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PubMed1982

Evaluation of a computer-assisted method for individualized anticoagulation: retrospective and prospective studies with a pharmacodynamic model.

We studied the effectiveness of a computer program based on a mathematic model of warfarin dynamics in assisting with the initial phases of anticoagulation. In retrospective evaluations the program was successful in predicting prothrombin complex activity (PCA) responses for three different groups of subjects, indicating that the model is a good representation of the physiologic system. In a prospective evaluation of the program a computer-assisted group of 10 patients was compared with a control of 10 patients who did not receive computer assistance. Because of the program's very conservative upper limits for warfarin dosage in the first few days of therapy, the computer-assisted patient require slightly more time (6 days), on the average, to first reach PCA values in the 20% to 30% therapeutic range than did the control patients (4.8 days). After the desired PCA had been achieved, however, the computer-assisted group remained within the therapeutic range for 83% of the time compared to only 60% for the control group. This difference was due primarily to much less overanticoagulation of the computer-assisted patients than of the controls.

Blood Coagulation↗
PubMed1999

Efficient operation of a high-volume anticoagulation clinic.

A pharmacist-operated anticoagulation clinic at a Department of Veterans Affairs (VA) medical center is described. An anticoagulation clinic established by the pharmacy service at the Denver VA Medical Center cares for 600 patients by using 1.35 fulltime-equivalent pharmacists. The pharmacists are privileged by medical staff to write prescriptions for warfarin, adjust warfarin dosages, and conduct appropriate laboratory monitoring. A protocol has been developed to standardize care. Patients referred to the clinic are scheduled for a same-day warfarin class and laboratory so that International Normalized Ratios (INRs) are available for the patient's appointment with the pharmacist; the patient's understanding of the material presented in the class is assessed during this appointment. The pharmacist determines the therapeutic range and duration of treatment and schedules a follow-up appointment. A locally developed computer program imports patient data from the hospitalwide computer system and simplifies scheduling and tracking of patient-related information. At any point in time, approximately 67% of clinic patients are in the therapeutic range, 13% are above range, and 20% are below range. From January to December 1994, 1.1% of clinic patients were admitted to the medical center for bleeding compared with 2.0% of patients receiving usual care, and 0.9% of clinic patients had thromboembolic complications compared with 3.1% of usual care patients. A computer program, clinical privileging of pharmacists, and a clinic protocol have helped a pharmacist-operated anticoagulation clinic to provide efficient care to veterans.

Adult↗
PubMed2006

Prediction of RNA secondary structure by free energy minimization.

RNA secondary structure is often predicted from sequence by free energy minimization. Over the past two years, advances have been made in the estimation of folding free energy change, the mapping of secondary structure and the implementation of computer programs for structure prediction. The trends in computer program development are: efficient use of experimental mapping of structures to constrain structure prediction; use of statistical mechanics to improve the fidelity of structure prediction; inclusion of pseudoknots in secondary structure prediction; and use of two or more homologous sequences to find a common structure.

Base Sequence↗
PubMed1989

A computer graphics program for measuring two- and three-dimensional form change in developing craniofacial cartilages using finite element methods.

Allometric analysis of chondrocranial growth seeks to provide objective measures of morphogenetic form change during ontogeny of the primordial skull. Linear measures, typically employed to study differential growth, become problematic at the histological level since an external referencing system is impossible to achieve for microscopic anatomies in embryos. The purpose of this paper is to describe a computer graphics program which generates spatially invariant measures of two- and three-dimensional form change using finite element methods. Anatomical form change is viewed as a continuous deformation of an initial finite element representing an anatomical unit into a second configuration. The algorithm consists of isoparametric scaling of finite elements, strain matrix formulation, and size/shape variable derivation. The routine includes four segments serving to extract nodal data, generate the strain matrix relating the two morphologies as well as deriving corresponding size/shape variables, reference the major and minor axes of form change, and provide graphic display of the anatomical geometries. Applications are provided measuring two- and three-dimensional form change in the developing craniofacial cartilages of rats subjected to treatment with the known teratogen diazo-oxo-norleucine (DON). The finite element routine provides craniofacial form change variables which are expected in light of cellular alterations induced by DON administration. Finally, computational differences between this routine and similar approaches using finite element methods for analyzing biological form change are examined.

Animals↗
PubMed1990

A system of personal computer control programs for tapping experiments.

A system of control and measuring programs on IBM-PC or compatible computers was developed to explore the precision and accuracy of a subject's timing mechanisms in sensorimotor behavior. Various rhythmic patterns composed of several accentuated and non-accentuated tones which the subject has to follow or to reproduce by finger tapping can be designed. All parameters of the stimulus tones, i.e., duration, pitch and inter-tone pause, in a pattern are variable. Two parallel, independent responses can be monitored simultaneously as well. In this way, the mutual influence of responses of two subjects or two responses of one subject can be analyzed. The programs are written in MODULA-2, the output data are in the ASCII format and can be processed by any common statistical package.

Data Interpretation, Statistical↗
PubMed1991

[Computer-assisted report generation and image transmission in bedside chest x-rays in intensive therapy units].

Since a few years ago, in our department the bedside chest X-rays of intensive care patients have been reported by means of a computer program which has also storing function. This computer program is a guideline for the radiologist and is organized in pages having a logical sequence. The program has proved very useful in learning the correct reporting of bedside chest X-rays. The nosographic data of the patients, the ventilatory and the technical data are stored for a better clinico-radiological correlation. The last four reports are displayed on the monitor to better understand the patient's history. The other reports become part of a "historical" archive. Most important is the cooperation with the referring physician: to make the most of it, a system has been implemented which sends the images from the Radiology Department to Intensive Care. The images are filmed with a camera and then digitalized on 1024 x 768 matrix with 16 million colors and 256 gray levels. Each workstation is composed of: AT286 computer with 60-MB hard disk, hardware or the digitalization and compression of images, a high-resolution monitor, an intercommunication system, and a modem. It is possible to zoom on the images, but a close-up on the image with the camera is better for improved spatial resolution. The images are stored on the hard disk: each image requires 3M bytes, but it can be compressed down to 25:1 with no detail loss. The images are transmitted via modem in at least 20 seconds/image. More images can be sent out-line. During transmission, it is possible to talk by the intercommunication system, pointing out structures on the monitor or drawing objects on both sides of the system. In our experience, image quality is good. We are therefore considering extending the network to other Departments and making the transmission of images of pathologic specimens possible. The natural evolution of this system is the teleconsult.

Computer Communication Networks↗
PubMed1996

Evaluation of health assessment skills using a computer videodisc interactive program.

Use of computer videodisc interactive programs has provided faculty and students with a greater breadth of information for evaluation and learning purposes. For the students, it provides the opportunity to actually observe physical assessment techniques during testing rather than relying on descriptions in a written question. It provides faculty with a greater variety of opportunities and broader range of techniques to more accurately evaluate students. Ultimately, students are better prepared in the performance of physical assessment and collection of appropriate data in the provision of patient care.

Computer-Assisted Instruction↗
PubMed1996

Automated infusion of nitroglycerin to control arterial hypertension during cardiac surgery.

OBJECTIVE: To evaluate the feasibility of closed-loop blood pressure control during cardiac surgery. DESIGN: A closed-loop system regulated peroperative hypertension by controlling the infusion rate of the vasodilator nitroglycerin (NTG). The controller consisted of a regulator which was monitored by a supervisory computer program. Mean arterial pressure (MAP) was calculated every 5 s from measurements of the radial artery pressure signal. The regulator calculated an NTG infusion rate with each new MAP measurement. The supervisory computer program monitored the regulator's actions and adapted or overruled the regulator when required. SETTING: The cardiac surgery operating room. PATIENTS: 46 patients who were scheduled for cardiac surgery and who developed peroperative hypertension. INTERVENTIONS: Patients were scheduled for either bypass or valve replacement surgery. The closed-loop system was used to control hypertension before and after cardiopulmonary bypass. The use of the closed-loop system did not require deviation from the protocol normally used during cardiac surgery. All patients received standard continuous anaesthesia with opioids. MEASUREMENTS AND RESULTS: Initial automatic control was achieved in 9.4 (4.1 SD) min. The percentage of time that MAP remained in a range around the target MAP of +/- 10 and +/- 20 mmHg was 74 and 94%, respectively. The mean NTG infusion rate while MAP was within 5 mmHg of target MAP was 1.14 (0.84 SD) micrograms kg-1 min-1. Target MAP was set between 65 and 90 mmHg. There was a small group of patients (6 out of 46) who did not respond to NTG and required alternative drug therapy. CONCLUSIONS: The controller provided fast and stable control in all patients. The expert knowledge implemented through the supervisory computer program enabled the controller to respond adequately to the rapid changes in arterial pressures commonly associated with cardiac surgery. We conclude that closed-loop control of arterial pressure is feasible not only in the cardiac surgical care unit but also during cardiac surgery.

Adult↗
PubMed2004

Advances in PCR technology.

Since the discovery of the polymerase chain reaction (PCR) 20 years ago, an avalanche of scientific publications have reported major developments and changes in specialized equipment, reagents, sample preparation, computer programs and techniques, generated through business, government and university research. The requirement for genetic sequences for primer selection and validation has been greatly facilitated by the development of new sequencing techniques, machines and computer programs. Genetic libraries, such as GenBank, EMBL and DDBJ continue to accumulate a wealth of genetic sequence information for the development and validation of molecular-based diagnostic procedures concerning human and veterinary disease agents. The mechanization of various aspects of the PCR assay, such as robotics, microfluidics and nanotechnology, has made it possible for the rapid advancement of new procedures. Real-time PCR, DNA microarray and DNA chips utilize these newer techniques in conjunction with computer and computer programs. Instruments for hand-held PCR assays are being developed. The PCR and reverse transcription-PCR (RT-PCR) assays have greatly accelerated the speed and accuracy of diagnoses of human and animal disease, especially of the infectious agents that are difficult to isolate or demonstrate. The PCR has made it possible to genetically characterize a microbial isolate inexpensively and rapidly for identification, typing and epidemiological comparison.

Animal Diseases↗
PubMedDate not supplied

Risk factors and recommendations for 230 adult primary care patients, based on U.S. Preventive Services Task Force guidelines.

We used a computer program based on the U.S. Preventive Services Task Force guidelines to identify recommendations for 230 adult patients who presented to an ambulatory family practice residency clinic. We entered risk factors into the computer program from sex-specific questionnaires that patients completed. On average, patients had 15.4 risk factors and 24.5 recommendations for preventive services (13.0 recommendations for screening, 10.5 for counseling, and 1.1 for immunizations). We noted a significant increase in the number of risk factors and recommendations with increasing age, except for counseling recommendations. The average patient incurs a large number of recommendations, which depend on many different risk factors, making the task of complete clinician compliance with the U.S. Preventive Services Task Force guidelines difficult. Many of these recommendations include counseling, which may take more time and require skills that clinicians may think they lack. Complete adherence may require several visits for the physician to address all recommendations. Measures to increase patient responsibility for health maintenance and innovations using comprehensive, interactive, and educational computer programs may help solve these problems.

Adult↗
PubMed1998

A questionnaire to assess neurological impairment in multiple sclerosis.

This study assessed the feasibility of using a self-report questionnaire to measure neurological impairment in multiple sclerosis (MS). Thirty patients aged 21-67 years participated. Each patient was examined and scored on three commonly used impairment scales; the extended disability status scale (EDSS), the neurologic rating scale (NRS) and the ambulation index (A1). Two other scales were also determined; the sum of the EDSS functional scores (SFS), and a five point scale rating functional status (FS). The physician also filled out a copy of the questionnaire based on interview and examination of the patient. All of these scores were determined and the physical questionnaire filled out blind to the patient's answers on their self-report questionnaire. The first 15 consecutive patients served as the pilot group to develop a computer program to convert answers on the questionnaire into predicted scores on each of the five scales. The second 15 patients served as the independent test group to assess the validity of the computer program. Using this program, both patient and physician questionnaires accurately predicted (r > 0.87) the scores on each of the five scales measured manually. In addition, the scores on all five scales were highly cross-correlated (r > 0.85) suggesting that, in fact, each measured a similar attribute of MS (i.e., impairment). Therefore, the five scales were combined into a single measure, the mean disability score (MDS), which showed the highest correlations (r > 0.95) of any scale between the predicted scores and the actual scores determined by examination. The results of this study indicate that the self-report questionnaire is a valid measure of neurological impairment in MS and, thus, that it can be used to survey this health outcome in an MS population. Moreover, this questionnaire can be filled out by a physician (based directly on the neurological examination) and, together with the computer program for scoring each patient, can be used to provide consistent scoring in clinical trials.

Adult↗
PubMed2004

Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial.

CONTEXT: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed. OBJECTIVE: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. DESIGN: Randomized controlled trial conducted from May 2000 to September 2002. SETTING AND PARTICIPANTS: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer. INTERVENTIONS: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106). MAIN OUTCOME MEASURES: Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation. RESULTS: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status. CONCLUSIONS: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk.

Adult↗
PubMed2001

Evaluation of a new computer intervention to teach people with autism or Asperger syndrome to recognize and predict emotions in others.

This randomized controlled trial looked at the effect of a new computer program designed to teach people with autistic spectrum disorders to better recognize and predict emotional responses in others. Two groups of 11 children (age 12-18) with autism or Asperger syndrome at two special schools participated: one group used the computer program for 10 half-hour sessions over 2 weeks. Within-program data showed a significant reduction in errors made from first to last use. Students were assessed pre- and post-intervention using facial expression photographs, cartoons depicting emotion-laden situations, and non-literal stories. Scores were not related to age or verbal ability. The experimental group made gains relative to the control group on all three measures. Gains correlated significantly with the number of times the computer program was used and results suggest positive effects. Further research could assess whether these gains generalized into real life or improved performance on theory of mind measures.

Adolescent↗
PubMedDate not supplied

Outcome of surgery for crooked nose: an objective method of evaluation.

OBJECTIVES: The aim of this study was to report the authors' surgical results, and to present their method of angle measurement using the Scion Image computer program to evaluate surgical results for crooked noses. METHODS: The study included 27 patients with crooked noses: classified as C-type and 14 classified as I-type. Deviation angles were measured by using the Scion Image computer program on frontal views before and at least 3 months after the operation. Correction of the crooked nose was performed through an open approach with the patients under general anesthesia. RESULTS: Significant correction was achieved for both types of crooked noses (p <0.05). The results for the I-type crooked noses were closer to the ideal angles than those for the C-type, but the difference was not significant. The findings showed that 66.7% of the patients with crooked noses, had good or excellent results after surgery: 53.8% of those with the C-Type and 78.6% of those with the I-type. CONCLUSION: It is difficult to achieve satisfactory results in the correction of crooked noses. The angle measurement method using the Scion Image computer program may be helpful in evaluating the effectiveness of different surgical techniques.

Adolescent↗
PubMed2004

Regression models for unbalanced longitudinal ordinal data: computer software and a simulation study.

A computer program GGOREX in the form of a SAS macro is developed for the analysis of longitudinal ordinal data. It is extended from GEECAT and GEEGOR developed by Williamson, Lipsitz and Kim in their paper in 1999. An illustrative example with some preliminary data from a study conducted by the National Institute of Child Health and Human Development and the University of Alabama at Birmingham is given. Another set of computer programs is developed to make it possible to conduct a simulation study to validate the GGOREX procedure in a finite sample. A simple computer program in FORTRAN using the IMSL software library is developed to solve for the probability distribution of the longitudinal ordinal responses according to the correlation specification.

Computer Simulation↗
PubMed1988

Effect of combining electrocardiographic interpretation results on diagnostic accuracy.

In order to test the diagnostic performance of various ECG computer programs a reference library of ECGs is being established and evaluation methods are being developed in an international co-operative project. A pilot study was undertaken in which 250 validated electrocardiograms (ECG) and vectorcardiograms (VCG) comprising seven diagnostic groups i.e., normal, left, right and bi-ventricular hypertrophy, anterior, inferior and combined infarction have been analysed independently by 11 different computer programs as well as by six cardiologists. A coding scheme was applied to assign individual diagnostic statements to a common set and to obtain combined program and cardiologist interpretation results. Preliminary results indicate that the accuracy of classification by different programs varies widely. Total accuracy varied between 57.2% and 75.8% (median 69.4%). The cardiologists had a higher accuracy (median 74.3%) than the majority of programs, at least when using the standard ECG. As it is considered premature to stress individual program results, in view of the current sample size, the enhancement in diagnostic accuracy obtained by combining interpretation results is highlighted. Indeed combined cardiologist and program results demonstrated the highest accuracy i.e., respectively 78.7% and 76.1%, higher than the result of any individual reader or program. The combined result of the five most accurate programs was 78.4%, that of the six least accurate was 71.5%, which is again higher than the respective individual components. These findings demonstrate that the combination of expert knowledge of computer programs can, similar to panel review and group analysis in clinical practice, enhance diagnostic accuracy.

Diagnosis, Computer-Assisted↗
PubMedDate not supplied

Computerized neuropsychiatric assessment of geriatric subjects by content analysis of brief samples of their speech.

The life expectancy of people living in the United States is increasing. Are very elderly individuals compromised mentally and physically in comparison to much younger persons? The purpose of this study was to test the efficacy of a computerized program applicable to the content analysis of 5-minute speech samples obtained from a group of individuals 90 years of age and older and to compare the results with those previously obtained in younger people with respect to their mental capacities in terms of a set of diverse neuropsychiatric dimensions. After obtaining informed consent from 26 elderly people, recorded verbal samples were elicited from each individual in response to purposely ambiguous instructions to talk for 5 minutes about any interesting or dramatic personal life experiences. The transcripts of their speech samples were digitized on a computer diskette and processed on the computer program. The computer program compared the scores obtained on each verbal sample with norms obtained on 15 previously validated content-analysis scales from individuals ranging in age from 5 to 80. The norms on these content-analysis scales are different for children (aged 5-10) and adults (aged 11-80). The computerized content-analysis scores obtained from this elderly cohort reveal plausible deviations from the norms for younger people.

Adolescent↗