Showing papers in "Journal of Medical Informatics in 1978"
TL;DR: The operation of MEDLINE requires three ongoing activities by persons having subject matter knowledge - literature selection, thesaurus maintenance and indexing, which is intended to give access to the most generally useful biomedical literature.
Abstract: The operation of MEDLINE requires three ongoing activities by persons having subject matter knowledge These are literature selection, thesaurus maintenance and indexing MEDLINE is intended to give access to the most generally useful biomedical literature rather than to provide indiscriminate comprehensive coverage Literature is selected with the guidance of a group of health-science educators, editors and librarians who review periodicals under consideration for inclusion and re-evaluate those that are already regularly indexed The MeSH thesaurus provides the descriptors that are used for subject indexing Its hierarchical structure facilitates both general and specific searching The appearance of new concepts and terminology in the literature requires a dynamic MeSH, but MeSH changes may complicate the process of searching backward in time Maintaining MeSH requires finding a balance between the need for adaptability and the need for stability Quality indexing requires accuracy and consistency in the assignment of subject headings To this end, indexers receive didactic training plus practice under supervision Precedents for indexers are detailed in an extensive Indexer's Manual and in MeSH annotations Work of all indexers is reviewed on at least a sampling basis, and special sessions are held each year to familiarize indexers with MeSH changes
52 citations
TL;DR: Three medical reference languages, Medical Subject Headings, International Classification of Diseases (ICD), and Systematized Nomenclature of Medicine (SNOMED), were compared through an analysis of their structures and found to differ in the degrees of complexity and specificity of meaning that they could convey.
Abstract: Three medical reference languages, Medical Subject Headings (MeSH), International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED), were compared through an analysis of their structures. They were found to differ in the degrees of complexity and specificity of meaning that they could convey. This variation in semantic power has been correlated with their different functions.Trois langages d'indexation medicale sont compares graˇce a l'analyse de leur structure; Medical Subject Headings (MeSH), International Classification of Diseases (ICD) et Systematized Nomenclature of Medicine (SNOMED). Ces langages different dans la mesure ou ils expriment, avec des degres varies, la complexite et la specificite des sujets etudies. Cette variation de leur pouvoir semantique est rapprochee de leurs differentes fonctions.
16 citations
TL;DR: The present authors give credit to Weed for having defined an education system in medicine based on the logical use of the medical record as a means of guiding a comprehensive approach to the patient.
Abstract: The problem-oriented medical record proposed by Weed allows the doctor to make explicit the implicit data used in medical practice. This process is highly educational. The present authors give cred...
7 citations
TL;DR: The National Library of Medicine's computer system has developed from a second generation computer to the large IBM multiprocessor system that is now used to maintain the MEDLINE file, provide retrieval services, and produce the computer photocomposed products of the NLM.
Abstract: The National Library of Medicine's computer system has developed from a second generation computer to the large IBM multiprocessor system that is now used to maintain the MEDLINE file, provide retrieval services, and produce the computer photocomposed products of the NLM. On-line maintenance facilities have been developed for the final steps in the input and file maintenance processes. The retrieval program, ELHILL, and its supporting programs now provide more bibliographic searches than any other system in the world. The photo-composed products, including Index Medicus, are produced through the use of flexible publication programmes which have allowed NIH to use several different photocomposers.Le systeme informatique de la National Library of Medicine (NLM) emit au depart un ordinateur de la deuxieme generation. Aujourd'hui, c'est un grand systeme IBM multiprocesseur qui gere les fichiers, procede aux recherches et a la photocomposition des documents edites par la NLM. Des facilites de maintenance en te...
7 citations
TL;DR: Training of searchers of the National Library of Medicine's (NLM) computer system has evolved from an intensive eight-month programme on batch retrieval through a highly compressed three-week course on interactive searching to the current five-level programme.
Abstract: Training of searchers of the National Library of Medicine's (NLM) computer system has evolved from an intensive eight-month programme on batch retrieval through a highly compressed three-week course on interactive searching to the current five-level programme. The five-level curriculum consists, in order, of a computer-assisted instruction program (*MEDLEARN*), the Initial Training course, a three to six month in-service practicum, the Advanced Training course, and continuing education. Each stage in the programme is intended for the more sophisticated user and deals with increasingly complex and refined searching techniques. Various types of media are incorporated into the instruction which seeks to tie together theoretical and rote material through an extensive amount of practical experience at the terminal. This modularized curriculum provides the flexibility required to teach the use of a dynamic system to a diverse student population. At the present time, approximately 400 students per year are avail...
7 citations
TL;DR: It was found that the items of greatest importance to the physicians, from the viewpoints of frequency of usage and of occasional interruption of the physician-patient transaction by being absent, were lab-test results, X-ray data, patient history, and previous treatments.
Abstract: A study is reported of the ways in which 26 physicians, mostly internists, use the medical record. It was found that the items of greatest importance to the physicians, from the viewpoints of frequency of usage and of occasional interruption of the physician-patient transaction by being absent, were lab-test results, X-ray data, patient history, and previous treatments. The most common general problems cited with the medical record were incompleteness (named by 38 per cent of the physicians), illegibility (27 per cent), and poor organization of the record (19 per cent).Cet article decrit l'utilisation que font des dossiers medicaux 26 medeeins, internistes pour la plupart.Cette etude montre que les criteres qui ont la plus grande importance pour les medecins, du point de vue de leur frequence d'utilisation et des manques, sont les resultats d'analyses biologiques, les donnees radiologiques, l'anamnese et les traitements anterieurs.Les problemes les plus courants sont lies au caractere incomplet des dossie...
6 citations
TL;DR: There is a regional dependence, with seasonal factors, of the process underlying case occurrences, and in general, that signal analysis methods are useful in the interpretation of small-sample spatio-tempered epidemiological data.
Abstract: Computer-based statistical signal methods have been applied to the analysis of case-occurrence time and location data from a 12-year complete series of anencephalic stillbirths in the Fylde Peninsula of Lancashire. In the absence of any certainty about causative or contributory factors in these occurrences, the primary questions are if the underlying process is Poisson, or if there is evidence of a seasonal influence, and if any regional differences or communicable factors can be identified.With the limited case numbers (124) most small-sample statistical tests were not sufficiently informative. But using pattern and point-process analysis methods and simulation techniques, further elucidation is possible; for example, it is shown that a seasonally rate-modulated Poisson process is a reasonable model for case occurrences in the southern region, but not in the north, for which a different process must apply and where some evidence exists of clustering of preferred inter-event intervals.It is concluded in p...
6 citations
TL;DR: The on-line services of the National Library of Medicine (NLM) have grown in both numbers of institutions using the service and in terms of total service provided.
Abstract: The on-line services of the National Library of Medicine (NLM) have grown in terms of both numbers of institutions using the service and in terms of total service provided. About 10 billed institutions are added per month with a total of 675 such institutions at the end of 1977. Total searches have now reached 900 000 per year. NLM services account for about 45 per cent of all the bibliographic searching in the US. The effect of prices has been significant.Les services temps reel de la National Library of Medicine (NLM) se sont considerablement developpes tant par le nombre des institutions qui utilisent le systeme que par la variete des services offerts aux utilisateurs.Dix organismes environ s'affilient par mois au systeme MEDLINE, qui comptait 675 abonnes a la fin de 1977. Dans une annee, le nombre des recherches s'eleve a 900 000. Actuellement les services de la NLM repondent a 45 pour cent des recherches bibliographiques effectuees aux USA. Cette importante activite a eu une repercussion significativ...
5 citations
TL;DR: The linguistic problems involved in the communication of morphological (descriptive) data resulting from investigations performed by physicians were solved by the use of an artificial English language based on the Systematized Nomenclature of Medicine.
Abstract: The linguistic problems involved in the communication of morphological (descriptive) data resulting from investigations performed by physicians were solved by the use of an artificial English language based on: (a) the Systematized Nomenclature of Medicine (SNOMED) completed by a set of semantic modifiers (mainly adjectives), (b) an elementary syntax using some prepositions and conjunctions, (c) a few simple rules of punctuation and lay-out.
5 citations
TL;DR: An information system HOISS (House Officer Information and Scheduling System) is described and it is shown that management was more consistent, the routine tests were done more regularly and there were less spurious tests performed.
Abstract: It has been suggested several times that care of patients with medical problems is not carried out in a consistent manner. Emergency medical care is most usually given by junior medical staff. It seems possible that their inexperience may further increase the inconsistency of care given.An information system HOISS (House Officer Information and Scheduling System) is des-ribed. It consists principally of a data-base of 80 clinical problems and a suite of programs to access the data-base. There is also a scheduling program which prints-out a worksheet of tests needed to be done that day. A review of the care of 86 patients is given. It is seen that there is considerable variation in the investigations done for a particular clinical problem. Also routine tests are not asked for and many investigations are done which cannot be justified from the patients condition.The results of five months experience with the system are presented. It is shown for the one problem considered that management was more consistent...
5 citations
TL;DR: The general considerations involved in setting up medical record objectives, which relate to medical activities, accounting procedures and technical solutions, are discussed.
Abstract: The difficulties met when clinical record systems are implemented using a computer have many causes. Some difficulties must be first solved by determining user requirements and then a technical solution found. The general considerations involved in setting up medical record objectives, which relate to medical activities, accounting procedures and technical solutions, are discussed. These factors are at the base of many system failures in the past decade.Les difficultes rencontrees lors de l'implementation d'un dossier medical sur ordinateur sont nombreuses. Certaines difficultes sont resolues en delimitant exactement les exigences de l'utilisateur et en prenant les mesures techniques qui s'imposent. Les considerations generales qu'impliquent les objectifs d'un dossier medical, notamment les solutions techniques et procedurales, sont discutees. Ces facteurs ont ete, au cours des dernieres annees, a l'origine de nombreux echecs.
TL;DR: The problems of creating and validating medical data are discussed and the necessity for clarity of thought, coherence and logic in data collection is stressed.
Abstract: The problems of creating and validating medical data are discussed. These difficulties relate to the structuring of data and its definition. The necessity for clarity of thought, coherence and logic in data collection is stressed. Difficulty in medical and lay staff training shows that this is a continuing problem. Data validation must be the major province of senior as well as junior doctors. It is an absolute essential continuing process and without valid data most analyses are not worthwhile because of high error rates and/or too much missing data.Cet article presente quelques difficultes concernant l'archivage et la validation des donnees medicales: role de la structure et de la definition des donnees, clarte des concepts, rigueur du recueil, education permanente des equipes medicales. Le role des permanents medicaux et les consequences d'une absence de validation correcte sont mis en evidence.
TL;DR: A model for analysis of medical reference languages, based on Saussure's distinction between paradigmatic and syntagmatic relations in language is proposed, and non-structural components, i.e. the size of the reference language and its ability to absorb new concepts are further considered.
Abstract: A model for analysis of medical reference languages, based on Saussure's distinction between paradigmatic and syntagmatic relations in language is proposed. Non-structural components, i.e. the size of the reference language and its ability to absorb new concepts are further considered.Les auteurs proposent un modele d'analyse des langages d'indexation medicate. Ce modele est fonde sur la distinction faite par Saussure entre les relations paradigmatiques et syntagmatiques du langage. Les constituants non-structuraux sont particulierement etudies, notamment la taille du langage d'indexation et sa capacite a assimiler de nouveaux concepts
TL;DR: An operational computerized system to aid clinicians in the design of total parenteral nutrition regimes is reported and financial savings have been noted by the pharmacy who can plan for a faster turnover of a smaller range of solutions.
Abstract: An operational computerized system to aid clinicians in the design of total parenteral nutrition regimes is reported. Two computer programs are described. The ‘Requirements' program uses patient data and the results of blood and fluid excretion analyses to calculate the nutritional requirements for a period of 24 hours. Accepted formulae are used in these calculations. The ‘Bottle Selection' program fits an intravenous bottle regime to the patient requirements from a standard set of commercially available intravenous feeding solutions.The system has been well accepted by the clinical staff who are free to accept, modify or reject a regime. Financial savings have been noted by the pharmacy who can plan for a faster turnover of a smaller range of solutions.The programs have been used routinely on a programmable calculator and have been written in CORAL for a Ferranti Argus 700E computer.Les auteurs decrivent un systeme d'aide a la prescription pour l'alimentation parenterale. Ce systeme est fait de deux pro...
TL;DR: Searcher requirements and capabilities in moving from a batch-mode linear operation to the iterative searching and retrieval provided by the random access mode of MEDLARS II are discussed.
Abstract: The development of MEDLINE searching philosophy and methodology is described. Searcher requirements and capabilities in moving from a batch-mode linear operation to the iterative searching and retrieval provided by the random access mode of MEDLARS II are discussed. A detailed tutorial on searching methodology for individual queries is covered. Elements of search formulation include requestor interview, query analysis, presearching, technics of selecting terminology, formulation logic, adapting indexing protocol in the search, on-line man-machine interface, and retrieval analysis. Similar searching technics are utilized in producing the two basic types of MEDLINE publications, recurring bibliographies (RBs) and literature searches (LSs). RBs are co-operative ventures between the NLM and professional organizations or other government agencies. LSs are NLM sponsored non-recurring bibliographies on a topic of current but also general interest to the medical community. All publications are produced through the retrieval and publication systems of MEDLARS II and graphic arts composing equipment. At the beginning of the 1978 publication year there were 27 RBs in routine production including Index Medicus. Through 1977, over 375 LSs had been produced.
TL;DR: The evolution of the network, and the domestic and international communication services, is discussed.
Abstract: A primary objective of the Data Communication Component (MEDLINE) of the Biomedical Communications Network (BCN) is to provide low-cost, reliable, nationwide and international access to the NLM on-line services. The network has evolved over several years and continues to change as new technologies and user requirements emerge. Today, TELENET and TYMNET form the backbone of the network complemented by a variety of other communication resources. This paper discusses the evolution of the network, and the domestic and international communication services.Le reseau de communication biomedical (Biomedical Communication Network-BCN) a pour composante principale le systeme de transmission de donnees MEDLINE. Tant au niveau national qu'international, l'objectif essentiel de MEDLINE est de permettre l'acces aux services temps reel offerts par la National Library of Medicine (NLM), et ceci avec de faibles courts d'exploitation et une grande fiabilite. Le reseau s'est developpe sur plusieurs annees et continue a evol...
TL;DR: The National Library of Medicine's on-line user community has grown from a small group of 25 institutions in October 1971 to more than 900 in January 1978.
Abstract: The National Library of Medicine's on-line user community has grown from a small group of 25 institutions in October 1971 to more than 900 in January 1978. Management of the MEDLINE User Network, co-ordination of on-line data-bases, and provision of user support services are an important function of the MEDLARS Management Section (MMS). MMS is the point of contact for on-line users; a service desk is maintained to provide immediate assistance; and technical materials describing the various data-bases are prepared including the monthly NLM Technical Bulletin and the On-Line Services Reference Manual. Other management and support activities include the preparation of statistical reports; handling of on-line centre applications received from the Regional Medical Libraries; co-ordination of codes and passwords for users; and the distribution of off-line prints, off-searches, and tape copies of the databases. A monthly current awareness service is also provided. The working procedures for these support activit...
TL;DR: The universal scale of measure reduces every abnormal value of similar severity to the same number to solve the problem of ignoring significant results scattered in a multitude of normal results.
Abstract: The main difficulty with numerical laboratory data is the risk of ignoring significant results scattered in a multitude of normal results. The universal scale of measure attempts to provide an answer to this problem. It reduces every abnormal value of similar severity to the same number.
TL;DR: The difficulties in fully exploiting correct and valid medical data held in a computer system are presented and the various economic aspects of such changes are considered including the importance of economy in supporting harmonious technical changes.
Abstract: The difficulties in fully exploiting correct and valid medical data held in a computer system are presented. The requirements for such a system to answer a physician's request are detailed and related to the clinical user, the computer interface and the technological interface, in particular that relating to adequate software. The technical aspects of hardware and software govern the progress of change and a degree of long-term compatibility is required, to ensure adequate exploitation of clinical data. The various economic aspects of such changes are considered including the importance of economy in supporting harmonious technical changes.L'exploitation quotidienne des donnees medicals souleve de nombreux problemes pratiques. Les interfaces hommes-machine doivent ětre adequats, les logiciels souples, pratiques et economiques. Le grave probleme de l'accumulation dans le temps des donnees a exploiter est directement en relation avec les possibilites d'evolution des produits informatiques. Un developpement ...
TL;DR: With the advent of automated digital and analogue computation procedures and equipment, automated data manipulation provides an systematic and comprehensive testing of each patient and permits a much greater case-load.
Abstract: With the incidence of ischaemic heart disease at epidemic levels and rising, techniques for detecting, predicting, and rehabilitating the condition of cardiac dysfunction are constantly under development. One technique, that of exercise stress testing, has been used in recent decades in the prediction, detection, and rehabilitation of cardiopulmonary disease. However, ergometric studies in this regard have been hampered by the tedium of physiologic data collection and analysis. With the advent of automated digital and analogue computation procedures and equipment, such data can be both operated on real-time for immediate display or stored for post-exercise and patient-history studies. Such automated data manipulation provides an systematic and comprehensive testing of each patient and permits a much greater case-load. In addition, special computer programs can compile and index specific parameters from a large sample size to facilitate statistical surveys of selected patient populations. The results of such statistical analyses can, if desired, be automatically printed out in a graphical form.
TL;DR: Evaluating the relationships of breast cancer to previous diseases, hormonal balance, conservative therapy and type of surgical therapy may be very important in supporting a less serious prognosis, a clearer clinical staging and a more certain choice of the right therapy.
Abstract: At the moment we still lack a clear correlation of clinical staging and pathology with therapy and prognosis in breast cancer patients. More studies need to be conducted dealing with the relationships of breast cancer to previous diseases, hormonal balance, conservative therapy and type of surgical therapy.These evaluations may be very important in supporting a less serious prognosis, a clearer clinical staging and a more certain choice of the right therapy. With computer help we have evaluated data from 500 patients with breast cancer.We have considered: age; previous breast diseases with particular regard to therapy; hormonal balance; obstetrical relevant past history; morphological and functional aspects of the breast; the histology of the tumour and metastases; and the results of therapy.Pour les cancers du sein, on ne dispose pas, actuellement, d'elements de correlation nets entre la situation clinique et l'anatomo-pathologie d'une part, et d'autre part, le traitement et le pronostic.Des etudes compl...
TL;DR: Analysis of half-hourly data of inter-arrival times showed a negative exponential distribution of patient arrival times and the doctor's service time varied from doctor to doctor and whether new or follow up patients were being seen.
Abstract: Out-patient medical clinics in Sri Lanka often have long queues of patients waiting to see a doctor partly due to a shortage of doctors. To apply operational research techniques to optimize the functioning of the clinic, an initial step is to determine the distributional pattern of patient arrival times and the doctors' service times. The results showed that the arrival times of patients were time dependent. However, analysis of half-hourly data of inter-arrival times showed a negative exponential distribution. The doctor's service time varied from doctor to doctor and whether new or follow up patients were being seen. Each of the service times seemed to fit into an Erlangian distribution.Dans les consultations externes de Sri Lanka, les attentes sont souvent longues par suite d'un manque de medecins. Il est possible d'optimiser le fonctionnement de ces consultations graˇce a la recherche operationnelle; la premiere etage consiste a determiner le profil des consultants et la duree des consultations. Les a...
TL;DR: The objective specification of the second variable (body weight) measured in an epidemiological field study of weanling diarrhoeal disease of infants has been approached by computer-based pattern analysis, complementing previous studies of the diarrhoale signal of daily defaecation count (DS).
Abstract: The objective specification of the second variable (body weight) measured in an epidemiological field study of weanling diarrhoeal disease of infants has been approached by computer-based pattern analysis, complementing previous studies of the diarrhoeal signal of daily defaecation count (DS). The weight data are available for 64 weeks in a subset of 50 out of 139 infants in the study.A weekly incremental weight signal (IWE) was estimated by successively differencing each new observed weight with a smoothed version of the previous value. Variable latency of the different features of this variable precludes the formation of an average-profile by coherent averaging the ensemble of records; a feature-analysis method based on statistical trend analysis was therefore developed. Features of the resulting IWE average profile can be linked to weanling events, transient diarrhoeal episodes, and typical post-neonatal shifts in level of the diarrhoeal signal.The results are consistent with the view that both nutriti...
TL;DR: The health curriculum vitae consists mainly of a chronological sequence of diagnoses, which are the mainstays of the medical record.
Abstract: The health curriculum vitae consists mainly of a chronological sequence of diagnoses, which are the mainstays of the medical record. Each diagnosis is connected vertically in the health curriculum vitae with its aetiological factors and its medical or surgical treatments in a causal concatenation; and horizontally throughout the other three parts of the record with its relevant functional, morphological (descriptive) and numerical laboratory data in a diagnostic association. The health curriculum vitae uses the Systematized Nomenclature of Medicine (SNOMED), the International Nomenclature of the Diseases of the Gastrointestinal Tract (CIOMS) and the International Standard Classification of Occupations of the International Labour Office.Le curriculum vitae medical consiste essentiellement en une suite chronologique de diagnostics, qui constituent les points d'appui du dossier medical. En effet, chaque diagnostic est relie verticalement a ses facteurs etiologiques et a ses traitements medicaux et chirurgica...
TL;DR: Computer processing of medical data can sometimes give a poor result because the complex process of codification, data capture and validation is rarely carried out as carefully as possible.
Abstract: Computer processing of medical data can sometimes give a poor result. This can be due to several reasons. First, medical data may be heterogeneous, sometimes inacurate and often subjective. Secondly, the complex process of codification, data capture and validation is rarely carried out as carefully as possible. Finally, the processing itself can be the cause of some inaccuracy when it does not correspond to the defined objectives for which the data have been collected.