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Optimizing physician access to surgical intensive care unit laboratory information through mobile computing.

Approximately 30 minutes of computer access time are required by surgical residents at Stanford University Medical Center (SUMC) to examine the lab values of all patients on a surgical intensive care unit (ICU) service, a task that must be performed several times a day. To reduce the time accessing this information and simultaneously increase the readability and currency of the data, we have created a mobile, pen-based user interface and software system that delivers lab results to surgeons in the ICU. The ScroungeMaster system, loaded on a portable tablet computer, retrieves lab results for a subset of patients from the central laboratory computer and stores them in a local database cache. The cache can be updated on command; this update takes approximately 2.7 minutes for all ICU patients being followed by the surgeon, and can be performed as a background task while the user continues to access selected lab results. The user interface presents lab results according to physiologic system. Which labs are displayed first is governed by a layout selection algorithm based on previous accesses to the patient's lab information, physician preferences, and the nature of the patient's medical condition. Initial evaluation of the system has shown that physicians prefer the ScroungeMaster interface to that of existing systems at SUMC and are satisfied with the system's performance. We discuss the evolution of ScroungeMaster and make observations on changes to physician work flow with the presence of mobile, pen-based computing in the ICU.

Algorithms↗

Virtual reality: an assistive technology in neurological rehabilitation.

The need for improved neurological rehabilitation strategies is self-evident. Recent developments in the computer technology of virtual reality hold the promise of exciting progress in this area. In this paper four areas of potential application of virtual reality to neurological rehabilitation are reviewed.

Activities of Daily Living↗

An object-oriented class library for medical software development.

The objective of this research is the development of a Medical Object Library (MOL) consisting of reusable, inheritable, portable, extendable C++ classes that facilitate rapid development of medical software at reduced cost and increased functionality. The result of this research is a library of class objects that range in function from string and hierarchical file handling entities to high level, procedural agents that perform increasingly complex, integrated tasks. A system built upon these classes is compatible with any other system similarly constructed with respect to data definitions, semantics, data organization and storage. As new objects are built, they can be added to the class library for subsequent use. The MOL is a toolkit of software objects intended to support a common file access methodology, a unified medical record structure, consistent message processing, standard graphical display facilities and uniform data collection procedures. This work emphasizes the relationship that potentially exists between the structure of a hierarchical medical record and procedural language components by means of a hierarchical class library and tree structured file access facility. In doing so, it attempts to establish interest in and demonstrate the practicality of the hierarchical medical record model in the modern context of object oriented programming.

Humans↗

[The individual typological characteristics of operator activity during long-term monotonous work on the computer].

Individual neurophysiological and psychophysiological characteristics were analyzed in two groups of subjects with different extraversion and genetically determined levels of cortical activity during learning the novel for them monotonous computer operation. Most of the subjects improved their performance to the end of four-hour work. The degree of visual fatigue correlated with changes in P70 component of the evoked potentials. The intergroup difference was revealed in overcoming the visual discomfort during attention concentration. The visual cortex was facilitated in the introverts with high-voltage cortical activity (1st group) and disfacilitated in the extraverts with the low-voltage cortical activity (2nd group). Increase of the simple motor reaction time in the extraverts is considered as a result of temporary impairment of the visual function during the monotonous operator's work, and the worsening of the emotional condition as a consequence of the visual discomfort. The problems are discussed concerning different adaptation mechanisms in realization of the activity under study depending on the genetically determined features of the CNS.

Adaptation, Physiological↗

Integration of a computer-based patient record system into the primary care setting.

The use of computer-based patient record systems (CPRS) in the primary care setting will increase significantly over the next few years. Real-time, point-of-care use of such systems must provide adequate payback to justify the intrusion into the provider/patient relationship. The authors describe, through the transition of a legacy system into a state-of-the art system, how such a system might be integrated into the primary care setting. Information flow is organized around an event, such as a patient encounter, or around the patient. The Medical Record (TMR) optimizes the provider/computer interaction through the use of protocols and clinical guidelines. Documentation is enhanced through the use of computer-generated progress notes.

Computer Security↗

[Voice control of endoscopic instruments by the operator--development and perspectives].

Present surgical techniques require the intraoperative control of an increasing number of technical devices (i.e. endoscopic surgery, fluoroscopy, laser systems). We present a system that allows direct command of medical devices by voice control. Practical testing of a voice-controlled arthroscopic fluid pump in the OR demonstrated safe and efficient function and a significantly improved control of the pump by the surgeon.

Arthroscopes↗

A three-dimensional virtual model of the head generated from digitalized CT or MR images for anatomical-radiological and neurosurgical evaluations.

A computer-generated virtual model has been developed that reconstructs the head in three dimensions from digitalized images obtained with magnetic resonance and computerized tomography. Through programming and the use of commercial graphic animation software, we have developed the whole process of the rotation of the head on different spatial planes. The procedure permits multidirectional anatomical sections to be made on the structure of the head, providing a true dynamic and user-friendly anatomical-radiological atlas. The system serves as a virtual model for the localization of an ideal surgical approach to any lesion thus avoiding possible neurological lesions.

Anatomy, Artistic↗

Medical expert system on fuzzy analog ganglionar lattices: explication and prospection based on sensitivity.

A reasoning method to explicate the conclusions-a posteriori- and to prospect for the next test-a priori-applied to medical expert systems based on fuzzy analog ganglionar lattices is presented. This method is founded on the sensitivity criterion of the consequent respect to the antecedents. It proves to be suited for problems of any complexity, specially when they are formulated on well-established intermediate concepts, such as syndromes, clinical finding, laboratory procedures, etc., as is usually the case in medical procedures. This type of expert system uses the structural properties of the ganglionar lattice to produce explications for its conclusions at different levels of abstraction, and to an arbitrary, but fixed, explicative degree. A measure to evaluate the consequent's achieved preciseness (certainty) is also supplied. A full example of application in the diagnosis of cardiac insufficiency with hypertensive myocardiopathy is shown, and a computational implementation of this analog procedure is described. Finally, the reasoning methods for explicating and prospecting are discussed.

Artificial Intelligence↗

The Sophus anaesthesia simulator v. 2.0. A Windows 95 control-center of a full-scale simulator.

The Sophus group was founded in Denmark in 1992 with the aims of doing research into human error in anaesthesiology. Development of a simulation-environment was seen as one of the tools for research and training. This article describes the PC user interface of the SOPHUS anaesthesia simulator, SOPHUS v. 2.0 for Windows 95, and the script language, SASL v. 1.2. The script language provides possibilities of making scenarios, which develop in different directions according to the treatment of the patient by means of IF/THEN-statements, loops etc.

Anesthesiology↗

Results of a patient education project using a touch-screen computer.

PURPOSE: The purpose of this project was to increase use of the Physician Data Query and Patient Information File services of the National Cancer Institute in a clinical setting. OVERVIEW: A patient education demonstration project was conducted at the University of Rochester Cancer Center using a touch-screen computer program called CancerHelp. Two computers were purchased, one stationed in the Patient Library at the University of Rochester Cancer Center and one circulated to three affiliated hospitals. Demographic information was asked at the beginning of the program and an evaluation was elicited at the end of the program. All information was given voluntarily; users of the system could bypass the questions if they wished. The computer program was very well received by patients and their families. The program was used 1758 times over 6 months. CLINICAL IMPLICATIONS: A touch-screen computer program can be an effective method for distributing cancer information.

Adult↗