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Showing papers in "Journal of Medical Systems in 1985"


Journal ArticleDOI
TL;DR: To test the feasibility of using sound to represent graphs, a prototype system was developed and human factors experimenters were performed and it was discovered that mathematical concepts such as symmetry, monotonicity, and the slopes of lines could be determined quickly using sound.
Abstract: A system for the creation of computer-generated sound patterns of two-dimensional line graphs is described. The objectives of the system are to provide the blind with a means of understanding line graphs in the holistic manner used by those with sight. A continuously varying pitch is used to represent motion in the x direction. To test the feasibility of using sound to represent graphs, a prototype system was developed and human factors experimenters were performed. Fourteen subjects were used to compare the tactile-graph methods normally used by the blind to these new sound graphs. It was discovered that mathematical concepts such as symmetry, monotonicity, and the slopes of lines could be determined quickly using sound. Even better performance may be expected with additional training. The flexibility, speed, cost-effectiveness, and greater measure of independence provided the blind or sight-impaired using these methods was demonstrated.

145 citations


Journal ArticleDOI
TL;DR: A software module in an expert system RED, which interprets data related to red cell antibody identification, is described, which combines the atomic hypotheses judged favorably by the antibody programs into a unified judgment concerning the case.
Abstract: We describe a software module in an expert system RED, which interprets data related to red cell antibody identification. There are three portions to this module: (1) the problem-solving component, which incorporates the knowledge required for antibody identification as a hierarchy of programs. The programs in the hierarchy organize within themselves small pieces of knowledge represented in the form of production rules, which are capable of making judgments concerning a specific hypothesis; (2) an intelligent data base for storage of patient data, red cell attributes, and test results; (3) the “overview critic” portion, which combines the atomic hypotheses judged favorably by the antibody programs into a unified judgment concerning the case. Overview makes the decision to terminate processing with a conclusion about which antibodies are actually present and what specific further tests need to be performed to resolve any remaining ambiguities.

48 citations


Journal ArticleDOI
TL;DR: RECONSIDER, a computer program designed to perform as a diagnostic prompting aid, was evaluated for its ability to include the correct diagnosis in an ordered computed list of candidate diseases.
Abstract: RECONSIDER, a computer program designed to perform as a diagnostic prompting aid, was evaluated for its ability to include the correct diagnosis in an ordered computed list of candidate diseases. The study was performed using 100 consecutive first admissions to the medical service of a university hospital, where the individuals entering the data into the program were blind to all but a limited set of findings known at time of admission. Each person entering the data created one or more lists of diagnostic possibilities (versions) using the program. The program suggested the correct diagnosis within the first 40 on its list 61% (498/797) of the time; the correct diagnosis was present with the first 40 in at least one version 93% (98/105) of the time. Performance was found to be best with cases having a single diagnosis and when more terms were entered into the program.

26 citations


Journal ArticleDOI
TL;DR: AI/GEN is an expert model of the diagnosis of deaf-blind syndromes that uses the EXPERT system developed by Rutgers University, and has been used to test the published diagnostic criteria against the revised expert criteria, the latter being significantly more accurate than the former.
Abstract: AI/GEN is an expert model of the diagnosis of deaf-blind syndromes that uses the EXPERT system developed by Rutgers University. Its knowledge structure employs criteria tables for diagnosis of the three types of CHARGE syndrome. The system has been used to test the published diagnostic criteria against the revised expert criteria, the latter being significantly more accurate than the former. The two sets of criteria are also compared with respect to the specificity and sensitivity of diagnosis. Expert systems can be of direct use to experts in refining and revising their diagnostic criteria.

22 citations


Journal ArticleDOI
TL;DR: In this paper, the authors proposed the concept of technostress and made a strong recommendation for conducting research based on key researchable hypotheses to provide some focus to future research, including strategic technological planning, organization culture development, and self-development programs.
Abstract: The article proposes the concept of technostress and makes a strong recommendation for conducting research based on key researchable hypotheses. A conceptual framework of technostress is suggested to provide some focus to future research. A number of technostress management strategies are put forward, including strategic technological planning, organization culture development, technostress monitoring systems, and technouser self-development programs. The management of technostress is compared to the chaining of Prometheus, which, left uncontrolled, can create havoc in an organization. The authors believe that organizations have a responsibility to introduce, diffuse, and manage computer technology in such a way that it is congruent with the principles of sound, supportive, and humanistic management.

21 citations


Journal ArticleDOI
TL;DR: This paper describes how such a system could be developed, with examples from the authors' prototype programs, and how this kind of system would help to build nursing science.
Abstract: The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.

14 citations


Journal ArticleDOI
Marjory Gordon1
TL;DR: Conclusions were drawn that both philosophically and conceptually, the components of practice are clear and a sufficient taxonomy for the content and structure of a data set is available.
Abstract: It has been argued that nursing practice components are not sufficiently clarified to develop specifications for a nursing data set within an NIS. The purpose of this paper was to examine this assumption. Conclusions were drawn that both philosophically and conceptually, the components of practice are clear. In addition, a sufficient taxonomy for the content and structure of a data set is available. A draft of 17 items, categories, definitions, and rationale for inclusion is presented. Validity and reliability of the specified item-categories is discussed. As in any profession, work on the precision of patient descriptors and therapeutic interventions is ongoing. This work is greatly enhanced if a data set is computerized and the content and organization is consistent with practice components. Large-scale studies of item-categories can further refine the structure and organization of a nursing data set.

14 citations


Journal ArticleDOI
TL;DR: In this paper, an artificial intelligence-based system has been developed and is currently being marketed to support the clinical decisions of practicing staff nurses, which can be used to efficiently analyze large amounts of data and assist instruction.
Abstract: Computer systems have assisted nursing by way of management information, billing, staffing, and record keeping. Computer systems also have been used to efficiently analyze large amounts of data and assist instruction. But can a large nursing knowledge database serve to support the clinical decisions of practicing staff nurses? One such artificial intelligence-based system has been developed and is currently being marketed.

13 citations


Journal ArticleDOI
TL;DR: In this paper, the authors present a method for ensuring compatibility between the data base schema and subsequent statistical analyses using examples derived from a multicenter clinical trial of diabetes and an observational data bank approach to disease surveillance in rheumatology.
Abstract: Data management software designed to support clinical data bases typically provides the user with the ability to “enter” and “retrieve” information according to simple user-specified criteria. In the medical research environment, such data base management systems can be self-limiting unless the user has carefully structured the data base schema to be consistent with subsequent statistical procedures used for analysis. For statistical purposes, the data base schema must be configured such that the dependent and independent variables are structurally situated to facilitate the use of statistical application programs. Furthermore, the analysis of time-oriented, prospective studies often requires the data base to be “relational.” This may be inconsistent with data collection procedures that result in “hierarchical” schemata. Methodology for ensuring compatibility between the data base schema and subsequent statistical analyses is presented using examples derived from a multicenter clinical trial of diabetes and an observational data bank approach to disease surveillance in rheumatology.

8 citations


Journal ArticleDOI
TL;DR: The MEGADATS pedigree plotting system, designed to display a human pedigree on a graphics device such as a pen plotter, is described and example plots are given, including a family with multiple mates and multiple original parent pairs.
Abstract: The MEGADATS pedigree plotting system, described in this paper, is designed to display a human pedigree on a graphics device such as a pen plotter. The plotting algorithm, which is order n in disk reads, where n is the number of individuals, is presented. Example plots are given, including a family with multiple mates and multiple original parent pairs.

7 citations


Journal ArticleDOI
TL;DR: Daily and weekly prediction models are developed to help forecast hospital laboratory work load for the entire laboratory and individual sections of the laboratory and on the basis of the predicted work load, staffing assessment is made and a productivity monitoring system constructed.
Abstract: Daily and weekly prediction models are developed to help forecast hospital laboratory work load for the entire laboratory and individual sections of the laboratory The models are tested using historical data obtained from hospital census and laboratory log books of a 90-bed southwestern hospital The results indicate that the predictor variables account for 50%, 81%, 56%, and 82% of the daily work load variation for chemistry, hematology, and microbiology sections, and for the entire laboratory, respectively Equivalent results for the weekly model are 53%, 72%, 12%, and 78% for the same respective sections On the basis of the predicted work load, staffing assessment is made and a productivity monitoring system constructed The purpose of such a system is to assist laboratory management in efforts to utilize laboratory manpower in a more efficient and cost-effective manner

Journal ArticleDOI
TL;DR: A constrained optimization model for the assignment of patients to dental students in a dental school clinic is presented to address issues of efficiency, educational requirements, facility constraints, faculty constraints, and continuity of care.
Abstract: This paper presents a constrained optimization model for the assignment of patients to dental students in a dental school clinic. Issues of efficiency, educational requirements, facility constraints, faculty constraints, and continuity of care are addressed in the model. A test problem and solution are used to illustrate the managerial impact of the model.

Journal ArticleDOI
TL;DR: The development of the National Survey of Hospital Data Processing started in 1980 as a special project within the Medical Systems Division at the University of Florida after seeing many years of research and millions of dollars invested in hospital data-processing systems often end in total frustration and institutional defeat.
Abstract: The development of the National Survey of Hospital Data Processing started in 1980 as a special project within the Medical Systems Division at the University of Florida. The need for this data base was evident after seeing many years of research and millions of dollars invested in hospital data-processing systems often end in total frustration and institutional defeat. Technical meetings were highlighted by heated discussions in hallways and elevators about the merits of a particular company's products or claims made by its sales staff. As a university center, it was not unusual for us to receive two to three phone calls per week from hospitals and data-processing directors asking for specific information on a particular product or service. 1 With no centralized data service and no reliable source of information, it was virtually impossible for anyone to give an honest answer about product performance in the hospital data-processing industry. Our initiation into the mechanics of a national study was actually accomplished on a small scale in 1981 by contacting only Southeastern United States hospitals and asking specific questions about their data-processing equipment, services, and future needs. A simple questionnaire was mailed, and we were surprised to find a high level of interest from hospitals that were concerned about the cumulative results of the study (see Appendix I). Our very first survey assessed the existing level of hospital satisfaction with their current data-processing services. In that study, we discovered a rather significant level of system dissatisfaction in almost all the responding hospitals. In a second survey to the same Southeastern hospitals, we looked into the causes of this dissatisfaction and tried to explore what was happening with shared services and the high level of complaints about cost and performance (see Appendix II). Once the data were analyzed, a formal reply was made available to the participating hospitals. It

Journal ArticleDOI
TL;DR: Examination of use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need suggests that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.
Abstract: A major topic in mental health (MH) research addresses the problem that patients who use mental health services have inappropriately high levels of somatic use, and examines whether provision of mental health services can decrease the inappropriate use (the so-called offset effect). However, the research showing higher somatic use by mental health patients has usually been unable to control for the patients' health status, or for their mental health status. In this paper we examine use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need. In two of the provider plans (an HMO and a prepaid independent practice association), MH users used significantly more outpatient somatic services than non-MH patients, after control for age and sex, and after control for the number of chronic conditions they had. People with MH need, however, did not use significantly more MH services than those without MH need. In the third plan, a Blue Cross/Blue Shield type of plan, results were different; MH users did not have significantly higher somatic utilization after control for chronic conditions, and those with MH need did have significantly higher somatic utilization after control for age and sex, but not after control for the number of chronic conditions. These results suggest that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.

Journal ArticleDOI
TL;DR: Here is a tragic case where the diagnosis was missed on three separate occasions over a 19-month period and the potential benefits of an alternate approach, which could have significantly changed the course of this particular patient's evaluation, are pointed out.
Abstract: Here is a tragic case where the diagnosis was missed on three separate occasions over a 19-month period. Both terminal conditions are treatable and potentially separable if discovered and aggressively managed. It is not the intent of this presentation to criticize the evaluation of this patient, but rather to point out the need and, also, the potential benefits of an alternate approach, which could have significantly changed the course of this particular patient's evaluation. We have conducted similar analyses with other CPC cases with almost equivalent specificity. These same evaluations have been performed in a real clinical setting with live patient data. What we have learned so far we think will be extremely helpful in extending the potential application of this technology: A text-based decision support tool is only as good as its practitioner. It takes practice and training to learn to use this system effectively. There are many traps in logic, and the use of words and terms within the text must be understood to effectively utilize this tool. There are shortcuts in logical analysis which we mentally use all the time but which cannot be accepted using this system (e.g., you must not rely on your memory or any specific associations to circumvent the system). The system will only become clinically relevant when the entire field of medicine is included in the data base. This is one of our current limitations with only two-thirds of the Merck medical text available for reference. This makes it difficult to apply to a general medical problem since we are not sure which direction the case might take, and often these are multisystem diseases or problems that put us at a severe disadvantage if we don't have the necessary data base. The structure and integrity of the data base are critical to the success of the system. Since numbers are ubiquitous, these cannot be used for key word elements. Techniques must be introduced to create word-oriented numbers that can be uniquely identified (e.g., "AGE14-20"). The publisher of the data must supply a continuous flow of up-to-date material that can be incorporated within the framework of the working system. It is possible to train medical technicians to use the system if they are familiar with medical terminology. The speed and, perhaps, the precision of their analysis could not be expected to rival that of a medical specialist.(ABSTRACT TRUNCATED AT 400 WORDS)


Journal ArticleDOI
TL;DR: Three basic conditions that have slowed NIS evolution are discussed and some evidence of real progress in computer-based support for nursing functions is offered.
Abstract: Computer-based information system (CBIS) support for nursing functions has typically been a by-product of some other automation effort such as communication, admission-discharge-transfer, or finance. Support specifically for nurses has been narrow in scope and little used, in spite of ongoing discussion about its need. However, the situation seems to be improving of late. But is the situation really improving? Or, are we merely witnessing unproductive machinations? Herein, we discuss three basic conditions that have slowed NIS evolution. Following that, however, we offer some evidence of real progress in computer-based support for nursing functions.

Journal ArticleDOI
TL;DR: A general-purpose minicomputer has been adapted and interfaced for the averaging and analysis of clinical evoked potentials and for compressed spectral arrays (CSA) of the routine EEG.
Abstract: A general-purpose minicomputer has been adapted and interfaced for the averaging and analysis of clinical evoked potentials and for compressed spectral arrays (CSA) of the routine EEG. In the first 2 years of operation, over 1,000 routine clinical studies of visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) have been performed with it, as well as over 100 CSAs and a variety of special and research studies. The CSA modality gives comparative frequency-domain pictures of left and right hemisphere power. An attached graphics terminal gives a live cumulative display of the EP and CSA. In addition, the system has automated and comprehensive physician-interactive graphics analysis and report generation capabilities. The reports are finalized versions used in the patient's chart, minimizing clerical efforts.


Journal ArticleDOI
H M Bursley1, P L Tikkanen1, N R Feistritzer1, M L Zweber1, D C Murdock1 
TL;DR: No correlation was shown to exist between the degree of nurse involvement in the selection of a hospital information system and the subsequent nurse utilization of that system, but investigators strongly believe that further refinement of the questionnaire and investigation would show a correlation of the two.
Abstract: Utilizing a survey approach, this descriptive correlational study explored the relationship between nurse involvement in the selection of a hospital information system and subsequent nurse utilization of that system. While no correlation was shown to exist between the degree of nurse involvement in the selection of a hospital information system and the subsequent nurse utilization of that system, the investigators strongly believe that further refinement of the questionnaire and investigation would show a correlation of the two.

Journal ArticleDOI
TL;DR: A synthesis of theories from the management information systems field provided the conceptual framework to describe how to design and develop effective computer-based information systems and revealed large gaps between nursing department needs and vendor-provided solutions.
Abstract: A synthesis of theories from the management information systems (MIS) field provided the conceptual framework to describe how to design and develop effective computer-based information systems. An analysis of activities and interviews with nurse managers in a tertiary care medical center provided the basis for describing five major nursing department functions and the information requirements arising from those functions. The MIS framework was applied to the nursing department information requirements in order to derive MNIS, a normative model of a nursing information system, which was then used to “bench mark” the current status of commercially available nursing information systems. The researchers compared the MNIS with 28 nursing information systems that vendors are currently developing or marketing. The comparison revealed large gaps between nursing department needs and vendor-provided solutions.

Journal ArticleDOI
TL;DR: The marketing and successful distribution of artificial-intelligence-based decision-support systems for nursing face special barriers and challenges, particularly from the present culture of the nursing profession and the typical organizational structures in which nurses predominantly work.
Abstract: The marketing and successful distribution of artificial-intelligence-based decision-support systems for nursing face special barriers and challenges. Issues that must be confronted arise particularly from the present culture of the nursing profession as well as the typical organizational structures in which nurses predominantly work. Generalizations in the literature based on the limited experience of physician-oriented artificial intelligence applications (predominantly in diagnosis and pharmacologic treatment) must be modified for applicability to other health professions.

Journal ArticleDOI
TL;DR: The use of discrete, stand-alone packages written in MUMPS as tools for the efficient development and maintenance of applications packages are discussed.
Abstract: A number of techniques exist to aid in the development of software applications. This paper briefly discusses the use of discrete, stand-alone packages written in MUMPS as tools for the efficient development and maintenance of applications packages. A preliminary set of requirements and a list of candidate functional clusters are included.

Journal ArticleDOI
TL;DR: The use of an objective measure of screen “goodness” is employed, namely, the Visual Evoked Potential of the humans performing the test, which indicates that when a “balanced” and well-designed screen is used as a stimulus, the second harmonic of the VEP wave form is always smaller than the first harmonic.
Abstract: In this paper we present a method to complement the sophisticated mathematical analyses on screen designs. The use of an objective measure of screen “goodness” is employed, namely, the Visual Evoked Potential (VEP) of the humans performing the test. After the screen is designed, the text on the screen is transformed into an intensity pattern using a recursive algorithm. This intensity pattern is used as a stimulus to obtain wave forms from the scalp of the subject, and the wave forms are analyzed as to their frequency content. A 2-D Fourier transform of the screen design is performed and the frequency components of the power spectrum are compared to the frequency components of the wave form. Our results indicate that when a “balanced” and well-designed screen is used as a stimulus, the second harmonic of the VEP wave form is always smaller than the first harmonic. The implications of such an analysis are discussed.

Journal ArticleDOI
TL;DR: The design principles and the functional capabilities of the microcomputer-based information system are described here, followed by an evaluation based on the first year of operation.
Abstract: Information processing is a major element of hospital risk management programs. A microcomputer-based information system has been designed and implemented in a medium-size university hospital. The design principles and the functional capabilities of the system are described here, followed by an evaluation based on the first year of operation.

Journal ArticleDOI
TL;DR: The details of an on-line microcomputer program developed for recording inventory data in the pharmacy of this hospital are described.
Abstract: Computers in general and microcomputers in particular are playing an important role in the management of hospitals in most of the developed countries of the world. The authors have undertaken a project on similar lines in King Fahad Hospital, Jeddah. Here, they describe the details of an on-line microcomputer program developed for recording inventory data in the pharmacy of this hospital.

Journal ArticleDOI
TL;DR: A microcomputer-based information system that integrates the concepts of text processing, data base processing, and data base analysis has been designed for cost evaluation in laboratories and serves as a tool for good financial management at various organizational levels in the clinical laboratory.
Abstract: A microcomputer-based information system that integrates the concepts of text processing, data base processing, and data base analysis has been designed for cost evaluation in our laboratories. This forms a flexible package that is directed by the needs of the user. The package, which has been used to calculate various cost parameters and productivity on the basis of comprehensive data and user-defined rules, serves as a tool for good financial management at various organizational levels in the clinical laboratory.

Journal ArticleDOI
TL;DR: The paper presents a method for optimization of the configuration of a computerized “heart station” (for interpretation of electrocardiograms from large ambulatory populations) and takes into account several factors that affect efficiency and acceptance of the newly introduced technology.
Abstract: The paper presents a method for optimization of the configuration of a computerized “heart station” (for interpretation of electrocardiograms from large ambulatory populations). The optimization model takes into account several factors that affect efficiency and acceptance of the newly introduced technology. Efficient operation may be determined by minimizing cost/ECG or maximizing number of ECGs/technician/hr. If the acceptance of new computerized medical technologies is expected to be gained smoothly and rapidly, great attention should be paid to the acutal “interfacing” of the new devices with patients and operators. The concerned model is general enough to assist in decisions concerning various technologies and is not limited to computerized ECG interpretation systems only.

Journal ArticleDOI
TL;DR: In this paper, the authors present guidelines for specifications of terms and conditions for maintenance service from the perspective of the laboratorian in the automated clinical laboratory in order to meet the increasing level of technical sophistication and complexity found in clinical laboratory instrumentation.
Abstract: The increasing level of technical sophistication and complexity found in clinical laboratory instrumentation today more than ever demands careful attention to maintenance service needs. The time-worn caution for careful definition of requirements for acquisition of a system should also carry over to acquisition of maintenance service. Guidelines are presented for specifications of terms and conditions for maintenance service from the perspective of the laboratorian in the automated clinical laboratory.