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PubMed1993

Computer-assisted three-dimensional gait analysis of amphotericin-induced carpal lameness in horses.

Motion of 6 clinically sound horses trotting at a speed of 4 m/s on a treadmill was captured by video cameras before and 9, 16, and 23 days after amphotericin-induced lameness to determine the quantitative variables of three-dimensional computer-assisted image analysis that objectively describe carpal lameness. Amphotericin-B was used to induce lameness, and phenylbutazone (2.2 mg/kg of body weight, PO, once) and butorphanol tartrate (0.1 mg/kg IM, q 6 h, to effect) were used to control discomfort. Four 60-Hz cameras were symmetrically placed around the treadmill to capture 6 seconds of images from retro-reflective spheres taped to the trotting horses. Images were transferred to a video-based digitizer and a computer work station, where 4 files of two-dimensional data were reduced to 1 file of three-dimensional data. The effect of lameness on motion analyzed was assessed by use of two-way ANOVA. Differences between means were assessed, using the Student-Newman-Keul's test (P < or = 0.05). Head and withers excursions, (dorsal vertical displacement of head and withers targets, respectively) during the sound forelimb support phase were increased significantly during all lameness measurement periods. Head excursion, but not withers excursion, during the lame forelimb support phase, was decreased significantly during all lameness measurement periods. Computer determinations of stride length swing phase, stance phase, forelimb abduction, and carpal and fetlock ranges of motion did not consistently characterize the lameness. It was concluded that three-dimensional computer-assisted image analysis could be used for objective lameness evaluation in horses and that head and withers excursions were the most consistent variables for assessing equine carpal lameness.

Amphotericin B↗
PubMed2006

Mutational data integration in gene-oriented files of the Hermansky-Pudlak Syndrome database.

Hermansky-Pudlak Syndrome (HPS) is a genetically heterogeneous disorder characterized by oculocutaneous albinism and prolonged bleeding due to abnormal vesicle trafficking to lysosomes and related organelles such as melanosomes and platelet dense granules. This HPS database (HPSD; http://liweilab.genetics.ac.cn/HPSD/) provides integrated, annotatory, and curative data that is distributed in a variety of public databases or predicted by bioinformatics servers for the recently cloned human and mouse HPS genes, as well as for the genes responsible for HPSrelated syndromes, such as ChediakHigashi Syndrome (CHS), Griscelli syndrome (GS), oculocutaneous albinism (OCA), Usher syndrome type 1B (USH1B), and ocular albinism (OA). The HPSD is designed by using a unique GeneOriented File (GOF) format. Seven blocks (genomic, transcript, protein, function, mutation, phenotype, and reference) are carefully annotated in each userfriendly GOF entry. The HPSD emphasizes paired human and mouse GOF entries. The genes included in this database (currently 58 in total) are arbitrarily divided into four categories: 1) Human and Mouse HPS, 2) Mouse HPS Only, 3) Putative Mouse or Human HPS, and 4) HPS Related Syndromes. All the mutations in these genes are integrated in the GOFs. We expect that these very informative and peerreviewed GOFs will be shortcuts to utilize the webbased information for the emerging interdisciplinary studies of HPS.

Animals↗
PubMed1997

Costs and effects of microsurgery versus radiosurgery in treating acoustic neuroma.

This study analyses costs and effects of treating acoustic neuroma patients by using microsurgery compared to radiosurgery. Radiosurgery is the stereotactic application of radiotherapy and an innovative medical technology. Cost and effect estimates of conventional treatment were based on a retrospective study in the Netherlands. Similar data for a comparable group of patients in Sweden were collected for radiosurgery, as this treatment option is currently not available in the Netherlands. Fifty-three acoustic neuroma patients who had been operated on the University Hospital Rotterdam between November 1990 and February 1995 were included. This group was compared with 92 acoustic neuroma patients treated with radiosurgery (Gamma Knife. Stockholm, Sweden) in the same period. Data on health care use were collected from patient files. To obtain data on production losses and quality of life, a questionnaire was sent by mail in February 1995. This booklet consisted of the Health and Labour-questionnaire (HLQ), the Short Form-36 (SF36) and the EuroQol. The response rate was 92%. Direct costs for microsurgery amounted to Dfl. 20.072,- and for radiosurgery to Dfl. 14.272,-. Indirect costs were respectively Dfl. 16.400,- and Dfl. 1.020,-. General health rating was better for radiosurgery than for microsurgery. On the whole, differences in clinical outcomes between the two patient groups were small. Assuming a reasonable occupancy rate of the expensive radiosurgery equipment, we demonstrated that for the short term treating patients with acoustic neuroma with an extra-meatal tumour diameter of less than 3 centimeters, radiosurgery is more cost-effective than microsurgery.

Adult↗
PubMed1981

[Accidents related to physical education in school: epidemiologic and preventive approach].

Generally speaking, this category of accidents seems to cause mostly relatively mild injuries. It could explain, at least in part, why there are so few papers on this topic in the medical literature except for clinical reports usually based on hospitalized cases. The main results of a study of the 9261 physical education accidents registered within five years in primary and secondary schools in Basle and Geneva are used to illustrate their epidemiological characteristics, as well as the localization and the severity of the injuries. The sources of data are the files of the accident insurance companies. Initial operational definitions, data sources, measurement of exposure to risk and the (largely criticized) notion of individual accident proneness are constraints and conditions of a pertinent epidemiological approach which have to be carefully taken into consideration. This approach should be combined with the clinical and the ergonomical approaches in order to get the best possible pictures of the causes, mechanisms and consequences not only of accidents in general but especially of those occurring in physical activities in childhood and adolescence. Some considerations on prevention are briefly outlined here. They intend to take into account the risk factors related to the tasks, the circumstances and especially to the student himself taken as an individual involved in a growth and development dynamics.

Adolescent↗
PubMed1997

An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images.

UNLABELLED: We have developed a software suite that automatically selects, analyses, quantitates and displays all the key image data in a myocardial perfusion SPECT study. METHODS: The files automatically selected (upon specification of the patient name) are rest and stress projections, rest and stress short axis and gated short axis files, and all 'snapshot' files. The projection data sets are presented in cine mode for evaluation of patient motion, while the lung/heart ratio at rest and stress is calculated from regions of interest (ROIs) that are automatically derived and overlayed on the LAO 45 images. Left ventricular (LV) cavity volumes at rest and stress are calculated from the short axis data sets, and the related transient ischemic dilation (TID) ratio derived and displayed. Quantitative measurements of global (ejection fraction) and regional function parameters are performed from the gated short axis dataset. All algorithms use the C++, X-Windows and OSF-Motif standards. The overall suite executes in less than 1 minute on a SunSPARC5 with 32 Mb of RAM and no proprietary hardware. RESULTS: The software was validated on 144 patients (118 rest 201T1/post-stress 99mTc-sestamibi, 18 post-stress 99mTC-sestamibi, 8 rest 201Tl) acquired on a 90 degrees dual detector (ADAC Vertex, 91 patients) and a triple detector camera (Picker Prism 3000, 53 patients). Overall, the individual algorithms for the analysis of projection, short axis and gated short axis images were successful in 622/660 (94.2%) of the images. In 80.5% of the patients (73/91 + 43/53) all algorithms executed successfully, without significant difference in success rates for 201Tl versus 99mTc-sestamibi images. CONCLUSION: Our automated approach to myocardial perfusion SPECT analysis and review is highly successful, intrinsically reproducible, and can produce time and cost savings while improving accuracy in a clinical or teleradiology-type environment.

Algorithms↗
PubMedDate not supplied

Evaluation of user acceptance of a clinical expert system.

OBJECTIVE: To measure the attitudes of physicians and nurses who use the Health Evaluation through Logical Processing (HELP) clinical information system. DESIGN: Questionnaire survey of 360 attending physicians and 960 staff nurses practicing at the LDS Hospital. The physicians' responses were signed, permitting follow-up for nonresponse and use of demographic data from staff files. The nurses' responses were anonymous and their demographic data were obtained from the questionnaires. MEASUREMENTS: Fixed-choice questions with a Likert-type scale, supplemented by free-text comments. Question categories included: computer experience; general attitudes about impact of the system on practice; ranking of available functions; and desired future capabilities. RESULTS: The response rate was 68% for the physicians and 39% for the nurses. Age, specialty, and general computer experience did not correlate with attitudes. Access to patient data and clinical alerts were rated highly. Respondents did not feel that expert computer systems would lead to external monitoring, or that these systems might compromise patient privacy. The physicians and nurses did not feel that computerized decision support decreased their decision-making power. CONCLUSION: The responses to the questionnaire and "free-text comments" provided encouragement for future development and deployment of medical expert systems at LDS Hospital and sister hospitals. Although there has been some fear on the part of medical expert system developers that physicians would not adapt to or appreciate recommendations given by these systems, the results presented here are promising and may be of help to other system developers and evaluators.

Adult↗
PubMedDate not supplied

Experience of transferring an integrated hospital-administration system from a CODASYL data-base to a standard MUMPS file structure.

University College Hospital, a teaching hospital situated in Central London, has been using computers since 1964. Development of an integrated on-line hospital administration computer system was started in 1974. By mid 1977, the components of the system which had been implemented included a patient Master Index, Registration of new patients, Waiting Lists, Bed State, Out-patient Appointments, X-ray, Microbiology and Disease Index. The system was implemented using the Rank Xerox Data Systems (CODASYL based data-base management software, with the majority of applications running on a terminal network supported by transaction processing programs. The experience gained during three years of using such a system is reviewed, with particular emphasis on the ways in which the system matched up in practice to the expected benefits of data-base management facilities. In early 1977, it was decided to replace the Rank Xerox mainframe with a minicomputer which was considered to be a more cost-effective solution to the hospital's computing requirements. The machine selected a PDP 11-70, is running the Digital Equipment Corporation's implementation of Standard MUMPS, an interpretive language developed in a hospital environment, with its own file management software. The decisions which were made in redesigning the existing computer systems for the new machine are discussed. The progress made to date in the transfer of applications from the mainframe to the mini is reviewed, and some of the features of the software available on each machine and its suitability for the implementation of on-line data management and retrieval systems are compared.

Computers↗
PubMedDate not supplied

Comparing Web and touch screen transaction log files.

BACKGROUND: Digital health information is available on a wide variety of platforms including PC-access of the Internet, Wireless Application Protocol phones, CD-ROMs, and touch screen public kiosks. All these platforms record details of user sessions in transaction log files, and there is a growing body of research into the evaluation of this data. However, there is very little research that has examined the problems of comparing the transaction log files of kiosks and the Internet. OBJECTIVES: To provide a first step towards examining the problems of comparing the transaction log files of kiosks and the Internet. METHODS: We studied two platforms: touch screen kiosks and a comparable Web site. For both of these platforms, we examined the menu structure (which affects transaction log file data), the log-file structure, and the metrics derived from log-file records. RESULTS: We found substantial differences between the generated metrics. CONCLUSIONS: None of the metrics discussed can be regarded as an effective way of comparing the use of kiosks and Web sites. Two metrics stand out as potentially comparable and valuable: the number of user sessions per hour and user penetration of pages.

Adolescent↗
PubMed1979

[An interactive system for recording, storage and processing of treatment data (author's transl)].

For correct radiation treatment and evaluation of treatment a complete recording of data is necessary. With this aim an interactive system was developed. Data recording for every patient is started from a terminal assigned to the physician. After completing the patient file with the data of the physical treatment plan, the file may be displayed on the terminal assigned to the particulr treatment unit, and additional data of the particular treatment session added. If a treatment is finished, a hardcopy of all data is generated by the system. Retrieval of patient data is always possible from the physicians terminal. The system is a contribution towards reducing the work in documentation the radiation treatment. It will be possible not only to carry out epidemiological studies, but also to investigate and perhaps optimate the results of treatment methods.

Computers↗
PubMed2000

Primary care satellite clinics and improved access to general and mental health services.

OBJECTIVES: To evaluate the relationship between the implementation of community-based primary care clinics and improved access to general health care and/or mental health care, in both the general population and among people with disabling mental illness. STUDY SETTING: The 69 new community-based primary care clinics in underserved areas, established by the Department of Veterans Affairs (VA) between the last quarter of FY 1995 and the second quarter of FY 1998, including the 21 new clinics with a specialty mental health care component. DATA SOURCES: VA inpatient and outpatient workload files, 1990 U.S. Census data, and VA Compensation and Pension files were used to determine the proportion of all veterans, and the proportion of disabled veterans, living in each U.S. county who used VA general health care services and VA mental health services before and after these clinics began operation. DESIGN: Analysis of covariance was used to compare changes, from late FY 1995 through early FY 1998, in access to VA services in counties in which new primary care clinics were located, in counties in which clinics that included specialized mental health components were located, and for comparison, in other U.S. counties, adjusting for potentially confounding factors. KEY FINDINGS: Counties in which new clinics were located showed a significant increase from the FY 1995-FY 1998 study dates in the proportion of veterans who used general VA health care services. This increase was almost twice as large as that observed in comparison counties (4.2% vs. 2.5%: F = 12.6, df = 1,3118, p = .0004). However, the introduction of these clinics was not associated with a greater use of specialty VA mental health services in the general veteran population, or of either general health care services or mental health services among veterans who received VA compensation for psychiatric disorders. In contrast, in counties with new clinics that included a mental health component the proportion of veterans who used VA mental health services increased to almost three times the proportion in comparison counties (0.87% vs. 0.31%: F = 8.3, df = 1,3091, p = .004). CONCLUSIONS: Community-based primary care clinics can improve access to general health care services, but a specialty mental health care component appears to be needed to improve access to mental health services.

Aged↗
PubMed1995

PBM: a software package to create, display and manipulate interactively models of small molecules and proteins on IBM-compatible PCs.

The PBM package was developed to create, display and conveniently manipulate protein and small molecule structures on IBM-compatible microcomputers. It consists of four modules: CREATE, SPHERE, RIBBON and CONVERT. CREATE includes commands to create or alter ('mutate') the primary and subsequently the tertiary structure of a given peptide or protein by defining phi and psi angles of residues at will, options to add, delete or alter atoms in a structure, utilities to choose easily between the most common rotamers of amino acid residue sidechains and options to analyse in various ways a protein conformation. SPHERE provides for an interactive manipulation of structures containing up to 2700 atoms which can belong up to six different molecules. All manipulations can be made with the use of an ordinary mouse, by choosing from a variety of pull-down menus. Three types of models can be implemented to display molecules on the computer screen or the plotter: skeletal, solid space-filling and wireframe space-filling models. RIBBON creates ribbon models of proteins and allows for a limited variety of interactive manipulations. CONVERT is a file converter, which is capable of converting files of atom coordinates of literally any format to Brookhaven Data Bank format files. The package produces very good results for protein molecules of reasonable sizes, both in terms of graphics quality and speed of operations, on an 80486 IBM PC-compatible machine equipped with a 1 MByte VGA display card and a colour VGA monitor, which is a recommended configuration.

Computer Graphics↗
PubMed1998

Repeated emergency department use by HIV-infected persons: effect of clinic accessibility and expertise in HIV care.

Repeated emergency department (ED) visits by HIV-infected persons may signify poor access to care or treatment from inexperienced ambulatory providers. We examined features of 157 clinics following 6820 HIV-infected patients and associations with repeated (> or =2) ED visits by these patients in the year before their first AIDS diagnosis. Patient clinical and health care data came from 1987-1992 New York State (NYS) Medicaid files and clinic data came from interviews of clinic directors. The HIV/AIDS experience of each study patient's clinic was measured as the annual number of Medicaid enrollees newly diagnosed with AIDS who were contemporaneously followed by the patient's clinic. Repeated ED use was observed for 24%. The adjusted odds ratio (AOR) of repeated ED visits was reduced for patients in clinics with a physician on-call (0.77; 95% confidence interval [CI] = 0.65, 0.92), evening or weekend clinic hours (0.77; 95% CI = 0.64, 0.93), or >50 AIDS patients/year in 1987-1988 (0.56; 95% CI = 0.44, 0.71) versus fewer patients in those years. Patients in clinics with more than one feature promoting accessibility or HIV expertise had a greater reduction in their AOR of repeated ED use. HIV-infected patients in clinics with greater accessibility and HIV expertise rely less on the ED for care.

Adult↗
PubMed1985

Characteristics of rural communities and the changing geographic distribution of physicians.

This research paper presents the results of a comparison of the characteristics of rural counties which attracted and failed to attract young physicians during the past decade. The data utilized in this research were from the Area Resource File which contains data on physicians for 1975 and 1979 and which permitted the examination of flows of physicians in counties over this period. Characteristics of rural counties examined included demographic and economic characteristics, population density, physical characteristics, health status measures, and the availability of health resources. Results from this preliminary analysis indicate that counties with at least 25,000 population were more likely to have gained a young physician and that, of all counties which added young physicians, the majority gained only one or two. Characteristics which best distinguished counties gained or lost physicians included population and population growth rate, health resources, growth rate of per capita income, and the proportion of the population agriculture.

Catchment Area, Health↗
PubMed2003

Processing sequence annotation data using the Lua programming language.

The data processing language in a graphical software tool that manages sequence annotation data from genome databases should provide flexible functions for the tasks in molecular biology research. Among currently available languages we adopted the Lua programming language. It fulfills our requirements to perform computational tasks for sequence map layouts, i.e. the handling of data containers, symbolic reference to data, and a simple programming syntax. Upon importing a foreign file, the original data are first decomposed in the Lua language while maintaining the original data schema. The converted data are parsed by the Lua interpreter and the contents are stored in our data warehouse. Then, portions of annotations are selected and arranged into our catalog format to be depicted on the sequence map. Our sequence visualization program was successfully implemented, embedding the Lua language for processing of annotation data and layout script. The program is available at http://staff.aist.go.jp/yutaka.ueno/guppy/.

Computational Biology↗
PubMed1996

[Computerized follow-up cards for ambulatory patients with implanted pacemaker or defibrillator].

The follow up of pacemaker and defibrillator dependent patients has a significant role for both the evaluation of pacing effectiveness and check of hemodynamic advantages about patient's quality of life. The bulky paper archives are often inaccurate, hampering the consultation. At present the paper card is the only document which can be utilized to record some data concerning the implant and patient clinical story. Therefore, there is the necessity for a card that can include all patient's data, and the implant and programming pacemaker/defibrillator data during follow up. This new pacemaker card has portable file or data-base including shared data with safety mechanism, which can be utilized in several controls by different users (physicians, hospital ward, primary care units, insurance companies). The pacemaker card includes a chip that permits to store a considerable amount of data; it can be update in every further medical control, in observance of laws. The card Chip Operating System (C.O.S.) consists of a microchip with a memory completely managed by the operating system inside the chip itself. The card can be read by means of a GCR-200 modem linked with a PC IBM-compatible computer and the data can be updated during the follow up. The pacemaker-defibrillator card will appear immediately on screen, and it can be printed, updated and/or modified by a Microsoft Windows operating programme. With this pacemaker card we are able to ensure serviceable medical work, particularly in terms of cost/benefit ratio giving to patient more and more reasoning and safe service.

Database Management Systems↗
PubMed2005

Accuracy of Medicaid payer coding in hospital patient discharge data: implications for Medicaid policy evaluation.

BACKGROUND: Ambulatory care-sensitive hospitalization rates derived from hospital discharge data have been used to compare ambulatory care across insurance and delivery system groups. OBJECTIVE: We sought to quantify the impact of coding inaccuracies in hospital discharge data on counts of hospitalizations for ambulatory care-sensitive conditions among Medicaid beneficiaries. METHODS: This was a cross-sectional comparison of administrative databases of all California Medicaid beneficiaries younger than 65 years of age. We compared the number of hospitalizations that were attributed to Medicaid beneficiaries in California's hospital discharge data for 1994 to 1999 with the number derived from a file that linked hospital discharge data with the Medicaid eligibility file. RESULTS: Hospital discharge data undercounted 28.2% of hospitalizations for ambulatory care-sensitive conditions among Medicaid beneficiaries and overcounted 13.4% of such admissions among non-Medicaid beneficiaries. Approximately 5% of hospitalizations for ambulatory care-sensitive conditions captured as Medicaid admissions in routine hospital discharge data were among patients who gained Medicaid coverage as a result of the hospitalization. Patients who acquire Medicaid coverage as a result of a hospitalization are much more likely to be placed into Medicaid fee for service rather than Medicaid managed care which biases comparisons of these 2 delivery models. CONCLUSION: Caution should be used in the interpretation of Medicaid hospitalization rates as calculated from routine hospital discharge data. State agencies that provide hospital discharge data should consider the opportunity to improve the evaluation of Medicaid services by linking hospital discharge data with Medicaid enrollment files.

Adult↗
PubMed1997

[Can medical files be used to audit hospital health care? Results of a regional audit of hospital file quality].

OBJECTIVES: The clinical audit method based on a retrospective analysis of medical files can be used to assess hospital health care. The reliability of the results obtained depends on the validity of the data in the file and its completeness. The aim of this work was to assess the quality of this information source. METHODS: The simplified ANDEM/ANAES from was proposed to 47 medical information departments of public and private hospitals participating in the public health care service in the Provence-Alples-Côte d'Azur region. The audit was conducted on a sample of hospital stays during a regular 6-month quality control assessment of hospital health care activity. RESULTS: Analysis of the 467 forms returned by 39 hospitals, showed that the quality of medical file recordings should be improved as a large amount of data or important documents were missing: reason for hospitalization (recorded on 74.1% of files), operation report (found in 83.2% of files) and discharge summary (found in 66.6% of files). CONCLUSION: Clinical audits would be compromised in certain hospitals by the use of medical files. Efforts to improve the quality of hospital medical files should be a priority.

Evaluation Studies as Topic↗