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PubMed1995

"Hyperstat": an educational and working tool in epidemiology.

The work of a researcher in epidemiology is based on studying literature, planning studies, gathering data, analyzing data and writing results. Therefore he has need for performing, more or less, simple calculations, the need for consulting or quoting literature, the need for consulting textbooks about certain issues or procedures, and the need for looking at a specific formula. There are no programs conceived as a workstation to assist the different aspects of researcher work in an integrated fashion. A hypertextual system was developed which supports different stages of the epidemiologist's work. It combines database management, statistical analysis or planning, and literature searches. The software was developed on Apple Macintosh by using Hypercard 2.1 as a database and HyperTalk as a programming language. The program is structured in 7 "stacks" or files: Procedures; Statistical Tables; Graphs; References; Text; Formulas; Help. Each stack has its own management system with an automated Table of Contents. Stacks contain "cards" which make up the databases and carry executable programs. The programs are of four kinds: association; statistical procedure; formatting (input/output); database management. The system performs general statistical procedures, procedures applicable to epidemiological studies only (follow-up and case-control), and procedures for clinical trials. All commands are given by clicking the mouse on self-explanatory "buttons". In order to perform calculations, the user only needs to enter the data into the appropriate cells and then click on the selected procedure's button. The system has a hypertextual structure. The user can go from a procedure to other cards following the preferred order of succession and according to built-in associations. The user can access different levels of knowledge or information from any stack he is consulting or operating. From every card, the user can go to a selected procedure to perform statistical calculations, to the reference database management system, to the textbook in which all procedures and issues are discussed in detail, to the database of statistical formulas with automated table of contents, to statistical tables with automated table of contents, or to the help module. he program has a very user-friendly interface and leaves the user free to use the same format he would use on paper. The interface does not require special skills. It reflects the Macintosh philosophy of using windows, buttons and mouse. This allows the user to perform complicated calculations without losing the "feel" of data, weight alternatives, and simulations. This program shares many features in common with hypertexts. It has an underlying network database where the nodes consist of text, graphics, executable procedures, and combinations of these; the nodes in the database correspond to windows on the screen; the links between the nodes in the database are visible as "active" text or icons in the windows; the text is read by following links and opening new windows. The program is especially useful as an educational tool, directed to medical and epidemiology students. The combination of computing capabilities with a textbook and databases of formulas and literature references, makes the program versatile and attractive as a learning tool. The program is also helpful in the work done at the desk, where the researcher examines results, consults literature, explores different analytic approaches, plans new studies, or writes grant proposals or scientific articles.

Computer-Assisted Instruction↗
PubMed1995

A multimedia guide to spinal cord injury: empowerment through self instruction.

The Spinal Cord Injury (SCI) Project is developing a series of instructional modules on SCI that will be distributed via CD-ROM for patient and family education. The modules are based on an instructional program and patient manual distributed by the Paralyzed Veterans of America. The program includes topics ranging from the anatomy and physiology of spinal cord injuries to legal rights established under the Americans With Disabilities Act. The SCI project expands on the instructional manual by combining digital multimedia techniques with motivational features such as games and personal guides. The user selects a personal guide from among a selection of individuals with spinal cord injuries to guide them through tutorials that include accounts of personal experiences. The guides appear in small video windows at various points throughout the tutorials and give personal insight into the topic at hand. The user can also query the other guides to hear their views on a topic. The user interface incorporates 'seamless access' features, which enable persons with a wide range of disabilities to use the program. Innovative features of these modules are the use of personal instructional guides, motivational games and activities, incorporation of alternative input or access strategies, and the use of high quality, low cost, multimedia production strategies.

Audiovisual Aids↗
PubMed1995

New information technologies for healthcare in Aquitaine about the NursePad project.

The first results of a highly successful multidisciplinary NursePad Project in Aquitaine in France are to be presented as a scientific demonstration. A unique data collection system using electronic notepads has reduced the clerical workload of nurses with a further benefit of improved data quality. The system is well accepted by the health professionals using it because the software was designed by them for themselves. It addresses their problems. The developers are anxious to extend their findings into other domains of healthcare, both inside and outside the hospital.

France↗
PubMed1995

Benefits of using hypertext in a health care environment.

This "hyperdemo" shows the development, management, and business benefits of using hypertext in a healthcare environment. The demonstration shows how existing information has been made available in both primary and secondary care; we cover two application areas.

Information Systems↗
PubMed1995

The importance of local data bases in medical expert systems: TICITL.

The database of our medical expert system, TICITL, contains the records of more than 15,000 gastroenterological patients. The data was collected over fifteen years (1977-1992) during which the patients were followed for at least three months to establish a final diagnosis. Using a new set of 230 gastroenterological cases, TICITL's first diagnosis was similar to the final diagnosis in 90% of the patients. When compared to foreign medical expert systems (M.E.S.), there is a considerable difference in diagnostic accuracy favorable to the local system. Another local program is also as accurate as TICITL. Consequently, we attribute these results to the database and strongly recommend employing real local patients whenever possible to implement M.E.S. in a new geographical area.

Databases, Factual↗
PubMed1995

Computerized knowledge bases in primary health care: a curse or a blessing for health promotion, prevention and patient quality?.

This paper presents a future scenario analysis of how the introduction of computerized knowledge bases (KBs) can come to affect primary care practice. For the collection and analysis of data, a two-level video method was applied. First, four consultations where a computerized KB was used were video-recorded. A search workshop was then carried out by letting a multi-disciplinary panel comment on the video recordings. The comments were categorized with regard to content and perspective. Analyses of the comments showed a concern for a disregard of patients' health beliefs and for difficulties in portioning out the acquired medical knowledge to the patient during the consultation. Furthermore, the computerized KB was found to easily break the natural flow of the consultation and be perceived as a third party. The conclusion is that the most critical aspects for using computerized KBs in a reformed primary health care concern the integration of the systems into the consultation process. Health promotion, prevention, and patient quality are central here, and the introduction of KB technology must not lead the consultation away from these issues.

Artificial Intelligence↗
PubMed1995

A computer-assisted case report and diagnosis system: sharing the knowledge database ADM and using hypermedia techniques.

The practice of medicine is characterized by its great variability and by many rare diseases. When the medical students work in hospital units, they must learn the general medical practice in the care of the patient. The purpose of this work was to present a French multifunction decision aid system using artificial intelligence techniques and Hypercard tools for different modules. Through an ergonomic interface, the system assists the user in the construction of medical observations, suggests diagnostic hypothesis, provides documentation and helps the user perform retrieval tasks. The knowledge comes from senior experts and from the pre-existent and large knowledge database, ADM.

Computer Peripherals↗
PubMed1995

User modeling techniques as support in the clinical decision-making process.

This paper describes research work on the design and creation of a medical folder management system capable of establishing co-operative dialogue with users who have access to the information contained therein. The research work has addressed the problem of integrating into the system knowledge about the medical domain and that about users, both necessary to activate co-operative dialogue. The CADMIO [2] prototype has been developed since the study was made. The last version of the CADMIO system stores information about users for the use in recognizing and interpreting their behavior, providing help, and in acquiring and returning further information. Depending on this information the system retrieves and shows the data of the medical folder in an intelligent way by highlighting links between data. It simplifies and increases the speed of the interaction by focusing on the data useful to the decisional activity of the physician.

Bayes Theorem↗
PubMed1995

An integrated system to represent and manage medical knowledge.

This paper describes an integrated system in Prolog that permits the creation of a personal Knowledge Base to express and formalize specialist knowledge in medicine. Formalisms used are production rules and frames. The integrated system is able to manage data and knowledge stored in a database built in M Technology (MUMPS).

AIDS-Related Opportunistic Infections↗
PubMed1995

GAP: a computer-assisted design tool for the development and analysis of evidence-based automated questionnaires.

This paper describes the design and use of a computer-assisted design tool for developing evidence-based automated questionnaires that may assist health practitioners to implement clinical practice guidelines. The Guideline Application Program (GAP) facilitates the design, development, testing, customization, and implementation of interactive patient-computer questionnaires, the analysis of patient-derived information, and the clinical application of practice guidelines that require knowledge of multiple patient-specific characteristics. GAP is being used to create a variety of software applications for HealthQuiz and Microsoft Windows-compatible computers. GAP-generated applications are presently used to support preventive care guideline implementation in primary care settings, preoperative screening in anesthesia clinics, student health screening in Universities, hormone replacement counseling for peri-menopausal women, and patient-reported data collection in various clinical research projects.

Algorithms↗
PubMed1995

Integration of a data dictionary and a clinical database in an expert system for acute abdominal pain.

Despite promising results, computer-aided diagnosis in acute abdominal pain is rarely used in the clinic. We therefore developed an expert system for acute abdominal pain to be used in clinical routine. The system is based on a new approach integrating a data dictionary, a clinical database and the knowledge base. A data dictionary editor has been developed (C++, WINDOWS, IBM-compatible PC) and a data dictionary for acute abdominal pain has been built up. The clinical database has been linked to a documentation program providing three modes of data entry. The documentation program has been evaluated extensively by clinicians. The integrated approach clearly separates clinical data from knowledge, but guarantees high consistency of data.

Abdominal Pain↗
PubMed1995

Description and advantages of an index-driven medical knowledge base.

In the FRAMEMED system design, the inherent attributes of its concepts are expressed in the hierarchical lists of its 26 Elements (e.g., Agents, Clinical Manifestations, Diseases, Tests, etc.). These concepts, contained in regular structures, are then alphabetized by phrase (and synonym), forming a combined index in which the user may quickly find a concept either alphabetically or hierarchically. Stored in the structures of the index are pointers to four types of knowledge records: 1) Descriptive (definition); 2) Relational (incidental attributes); 3) Conditional (rules); and 4) Procedural (how to). In contrast to the index which is stored in regular structures for rapid access (like relational databases), the knowledge records are stored in free text (variable length) and may include pointers to imaging and audio records. A particular feature of the FRAMEMED system is careful attention to modifiers, an aspect usually not emphasized in other systems. In trying to structure the free text describing a patient encounter, for example, the major concepts such as cough, fever, stiff neck, etc., are relatively easy to code (although a common system has not yet been agreed upon). The devil lies in the modifiers such as 'history of', 'severe,' 'constant,' 'absent,' 'left,' 'abnormal,' etc., particularly when there is concatenation of modifiers modifying modifiers. Our Relational records (in our knowledge base) and our Chronological Medical Records (CMR) in our patient record have the same format, namely, a title, several related items, and a date/author. For example, our disease profile (Relational record) for 'Influenza' might include 'cough,' 'fever,' and 'stiff neck.' The CMR of a particular patient encounter might include the same items. The only differences would be the title (disease name for the disease profile, date for the CMR, and the omission of the redundant date in the date/author line of the CMR). Each related item in either of these records is expressed in a four-part string, namely: 1) Relation; 2) Code; 3) Phrase; and 4) Comment. Modifiers (common ASCII symbols) are structured into each of these parts. For example, if the patient did not have 'cough,' the default '+' in the Relation would be edited to a '-', while 'history of' cough would be '>'. Each Relation can be graded (on a 5-level scale) for both importance and frequency. The Code for a test can carry the result suffix, '+ positive/high,' '-negative/low,' '# abnormal (qualitatively)', or '1 unremarkable/normal.' Topological information, such as '/left,' can be appended to a Code. If the cough is getting worse, its code can have the suffix, '<'. The standardized Phrases associated with the Codes come from the hierarchical lists of the index section described earlier. Phrases are not stored, being rematched to the codes as needed for user display. This practice not only saves memory space but allows a CMR encounter recorded in one language to be displayed in another second language subsequently, requiring only the existence of the hierarchical code/phrase in the second language. A free-text Comment is allowed for any related item in a Relational record or CMR, to allow the doctor to add important nuances such as 'worse on arising' or for a numeric result such as a test result or a thermometer reading. Some structuring can be accommodated in the Comment by introducing symbols such as '> relieved by,' followed by a list containing entries such as 'antacids.' Time can be sturctured through symbol lists such as '@-2 mo' representing '2 months previously.' Because Relational records in the knowledge ase and patient encoutner records in the CMR both display findings in hierarchical order; all similar items (e.g., Agents, Clinical Manifestations, Tests, Procedures, etc.) occur together and in an unique order. (abstract truncated)

Abstracting and Indexing↗
PubMed1995

Image-oriented rule generating tool for medical knowledge base.

This paper describes an automatic programming tool for the end users in the medical knowledge representation. When end users work with the rule generating tool (RGT) that we have designed, they can represent an idea using an Image-oriented interface such as a picture, movie, audio reference or two dimensional bar code. Such representations can be valuable tools for medical study, diagnosis, decision making and treatment monitoring to supplement the expertise of medical personnel. The RGT will automatically generate rules in the logic programming language Prolog and then add them to the knowledge base.

Algorithms↗
PubMed1995

A knowledge-based care protocol system for ICU.

There is a growing interest in using care maps in ICU. So far, the emphasis has been on developing the critical path, problem/outcome, and variance reporting for specific diagnoses. This paper presents a conceptual knowledge-based care protocol system design for the ICU. It is based on the manual care map currently in use for managing myocardial infarction in the ICU of the Sturgeon General Hospital in Alberta. The proposed design uses expert rules, object schemas, case-based reasoning, and quantitative models as sources of its knowledge. Also being developed is a decision model with explicit linkages for outcome-process-measure from the care map. The resulting system is intended as a bedside charting and decision-support tool for caregivers. Proposed usage includes charting by acknowledgment, generation of alerts, and critiques on variances/events recorded, recommendations for planned interventions, and comparison with historical cases. Currently, a prototype is being developed on a PC-based network with Visual Basic, Level-Expert Object, and xBase. A clinical trial is also planned to evaluate whether this knowledge-based care protocol can reduce the length of stay of patients with myocardial infarction in the ICU.

Alberta↗
PubMed1995

A simplified judgment system for medical informatics.

This report describes a new simplified judgment system which enables users to register appropriate judgment rules with ease and to apply them to a wide variety of medical problems. The rule utilized in this system is 3-AND-3-OR, quite a simple one. By applying this judgment rule to the data of as many as 60 items, judgment results of the individual on each item is given by four different grades or categories, namely: 1) normal, 2) borderline, 3) abnormal, and 4) severe. As many as 20 types can be obtained simultaneously. The simplicity of the algorithm allows medical users who are not the experts in computer technology to use this system on a DOS-based personal computer.

Algorithms↗