Showing papers in "Journal of Medical Systems in 1994"
TL;DR: A cardiological knowledge-based system based on the decision tree approach supporting the mitral valve prolapse determination and a computer tool called ROSE (computeRised prOlaps Syndrom dEtermination) based on algorithms of automatic learning are introduced.
Abstract: Computerized information systems, especially decision support systems, have become an increasingly important role in medical applications, particularly in those where important decision must be made effectively and reliably. But the possibility of using computers in medical decision making is limited by many difficulties, including the complexity of conventional computer languages, methodologies and tools. Thus a conceptual simple decision making model with the possibility of automating learning should be used. In this paper we introduce a cardiological knowledge-based system based on the decision tree approach supporting the mitral valve prolapse determination. Prolapse is defined as the displacement of a bodily part from its normal position. The term mitral valve prolaps (PMV), therefore, implies that the mitral leaflets are displaced relative to some structure, generally taken to be the mitral annulus. The implications of the PMV are the following: disturbed normal laminar blood flow, turbulence of the blood flow, injury of the chordae tendinae, the possibility of thrombus's composition, bacterial endocarditis, and finally hemodynamic changes defined as mitral insufficiency and mitral regurgitation. Uncertainty persists about how it should be diagnosed and about its clinical importance. It is our deep belief that the echocardiography enables properly trained experts armed with proper criteria to evaluate PMV almost 100%. But unfortunately, there are some problems concerned with the use of echocardiography. In that manner we have decided to start a research project aimed at finding new criteria and enabling the general practitioner to evaluate PMV using conventional methods and to select potential patients from the general population. To empower one to perform needed activities we have developed a computer tool called ROSE (computeRised prOlaps Syndrom dEtermination) based on algorithms of automatic learning. This tool supports the definition of new criteria and the selection of potential PMV-patients.
50 citations
TL;DR: The results demonstrate that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of cases from claims data with specific clinical characteristics in order to perform health care analysis and research on large populations of women with newly diagnosed and treated carcinoma of the breast.
Abstract: To develop and optimize algorithms for the identification of newly diagnosed and treated cases of women with carcinoma of the breast, an analysis was performed of cases identified from the claims database of a large health maintenance organization (U.S. Healthcare). An initial algorithm was developed from the patterns of claims which suggested common clinical presentations of carcinoma of the breast, and the positive predictive value was 88% (411/469). To attempt to improve upon the positive predictive value, multiple modifications of the initial algorithm were performed. The best identified modification of the initial algorithm yielded a positive predictive value of 93% (400/432) with a loss of only 3% (11/411) of the true positive cases. These results demonstrate that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of cases from claims data with specific clinical characteristics. The best algorithm identified provides a powerful and accurate tool to perform health care analysis and research on large populations of women with newly diagnosed and treated carcinoma of the breast.
47 citations
TL;DR: The incomplete understanding of drug effects at the time of marketing has led to ongoing epidemiological monitoring, and the Danish data sources probably have high validity compared with international sources, since they are population based.
Abstract: The incomplete understanding of drug effects at the time of marketing has led to ongoing epidemiological monitoring. The Danish National Health Service covers part of the expenses for most kinds of prescription drugs. The accounting system within the pharmacies is increasingly computerized. In 1992 we found that 96% of the pharmacies were computerized. The computerized accounting systems give no information about adverse drug effects, but this can be obtained from the Danish Hospital Register by cross-checking registries, and in some cases from the register of birth and the register of congenital malformation. There is a great need for new data sources in pharmacoepidemiology. In spite of some evident methodological problems, the Danish data sources probably have high validity compared with international sources, since they are population based.
46 citations
TL;DR: Policy makers would get more immediate “bang per buck” with emphasis on improving the efficiencies of hospitals with higher returns to scale than other hospitals, and a significant degree of comparability between the DEA measure and these measures often used to indicate efficiency.
Abstract: This study employs a simple cross sectional design using longitudinal data to explore the underlying factors associated with differences in hospital technical efficiency using data envelopment analysis (DEA) in the Department of Defense (DOD) sector across three service components, the Army, Air Force and Navy. The results suggest that the services do not differ significantly in hospital efficiency. Nor does hospital efficiency appear to differ over time. With respect to the efficient use of input resources, the services experienced a general decline in excessive usage of various inputs over the three years. Analysis of the returns to scale captures opportunities for planners of changing the relative mix of output to input slacks for increasing a hospital's efficiency. That is, policy makers would get more immediate "bang per buck" with emphasis on improving the efficiencies of hospitals with higher returns to scale than other hospitals. Findings also suggest a significant degree of comparability between the DEA measure and these measures often used to indicate efficiency.
41 citations
TL;DR: This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision and has tremendous potential to solve both traditional and non-traditional health care problems.
Abstract: Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher.30 The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.
37 citations
TL;DR: This paper has developed a decision model which attempts to schedule residents based on the requirements of the residency program as well as the desires of residents as to days-off, weekends, on-call nights, etc.
Abstract: When medical students finish their school they must go through a horrendous apprenticeship known as hospital residency to be able to practice medicine. During residency, they work at least 16-hr a day, 5-days a week, with 2 or 3 nights on-call. These can turn into 36-hr shifts. This means that many patients are being treated by exhausted novices, who are therefore much more likely to make mistakes. It was one such mistake, leading to the death of a New York woman, which led to serious attempts to reforming working hours of residents. In this paper, we developed a decision model which attempts to schedule residents based on the requirements of the residency program as well as the desires of residents as to days-off, weekends, on-call nights, etc.
34 citations
TL;DR: Several forms of analysis are used to evaluate the efficiency of acute care Veterans Affairs hospitals and promising indicators of efficiency are hospital size, inpatient surgeries, outpatient surgeries, and the aggregate emergency room and outpatient visits.
Abstract: Several forms of analysis are used to evaluate the efficiency of acute care Veterans Affairs hospitals. The smaller hospitals with fewer than 100 beds and hospitals not in operation a full year have been excluded. The types of analysis used are input ratio analysis and productivity analysis of three outputs consisting of surgeries, discharges and emergency and outpatient visits. Also used is data envelopment analysis (DEA) of two subsamples segmented by whether the hospital is a member or not of the Council of Teaching Hospitals. Finally, multiple regression is used to find indicators of the relative efficiencies generated by the DEA. Results show that about one half of all hospitals are relatively inefficient. Also promising indicators of efficiency are hospital size, inpatient surgeries, outpatient surgeries, and the aggregate emergency room and outpatient visits.
28 citations
TL;DR: The diagnostic system is a rule base system based on image analyses and works under the PC windows environment and consists of seven modules: I/O module, Patient/Clinic database, image processing module, classification module, rule base module and system control module.
Abstract: This paper describes a computer diagnostic system for malignant melanoma. The diagnostic system is a rule base system based on image analyses and works under the PC windows environment. It consists of seven modules: I/O module, Patient/Clinic database, image processing module, classification module, rule base module and system control module. In the system, the image analyses are automatically carried out, and database management is efficient and fast. Both final clinic results and immediate results from various modules such as measured features, feature pictures and history records of the disease lesion can be presented on screen or printed out from each corresponding module or from the I/O module. The system can also work as a doctor's office-based tool to aid dermatologists with details not perceivable by the human eye. Since the system operates on a general purpose PC, it can be made portable if the I/O module is disconnected.
16 citations
TL;DR: A mathematical model for determining the number of staff among full time and part time staff as well as overtime when patient demands are uncertain is proposed to accommodate patient needs efficiently and economically while remaining flexible in an uncertain demand environment.
Abstract: Determination of appropriate nursing staff levels to provide quality service and maintain economic efficiency is a difficult problem for health care administrators to solve. The objective of this paper then is to prevent a mathematical model for determining the number of staff among full time and part time staff as well as overtime when patient demands are uncertain. The demand level is considered as a distribution on a daily basis. The model intends to integrate an entire week as a whole so that the number of staff is found on a weekly basis. Based on this model, the nursing workforce can accommodate patient needs efficiently and economically while remaining flexible in an uncertain demand environment.
14 citations
TL;DR: The system reaches 90% accuracy with random clinical material and special validation stages have been used to determine whether a real response is present, and if so, peak V is detected.
Abstract: Automatic peak detection of auditory brainstem responses is a multistage process The main task is the detection of the pedestal peak, which is a broad peak filtered out from the auditory brainstem signal Special validation stages have been used to determine whether a real response is present, and if so, peak V is detected The system reaches 90% accuracy with random clinical material
12 citations
TL;DR: Using an established taxonomy of disease codes for alcoholism and alcohol abuse in a national inpatient database, a monthly time-series of hospitalizations was modeled and is both statistically adequate and accurate in forecasting future monthly demand for inpatient hospitalizations.
Abstract: While the proposed forecasting methodology has a well-established record in evaluating economic time-series, there is minimal, if any, use of this technique in projecting hospitalizations for specific chronic conditions. Using an established taxonomy of disease codes for alcoholism and alcohol abuse in a national inpatient database, a monthly time-series of hospitalizations was modeled. The model derived is both statistically adequate and accurate in forecasting future monthly demand for inpatient hospitalizations. This type of model specifications could be used by hospital planners and policy makers in evaluating monthly resources for specific chronic conditions.
TL;DR: Integration of space data for getting insight into the existing condition from ecological point of view is necessary and is suitable for the several years study of trends of existing water supply system condition.
Abstract: The ecological approach to the disease facilitates the understanding of the reasons for the multiplity of causal factors and the finding of those on which the preventive measures will be easily and successfully directed. That is the reason why integration of space data for getting insight into the existing condition from ecological point of view is necessary. The ecological need to sum up the work of the water research and to estimate the future water quality trends by observing the relevant parameters as influential ecological factors for the health of the population resulted in relation base VODE. Basides it integrates the data group of waters data and from the ecological standpoint is suitable for the several years study of trends of existing water supply system condition with special survey of the results of the water quality analyses in view of the recognition of the actual pollutions that are significant for the health problems of population, group and individuals. One gets informations by putting questions and than plans necessary interventions, what is the new significant contribution in the approach to the analytical and monitoring techniques, i.e., application of informatical techniques in water pollution control.
TL;DR: The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased, which is important for internal quality control/assurance programs and rate comparisons within and across institutions over time.
Abstract: A longitudinal cross sectional study of Hospital Emergency Department (HED) procedures over a nine month period was conducted. A total of 1,541 procedures were observed on 56 randomly selected 8-h work shifts. Shifts were distributed: 34% day shift; 34% evening shift; and 32% on the night shift. Observations on the evening shift were oversampled to capture an adequate number of trauma patients. Observations were distributed: 33% day shift; 39% evening shift; and 28% on the night shift. Measurements included: type of procedure; adherence to specific barrier technique, i.e., use of gloves, gowns, masks, and eye protection; and occurrence of adverse exposure. Ten types of HED procedures were documented and analyzed. Computerized tracking of study observations established periodic rates of HED health care worker (HCW) adherence to universal precautions. These data are important for internal quality control/assurance programs and rate comparisons within and across institutions over time. The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased. Conducting ongoing or periodic observational studies of this kind are important and necessary in order to gauge HED response to the epidemiologic challenges of urban society.
TL;DR: The study showed that even in a well organized maternal care service as in Sweden lacunae exist in the information system and these deficiencies could be eliminated by the use of a computerized medical record based on an essential data set.
Abstract: In our attempt to develop an “Essential Data Set” for a computer based information system to support Maternal & Child Health Care services an analysis of Swedish maternal care services was undertaken. The present study analyses the information system in the domain of maternal and child health care at the primary health center level with a view to identify areas where a computer-based medical record could effect improvements. The study showed that even in a well organized maternal care service as in Sweden lacunae exist in the information system. The paper forms, called MHV1, MHV2, MHV3 and FV1, though well designed, were incomplete in a large number of the cases. The MHV1 forms were completed in less than 45%, the MHV 2 form in 87.5% and the FV1 form in 70% of the cases. Certain elements of the data set were less likely to be completed than others. Another weak spot was the inaccessibility of the paper records during off-hours. These deficiencies could be eliminated by the use of a computerized medical record based on an essential data set.
TL;DR: In this article, pharmacist uses of computerized medical informatics are explored and it is shown that pharmacists felt more strongly than other health care practitioners that computer information systems would readily fit into their daily professional lives.
Abstract: Information is a powerful weapon against disease and has been shown to improve survival and life expectancy. 1,2 Health information dissemination through audio-visual materials and computerization has been shown effective educational devices to decrease or minimize both pathologic and sociologic concerns. 3'4 For example, in a study of 801 asthmatic patients, conventional education at quarterly visits was compared to enhanced education (four booklets on asthma management covering both regular control and procedure in acute episodes in a personalized manner. 5 Subgroup analysis showed 54% fewer hospital admissions in the enhanced-education group. Many countries such as England, Australia, Ireland, and Italy have turned to pharmacists to provide such information to patients. 6-9 Pharmacy in the United States is undergoing a movement oriented to more patient specific pharmaceutical care and faster dissemination of accurate drug information in an effort to elicit positive patient outcomes.l° Pharmacists in patient-oriented care are involved in poison control, drug abuse, health education, patient profile systems and improving rates of childhood immunizations. 11,12 Patients have been shown to benefit from these services especially in terms of improved compliance. 13 Additionally, it has been shown that pharmacist are among the most computer literate and computer receptive of the health care professionals. 14 In this study, pharmacists felt more strongly than other health care practitioners that computer information systems would readily fit into their daily professional lives. Hence, pharmacists appear to be ideal practitioners to disseminate drug and health information. In this article, pharmacist uses of computerized medical informatics are explored. Ideally this model will be implemented in an accessible but private area oriented toward patient counseling. This model, implemented under the auspices of the Nebraska Drug Information Network, is suited for the ambulatory setting but with the advent of affordable multimedia laptop computers, it will also find a place at the patient's bedside.
TL;DR: This paper deals with the factors of production, the constitutive criteria and the formal aspects of health service production in the view of medical informatics.
Abstract: Medical informatics aims to improve the process and the result of health care delivery, both in its theoretical and practical aspects through the application of formal methods and concepts of informatics and the utilization of up-to-date information and communication technology. As part of a theoretical framework this paper deals with the factors of production, the constitutive criteria and the formal aspects of health service production in the view of medical informatics.
TL;DR: Even some EISs which never pay for themselves financially can be advantageous if they sufficiently reduce the uncertainty of net income for “risk averse” hospitals.
Abstract: This manuscript integrates the utility-increasing advantages of risk reductions into well-known value-of-information justifications for executive information systems (EIS) Accordingly, even some EISs which never pay for themselves financially can be advantageous if they sufficiently reduce the uncertainty of net income for “risk averse” hospitals The manuscript demonstrates the potential importance of risk reductions in the context of a hypothetical hospital administrator charged with selecting among alternative managed care contracts, each with uncertain outcomes An administrator representing a hospital with diminishing marginal utility from income, a standard interpretation of risk-aversion, may find that an otherwise unprofitable EIS reduces income variations (risk) sufficiently to justify its purchase
TL;DR: A methodology for the enhancement of database security in a hospital environment is presented which is based on both the discretionary and the mandatory database security policies and the advantages of both approaches are combined to enhance medical database security.
Abstract: A methodology for the enhancement of database security in a hospital environment is presented in this paper which is based on both the discretionary and the mandatory database security policies. In this way the advantages of both approaches are combined to enhance medical database security. An appropriate classification of the different types of users according to their different needs and roles and a User Role Definition Hierarchy has been used. The experience obtained from the experimental implementation of the proposed methodology in a major general hospital is briefly discussed. The implementation has shown that the combined discretionary and mandatory security enforcement effectively limits the unauthorized access to the medical database, without severely restricting the capabilities of the system.
TL;DR: The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.
Abstract: The purpose of this study was to evaluate the relevance of available practice guidelines to clinical quality improvement programs. A sample of 19 guidelines was evaluated in four prominent primary care areas. Two research assistants independently coded the clinical conditions and recommended/not recommended procedures abstracted from the guidelines (Cohen's kappa .67 and .50, respectively). An average of 35.1 (±25.8) medical conditions and 48.4 (±41.5) clinical procedures were defined by the guidelines. Most conditions were defined by using ICD-9-CM, age/sex group, or therapy, but 29% of definitions included symptoms which are not coded routinely. CPT codes alone were unable to identify most procedures. AHCPR guidelines mentioned significantly more procedures (p < .001) and fewer symptoms (p < .001) per clinical condition than other guidelines. The difficulty of finding codes for conditions and procedures, the high rate of non-codable items, and the lack of recommended measures limit the applicability of published clinical practice guidelines to continuous quality improvement programs.
TL;DR: To enhance capabilities of computerized health information system, following principles must be incorporated in the designs: complete coverage, uniform collection of data across time and files, and inclusion of linking capabilities.
Abstract: Relative ease, implied accuracy, and unprecedented possibilities of computerized health care information systems, is very tempting for researchers. Attempts at determining the referral patterns for cancer screening at a large county hospital through the use of computerized administrative and clinical files, and some of the problems encountered is reported here. Only 17% of women over 18, and 16% of women over 50 who visited this hospital were referred and received screening for cervical and breast cancer, respectively. Pap testing was concentrated at clinics dealing with reproductive health, and women with higher visit frequencies had a higher referral rate. Major problems encountered were lack of uniformity in capturing information for similar variables in different files, inconsistency in capturing data elements, and partial coverage. To enhance capabilities of computerized health information system, following principles must be incorporated in the designs: complete coverage, uniform collection of data across time and files, and inclusion of linking capabilities.
TL;DR: Six years have passed since the total hospital information system of Miyazaki Medical College, nicknamed PHOENIX, began its functions for the first time, and it was revealed that the waiting period was most reduced at the hospital pharmacy.
Abstract: Six years have passed since the total hospital information system of Miyazaki Medical College, nicknamed PHOENIX, began its functions for the first time. It started with order entry systems, and has accomplished various systems, leaving one entry system unfinished; the injection order entry system which will be completed in the near future. It was revealed that the waiting period was most reduced at the hospital pharmacy. The waiting period for the visitors was also reduced. Usefulness of the PHOENIX system was greatly advanced by the function of a unique system of personal computer LAN, nicknamed PALM. This personal computer environments consisted of 200 or more Apple Macintosh computers. In this PALM environment, file servers, CD-ROM MEDLINE, clinical information databases, electronic mails (available in LAN and Internet) and sharing of printers are on service 24 hr a day.
TL;DR: A flexible random allocation program that assigns treatments to patients according to their prognostic factors in multi-institutional clinical trials based on Pocock and Simon's minimization method and Zelen's method for institution balancing is described.
Abstract: This paper describes a flexible random allocation program that assigns treatments to patients according to their prognostic factors in multi-institutional clinical trials. The source lists are available in the appendix of this paper. This program is based on Pocock and Simon's minimization method and Zelen's method for institution balancing. The numbers of institutions, treatments, and prognostic factors can be set arbitrarily. The maximum number of institutions, treatments, or prognostic factors that can be accommodated by the program is limited only by the size of the main memory. For example, an IBM-PC with a 640KB main memory can run a program of 1500 institutions, 4 treatments and 20 prognostic factors.
TL;DR: A general purpose neural network simulator system that can be used for various kinds of medical data processing such as one dimensional signal processing or two dimensional image processing.
Abstract: We developed a general purpose neural network simulator system for medical data processing. This system has a flexible network definition language. Users can define arbitrary hierarchical neural networks using the definition language to analyze medical data that contains some complex patterns. The learning algorithm used in this system is back propagation. Learning curves are displayed on multiple windows. This is a general purpose system, so it can be used for various kinds of medical data processing such as one dimensional signal processing or two dimensional image processing. The system can run on a standard UNIX workstation, which is faster and more powerful than most personal computers. The system needs an X window system/Motif Motif and C compiler. These are standard system programs already available on most UNIX workstations. The source code of the system can be retrieved from our anonymous ftp site via Internet.
TL;DR: This work presents the new additional approach to the decision-making process by so called Prerequisite Matrix as well as application of it to a BSP study of the Ideational Project Health Information System of the Public Health Institute of Split.
Abstract: Any BSP study results in information architecture and information system development priorities. However, in the decision-making process it is observed that one important factor is not included—prerequisites of performance of each individual information subsystem. This work presents the new additional approach to the decision-making process by so called Prerequisite Matrix as well as application of it to a BSP study of the Ideational Project Health Information System of the Public Health Institute of Split. As a result, we have dynamic priorities of subsystems which contribute to the optimal established information system development as a whole.
TL;DR: A visual data analysis system that can easily manage a large volume of medical imaging data and analyze sets of imaging data using general image processing methods, so that various kinds ofmedical imaging data such as ECG charts, X ray image films, and MRI images, can be processed.
Abstract: We developed a visual data analysis system that can easily manage a large volume of medical imaging data. This system can analyze sets of imaging data using general image processing methods, so that various kinds of medical imaging data such as ECG charts, X ray image films, and MRI images, can be processed. The system has a graphical user interface (GUI). A physician who is novice at the system can manipulate the imaging data intuitively by pull down menus, pop up menus and buttons within the window system. The system can run on a standard UNIX workstation which is faster and more powerful than most personal computers. The system needs an X window system/Motif and C compiler. These are standard system programs already available on most UNIX workstations. The source code of the system can be retrieved from our anonymous ftp site via Internet.
TL;DR: The design of a Microsoft Excel Program which interactively creates attractive and outstanding survival curves is described, which may be a most useful and effective tool in creating medical research papers containing survival analysis.
Abstract: This paper describes the design of a Microsoft Excel Program which interactively creates attractive and outstanding survival curves. This program enables medical researchers to easily create quality presentation graphs of survival curves and obtain high quality slides and prints, which can be inserted in papers or used directly at medical meetings. Through the use of vertical bars, this program can display the exact points where censored cases occur on survival curves, making it possible to monitor censoring patterns between groups. Furthermore, this program can also create survival curves based on the proportional hazards model for specific patterns of covariate values, given estimated regression coefficients and baseline survival function. This program may be a most useful and effective tool in creating medical research papers containing survival analysis.
TL;DR: The primary finding of this paper is that a mediated architecture is the only practical way to offer distributed knowledge and data resources to the CPR user.
Abstract: This paper has three major goals: (1) Show by demonstration (in a currently implemented CPR) that for this case, the additional information entry required by providers to acquire the information for Clinical Decision Support (CDS) and Resource Auditing (RA) comes as a side effect of patient care documentation. (2) Use simple simulation to explore the practical issues of allowing users database access to this cross-patient information for CDS and RA. (3) Relate by argument the findings in 1 and 2 to the concept of mediated information systems architectures for CDS and RA. The primary finding of this paper is that a mediated architecture is the only practical way to offer distributed knowledge and data resources to the CPR user.
TL;DR: It may be practical for the existing computer center or department of medical informatics, in charge of the computing service, to conduct statistical activities until formal organizations are established at the academic institution.
Abstract: In this paper, we discuss the organizational structure for the conduct of statistical activities at medical Colleges and Universities. Here, we have particularly focused on two significant statistical activities, i.e., statistical consultation and research. The consulting service for medical researchers consists of practical statistical analysis, instruction on computer manipulation and software, response to reviewer's comments and statistical design of prospective studies. From our various experiences, we describe the actual implementation of statistical consultations for medical researchers. It has played an important role in supporting medical research. In addition, we also outline some research, with respect to new ways of applying statistics in medical science. This paper concludes that it may be practical for the existing computer center or department of medical informatics, in charge of the computing service, to conduct statistical activities until formal organizations are established at the academic institution. To realize the conduct of statistical activities by Department of Medical Informatics, it needs a team of biostatisticians, data analysts and computer personnel.
TL;DR: A simple outpatient follow-up system was developed with a laptop personal computer to assist management of patients with hepatocellular carcinoma after hepatic resections based on a non-relational database program and the graphical user interface of Macintosh operating system.
Abstract: A simple outpatient follow-up system was developed with a laptop personal computer to assist management of patients with hepatocellular carcinoma after hepatic resections. Since it is based on a non-relational database program and the graphical user interface of Macintosh operating system, those who are not a specialist of the computer operation can use it. It is helpful to promptly recognize current status and problems of the patients, to diagnose recurrences of the disease and to prevent lost from follow-up cases. A portability of the computer also facilitates utilization of these data everywhere, such as in clinical conferences and laboratories.
TL;DR: In the future, an indication of total imparted energy should replace the use of mean glandular dose as the standard for describing radiation dose in screening mammography.
Abstract: Screening mammography has not yet become a standard procedure There are great variations in image quality and radiation dose Mean glandular dose has become the most frequently used description of radiation dose in screening mammography Because of the low energy x-ray beam required for the procedure, the use of mean glandular dose as the radiation exposure indicator may cause a misunderstanding of the dose-risk relationship and result in confusion about radiation exposure and the risk of induced neoplasm Data are presented to show that increases in both maximum glandular dose and imparted energy are greater than the increases in mean glandular dose with comparable increases in breast thickness In the future, an indication of total imparted energy should replace the use of mean glandular dose as the standard for describing radiation dose in screening mammography