Showing papers in "Journal of Medical Systems in 1993"

The effect of obesity on ventilatory response and anaerobic threshold during exercise

Abstract: To facilitate making the physical fitness programs for obesity control, we investigated the effects of obesity on the ventilatory response during exercise and exercise tolerance. One hundred eighteen adults were divided into a normal group and fatty group by percentage of body fat. Each subject performed a submaximal exercise test under the gas-exchange measurement. The fatty group was inferior to the normal group in exercise tolerance. The respiratory mode, during exercise, in the fatty group was characterized by higher respiratory rate and less tidal volume compared with the normal group. This mode may result in increased dead space and therefore unavailable ventilation capacity. These data suggest that the characteristic respiratory mode in the fatty group was a factor in the lower exercise tolerance.

Intelligent medical record-entry (IMR-E)

Abstract: This paper describes an automated medical record designed to allow providers to enter patient data at the point of care. The system runs on PCs and Macintoshes and uses a graphical user interface and object-oriented programming to take advantage of current mouse and pen technologies. The provider acquires all relevant patient data by pointing and clicking at selections on input screens, many of which contain anatomical drawings to help the provider quickly and accurately describe patient findings. The system also generates a grammatically correct progress note using the problem-oriented structure. Furthermore, items identified in the assessment and plans portion of the program can be ported to expert systems for medical decisions assistance or to billing systems. The system allows the provider to obtain the necessary information on a focused patient visit in less than 5 min or to enter a complete history and physical.

The effects of electronic mail on communication in two health sciences institutions

Abstract: A study was done during 1991–1992 to determine the perceived impact of electronic mail (E-mail) relative to other forms of communication in health sciences institutions. E-mail subscribers at two major health sciences institutions were sent 2919 surveys, and 823 (28%) completed survey instruments were returned. A significant positive impact of E-mail was found relative to other forms of communication (e.g., paper, phone) with regard to E-mail messaging, response rates, influence, value, formality, perceptions, errors in communication, cost-effectiveness, communication style, and other factors. Areas where no differences were found between communication mechanisms were also revealing. Technical problems, maintenance, and confidentiality of E-mail messaging were not found to be significant problems. Trends, value, and impact of E-mail use in health sciences institutions are also discussed.

Computer-based patient education revisited

Abstract: Good patient education teaches ideas and skills that help patients cope with immediate medical problems, maintain health and avoid disease. Patient education is increasingly important as hospital stays are shortened, patients become more active health consumers, and there is more need to document informed consent for treatment. It is difficult to provide consistent high quality patient education and reimbursement is problematic. Computers have unique attributes for individualized, effective instruction, including variable lesson pacing controlled by the patient and the ability to accurately track the level of patient understanding to document informed consent and for third party reimbursement purposes. The ability of the computer to persuade as well as inform helps motivate behavior change. The unrealized potential of computer-based patient education makes clear the need for further research on how to effectively use this unique tool for patient education.

Usefulness of anaerobic threshold for evaluating daily life activity and prescribing exercise to the healthy subjects and patients

Abstract: Forty-three subjects were studied as for the relationship between anaerobic threshold (AT) and medical data including individual life style. Age, habit of exercise, and obesity are related to AT, showing a correlation coefficient of 0.533, 0.457 and 0.428, respectively. On the other hand, plasma lipid levels and alcohol are not so strongly related to AT, showing low correlation coefficient of 0.241 and 0.209 respectively. No correlation is found on the other factors such as FBS, Liver and blood pressure etc. Physical active life, commuting time, cumulative exercise hours in a month and work hours in a month are correlated to AT, showing correlation coefficient of 0.799, 0.734, 0.708 and 0.671, respectively, and even “more than once a month” frequency of execise has affected AT. In conclusion, AT is a useful index for evaluating daily life activity and prescribing exercise regimen.

Medical uses of the Internet

Abstract: The Internet is commonly known as the Network of Networks. Born in the early 70's, it was started as a military experiment in network design. The goal was to create a network that would function during a nuclear war. It began by linking a few computer and supercomputer centers across the United States allowing scientists to log into these systems from far away and use them as if they were sitting in front of the machine. It worked so well that more and more academic centers have chosen to invest in the hardware needed to link to this information highway. This experiment created a robust inter-network and it has grown rapidly. In October of 1993, there were estimated to be over 2,000,000 computer hosts from over 230 countries with 13 million users in the United States alone. A conservative estimate has the network doubling in size every 12 months. Why has it grown so fast? In part because of the billing structure. Once a campus invests in the hardware to connect to the net, utilization is free. One may send messages across the net and login to systems across the continent without paying an additional fee. This was true because the network was subsidized by the federal government. The Internet provides three primary services which give it its value. (1) Electronic mail. Using the appropriate address, one may send a message to any user on the network and it will usually arrive within minutes. Messages can be from one to over 25,000 lines in length. (2) Remote Login. This allows a user to log into any machine on the Internet using the appropriate UserlD and Password and interact with it as if she were connected directly to it. Many systems allow remote users access to basic services on their systems such as searching an electronic card catalog. (3) File Transfer Protocol (FrP). This allows a user to retrieve a file from a remote system and bring it to one's own machine. These files can be text files, images files or executable programs. Until recently exploring this jungle of computers was very difficult. There were no maps and there were many different operating systems each with different commands. The only way to find a resource would be to stumble upon it or have someone tell you it existed. Now software packages such as Archie, Gopher, Veronica and WAIS have made locating resources a great deal easier.

Seasonal variation in serum cholesterol levels in health screening populations from the U.K. and Japan

Abstract: We have performed time series analyses on data from 140,000 men and 32,000 women in the U.K. and 30,000 men and 12,00 women in Japan, seen over periods ranging from 4 to 6 1/2 years, in order to test for seasonal variation in serum cholesterol levels. In both countries and both sexes we found a strong seasonal effect, with mean cholesterol levels being some three to five percent higher in winter than in summer. Mean monthly cholesterol levels were negatively correlated with mean monthly air temperatures (r=−0.60 to −0.71). The seasonal differences observed were independent of changes in body weight, and have important implications both for long-term epidemiological or follow-up studies, and for the interpretation of patient data.

Development of a scalar hospital-specific severity of illness measure

Abstract: Cost-function analysis of hospitals has been criticized for not including severity adjustments. We tested a scalar hospital-specific severity index, derived from Admission MedisGroup Scores. Alternative versions (i.e., linear/nonlinear) of the index were evaluated by estimating cost functions on a sample of 201 Pennsylvania hospitals. The scalar index was a strong predictor of costs. The results also suggest that the omission of a severity variable in a hospital cost function may cause a specification error.

Sigmoidoscopy and other tests for screening of colorectal cancer

Abstract: We have been carrying our mass detection for colorectal cancer with fecal occult blood test and sigmoidoscopy. The occult blood test is negative in 60% with colorectal cancer.

Hard drinking water and ischemic heart disease: calcium, bloodlipids, and acute myocardial infarcts

Abstract: The human body has a need for a minimum of 2 L of water per day. Normally the amount is between 2.5 and 3 L. The drinking water gives 1.8 L, the food 0.8 L, and 0.4 L comes from the body metabolism. The total amount is 3.0 L. The excretion of water is 1.8 L through the kidneys, 0.7 L through the skin, 0.3 L through the lungs, and 0.2 L through the feces, equal to 3.0 L. Naturally there is a wide span between different individuals and between different external environments.

Metaparadigm: a soft systemic MIS design approach

Abstract: The aim of this paper is to introduce the soft systemic approach to medical information system design, called metaparadigm. The metaparadigm is a metadesign paradigm. Using it we first design an IS design paradigm and it is our deep belief that metaparadigms employment can enhance many conventional IS design weaknesses and result in successful information system design and use. In the paper we show the applicability of the metaparadigm in MIS design and introduce a new personal MIS design paradigm.

Clinical Laboratory Test Reference (CLTR)

Abstract: As the healthcare system undergoes a transformation in scope and funding, there remain many unfinished projects which will be essential for the next generation of automated medical support services. The most demanding and labor intensive tasks for this new frontier deal with the accumulation of knowledge which can be used as a clinical database to support supervisory functions in a physician operated interactive care delivery environment. These databases will contain the worlds accumulated knowledge in specialized areas. They will be organized by topic or clinical service, and have significant impact on the quality of care as well as medical malpractice exposure. This article will describe a clinical pathology database that has been adapted for medical practice. The database contains information about laboratory tests and their interpretation. The data is structured for rapid reading and has references where indicated. The database can be used in a stand alone program or integrated into an information system within an application program. The files are reviewed on a continuing basis and quarterly updates are made available to subscribers.

Evaluation of impairment related to low back pain

Abstract: Low back pain is the leading cause of disability and expense from work-related conditions in the United States Forty percent of the expense of the worker's compensation program is spent on claims involving the low back There are several systems of impairment evaluation in use in the United States, but the most commonly used has been developed by the American Medical Association Evaluation of impairment related to the low back is expressed as a percent impairment of the whole person and is calculated by combining values related to: (1) diagnostic based categories, (2) range of motion of the spine, and (3) neurologic deficits in the lower extremities Using this system, and given a cooperative patient, a reproducible quantification of impairment can be obtained to help administrators of the worker's compensation system more fairly compensate injured workers for partial permanent disability

Performance-based management in local health departments: measuring the success of implementation

Abstract: Six of eight local health departments in North Carolina's Southwest Perinatal Region III participated in a PBMS demonstration project also involving the state health department, the Centers for Disease Control, and the School of Public Health of the University of North Carolina at Chapel Hill. In all six counties the problem of reducing prematurity and low birthweight was selected to test this innovation. Using standardized instruments, staff awareness of and concern for low birthweight problems and programs were measured, as was level of success of implementation of PBMS. Factor analysis of three rounds of Awareness and Concern responses produced three uncorrelated factors: awareness of low birthweight problems, awareness of low birthweight programs, and concern for low birthweight. The results suggest that the PBMS increased awareness of the problem and the program, and that the project succeeded in half of the counties, helped some counties achieve some goals, and provided some benefits to some counties. The implications for Total Quality Management are discussed.

Using ILIAD system shell to create an expert system for differential diagnosis of renal masses

Abstract: Differential diagnosis of renal masses is an important and difficult process. A renal mass diagnostic system (RMDS) developed by using the ILIAD expert system shell has been created for diagnostic consultations and patient simulations. Seventy-two cases of renal mass have been tested on this system and the diagnostic accuracy was compared to that of residents. The overall diagnostic accuracy (75%) for renal masses is significantly better than second-year urological residents (60%) and not worse than urological chief residents (71%). The expert system also displays the cost of the diagnostic procedures so that the user can choose the most cost-effective diagnostic process. We conclude that this powerful renal mass diagnosis system developed by using ILIAD system shell can be used as a teaching, self-training and clinical tool for urological residents.

Computerized patient information system in a psychiatric unit: five-year experience

Abstract: A computerized psychiatric clinical application based on CLICKS program was developed, consisting of a network of 34 personal computers, run by Novell Netware version 3.11. It includes all clinical records and covers most of the administrative needs of the department; it may be used also in the outpatient clinics. Implementation of the system followed the stages of planning, record structuring, record programming, practice and operation. The system is favorably accepted by the patients, has several important advantages over pencil and paper record keeping, and although it is slightly more time-consuming, it improves record quality and departmental efficiency.

Total Quality Management system: its application in a community hospital research department

Abstract: Lehigh Valley Hospital initiated a program of total quality management using the model taught by Philip Crosby Associates. When the training began in the Research Department, we used the application of this model to identify, define and chart the various processes that a research project or study moves through from conception to publication. The resulting charts and process outlines enabled the Research Department personnel to recognize problem areas in the processes, and to chart the progress of a study at any given time. This provided us with both a better understanding of input and output in the research processes, and an opportunity to improve efficiency by correcting problem areas.

Bringing the promise home: policy options and strategies to promote medical information networking

Abstract: An Arthur D. Little study released last year concluded that the widespread use of telecommunications and information technology applications can reduce the annual cost of health care in the U.S. by over $36 billion. 1 Yet the potential of medical information networking depends on the existence of an accessible, ubiquitous, and affordable information network--the electronic infrastructure that transports information. Such a network is likely to be a network of many of the networks used today for other services, including voice communications (the telephone)and video entertainment (cable television), as well as the fast growing Intemet, which is emerging from the research and education sector into wider use. A significant stumbling block remains, however: the \"last mile\" of wire that connects subscribers to the network. While cable operators have coaxial cable in place capable of carrying substantial amounts of information to homes, their network is not switched and often does not serve business areas with few residences. On the other hand, the public switched telephone network we use today was built for analog voice service, not the transport of high speed digital information. The critical issue for policy makers is to develop policy options that drive us toward the network we want for these sophisticated applications in medicine and other fields. Almost all experts agree that will eventually mean a digital, broadband network capable of seamlessly transporting voice, data and video and delivering scores of new services. This \"information superhighway,\" as it is being popularly called, cannot be simply created on demand, however; the most optimistic projections for the widespread availability of fiber optic links to homes and small

Graphical interface for medical image processing

Abstract: We have developed a graphical interface which allows users of varying levels of computer experience and proficiency to manipulate medical image-processing data with “point-and-click” ease. The power which had formerly been associated with protocols and shell scripts has been combined with the flexibility and “user-friendliness” of buttons and dialog boxes.

Evaluation of hyperechoic liver tumors in MHTS

Abstract: Hepatocellular carcinoma (HCC) shares only a small proportion of hyperechoic liver tumors detected in MHTS and mimics hemangioma on ultrasonography (US). The precise diagnosis of HCC is hence difficult in MHTS, but presence or absence of underlying chronic liver disease and serum alfa-fetoprotein (AFP) titer might provide useful informations.

An Artificial Intelligence system to predict progression of immune dysfunction in healthy older patients

Abstract: In 1983, forty nine participants returning for their annual HEALTH WATCH evaluation were assessed for immune function status and served as healthy controls in an early study of “normal” reference values for T4 and T8 lymphocyte counts and T4/T8 lymphocyte ratios, B lymphocyte counts, and other laboratory tests for immune function then available. Balascopy, a computer-assisted pattern recognition system for detection, quantification and cognition of multiple imbalances among clinical laboratory and health behavioral parameters, facilitates identification of otherwise healthy individuals with evidence of early immune dysfunction. When the T4 and T8 immunology tests were combined with 7 health index behavioral subscores, and 24 routine clinical laboratory tests, we are able to obtain a bodyprint unique for each patient, providing a comprehensive health status profile specific for that individual. These bodyprints serve as tools for the evaluation of otherwise undetectable metabolic, immunological and behavioral imbalances in a given patient in an unprecedented individualized manner. We show here a longitudinal look at a balascopic evaluation of one patient who has evidence of progressive immune dysfunction with development of only mild clinical symptoms.

EM-PSYCH: a training program scheduling database

Abstract: EM-PSYCH is a scheduling database for training programs. It stores scheduling records and generates schedules and letters informing students, supervisors, and advisors of deadlines. Since EM-PSYCH was originally designed for a psychoanalytic institute, the institute model is presented as well as the database model to illustrate how the database program can be applied. EM-PSYCH is very user friendly and makes scheduling and sending reminders efficient and easy. It can handle any number of trainees and can be modified for any number of years or schedule interval. It can be easily adapted for psychiatric residencies, medical student education, psychology internships, and other training programs.

West Virginia's Mountaineer Doctor Television

Abstract: The Robert C Byrd Health Sciences Center of West Virginia University (RCB HSC) is located in Morgantown, WV and offers a full array of services (Figure 1) The central mission of the RCB HSC is service to the State of West Virginia West Virginia is a state with an approximate population of 18 million, 55 counties, approximately 3,000 physicians, and 63 hospitals (over half of which have less than 100 beds) Because of its terrain and distance to urban areas, recruitment of primary care physicians to rural West Virginia is a problem In order to reduce feelings of isolation and to increase retention of providers in rural areas, the RCB HSC has developed many programs to support rural providers For example, in 1985, the WVU School of Medicine started a program called the Medical Access and Referral System (MARS) This toll-free service enables RCB HSC specialists to instantly provide medical information to West Virginia's rural practitioners MARS now receives over 1,500 calls a month Rural practitioners that use MARS have indicated that it is a lifeline that allows them to provide better patient care Another successful program at the RCB HSC designed to address the issue of isolation is the Visiting Clinicians Program This program brings selected primary care physicians from rural West Virginia to the RCB HSC regularly to teach students in the morning and to be matched in the afternoon with a specialist of their choice These rural doctors receive a stipend for their teaching, CME credit for their learning, and are appointed to the clinical faculty of the West Virginia University School of Medicine These and other RCB HSC outreach programs now operate in 53 of West Virginia's 55 counties (Figure 2) Briefly, other programs include:

Earthbound applications for NASA's physician workstation

Abstract: The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

Correlative evaluation of serum lipid, blood glucose, blood pressure, serum immunoreactive insulin, and liver function in persons undergoing regularly scheduled health evaluations

Abstract: Two hundred and thirty eight persons were examined to evaluate the interrelations among seven key factors for arteriosclerosis: body mass index (BMI), systolic blood pressure (BPs), plasma glucose (PG), serum cholesterol (CHO), serum triglyceride (TG), serum glutamic-pyruvic transaminase (SGPT), and serum insulin (IRI). BPs showed the significant positive correlation with PG (r=0.346), BMI (r=0.318), and IRI (r=0.200).However, there were no significant correlations between BPs and CHO, between BPs and TG, between BPs and SGPT. SGPT showed the significant positive correlation with IRI (r=0.367), BMI (r=0.268), and TG (r=0.343); but no significant correlations were observed in relations between SGPT and PG, between SGPT and BPs, between SGPT and CHO. IRI showed the significant positive correlations with TG (r=0.234), and PG (r=0.427). These data suggest that IRI has an effect on BPs and SGPT. The effect of IRI on BPs relates with PG but does not relate with serum lipid. The effect of IRI on SGPT relates with TG but not with PG.

Serum urate as a free radical scavenger in diabetics

Abstract: We have looked at the relationship between serum urate and the molar equivalent serum antioxidant capacity (MESA) in diabetic and normal individuals who attended St Bartholomew's Hospital diabetic clinic and BUPA Health Screening Centre, London, and have compared serum antioxidant capacity between the two groups. Sample response curves showed less serum antioxidant potential in diabetics than in nondiabetics, and a linear relationship between serum urate and MESA. Simple regression analysis gave a correlation coefficient of 0.9 (p<0.0001). Significant differences between the two groups were found for both mean MESA values (p<0.0001) and mean uric acid levels (p<0.005).

The empirical object of medical informatics

Abstract: Medical informatics is the science of information processing and the creation of information processing systems in medicine and health care delivery. Its methodological approach is based on the area specific applicability of a multidisciplinary theory of engineering and managing computerized information systems related to its empirical object. This paper gives a systemic view of the health care system, representing the empirical object of medical informatics.

Dynamical monitoring network system for perinatal care

Abstract: A new type of monitoring network system for perinatal care is proposed and has been developed. The patient monitoring system and data analyzing system are connected by a local area network (LAN). The doctor can retrieve past sampled data and results of data analysis, and make a detailed analysis at the same time that the patient is being monitored. The mainframe of the hospital information system (HIS) is connected with a data server in the perinatal care area via LAN. The database in perinatal care is supplied to the HIS and the doctor through this monitoring network system. If data sampled at maternity clinics or hospitals are once transmitted to the data server on LAN via the public telephone circuit, these data are available for the specialists on LAN. This function is utilized for supporting the obstetricians.

Hepatocellular carcinoma: the diagnostic difficulties of ultrasonography and analysis of risk factors in MHTS

Abstract: Thirty-nine cases of hepatocellular carcinoma (HCC) out of 55,135 examinees were examined. The diagnostic problems of ultrasonography (US) in detecting HCC and the risk value of 10 factors in HCC were discussed. We also propose the surveillance programs for HCC in Multiphasic Health Testing and Services (MHTS). US will be performed at 3-, or 6 monthly intervals in conjunction with AFP monitoring for the examinees over 50 males and over seventy females with liver dysfunction (GOT>38 IU/ml) is recommended.

Computing outreach initiatives for medical literature services: the IAIMS approach of the American College of Obstetricians and Gynecologists

Abstract: The American College of Obstetricians and Gynecologists was founded in 1951 and continues to be the leading group of professionals providing health care for women. A private, voluntary, non-profit organization, ACOG today has a membership of over 33,000 physicians specializing in obstetric/gynecologic care. Approximately 90% of physicians in the field belong to ACOG. ACOG has four primary purposes: (1) to serve as a strong advocate for quality health care for women; (2) to maintain the highest standards of clinical practice and continuing education for its members; (3) to promote patient education and stimulate patient understanding of, and involvement in, medical care; and (4) to increase awareness among its members and the public of the changing issues facing women's health care. To fulfill its purposes, ACOG: (1) develops and sponsors continuing education programs; (2) creates standards of care and guidelines to evaluate and improve medical practice; (3) promotes access to the latest research through its publications and clinical gatherings; and (4) supports programs for improved graduate medical education in obstetrics and gynecology. Over a decade ago, ACOG realized that, in order to meet its purposes, it must plan for the increasing role of information technology in obstetrics and gynecology. In 1983, a task force planning for education programs of the College released a long-range plan for an obstetric-gynecologic information system to be put into use by 1991. Implementation of the plan began in 1984 with an electronic communications network for Executive Board members and key staff via a group conference on AMANET. Other early projects included an ACOG database on CompuServe and the addition of key ACOG publications fulltext to the CCML database on BRS Colleague. In 1985, inspired by the Matheson-Cooper report recommendations and its own long-range information plan, ACOG applied for a planning phase Integrated Academic