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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↗

Virtual reality and telepresence for military medicine.

For decades, warfighters have been putting in place a sophisticated "digital battlefield", an electronic communication and information system to support advanced technology. Medicine is now in a position to leverage these technologies to produce a fundamental revolution, and the keystone is the digital physician. Today nearly all information about a patient can be acquired electronically, and with the new technologies of teleoperation and telesurgery we can provide remote treatment and even surgery through telemedicine. The following framework for military medicine will leverage upon the current electronic battlefield. A personnel status monitor (PSM) will have a global positioning locator to tell the position of each soldier and a suite of vital signs sensors. When a soldier is wounded, the medic will instantly know the location of the soldier, and how serious is the casualty. This will permit the medic to locate the most critically wounded soldier. Once stabilised, he will be placed in a critical care pod, a fully automated intensive care unit in a stretcher, which will monitor his vital signs, administer fluids and medications and provide environmental protection. If immediate surgery is needed, a remote telepresence surgery vehicle will come to the wounded soldier, the medic will place him in the vehicle, and a surgeon will operate remotely using telepresence surgery from a distant Mobile Advance Surgical Hospital (MASH) to the combat zone. Also, the expertise from any specialist will be available from the rear echelons as far back as the home country. For education and training in combat casualty care, virtual reality simulators are being implemented. This same scenario can be utilised in civilian health care, especially in providing care to patients in remote areas who do not currently have access to simple, let alone sophisticated, health care.

Computer Simulation↗

[A diagnostic-therapeutic complex with changeable structure].

The paper describes the principles in the construction of diagnostic and examining complexes which record biological potentials in the frequency range of 0 to 20 kHz in real time and process them and, if required, either form the stimulating exposures or synchronize a recording process with external stimuli, as well as different purpose diagnostic and examining complexes designed by these principles. While solving different problems, the core of the complexes remains constant and only do the crate module ratio and attendant periphery change. The basic difference of the complexes is their software. The programme for examinations, processing of their results and creation of a database has a convenient interactive multi-window interface with an user.

Diagnosis, Computer-Assisted↗

Occupational health and safety information systems in the pharmaceutical industry.

This chapter outlines a health and safety management system that encompasses all of the work environments in a pharmaceutical company, including the laboratory, manufacturing, sales, and corporate forces. It discusses information flow and integration to address physical, biological, and chemical hazards present.

Computer Communication Networks↗

Florida physicians' guide to on-line information and the Internet.

The combination of new computing technology with progress in data communications over wide geographic areas offers computer users the opportunity to publish information to each other rapidly across wide geographic expanses. The concept of networking computers to gain access to the most recent and widest range of available information is consistent with the aims and methods of quality health care. The Internet is the ultimate extension to the computer network concept- an unlimited link of digital servers and users world-wide, united by common protocols for purposes of information exchange, self-policed and without central controls. Although the concept is attractive, on-line servers and the Internet are sophisticated information tools whose most effective use requires that users be oriented to basic concepts and conventions. This article summarizes the basic conventions in computer networking and data security; the differences in concept and use between bulletin board systems (BBSes), online systems, and the Internet for information access; the various classes of Internet information resources and their uses; the basic use of search engines to expedite information retrieval in the Internet; and offers practical advice in choosing methods of Internet access.

Computer Communication Networks↗

Ten basic World-Wide Web sites for Florida physicians.

The Internet is a rapidly growing information resource for rapid publication and access to information. While it has attracted a certain mystique and is undoubtedly attractive as an information source, its rapid and chaotic growth mitigates against ease of use for novices. The authors-all associated with health-care providers in the Dade/Broward market-offer the novice user their best assessment for initial Web sites to explore for health care information, and general guidance on using Internet search engines to direct effective searches.

Computer Communication Networks↗

Increasing the effectiveness and efficiency of academic advising through computerization.

Academic advising is an essential part of any university degree program and becomes especially important in programs where there is competitive and limited admission to professional courses. This requires that academic advisors have ready access to student scholastic and demographic data for counseling and statistical purposes. The use of computers in creating a database for student records has become routine in most universities and colleges. Computerization of these records through the registration process creates a university database with the potential for many different applications. This article describes the development of a computer software program for a baccalaureate science of nursing program that makes use of a university's database to provide the foundation of a computer software program used in the nursing academic advising office. Identifying the special needs and requirements of the nursing advising program and developing a close working relationship with the computer programmer were essential in the development and implementation process. The result was an increase in the effectiveness and efficiency of the advising process, better record keeping, and better use of available student data for statistical purposes.

Databases, Factual↗

Technology assessment. A framework for generating questions useful in evaluating nursing information systems.

Nursing information systems are computer systems that enable nurses to collect, manipulate, store, retrieve, display, and communicate data to administer nursing services and resources, manage nursing practice to improve patient care, and advance nursing knowledge. Selection and implementation of a nursing information system require a clear vision of the need for the system, careful planning, and astute forward thinking. Technology assessment provides a framework for generating pragmatic questions that can be used in systematically evaluating nursing information systems. This article provides a brief overview of nursing information systems, explains the technology assessment framework, and gives examples of questions useful in evaluating a nursing information system.

Computer Security↗

Interactive videodisc instruction is an alternative method for learning and performing a critical nursing skill.

A study was conducted to compare the effectiveness of interactive videodisc instruction (IVDI) with the traditional lecture/demonstration as an alternative method for learning and performing a critical nursing skill. Students were assigned randomly to a treatment group that worked in small groups to complete the IVDI on intravenous therapy skills and a control group receiving the same content in a classroom lecture/demonstration format. After the instruction, each subject performed a re-demonstration of the learned skills using specific guidelines. Results revealed that although the IVDI group scored higher on the overall re-demonstration, there was no significant difference in the ability of the two groups to effectively perform this critical nursing skill. These findings support the use of IVDI as an alternative self-paced, independent study method for learning psychomotor skills and are consistent with previous studies, which indicate that working in small groups on the computer has a positive effect on self-efficacy and achievement.

Computer-Assisted Instruction↗