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PubMed1985

A student emergency medicine clerkship that uses new information technologies.

The effective teaching of clinical emergency medicine to medical students requires efficiency in the management of both student and faculty time. Presented is a course outline that makes use of the following elements to structure and augment clinical time in the emergency department (ED): Videotape to present a 19.7-hour series of faculty-produced lectures covering a "core" emergency medicine curriculum. A microcomputer to facilitate staggered scheduling of clinical time. A microcomputer test generation program that permits a secretary to formulate, administer, and grade a different final exam with each rotation. Computer-assisted recordkeeping for faculty evaluation of a student's clinical performance. Once established, this program can be administered with fewer than five faculty hours per month assisted by a part-time (25% full-time equivalent) clerical coordinator. The total cost for the instructional program is $86.37 per student using the new technologies, and $144.15 per student when presenting the same program using traditional teaching techniques. The use of new technologies in student teaching will therefore result in significant savings.

Clinical Clerkship↗
PubMed1991

Bayesian image reconstruction for emission tomography incorporating Good's roughness prior on massively parallel processors.

Since the introduction by Shepp and Vardi [Shepp, L. A. & Vardi, Y. (1982) IEEE Trans. Med. Imaging 1, 113-121] of the expectation-maximization algorithm for the generation of maximum-likelihood images in emission tomography, a number of investigators have applied the maximum-likelihood method to imaging problems. Though this approach is promising, it is now well known that the unconstrained maximum-likelihood approach has two major drawbacks: (i) the algorithm is computationally demanding, resulting in reconstruction times that are not acceptable for routine clinical application, and (ii) the unconstrained maximum-likelihood estimator has a fundamental noise artifact that worsens as the iterative algorithm climbs the likelihood hill. In this paper the computation issue is addressed by proposing an implementation on the class of massively parallel single-instruction, multiple-data architectures. By restructuring the superposition integrals required for the expectation-maximization algorithm as the solutions of partial differential equations, the local data passage required for efficient computation on this class of machines is satisfied. For dealing with the "noise artifact" a Markov random field prior determined by Good's rotationally invariant roughness penalty is incorporated. These methods are demonstrated on the single-instruction multiple-data class of parallel processors, with the computation times compared with those on conventional and hypercube architectures.

Algorithms↗
PubMed1987

Computer instruction as part of a course on analytic medicine for first-year students.

The Medical University of South Carolina integrated instruction in information science and computer technology into a required freshman-level course. Analytic and Community Medicine. The advantages of this placement in the curriculum are two-fold. First, the course provides an opportunity to integrate computer methodology with clinically relevant topics such as medical decision-making. This integration enhances the students' view of the computer as a useful tool that can aid the physician in the practice of medicine. Course organizers are convinced that the success of the first offering is attributable to this integration. Second, the instruction comes early in the medical education process and allows the concepts learned to be utilized throughout the students' medical school careers. The degree to which these concepts and methods are actually utilized by students will depend upon the degree of reinforcement of these ideas in the clinical years and residency. Thus, faculty members must act as role models who not only acknowledge the importance of mastering the use of computers in medicine but also manifest those skills.

Community Medicine↗
PubMed1989

A review of medical education and medical informatics.

Physicians have considerable difficulty collecting and interpreting information from patients, dealing with the uncertainties associated with diagnosing and treating their patients, communicating precisely with one another, keeping up to date, and applying recommended procedures when indicated. Some of the advances in information technology may help physicians to manage information more effectively through more accessible, validated clinical indexes, data bases of diagnostic test characteristics, computerized audits of clinical activities with feedback, expert systems, on-line access to the medical literature, and other tools of medical informatics. Medical educators can catalyze this process by facilitating the introduction of information technology into academic clinical settings so that students can learn its use first-hand and by promoting the evolution of this and other aspects of medical informatics, a new discipline dedicated to the solution of information problems in health care. The potential roles for computer-aided instruction and centralized computer laboratories in medical schools are much less clear.

Canada↗
PubMed1977

Roentgen-tele-data: a radiodiagnostic recording system.

A radiodiagnostic data-handling system with telephones connected to the hospital exchange is described. Time, date, and location of examination are automatically recorded. The system can deliver spoken instructions from the computer and warns if data are not valid. Diagnosis, their degree of verification, and cases of special interest are added at display terminals. Codes, equipment, and output are described. Costs represent 1% of the department's expenditures. Future plans include a booking sytem, rapid access, and on-line connection to the main data system.

Computers↗
PubMed1986

The development and evaluation of an online computer-assisted Rorschach Inkblot Test.

An interactive computer program was developed in the BASIC language to present the performance and inquiry phases of the Rorschach Inkblot Test. As the subjects handled the traditional cards they entered their perceptions into the computer database, guided by instructions presented on the computer display. No assumptions were made about the percepts, but the Klopfer scoring questions were asked directly by the computer during the inquiry. The program scored the test as the subject answered the scoring questions on the keyboard. Thirty subjects were assessed using a test-retest design. One subgroup was tested first by a psychologist, and the other was tested first by the computer. The determinants of the psychologist and computer testing situations were found to be correlated and overall not significantly different except in location and time scores where the media differed.

Humans↗
PubMed1987

PEDA: a microcomputer program for parameter estimation and dosage adjustment in clinical practice.

PEDA, an integrated program in BASIC for implementation on microcomputers, has been developed for use in clinical practice to assist dosage adjustment for individual patients. A parameter optimization for individual patients is based on the principle of Bayes' theory and Maximum Likelihood Estimation, and utilizes a prior information on the distribution of population pharmacokinetic parameters, means and variances, as well as serum drug concentrations. The program can accommodate a one-compartment open linear model and a non-linear model at steady state (Michaelis-Menten model) and handle both uniform and non-uniform multiple dosage regimens mostly arising from clinical settings. Clinical examples which demonstrate the ability and the flexibility of the program are provided. The program may also be used as an aid for instruction in clinical pharmacokinetics.

Adult↗
PubMed1990

Increase of interproximal bone density after subgingival instrumentation: a quantitative radiographical study.

Ten interproximal sites, with periodontal pockets deeper than 5 mm and showing loss of bone on standard dental radiographs, were treated by subgingival instrumentation in 10 patients properly motivated and given thorough hygiene instructions. The index of gingival inflammation, the plaque index, the degree of mobility, the depth of the pockets, and the loss of attachment were measured before starting the treatment, and 2 months, 6 months, and 1 year after treatment. Standardized reproducible radiographs of the 10 sites were taken by using a recently developed paralleling instrument before treatment, immediately after and 2 months, 6 months, and 1 year afterwards. The density of the interdental bone was measured on the radiographs by a computer assisted densitometric technique at three levels of the interdental septum: the most occlusal or "superficial" level; the "deep" level, arbitrarily chosen 1.5 mm below; and the "control" level, in a much deeper area of interproximal bone. As further control, the density of the superficial crestal bone was also followed in 5 healthy untreated sites from 5 of the patients. As expected, a significant improvement of the clinical parameters was observed during the year following therapy. The results of the radiographical analysis showed statistically significant increases of both the superficial and deep average densities of interproximal bone at 6 months and 1 year after treatment. The superficial bone density was, on the average, 13% higher at 6 months and 16% higher at 1 year, as compared to that measured immediately after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMedDate not supplied

Computer-assisted insulin dosage adjustment.

We report our first experience with a new microprocessor device for assisting individuals with diabetes in the adjustment of insulin therapy. The computer weighs 200 g and can receive, store, and analyze patient-entered capillary blood glucose (CBG) data on an ongoing basis. Changes in the injected mixtures of short- and intermediate-acting insulins are recommended according to algorithms designed to bring the premeal CBG levels to any desired target value set by the physician. Throughout the present study, the premeal target glucose level was set to 110 mg/dl. Seven (type I) insulin-dependent diabetic individuals ranging in age from 11 to 43 yr were selected to participate in the first use of a BCMC (Better Control Medical Computers, Inc., Toronto, Ontario, Canada) computer on an outpatient basis. All subjects were concerned about diabetes control and were fully informed about as well as thoroughly practiced in the use of manual insulin dosage adjustment schemes, based on approximately equal to 4 times daily CBG estimation, as currently taught in our diabetes clinics. During the last 7 days of the control period of self-adjustment, their mean +/- SEM CBG levels (measured before breakfast, lunch, dinner, and bedtime snack) were, respectively, 178 +/- 20, 187 +/- 35, 208 +/- 22, and 207 +/- 13 mg/dl. Immediately after the control period they were given the device and were instructed in the procedure for entering glycemic data and following manufacturer's recommendations in regard to insulin dosages. This experimental period lasted 8 wk and the outcome was assessed as before. Thus, 8 wk after starting daily use of the instrument, all glycemic values measured as before had fallen significantly (P less than 0.005-0.05) closer to normal: 116 +/- 9, 110 +/- 6, 148 +/- 15, and 135 +/- 9 mg/dl, respectively. Concurrently there was also a significant (P less than 0.01) reduction in the variability of glycemia measured before the main meals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Fulfilling the promise: implementing IAIMS at Georgetown University.

Predictions are that the integration of multiple information systems of a medical center will change the way doctors work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. The IAIMS program sponsored by the NLM is designed to achieve integration of resources in the medical center environment. The purpose of the IAIMS project at Georgetown is to develop a medical decision support system by bringing together multiple sources of information that reside on disparate computers and different database systems. This immense and complex task is described in this paper from an organizational, academic and technical perspective. Georgetown is developing a Biotechnology and Biomedical Knowledge Network which includes several informational and clinical databases, a variety of scholar workstations, instruction on use of computers, a campus-wide network with local area network nodes and a modular approach to systems integration. The IAIMS project is spearheaded by the medical library which has enabled a broad body of medical center users to benefit directly from new, dynamic services.

Academic Medical Centers↗
PubMed1992

Health status measurement. Implementation strategies.

The creation of valid instruments of health status measurement does not guarantee their use in the clinical setting. Traditional continuing medical education has not been shown to effect physician behavioral change. Examination of the literature on the dissemination of new technology underscores the need for the acceptance and use of new methods by local opinion leaders whose behavior serves as a model for their colleagues. Since health status measurement will require a new way of evaluating the patient visit and the creation of new provider behaviors, widespread implementation will require the recruitment of local clinical leaders to serve as spokesmen for reconsideration of office care procedures. Advocates of health status measurement should seize on a variety of opportunities to disseminate their work. Medical school curricula in courses such as physical diagnosis could expose different approaches to the patient encounter to a new generation of physicians in a fairly painless and seamless manner. Academic practice plans, by virtue of their increasing trend to centralization, could commit to patient-oriented data collection--if not for instructional purposes, then for the overall health of the delivery system. The instruction of nurses and paraprofessionals in the collection of these data could expand the measures and help drive the system when physicians are not embracing the technology. There is need to exploit the enhanced capacity of computer hardware and software in the service of efficient data collection and trend analysis of health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1991

Medical Practice Support System. A medical practitioner's multimedia workstation.

The United States Navy has developed a computer based Medical Practice Support System (MEPSS) intended for use by medical practitioners working in isolated situations. The system, now being tested in operational settings, emphasizes inexpensive, easily obtained off-the-shelf hardware and specially developed, readily implemented software to provide users with: 1) medical record keeping, 2) an electronic medical library, 3) interactive video instruction programs suitable for continuing medical education, 4) computer based medical diagnosis and treatment assistance, and 5) electronic communications with other facilities. This demonstration emphasizes a user based developmental approach, integration of diverse systems under a single user interface, and portable hardware. The resulting system makes medical information needed by practitioners instantly available at the time of a patient encounter, whenever and wherever that encounter may occur. Making clinically valuable information immediately available, MEPSS demonstrates how practitioners can use computers to help their own efforts to improve patient care quality and efficiency.

Decision Making, Computer-Assisted↗
PubMedDate not supplied

A real-time analysis of a transplantation program with a personal computer.

This study concerns the use of commercial software (a spreadsheet combined with database and graphic functions) to analyze data on kidney transplantation. The program consists of a section containing (macro) instructions, a section for entering data, a database, a set of spreadsheets (one for each field) with which the statistical calculations and summary tables are executed, and a set of diagrams for the final visual output. Three kinds of data are made available: descriptive statistics, actuarial survival rates, and risk factor evaluation. The program can analyze the importance of the variables considered and estimate the effect of a therapeutic or diagnostic maneuver.

Computer Systems↗
PubMedDate not supplied

Quality videotapes with the help of a computer.

The last few years have seen a tremendous growth in videocassette usage, not only for entertainment, but also as a viable teaching method. Most homes in American now have at least one VCR. At Ozarka Vo Tech in Melbourne, AR, educators recognize the educational value of videotapes and have combined efforts to produce several quality computer-generated videotapes. With funding from projects, P189-01 A Competency-Based, Computer-Assisted, And Computer-Managed Model LPN Program, and the PI 2B061 Comprehensive Learning Lab, educators have been able to produce teacher-made videotapes to augment the different educational programs at our school. This article describes the method used, equipment needed, and general hints for improving the quality of teacher-made videotapes.

Humans↗
PubMed1990

[The evaluation of the adaptation of pupils starting instruction at 6 years old to new academic programs by using a computer analysis of cardiac variability].

Examination of the pulse variability of 6 years old (experimental group) and 7 years old control group schoolchildren is performed for establishing their adaptation capability to the educational process at the end of VI and VII class. 76 schoolchildren are comprised in the investigation. The analysis of the pulse variability is made on the basis of 10 min. ECG record on telemeter "Biomedica". A computer processing is made on the records by complex programmes for receiving indices related to the statistical characteristic of the dynamic order of cardiac intervals and to such giving their distribution. The receiving statistically significant differences for most of the indices between both groups of schoolchildren from VI class show an expressed activation of the adrenergic mechanisms with EG as well as higher "physiological value" of adaptation to the educational process. In VII the class the indices of the heart variability with EG practically show no differences from those of CG. This ascertainment proves, that at the age of 13 the potentialities for studies of those children starting school at 6 years are compensated with the children starting school at 7 years. This imposes the studies and the organization of the educative process for both 6 and 7 years old schoolchildren to be taken into consideration, to the completion of 7th class, with their age adaptive potentialities.

Adaptation, Physiological↗
PubMed1988

Implementing RECONSIDER, a diagnostic prompting computer system, at the Georgetown University Medical Center.

RECONSIDER, a computer program for diagnostic prompting developed at the University of California, San Francisco, has been implemented at the Georgetown University Medical Center as part of the Integrated Academic Information Management System Model Development grant project supported by the National Library of Medicine. The system is available for student use in the Biomedical Information Resources Center of the Dahlgren Memorial Library. Instruction on use of the computer system is provided by the library and instruction on medical use of the knowledge base is directed by the faculty. The implementation, capabilities, enhancements such as the addition of Current Medical Information and Terminology (5th ed.), and evaluation of the system are reported.

Computer User Training↗
PubMed1986

A BASIC program for computer-assisted point-counting techniques.

Description is given of a BASIC program running on inexpensive microcomputers (Commodore CBM 64, SX 64 and Apple II[e]) to facilitate and accelerate substantially the point-counting technique, one of the most widely used methods in the determination of such stereologic parameters as VV, AA, SV, BA, JV, KV and NV. The program aims to alleviate the most laborious manipulations required to obtain estimates of stereologic parameters and their statistical assessments. The program requires the declaration of the coherent grid constants, the desired stereologic parameters and the definition of up to ten keys of the computer keyboard to be used as score counters for the registration of particular grid-object events. After the registration of these decision events, the program is used to count points, intersections, transsections, number of profiles and tangents of a coherent test grid system with the objects of interest in a histologic section. The computer then calculates the stereologic parameters as well as the standard deviation and standard error of mean of these parameters, using the contents of the score counters as arguments. The flexibility of the program allows for the construction of investigator-defined parameters that can be expressed as a ratio of particular events as well as the use of standard stereologic parameters. While the program has been successfully utilized by nonprogrammers following basic instruction, knowledge of the elementary principles of stereology is a must in utilizing all of the possibilities of the program.

Biometry↗