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PubMedDate not supplied

The Epidemiologic Surveillance Project: a computer-based system for disease surveillance.

The Epidemiologic Surveillance Project (ESP) is a computer-based surveillance system for the rapid transmission and analysis of national morbidity data. These data are transmitted weekly by state health department computers to the Centers for Disease Control (CDC), using a commercial electronic mail facility (MINET). Participating state health departments transmit data through existing computer systems using a standard record and data transmission protocol. State and national data are rapidly analyzed at the CDC, and reports of these analyses are transmitted through MINET to the states. Maps based on these data and other tabular displays of demographic and epidemiologic characteristics of the diseases being tracked are periodically prepared and distributed. Because the efficiency, speed, and uniformity of tabulation of this system are greater than those of systems that use protocol and telephonic reports of case totals, the ESP may be a model for future surveillance systems.

Centers for Disease Control and Prevention, U.S.↗
PubMed1989

An intercomparison of the accuracy of computer planning systems for brachytherapy.

The accuracy of brachytherapy computer planning systems has been investigated by means of an intercomparison of the dose distributions as calculated by these systems for five specific test cases. In this intercomparison, 13 radiotherapy institutions in The Netherlands participated. The planning systems evaluated comprise all commercial systems in clinical use in The Netherlands (different versions of in total four manufacturers) as well as in-house developed systems. The five test cases were designed in order to quantify the errors introduced by: (a) the calculation algorithm including the method of source specification used; (b) the localisation procedure via orthogonal radiographs; and (c) the clinical dose specification system in the case of a geometrically irregular implantation for which no established, rigid dose specification method is available. The results of this comparison can be summarized as follows: The accuracy of most calculation algorithms appears to be satisfactory except for the region close to the longitudinal axis of linear sources. Source strength specification in terms of activity or milligram radium equivalent can result in dosimetric errors which may be clinically relevant and therefore specification of the source strength in terms of "output", i.e. air-kerma rate at a specified distance, is to be preferred. This concurs with recent national and international recommendations regarding source strength specification. Localisation via orthogonal radiographs, as commonly used, appears to cause noticeable errors. This aspect could be improved in a quality assurance program. In case of "irregular" implantations, the uncertainty in clinical dose specification clearly dominates the overall accuracy. This illustrates the need for a consistent dose specification system, which is capable of including interstitial implants with a source geometry deviating from the rules given by the existing specification systems. It can be concluded that in brachytherapy, whenever possible, a well-defined, rigid clinical dose specification system should be applied, but that even in such cases the delivered dose may be in error by more than 5% (1 S.D.).

Brachytherapy↗
PubMed1970

Mechanization of library procedures in the medium-sized medical library. XII. An information retrieval system: a combination of a manual selective dissemination of information, and a personal file indexing system by computer.

The introduction of a manual selective dissemination of information system with a computer-based personal index service into a Medical School Library is described. An account is given of the selection of participants, the development and maintenance of search profiles, the daily procedures, the forms and outputs of the system, and the computer index maintenance system. The costs of both the manual citation selection system and the computer index maintenance system are reported.

Computers↗
PubMed1984

Building safe computer-controlled systems.

Software safety becomes an issue when life-critical systems are built with computers as important components. In order to make these systems safe, software developers have concentrated on making them ultrareliable. Unfortunately, this will not necessarily make them safe. This paper discusses why reliability enhancement techniques are not adequate to ensure safety and describes what needs to be done to protect life and property in these systems.

Computers↗
PubMed1976

Randomised controlled trial of computer-held medical records in hypertensive patients.

A total of 278 hypertensive patients in three clinics were randomly allocated to have their medical records held in a computer system (136) or on standard hospital notes (142). For the computer system the doctor completed a structured input form, and the information on symptoms, physical findings, and diagnoses was more complete than that in the standard notes. This resulted in certain symptoms and risk factors being recognised more often when the computer system was used. The hypertension clinics' routines were not disrupted by the introduction of a computer-held system, and follow-up consultation times were not affected by the type of records kept, although the first consultation took eight minutes longer when computer documents were completed. The patients remained in the trial for one year and clinical management was assessed from blood pressure control, drop-out rates, and the frequency of performing investigations. These estimates of management showed no significant difference between the two groups, but the attempt to tailor the computer system to help management made the system acceptable to the doctors using it. The computer system continues to be used and is providing data for research into hypertension.

Computers↗
PubMed2005

Evaluation of a computed radiography system for megavoltage photon beam dosimetry.

Computed radiography (CR) systems have been gaining adoption as digital replacements for film for diagnostic and therapy imaging. As a result, film processors are being removed from service, leaving a void for the medical physicists who use film and processors for two-dimensional mega-voltage beam dosimetry. This is the first report to evaluate the ability of a commercial CR reader and storage phosphor plate system to accurately quantitate absolute dose and dose distributions from a 6 MV photon beam. There are potential advantages and disadvantages of current CR systems compared to film systems. CR systems inherently produce a linear dose-response over several logs of dose. However, the barium in the storage phosphor has a higher atomic number than the silver in film, resulting in significant energy sensitivity. The purpose of this work is to fully characterize the impact of these and other features of this CR system relevant to dosimetry. The tests performed and reported on in this study include uniformity of readout across a uniform field, geometrical accuracy, intra- and interday reproducibility, signal decay with time and with light exposure, dose-to-signal calibration, high dose effects, obliquity effects, perpendicular and parallel calibration results, field size and depth of measurement effects and the use of lead filters to minimize them, and intensity modulated radiation therapy quality assurance test results compared to that for film. Practical techniques are provided to optimize the accuracy of the system as a dosimetric replacement for film.

Photons↗
PubMed1999

Automated metabolic profiling and interpretation of GC/MS data for organic acidemia screening: a personal computer-based system.

We have developed a personal computer-based system designed for automated metabolic profiling of urinary organic acids by gas chromatography-mass spectrometry (GC/MS) and data interpretation for organic acidemia screening. For the automated profiling, we compiled retention indices, two target ions and their intensity ratio for 126 urinary metabolites. Metabolites above the cut-off values were flagged as abnormal compounds. The data interpretation was based on combination of the flagged metabolites. Diagnostic or index metabolites were categorized into three groups, "AND," "OR" and "NO," and compiled for each disorder to improve the specificity of the diagnosis. Groups "AND" and "OR" comprised essential and optional compounds, respectively, which and both to reach a specific diagnosis. Group "NO" comprised metabolites that must be absent to make a definite diagnosis. We tested this system by analyzing urine specimens from 48 patients previously diagnosed as having organic acidemias. In all cases, the diagnostic metabolites were identified and each correct diagnosis could be found among the possible diseases suggested by the system. Hence, with this simplified automated system, more people will be able to participate extensively in any screening programs using GC/MS.

Acidosis↗
PubMed2005

Automated Water Analyser Computer Supported System (AWACSS) Part II: Intelligent, remote-controlled, cost-effective, on-line, water-monitoring measurement system.

A novel analytical system AWACSS (Automated Water Analyser Computer Supported System) based on immunochemical technology has been evaluated that can measure several organic pollutants at low nanogram per litre level in a single few-minutes analysis without any prior sample pre-concentration or pre-treatment steps. Having in mind actual needs of water-sector managers related to the implementation of the Drinking Water Directive (DWD) [98/83/EC, 1998. Council Directive (98/83/EC) of 3 November 1998 relating to the quality of water intended for human consumption. Off. J. Eur. Commun. L330, 32-54] and Water Framework Directive (WFD) [2000/60/EC, 2000. Directive 2000/60/EC of the European Parliament and of the Council of 23 October 2000 establishing a framework for Community action in the field of water policy. Off. J. Eur. Commun. L327, 1-72], drinking, ground, surface, and waste waters were major media used for the evaluation of the system performance. The first part article gave the reader an overview of the aims and scope of the AWACSS project as well as details about basic technology, immunoassays, software, and networking developed and utilised within the research project. The second part reports on the system performance, first real sample measurements, and an international collaborative trial (inter-laboratory tests) to compare the biosensor with conventional anayltical methods. The systems' capability for analysing a wide range of environmental organic micro-pollutants, such as modern pesticides, endocrine disrupting compounds and pharmaceuticals in surface, ground, drinking and waste water is shown. In addition, a protocol using reconstitution of extracts of solid samples, developed and applied for analysis of river sediments and food samples, is presented. Finally, the overall performance of the AWACSS system in comparison to the conventional analytical techniques, which included liquid and gas chromatographic systems with diode-array UV and mass spectrometric detectors, was successfully tested in an inter-laboratory collaborative trial among six project partners.

Algorithms↗
PubMed1992

CHESS: a computer-based system for providing information, referrals, decision support and social support to people facing medical and other health-related crises.

CHESS (the Comprehensive Health Enhancement Support System) is an interactive, computer-based system to support people facing health-related crises or concerns. CHESS provides information, referral to service providers, support in making tough decisions and networking to experts and others facing the same concerns. CHESS will improve access to health and human services for people who would otherwise face psychological, social, economic or geographic barriers to receiving services. CHESS has developed programs in five specific topic areas: Academic Crisis, Adult Children of Alcoholics, AIDS/HIV Infection, Breast Cancer and Sexual Assault. The lessons learned, and the structures developed, will serve as a model for future implementation of CHESS programs in a broad range of other topic areas. CHESS is designed around three major desired outcomes: 1) improving the emotional health status of users; 2) increasing the cost-effective use of health and human services; and 3) reducing the incidence of risk-taking behaviors that can lead to injury or illness. Pilot-testing and initial analysis of controlled evaluation data has shown that CHESS is extensively used, is useful and easy-to-use, and produces positive emotional outcomes. Further evaluation in continuing.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Evaluation of a computer-aided system providing pictorial task instructions and prompts to people with severe intellectual disability.

The present study extended the evaluation of a computer-aided system providing pictorial instructions and prompts to promote task performance in people with severe intellectual disability. Four people were presented with two sets of tasks. The participants used the computer-aided system for one set and a card (control) system for the other. The results indicate that the computer-aided system was more effective than the card system with all participants. Three of the participants preferred the computer-aided system, while one favoured the card system.

Adolescent↗
PubMed1982

A redundant ray projection completion method for an inverse fan beam computed tomography system.

An actively synchronized heart gated computed tomography (CT) system has been developed at Peter Bent Brigham Hospital, Boston, MA, for a Technicare 2020 CT scanner. For even the most precise physical synchronization of the scanning apparatus, there will usually be a few gaps in the data for a particular time slice of the cardiac cycle. Of the several gap filling methods that have been developed here, the most nearly ideal is the use of redundant ray measurements. For this type of scanner, there are no truly redundant rays, and normalization errors are particularly problematic. A practical algorithm has been devised and tested here both on phantom data and on cardiac gated data (dog heart). The reconstructions obtained were usually artifact free and showed no loss of resolution, even when up to one-third of the projection data were replaced by redundant ray measurements.

Animals↗
PubMed1993

A national survey to assess current use of computerised information systems in obstetrics.

OBJECTIVE: To ascertain the number and type of obstetric computer systems (OCS) in Great Britain, and to ascertain user satisfaction with these systems. DESIGN: A postal questionnaire was circulated to every consultant obstetrician in Great Britain at the beginning of 1992. MAIN OUTCOME MEASURES: Information was sought on the hardware, software and uses of obstetric computer systems. Satisfaction with, benefits and problems of the system were also assessed. RESULTS: There was an 87.5% response rate. Of the 264 units questioned, 100 units reported that they had a computer system. Sixty-five units used terminals connected to a mainframe or minicomputer and 17 used stand-alone personal computers (PCs). Local area networks (LANs) were used in 19 units and wide area network (WANs) in 22 units. Software varied from commercial turnkey systems to in-house systems. The quoted annual running cost ranged from 50 pounds to 48,000 pounds. Most units were satisfied with their system. Problems included slow operating times, unreliability, user unfriendliness, deficiencies in training and inadequate customer support services. CONCLUSIONS: Obstetric computer systems are now coming into widespread use. Despite problems, the use of such systems is likely to increase. This survey establishes a database for those units who are considering acquiring or changing their computer system for the purpose of audit or research.

Attitude to Computers↗
PubMed1982

Is it time for a computer in your practice? II. What tasks your computer can perform.

In this article, the potential benefits of an office computer system have been detailed. As computer costs and sizes decrease, and computing capabilities increase, even more benefits will be had in the future. Of course, not all of these benefits are applicable to all practices. Equally important to note are the many problems associated with installation and use of computer systems, and these must be taken into account before an intelligent decision can be made as to whether its acquisition would benefit your practice. Helping the physician to weigh the benefits of an office computer system against its costs and potential problems will be the subject of the next article in this series.

Computers↗
PubMed2001

Accuracy evaluation of surface-based registration methods in a computer navigation system for hip surgery performed through a posterolateral approach.

OBJECTIVE: Many computer navigation systems have recently been developed for brain surgery, and the use of such systems in orthopedic surgery is increasing. Intraoperative registration of preoperative images is one of the most important steps in controlling the overall accuracy of computer navigation systems. Various parameters, such as CT-scan slice thickness, reconstruction pitch, intraoperative data sampling area, and data sampling volume, may affect the accuracy of registration. The purpose of this study was to evaluate the effect of the aforementioned parameters on the accuracy of registration for hip surgery performed through a posterolateral approach, and to find a clinically suitable trade-off between accuracy and surgical invasiveness. MATERIALS AND METHODS: One cadaveric pelvis and one cadaveric femur were used for this study. Four alumina ceramic balls with a diameter of 28 mm and within 1 micrometer of sphericity were attached to the pelvis, and three similar balls attached to the femur, to determine relative position. CT-scan images of the pelvis and femur were obtained with a helical scanner. Three sets of slice thickness and slice pitch were chosen for data acquisition, and two additional sets of reconstructed data were made. Bone contours were extracted by cutting out the surrounding substrate at a given CT number threshold, and surface models of the bone were made from the resultant data. The positions of the pelvis and femur were tracked by LED markers attached to the bone using an optical three-dimensional position sensor (OPTOTRAK). Registration of the computer models to the real objects was performed by measuring the position of a certain number of surface points on each object with an OPTOTRAK pen-probe. RESULTS AND CONCLUSION: Slice thickness and reconstruction pitch affected the accuracy of registration. As the sampling area was expanded from the periarticular area to the distant peripheral area, accuracy increased slightly. Accuracy did not increase when the whole area was used, but in fact decreased, especially in the femur. The positive effect of increasing the number of sampling points was saturated at 30 points when the surface of the periarticular area was sampled. The following trade-off between accuracy and invasiveness, in terms of various parameters of preoperative and intraoperative data, is proposed as clinically optimal: perform the CT scan with 3-mm slice thickness and 1-mm reconstruction pitch, and sample the periarticular area with 30 sampling points. With these parameters, the accuracy of registration was 1.2 mm and 0.9 degrees of bias with 0.7 mm and 0.3 degrees of RMS in the pelvis, and 1.4 mm and 0.6 degrees of bias with 1.3 mm and 0.3 degrees of RMS in the femur.

Cadaver↗
PubMed2002

A new era of robotic surgery assisted by a computer-enhanced surgical system.

Computer-enhanced robotic surgery has now been introduced into general surgical practice. The robotic system enables us to manipulate endoscopic instruments, as well as instruments during open surgical intervention, regarding both the operative field and operation techniques. This technologic innovation should therefore help surgeons overcome various difficulties and allow them to perform more precise, safer, and more minimally invasive surgery in the coming era.

General Surgery↗
PubMed1998

Communicating do-not-resuscitate orders with a computer-based system.

BACKGROUND: Do-not-resuscitate (DNR) orders for critically ill patients are frequently miscommunicated between attending physicians, house staff, and nurses. A computer-based system was developed to improve the communication of a procedure-specific DNR order form. METHODS: Concordance of understanding of patients' DNR status was measured with the use of unstructured DNR orders (period 1), procedure-specific DNR order forms (period 2), and procedure-specific DNR order forms administered with a computer-based communication system (period 3). The 3 components of the DNR order assessed were (1) the clinical events to which the DNR order applied, (2) whether the DNR order withheld all elements of cardiopulmonary resuscitation, and (3) whether other treatments were to be withheld. RESULTS: For the 147 patients, the computer-based system in period 3 (n = 71) improved concordance for attending physicians and nurses or residents for all 3 of the DNR components compared with period 1 (n = 40) and some of the DNR components compared with period 2 (n = 36). Concordance was "substantial" or "almost perfect" as measured by the K statistic during period 3. The proportion of agreement for the composite of all 3 components of the DNR order increased during each period (P<.001, period 3 vs period 1). Overall agreement between all caregivers for the composite DNR order also improved from period 1 (22.2%) to period 2 (47.8%) and period 3 (61.9%; P<.001 vs period 1). Errors in order entry were detected by physicians because of the computer system and corrected in 9.9% of DNR orders in period 3. Progress note documentation of DNR status did not improve during period 3. The procedures of period 3 were considered acceptable by the physician and nursing staff. CONCLUSION: A computer-based system combined with a procedure-specific DNR order form improves communication of patients' DNR status in a critical care setting.

Adult↗