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PubMed1980

Use of electrochemical sensors for on-line monitoring of ionized calcium, potassium, and glucose in whole blood of living dogs.

We report the development and evaluation of electrochemical sensors for continuous on-line measurement of whole-blood ionized calcium, potassium, and glucose in living animals. Ionized calcium and potassium are measured with ion-selective electrodes, by using a unique differential approach. A polarographic sensor coupled with a membrane with bound glucose oxidase is used in the glucose analyzer. The modular concept of instrument design permits one mainframe, computer, and pump system to house any analyzer module or a combination of modules. A small volume of venous blood (about 2 mL/h) is continuously withdrawn from the subject through a double-lumen catheter and pumped through the analyzer(s). Results of in vitro correlation studies and studies in normal dogs (including responses of ionized calcium, potassium, and glucose to various stresses) support the validity of the measurements.

Animals↗
PubMed1995

[The use of the microcomputer in selecting the basic cause of death].

The article begins with a discussion of some mortality statistics issues, problems encountered in the manual selection of underlying cause of death, and also the increasing need for information on associated causes. These circumstances led the National Center for Health Statistics to develop the computerized ACME System, which has been in use in São Paulo State since 1983. The ACME System's requirement of a mainframe computer, as well as other operational limitations, has prevented its installation throughout the country. In order to standardize and improve the quality of mortality data in Brazil, the Informatics Department of the Ministry of Health's National Health Foundation and the World Health Organization (WHO) Collaborating Center for the Classification of Diseases in Portuguese developed the microcomputer-based Underlying Cause Selection System (SCB) in 1993. This is an expert system that employs artificial intelligence techniques to reproduce the reasoning of a coder in selecting the underlying cause of death, according to the rules and provisions of the Ninth Revision of the International Classification of Diseases. The SCB has a very user-friendly interface, occupies 2.6 megabytes of hard disk space, and can run on any 386 or higher XT or AT computer. In addition to selecting the underlying cause of death, the system stores data on associated conditions.

Artificial Intelligence↗
PubMed1994

Information for chemical management. The approach of the International Register of Potentially Toxic Chemicals.

The International Register of Potentially Toxic Chemicals (IRPTC) chemical data bank system was developed with the view to covering all the sets of information needed for the identification of hazard and providing a useful tool for risk assessment. The IRPTC data bank has been conceived to allow countries to establish their own information management system for national chemical management and to serve a worldwide information exchange network. The electronic search facilities help to provide tailor made data sets to fit the information needs of the different groups and individuals. There is a great variety of information users, ranging from those dealing with the hazard assessment and risk management to the exposed workers and citizens concerned about the effects of the emissions from the smokestack of the neighbouring factory. The need for authoritative information is particularly crucial for developing countries which do not have the advanced technological means or resources to establish mainframe computing links with IRPTC. A personal computer version has therefore been developed to give these governments and institutions access to the same data at an extensively reduced cost.

Database Management Systems↗
PubMedDate not supplied

Point-of-care versus central laboratory testing: an economic analysis in an academic medical center.

A cost-effectiveness study was conducted to determine time and labor costs for point-of-care (POC) versus central laboratory testing. A prospective, observational time and motion study was carried out at a teaching hospital located in Philadelphia, Pennsylvania. The cohort consisted of 210 patients presenting to the emergency department who were triaged at the urgent or emergent level during a 4-week period. Patients who had blood drawn for a seven-chemistry profile (Chem-7), which includes analysis of sodium, potassium, chloride, carbon dioxide, blood urea nitrogen, glucose, and creatinine, or for cell blood count (CBC) tests as part of regular care, also had an additional split sample drawn for POC analysis of sodium, potassium, chloride, blood urea nitrogen, glucose, and/or hematocrit. Blood drawn for POC analysis did not require additional needlestick(s), nor did it alter regular care procedures. Physicians and all emergency department staff participating in the care of the patients were blinded to POC test results. Main outcome measures included test turn-around time (TAT), physician determination of impact of rapid TAT and laboratory values on therapeutic approach, and cost per test for POC versus central laboratory testing. POC TAT was a mean of 8 minutes (time from blood drawn to results shown on the POC device display). Central laboratory TAT was a mean of 59 minutes (time from blood drawn to entry of results into mainframe computer). Therapeutic TAT was a mean of 1 hour and 25 minutes (time from blood drawn to analysis in central laboratory, to when the physician viewed test results). After therapeutic course of care was decided for the patient, physicians reported that POC testing, independent of other rate-limiting steps, would have resulted in earlier therapeutic action for 40 of 210 (19.0%) patients. The cost per test for Chem-7 and CBC tests was $11.14 and $9.48, respectively. The cost per test for POC analysis ranged from $14.37 to $16.67, depending on the POC test volume (estimated volume based on 20% to 50% of emergency department patients that had either Chem-7 or CBC test done applied over the useful life of the POC testing equipment) and the personnel (nurse or emergency department technician) who performed the test. With an increasing volume of POC tests performed per unit time, costs for POC testing would be reduced substantially. POC test costs are volume dependent under current reimbursement mechanisms for emergency department patient care services, for example, fee-for-service payment.(ABSTRACT TRUNCATED AT 400 WORDS)

Academic Medical Centers↗
PubMed1994

Computerized screening for appropriate dosing of renally eliminated medications.

A method of rapid screening for appropriateness of certain drug doses is described. The program extracts patient information from a hospital mainframe computer system, performs an estimation of creatinine clearance (CrCl), and prints a report of patients, drugs, doses, and CrCl for patients within a specified CrCl range.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

Implementing a local area network for nursing in a large teaching hospital.

The authors describe the assessment, planning, implementation, and benefits of a local area network (LAN) for the nursing service of a 504-bed urban teaching hospital. The major goals of the network were to increase the efficiency and effectiveness of the nursing administrative areas and improve communication systems. A network of more than 90 workstations, spanning 12 buildings, was installed. The network provides access to multiple programs that support clinical, managerial, and research activities. Gateways provide access to the hospital's two mainframe computers. Network benefits identified by nursing management include: improved communication and access to information; increased accuracy, efficiency and timeliness of data; and improved computer literacy.

Boston↗
PubMedDate not supplied

Isomorphic corneal topography: a clinical approach to 3-D representation of the corneal surface.

BACKGROUND: Newer methods of refractive surgery produce their effect by reshaping the corneal surface. It follows that topographic representations, used primarily to map refractive power, should now emphasize morphology and contour features. METHODS: We introduce a procedure using commercially available instrumentation which provides isomorphic three-dimensional corneal topography. The representations may be displayed either as refractive power, as is conventionally done, or as the more surgically relevant contour configuration. These images contain data points that are continuous rather than stepped as in the familiar color-coded displays. RESULTS: The technique proved easy to execute requiring no special software or mainframe computing. The corneal displays generated were freely rotatable and rescalable. CONCLUSIONS: In addition to producing clear and intuitive three-dimensional representations, the digital graphics environment allows manipulation unavailable in the conventional color-coded format; such representations should be particularly valuable for pre- and postoperative evaluation.

Computer Simulation↗
PubMed1995

Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center.

We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS.

Academic Medical Centers↗
PubMed1998

Research implications of improvements in access to the ONS Longitudinal Study.

In this article we outline significant changes in the way the ONS Longitudinal Study data are stored, accessed and analysed. The data were held previously on mainframe computers. Recent technological changes have made it possible to introduce PC-based systems without compromising confidentiality. The advantages of this new computing environment are illustrated with recent findings on geographic inequalities in health.

Adolescent↗
PubMed1986

Implementing a mainframe packaged pharmacy computer system in a 190-bed hospital.

The implementation of a pharmacy computer system in a 190-bed institution is described. A computer system was instituted in the pharmacy department as part of a hospitalwide conversion to an online information system. Planning for implementation began nine months before the actual live date (date of full computerization). Problems in the existing distribution and record-keeping systems that might be eliminated by computerization were identified, and changes in the layout of the pharmacy and department procedures were initiated to prepare for computerization. The events leading to computerization are presented in chronological order, and the advantages and shortcomings of the system are discussed. Because of careful planning, the cooperation of all pharmacy staff members, and frequent assistance from the computer vender, the nine-month conversion to a computerized system proceeded smoothly.

Computers↗
PubMed1986

Using the computer as a referral source to find the patient at nutritional risk.

The use of the computer-generated reports helped to identify the patient at nutritional risk on the basis of length of stay and diet order and permitted the dietitian to serve the patient in an appropriate and timely manner. Of 572 patients assessed in one year, 265, or 46%, were identified as needing nutrition assessment by the computer reports. As a result of increased visibility and increased medical record entries, awareness of the dietitian's expertise has increased. Several inservice presentations on tube-feeding products, tube-feeding administration, and TPN have been requested and given to medical, surgical, and intensive care nurses. Although specific data were not collected, a decrease in tube feeding wastage was noted. As a result of increased monitoring of tube feedings, a more efficient system of labeling tube feedings was designed. At Fairview General Hospital, use of the mainframe computer-generated patient lists has not only saved the dietitian valuable time in identifying patients with nutrition needs but also has afforded her the opportunity to practice current nutrition assessment on more patients. Possible future applications include microcomputer hook-up with the mainframe computer's data banks to complete nutrition assessment calculations.

Computers↗
PubMed1984

New directions in scientific computing: impact of advances in microprocessor architecture and system design.

The new generation of microcomputers has brought computing power previously restricted to mainframe and supermini computers within the reach of individual scientific laboratories. Microcomputers can now provide computing speeds rivaling mainframes and computational accuracies exceeding those available in most computer centers. Inexpensive memory makes possible the transfer to microcomputers of software packages developed for mainframes and tested by years of experience. Combinations of high level languages and assembler subroutines permit the efficient design of specialized applications programs. Microprocessor architecture is approaching that of superminis, with coprocessors providing major contributions to computing power. The combined result of these developments is a major and perhaps revolutionary increase in the computing power now available to scientists.

Computers↗
PubMed1987

Interactive statistical analysis of survival data.

This paper describes a SAS macro which facilitates the interactive analysis of right-censored survival data. Such data commonly occur in medical studies. The program produces Kaplan-Meier survival curves on a wide variety of graphics devices. The program also performs log-rank and generalized Wilcoxon significance tests among all plotted curves and for each pairwise contrast if desired. Because the program is intelligent and does not prompt the user for information that it can independently obtain, it is quite easy to use.

Computer Graphics↗