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The development of uniform, ethical and internationally enforceable standards for handling computerised electronic patient records is a major requirement for the implementation of the next generation of health information systems. This paper develops a model code of ethics to address this issue.
Some characteristics of the neural network approach have been tested and validated for the particular problem of diagnostic classification in the field of computerized electrocardiography. Two different databases have been used for the evaluation process: CORDA, developed by the Medical Informatics Department of the University of Leuven, and ECG-UCL, developed by the Cliniques Universitaires Saint-Luc, Université Catholique de Louvain. Electrocardiographic signals classified on the basis of electrocardiographic independent clinical data, with a single diagnosis and no conduction abnormalities, have been considered. Seven diagnostic classes have been taken into account, including the different locations of ventricular hypertrophy and myocardial infarction. Two architectures of neural networks have been analyzed in detail considering three aspects: the normalization process, pruning techniques, and fuzzy preprocessing by the use of radial basis functions. The comparison of the results obtained with the two databases will be discussed in detail.
The medical care for the integrated crew of the International Space Station (ISS) will require close co-operation between the partner agencies in the areas of selection, medical surveillance, countermeasures, and handling of acute medical problems. Based on a commonly accepted policy of shared care and responsibilities medical guidelines, procedures, and standards for medical data and communication need to be harmonised under the responsibility of the Multilateral Medical Operations Panel (MMOP). A supporting telemedical network connecting the partners on an organisational and technical level will facilitate the harmonisation process and provide new tools for effective co-operation between medical professionals. Earth bound projects with similar application areas can profit from and contribute to this development and need to be considered for efficient implementation and exploitation.
Resuscitation of the severely injured patient who presents in shock has improved greatly, following focused wartime experience and insight from laboratory and clinical studies. Further benefit is probable from technologies that are being brought into clinical use, especially hypertonic saline dextran, haemoglobin-based oxygen carriers, less invasive early monitors, and medical informatics. These technologies could improve the potential of prehospital and early hospital care to pre-empt or more rapidly reverse hypoxaemia, hypovolaemia, and onset of shock. Damage control surgery and definitive interventional radiology will probably combine with more real-time detection and intervention for hypothermia, coagulopathy, and acidosis, to avoid extreme pathophysiology and the "bloody vicious cycle". Although now widely practised as standard of care in the USA and Europe, shock resuscitation strategies involving haemoglobin replacement and fluid volume loading to regain tissue perfusion and oxygenation vary between trauma centres. One of the difficulties is the scarcity of published evidence for or against seemingly basic intervention strategies, such as early or large-volume fluid loading. Standardised protocols for resuscitation, representing the best and most current knowledge of the clinical process, could be devised and widely implemented as interactive computerised applications among trauma centres in the USA and Europe. Prevention of injury is preferable and feasible, but early care of the severely injured patient and modulation of exaggerated systemic inflammatory response due to transfusion and other complications of traditional strategies will probably provide the next generation of improvements in shock resuscitation.
The development of a total digital high resolution mammography display system must meet a number of requirements that remain a challenge nowadays, most probably because of the special nature of breast imaging. In this paper, we discuss our particular approach to address some problems concerning the complexity of soft-copy diagnosis in digital mammography, such as image quality and user interface evaluation. Based on the experience obtained in the previous implementation of a medical image browser, a more ambitious project is being developed at the Department of Radiology of the University of Santiago de Compostela (Spain) in collaboration with the Department of Medical Informatics of INTELSIS, an emerging software company in our country. This new system will provide complete support to display, store and analyze mammographic studies in digital format.
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OBJECTIVE: This guideline provides evidence-based recommendations to manage diffuse acute otitis externa (AOE), defined as generalized inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The primary purpose is to promote appropriate use of oral and topical antimicrobials and to highlight the need for adequate pain relief. STUDY DESIGN: In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) selected a development group representing the fields of otolaryngology-head and neck surgery, pediatrics, family medicine, infectious disease, internal medicine, emergency medicine, and medical informatics. The guideline was created with the use of an explicit, a priori, evidence-based protocol. RESULTS: The group made a strong recommendation that management of AOE should include an assessment of pain, and the clinician should recommend analgesic treatment based on the severity of pain. The group made recommendations that clinicians should: 1) distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the ear canal; 2) assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); and 3) use topical preparations for initial therapy of diffuse, uncomplicated AOE; systemic antimicrobial therapy should not be used unless there is extension outside of the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The group made additional recommendations that: 4) the choice of topical antimicrobial therapy of diffuse AOE should be based on efficacy, low incidence of adverse events, likelihood of adherence to therapy, and cost; 5) clinicians should inform patients how to administer topical drops, and when the ear canal is obstructed, delivery of topical preparations should be enhanced by aural toilet, placing a wick, or both; 6) when the patient has a tympanostomy tube or known perforation of the tympanic membrane, the clinician should prescribe a nonototoxic topical preparation; and 7) if the patient fails to respond to the initial therapeutic option within 48 to 72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. And finally, the panel compiled a list of research needs based on limitations of the evidence reviewed. CONCLUSION: This clinical practice guideline is not intended as a sole source of guidance in evaluating patients with AOE. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition and may not provide the only appropriate approach to the diagnosis and management of this problem. SIGNIFICANCE: This is the first, explicit, evidence-based clinical practice guideline on acute otitis externa, and the first clinical practice guideline produced independently by the AAO-HNSF.
MEDICUS is a teleradiology system which has been developed in a joint project of the German Cancer Research Center (Deutsches Krebsforschungszentrum) and the Transfer Center Medical Informatics (Steinbeis-Transferzentrum Medizinische Informatik) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. Special attention has been given to the design of the user interface and data security, integrity, and authentication. The software is in use in 13 radiology departments in university clinics, small hospitals, private practices, and research institutes. More than 25 thousand images have been processed in 6 months. The system is in use in six different application scenarios. MEDICUS is running under the UNIX operating system. The connection of the modalities could in most cases not be realized with the DICOM protocol as older machines were not equipped with this standard protocol. Clinical experiences show that the MEDICUS system provides a very high degree of functionality. The system has an efficient and user friendly graphical user interface. The result of a comparison with other systems shows that MEDICUS is currently the best known teleradiology system. Cost reductions are already obvious, but additional research has to be performed in this field. An even more powerful commercial successor is currently under construction at the Steinbeis-Transferzentrum Medizinische Informatik in Heidelberg.
Telemedicine began from the humble beginnings of the first telephone call from Alexander Graham Bell to his associate, Watson. These systems already have been used for educational programs, consultative care, image transfer, second opinions, and direct acute patient care. Most of the original programs failed because of several reasons, primarily because of lack of funding when a grant ended. The major lesson of these programs is that a solid business plan is needed initially for long-term survival. The reliability of telemedical examinations has been demonstrated superficially, but more conclusive work in this area is needed. Studies that evaluate clinical, financial, and satisfaction outcomes are required simultaneously. Further integration of medical informatics into telemedicine systems is needed before these systems can achieve more acceptance. Twenty years ago, few people predicted this technologic revolution. Innovations arise almost daily. The future seems promising for telemedical systems, but much work is required. Partnerships with industry must move beyond niche projects, and regulatory and medicolegal issues must be resolved. Anesthesiologists can expect their practice to be affected directly by technology, and should embrace it, evaluate it, and help lead its use in this millennium.
This paper describes the application of the data analysis tool InfoZoom to a database containing the results of blood examinations for about 400 patients with a suspect of thrombosis. The main goal was to find correlations between the measurements and the occurrence of a thrombosis. No automatic method for data mining is used. Instead, InfoZoom uses a novel technique to display data sets as highly compressed tables which always fit completely onto the screen. The user can interactively explore animated tabular views of the data. In this way, the user gets a feeling of the data, detects interesting knowledge, and gains a deep understanding of the data set.
Advances in imaging techniques have been mirrored by advances in the use of computers to extract and interpret image data. Helping clinicians to make effective use of this superabundance of information is a key aim of medical informatics research. One approach is to incorporate digital images and image processing within a knowledge-based decision aid for radiologists. This paper describes a generic design for such aids. The work is based on an abstract model of decision-making which is used to organize the presentation of information from a knowledge base. We describe a system in which the model of decision-making is augmented to describe processes underlying image interpretation. The augmented model, implemented as a logic program, is used to control the application of image processing operators to detect and describe radiological signs. Through the use of this model we are able to combine information from image processing with information from a symbolic knowledge base. The operation of the model is illustrated by considering three different applications in the domain of breast X-rays or mammograms.
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Medical literature is too prolific and user's guides are necessary to extract useful information for optimal treatment of our patients. The goal of this paper is to help doctors find relevant articles and to read them efficiently for applying the results to their patients. An excerpt has been written concerning the subject by the Mac Master team and the members of the Cochrane Collaboration in the JAMA, the BMJ and on the Internet: a web site is now devoted to user's guides to medical literature. Simple rules facilitating access to relevant papers and interpretation of the results have been given. They have been applied to oncology, especially to papers concerning effectiveness of therapeutic interventions. It is essential that doctors use simple rules and learn how to select relevant articles and understand and use them to treat their patients according to Evidence-Based Medicine Group.
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There have been two major approaches to the development of networked electronic patient record (EPR) architecture. One uses object-oriented methodologies for constructing the model, which include the GEHR project, Synapses, HL7 RIM and so on. The second approach uses document-oriented methodologies, as applied in examples of HL7 PRA. It is practically beneficial to take the advantages of both approaches and to add solution technologies for network security such as PKI. In recognition of the similarity with electronic commerce, a certificate authority as a trusted third party will be organised for establishing networked EPR system. This paper describes a Japanese functional model that has been developed, and proposes a document-object-oriented architecture, which is-compared with other existing models.
New knowledge from biotechnology and new capabilities provided by the evolving global information infrastructure are already transforming health care. Three clusters of technologies hold particular promise: grid computing, intimate computing, and micro laboratory computing. The confluence of these technologies will change clinical laboratory equipment into portable devices, easing the administrative details involved in delivering care and ushering in a new age of monitoring clinical states. Two vignettes, an office visit and a clinical trial, are offered as prognosis for clinical care in 2013. New capabilities hold the power to transform health care, making it truly patient centered as the Institute of Medicine (IOM) has urged.
A prognosis of how the information society in health care will look like in 2013 must start from the current state of affairs at the given locality regarding healthcare management by public authorities including legislative, ICT technological levels and accessibility of professional knowledge in individual fields of medicine. It is presumed that after 10 years the influence of this 'starting point' will still persist and knowledge of the current state of affairs will be needed to positively but also negatively differentiates the prognosis [Health Care in the Information Society: A Prognosis for the Year 2013, in this issue] for individual localities, e.g. Germany versus neighbouring the Czech Republic. The present article focuses on aims of Czech health care and the measures that are taken in Czech health care that are carried out and which have been already initiated. Their significance towards the future prognosis according to [Health Care in the Information Society: A Prognosis for the Year 2013, in this issue] is clear. The first measure is legalisation of conditions, which allow health care administration only be carried out with electronic forms and the protection of these sensitive personal data when they are placed in a centralised data depository where they are prepared for physicians who use them while providing health care in health institutions. In the Czech Republic an information system is developed called Internet Access to Health Patient Information (IHPI). The second measure is creating a unified central system of health information together with methodologies for data collection, data standards and protocols. In the Czech Republic there is the National Health Information System (NHIS) governed by the Institute for Health Information and Statistics (IHIS CR). The NHIS enables care providers to get information about the health state of citizens, about health institutions, about their activities and economics, it enables to regulate the provision of health care, to define conceptions of state health politics and to administrate public health. The third measure is legalisation of possibilities to establish centralised health care registers that are designated for recording and following of patients with chosen socially serious diseases. These registers help with diagnosis and therapy and reveal consequences of diseases for the patients. It helps to evaluate accessibility and quality of provided health care in the country. An important goal of the use of health care registers and information systems is for educational purposes and as causal expert systems for physicians. The National Health Registers have been introduced to the whole of the Czech Republic; some of them are accessible on-line in a countrywide data network. The last part of the paper focuses on research and education for developing the information society in Czech health care and on co-operation with EU countries in selected projects and initiatives.