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At least 1,531 records · Page 85Linked to original sources
PubMed1988

Discrepancies in dose and dose specification in interstitial implants.

The first step in the execution of an interstitial implant is the decision on size and location of the target volume. Several implant systems, e.g. the Paterson-Parker system and the Paris system, give instructions for the optimal arrangement of sources to assure that the planned target volume is adequately covered. They also give guidelines to calculate the reference dose rate encompassing the planned target volume. These systems provide different solutions for the source arrangement for the same planned target volume, and vice versa, resulting in different reference dose rates. The problem of dose specification is discussed. For a number of theoretical implants predicted reference dose rates for the planned target volume were compared with the computer calculated dose rates for that volume. Discrepancies increase when moderate digressions from the adopted implant system rules are allowed, such as could commonly occur clinically. For a number of examples the degree of change in dose rate, if over 10%, and the position where this deviation is likely to occur are described. For optimal results the clinician should be well aware of these variations.

Brachytherapy↗
PubMedDate not supplied

Computerized management of patient care in a complex, controlled clinical trial in the intensive care unit.

Acute respiratory distress syndrome (ARDS) is often not responsive to conventional supportive therapy and the mortality rate may exceed 90%. A new form of supportive care, extracorporeal carbon dioxide removal (ECCO2R), has shown a dramatic increase in survival (48%). A controlled clinical trial of the new ECCO2R therapy versus conventional continuous positive pressure ventilation (CPPV) is being initiated. Detailed care protocols have been developed by 'expert' critical care physicians for the management of patients. Using a blackboard control architecture, the protocols have been implemented on an existing hospital information system and will direct patient care and help manage the controlled clinical trial. Therapeutic instructions are automatically generated by the computer from data input by physicians, nurses, respiratory therapists, and the laboratory. Preliminary results show that the computerized protocol system can direct therapy for acutely ill patients.

Blood Gas Analysis↗
PubMed1989

Pediatric and adult emergency management assistance using computerized guidelines.

This study was performed to determine if computer assistance is able to improve the initial management of pediatric patients in critical emergencies. A computer program that provides an easily accessible, concise set of information to assist in the management of medical emergencies is described. It provides size- and age-specific endotracheal tube sizes, drug doses, continuous intravenous (IV) drug infusion preparation instructions, and emergency management guidelines for pediatric and adult patients with one of several acute emergencies. These emergencies include asystole, respiratory failure, anaphylaxis, shock, myocardial infarction, cardiac arrhythmias, seizures due to several common causes, and rapid sequence anesthesia induction. The use of this program was shown to reduce the time required for the preparation and administration of emergency therapy while minimizing management errors. A lap-top computer running this program may be a worthwhile addition to emergency departments and hospital resuscitation carts as a resource, especially for physicians less experienced in the care of children.

Adult↗
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↗
PubMed1983

Is it possible to make a diagnosis in an ambulance?

We have developed a computer method to make a diagnosis for an emergency patient using the data reported by a person who has no technical knowledge of medicine such as a member of the public or an ambulance attendant. The speedy instruction will be made possible by a computer diagnosis, by which an ambulance attendant could deliver the patient expeditiously to the most appropriate medical facility. We first conducted a survey by means of questionnaire and investigated the relationship between the patients' data and diagnosis of medical doctors. It was shown that fairly accurate diagnosis could be made on treatment, hospitalization, an appropriate medical department and need of urgent care, using simple information like age, sex, cause of illness or injury, and 15 symptoms which trained laymen could judge. Accuracy of the diagnosis was 79.3% on the average.

Ambulances↗
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↗