopter transport appears to be warranted.
This paper presents a study of the application of autonomously learning multiple neural network systems to medical pattern classification tasks. In our earlier work, a hybrid neural network architecture has been developed for on-line learning and probability estimation tasks. The network has been shown to be capable of asymptotically achieving the Bayes optimal classification rates, on-line, in a number of benchmark classification experiments. In the context of pattern classification, however, the concept of multiple classifier systems has been proposed to improve the performance of a single classifier. Thus, three decision combination algorithms have been implemented to produce a multiple neural network classifier system. Here the applicability of the system is assessed using patient records in two medical domains. The first task is the prognosis of patients admitted to coronary care units; whereas the second is the prediction of survival in trauma patients. The results are compared with those from logistic regression models, and implications of the system as a useful clinical diagnostic tool are discussed.
A limiting factor in realizing the full potential of electronic medical records (EMR) is physician reluctance to use these applications. There have been very few formal usability studies of experienced physician users of EMRs in routine clinical use. We distributed the Questionnaire for User Interaction Satisfaction (QUIS) to 75 primary care physicians who routinely use the Brigham and Women's Integrated Computing System (BICS). BICS scored highest in the area of screen design and lowest in the area of system capability. Overall user satisfaction was most highly correlated with screen design and layout, and surprisingly not with system response time. Human-computer interaction studies can help focus our design efforts as we strive to increase clinician usage of information technology.
OBJECTIVE: There is no data on the use of hospital-wide online medical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied. METHODS: In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patient's record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of how much data was copied, the number of characters was also recorded. RESULTS: Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfully retrieved data from the patient's record. Data was copied for 170 patients - 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied-an average of 1,543 characters per instance of copying. CONCLUSION: We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR data-base, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.
The author considers the potential advantages and disadvantages, as well as possible unintended consequences, of introducing electronic medical record systems in health care organizations. Special consideration is given to the issues such information systems raise concerning privacy, confidentiality, and quality of care from both patient and provider perspectives. The potential gains from computerizing medical records include the benefit of instantaneous availability of patients' medical history, treatment regimes, and current health status in routine and emergency clinical situations. Ease of access to this information should reduce adverse outcomes. The added value of a complete and up-to-date medical record immediately available to medical caregivers seems undeniable. The potential disadvantages include issues around patient confidentiality and unauthorized access to records, the enormous capital investment for computer hardware, and system maintenance.
Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.
OBJECTIVE: The purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications. DESIGN: Data were collected on the first day following nursing home admission in this non-experimental study. SETTING: A stratified, proportional probability sample of eight nursing homes in a large Mid-South city participated in this study. PARTICIPANTS: A consecutive sample of 574 new and readmitted nursing home residents who did not refuse participation. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Data were collected on regularly scheduled prescription medications and resident and nursing home characteristics. RESULTS: Residents without a diagnosis of dementia were more likely to receive cardiovascular medications (Odds Ratio = 2.34; 95% CI = 1.56-3.49), and white residents were more likely to receive cardiovascular medications (Odds Ratio = 1.74; 95% CI = 1.19-2.53) or central nervous system medications (Odds Ratio = 1.72; 95% CI = 1.18-2.51). Older residents were less likely to receive central nervous system medications (Odds Ratio = 0.97 per year; 95% CI = 0.96-0.99), and females were more likely to receive cardiovascular medications (Odds Ratio = 1.89; 95% CI = 1.30-2.75). CONCLUSIONS: Resident characteristics were the most important predictors for cardiovascular and central nervous system medication prescriptions of new and readmitted nursing home residents.
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BACKGROUND: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. METHODS: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. RESULTS: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. CONCLUSIONS: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.