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A microcomputer-based system designed to provide nurses and physicians access to expert synthesized knowledge in the area of pulmonary arterial waveform troubleshooting has been developed and implemented. Evaluation using triangulation methods show that there was a substantive increase in knowledge in both nurses and physicians.¿.
1. INTRODUCTION. Data collection is a critical component of multi-center clinical trials. Clinical trials conducted in intensive care units (ICU) are even more difficult because the acute nature of illnesses in ICU settings requires that masses of data be collected in a short time. More than a thousand data points are routinely collected for each study patient. The majority of clinical trials are still "paper-based," even if a remote data entry (RDE) system is utilized. The typical RDE system consists of a computer housed in the CC office and connected by modem to a centralized data coordinating center (DCC). Study data must first be recorded on a paper case report form (CRF), transcribed into the RDE system, and transmitted to the DCC. This approach requires additional monitoring since both the paper CRF and study database must be verified. The paper-based RDE system cannot take full advantage of automatic data checking routines. Much of the effort (and expense) of a clinical trial is ensuring that study data matches the original patient data. 2. METHODS. We have developed an RDE system, Pivot/Remote, that eliminates the need for paper-based CRFs. It creates an innovative, distributed database. The database resides partially at the study clinical centers (CC) and at the DCC. Pivot/Remote is descended from technology introduced with Pivot [1]. Study data is collected at the bedside with laptop computers. A graphical user interface (GUI) allows the display of electronic CRFs that closely mimic the normal paper-based forms. Data entry time is the same as for paper CRFs. Pull-down menus, displaying the possible responses, simplify the process of entering data. Edit checks are performed on most data items. For example, entered dates must conform to some temporal logic imposed by the study. Data must conform to some acceptable range of values. Calculations, such as computing the subject's age or the APACHE II score, are automatically made as the data is entered. Data that is collected serially (BP, HR, etc.) can be displayed graphically in a trend form along with other related variables. An audit trail is created that automatically tracks all changes to the original data, making it possible to reconstruct the CRF to any point in time. On-line help provides information on the study protocol as well as assistance with the use of the system. Electronic security makes it possible to lock certain parts of the CRF once it has been monitored. Completed CRFs are transmitted to the DCC via electronic mail where it is reviewed and merged into the study database. Questions about subject data are transmitted back to the CC via electronic mail. This approach to maintaining the study database is unique in that the study data files are distributed among the CC and DCC. Until a subject's CRF is monitored (verified against the original patient data residing in the hospital record), it logically resides at the CC where it was collected. Copies are transmitted to the DCC and are only read there. Any pre-monitoring changes must be made to the data at the CC. Once the subject's CRF is monitored, it logically moves to the DCC, and any subsequent changes are made at the DCC with copies of the CRF flowing back to the CC. 3. DISCUSSION. Pivot/Remote eliminates the need for paper forms by utilizing portable computers that can be used at the patient bedside. A GUI makes it possible to quickly enter data. Because the user gets instant feedback on possible error conditions, time is saved because the original data is close at hand. The ability to display trended data or variables in the context of other data allows detection of erroneous conditions beyond simple range checks. The logical construction of the database minimizes the problem of managing dual databases (at the CC and DCC) and keeps CC personnel in the loop until all changes are made.
Many institutions are currently in the process of reorganizing their medical curricula from various traditional forms to a problem-based format. This method of instruction inevitably leads to a shift from traditional lecture and laboratory sessions to a more student oriented, small group session--a self-guided learning approach. This paper discusses the development and use of a system designed to provide the student with the necessary tools to access and control their learning environment.
Informed patients are better equipped to participate in their own health care decisions. We present Medical HouseCall (TM), a consumer expert system and medical information guide, derived in part from a diagnostic and treatment software used by physicians (Iliad). HouseCall(TM) generates a differential diagnosis based on the user symptoms and medical history. HouseCall(TM) also provides alerts for potentially harmful drug interactions, allows for the recording of personal medical history, and offers extensive but easy-to-read information about a variety of medical topics. Focus group evaluations of HouseCall (TM) have demonstrated the program's ease of use, as well as an appreciation of technology that can be used at home to investigate and understand health issues and participate in solving medical problems.
The University of Texas Medical Branch in Galveston has been the site of a three year project to develop a unique set of computer-based health promotion programs for patients in community-based settings. The Healthy Touch Series is a collection of four interactive multimedia programs that were produced to provide health promotion information to underserved groups on topics related to maternal-infant health. The programs have bilingual audio tracks in English and Spanish and run on a CD-ROM platform with touch-screen control. Use of the technology with a large group of patients led to many modifications and alternations. Formative evaluation results review the key concepts we learned.
Hypertext and hypermedia are used to access loosely structured information. The lack of conceptual model for hypertext application makes it difficult to represent the mental model of the author. Users are often lost in the information and the objective of the author is not achieved. In this paper, we describe an approach to handle information and knowledge in the FORUM hypermedia authoring system. It allows the author to create and maintain the hypertext more easily and facilitates the navigation of the reader. An application for learning uterine magnetic resonance imaging is also presented.
1. INTRODUCTION. Training in the diagnosis of arrhythmias is an important part of the curriculum for medical students, postgraduates, and paramedical staff. Although several CAI for arrhythmia have been developed [1-3], we could not get CAI software for arrhythmia for the MS-Windows environment. In this report, we present a newly-developed computer-assisted reference system for arrhythmia that functions in the Windows environment. 2. DESCRIPTION OF THE SYSTEM. The system consists of a program and two data files. An MS-Windows program (ECG9405.EXE, 180kB) was compiled using Borland's C++ v.3.1. A binary file (ECPAT.BAS 33kB) includes data of normal and abnormal wave segments of ECG: P wave, PQ interval segment, and QRs complex with/without T wave. A mother file (ECG9405.sys, 57kB) includes 85 data sets to generate ECG waveforms of arrhythmia. Each data set contains a sequence of wave form numbers, the text for questions and answers, and the commands strings. There are five major commands: 1) to create a new window as "wave window"; 2) to make electrocardiogram data; 3) to plot the data on the window; 4) to create a "dialog box" for questions and explanations; and 5) to check the answers. he program gets a data set from the data according to the user's choice. The program then interprets the data set and executes the commands. The wave segment data are plotted in a "wave window" at every 10 milliseconds; this is controlled by the MS-Windows' timer. The timer interval can be changed by selecting the speed button. The ECG waveforms are displayed on a window just like an ordinary ECG monitor with beat sound. Many windows can be created by the user and many ECG waves simultaneously plotted on CRT. 3. USAGE OF THE SYSTEM. The "main window" has a menu that has three items corresponding to the training course: BASIC, TRY, and TEST. Thirty-five types of arrythmias are listed in the "list box" of the windows in BASIC course e.g., sinus arrhythmia, atrial flutter, atrial premature contraction, ventricular extrasystole, ventricular flutter, etc. If the user selects one of them on the list by double clicking, some textual explanations of the wave are described in a dialog box. Ten multiple choice questions are displayed in the dialog box in course of learning TRY and TEST; the answers to these are requested. In the TEST course, the system offers random access to each arrhythmia. he user can send the pictorial ECG data in the window to other graphics programs through a clip board. 4. DISCUSSION. It was successfully used in a lecture of electrocardiogram for medical students. They seem to be interested in this system because of its simple usage and the dynamic drawing of ECG waves on CRT. Multiple computer-based medical resources can be run on MS-Windows. The system is able to run simultaneously with other programs, such as an electronic reference system [4]. The system may be obtained from the authors upon request.
To minimize the learning problems, related to the present teaching method, we developed the Educational Program on Ophthalmology, that offers an interactive and self-controlled way of learning, through the multimedia and hypertext (hypermedia) resources to the students. The software has 200 images (pictures and photos), 40 minutes of digitized voice (.WAV), 50 minutes of video animation (.AVI) and more than 200 links. The first evaluation demonstrated a great interest from the medical graduated students, who feel motivated with the utilization of the software.
Medical informatics has experienced dramatic growth, both as an applied and as a research discipline in recent years. In this paper, we argue that there is a need to expand the research base to characterize the cognitive dimension of informatics. Theories and methods from cognitive science can provide an effective counterpart to traditional medical informatics in addressing issues of usability of the systems, the processing of information, and the training of physicians. In the first part of the paper, we address the problems inherent in applying basic theories to practice and suggest some potential solutions. The second section deals with epistemological issues that are fundamental to cognitive science research and medical informatics. We then discuss two areas of application of cognitive scientific theories and methods to medical informatics: cognitive evaluation of human computer interface and intelligent medical decision support systems. The paper addresses the progress that has been made thus far and discusses how future cognitive research can facilitate further growth in the development of these applications.
An interactive multi-media courseware on the Temporo-mandibular Joint is presented. All the latest technological innovations are integrated into this document to make the learning process more enjoyable for the user. We believe that the complex anatomy and physiology of this joint, and mostly its various disorders will be better understood with this interactive multi-media approach. The courseware is intended for continuing education in dentistry and medicine.
Presentation of diagnosis and treatment planning for orthodontic problems by orthodontists is often a hurdle and a nuisance to most patients. The reasons are that it has much content which may be hard to understand without having expert knowledge related to the temporal change in dentofacial structures known as the growth, development and physiological aspects of masticatory apparatus. To complement this, we have developed an interactive consultation multimedia software for orthodontic patients. he design concept of the current software has three aspects. Firstly, since the software is operated by orthodontic patients themselves or by their parents, it enhances the operational feasibility. Secondly, it helps the patients choose the information in which they are interested. Thirdly, it emphasizes audio-visual understanding of orthodontic practice, including terminology. e used a hypertext machine with a 240MB hard disk drive, an 8MB RAM and a 13 inch color monitor. In developing the current software, we also used a video camera, a video color board, a microphone, and an image scanner together with an image recorder, a movie and sound data editing system, image scanning and editing, an image changer, a spread sheet and mathematical software. he current software consists of various multimedia such as images, sounds, characters, and biosignals. The "stack" of the software consists of three parts: a) "General Understanding of Occlusion" b) "Understanding Specific Types of Occlusion Exhibited by the Patient" c) "Orthodontic Terminology" When card A is selected the patient can choose either "Good Occlusion" or "Malocclusion." If "Malocclusion" is chosen, respective occlusal types are shown. The next card provides pathological conditions caused by respective malocclusion, e.g., gingivitis. After selecting card B which asks the patient, "What do your teeth look like?" the following buttons are provided: "Maxillary Protrusion," "Reversed Occlusion," "Crowding," "Open Bite," and "Spaced Arch." After selecting one of these, the card with an explanation of the respective malocclusion is shown according to the patient's physiological age. Finally, after card C is selected, a new card which has a list of orthodontic terminology is presented. Patients can search any term according to their choice to open a new card which gives a detailed explanation. e confirmed that the current consultation multimedia software can provide a comfortable environment to the patients and their families to learn where the orthodontic problems lie and how they could be solved.
Old paradigms of research need to change as funding becomes more competitive and less available and as institutions demand more productivity of research scholars while providing decreasing levels of support. Development of a Nursing Collaboratory provides an opportunity for nurse researchers to communicate and collaborate (using the Internet) during phases of the research process. A proposed model of Nursing Collaboratory development is described, and opportunities and issues are discussed.
Since the nurse emerged as a qualified professional to attend human beings, the role which always characterized his/her action was assistance. Already since the foundation of the first nursing school, teaching aimed at developing the student to dispense nursing care necessary for the patient's assistance. When the nurse started to perform their activities in nosocomial and community institutions, the need for someone who would be responsible for the organization, coordination and control of nursing personnel and the Nursing Unit itself, in short, someone who would head the services became apparent. At present, the professional role of the nurse is changing regarding his/her overall assistance to the patient, caring directly, determining and/or carrying out nursing assistance necessary for the patient's health, maintenance or recovery. In this manner, it is necessary for nurses to use tools of administration science such as planning, decision making, and planned changes in order to be able to provide the nursing assistance with quality. Thus, this study aims at helping the development of the nurse's interest in computer during the teaching-learning process, motivating the search for knowledge in computerized sources. We intended to offer the opportunity for discussion and reflection on problems of nosocomial nursing practice, favoring interchange of theory and practice. The system is being developing using ToolBook Live Software to be run in Windows environment. The content of the subject allow the user (student or professional nursing) to choose the most correct answers to questions in the knowledge area. In this case, to discuss nursing administration issues through the study of practical situations is possible, such as the opportunity the verify the performance in tests.
After trying a variety of nurse scheduling packages, the Chiba University Hospital chose to develop their own system and implemented it in April 1994. The system is the newest component of their HIS which has been functioning since 1991. The rostering system avails itself of the modern client server technology which has been installed over the past few years.
Information retrieval systems are proliferating in biomedical settings, but many problems in indexing, retrieval, and evaluation of systems continue to exist. The SAPHIRE Project was undertaken to seek solutions to these problems. This paper summarizes the evaluation studies that have been done with SAPHIRE, highlighting the lessons learned and laying out the challenges ahead to all medical information retrieval efforts.
This paper focuses on the visual interface for image retrieval from radiology image database and describes a Radiologic Pictionary. A Radiologic Pictionary is a picture-based controlled vocabulary that allows visual query formulation by providing the user with images (samplers) that are linked to the hierarchical index of radiological findings and mapped into image data within the database. Samplers selected during query formulation point to image records that share their characteristics; all matching images are returned to the user.
The practice of medicine is information-intensive. From reviewing the literature to formulating therapeutic plans, each physician handles information differently. Yet rarely does a representation of the user's information needs and preferences--a user model--get incorporated into information management tools, even though we might reasonably expect better acceptance and effectiveness if the tools' presentation and processing were customized to the user. We developed the Physician's Information Customizer (PIC), which generates a shareable user model that can be used in any medical information-management application. PIC elicits the stable, long-term attributes of a physician through simple questions about her specialty, research focus, areas of interest, patient characteristics (e.g., ages), and practice locale. To show the utility of this user model in customizing a medical informatics application, PIC custom-filters and ranks articles from Medline, using the user model to determine what would be most interesting to the user. Preliminary evaluation on all 99 unselected articles from a recent issue of six prominent medical journals shows that PIC ranks 66% of the articles as the user would. This demonstrates the feasibility of using easily acquired physician attributes to develop a user model that can successfully filter articles of interest from a large undifferentiated collection. Further testing and development is required to optimize the custom filter and to determine which characteristics should be included in the shareable user model and which should be obtained by individual applications.
This contribution describes the software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) that is designed as an ISDN based computer supported cooperative work (CSCW) tool for usage in medical diagnostics. Medical image data from various sources (for example CT and MR) can be interchanged and analyzed in bilateral teleconferences via ISDN. During a cooperative session, user interactions for image processing etc., are synchronized and performed on both workstations, Features like telepointing, remote control, and audio connection enhance communication quality. With ISDN as a transmission line, widespread availability and low communication costs are achieved. Further, automatic tissue labeling in intracranial MR data can be invoked. For this purpose, artificial neural network classifiers such as multilayer perceptron and Kohenen feature map are integrated. Classification results can be viewed as 3D-reconstructions.