Showing papers in "M.D. computing : computers in medical practice in 1991"
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2,876 citations
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TL;DR: JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive.
Abstract: JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. American Association for the Advancement of Science is collaborating with JSTOR to digitize, preserve and extend access to Science.
234 citations
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TL;DR: It is concluded that CLAS has an important role in patient care at LDS Hospital and that there has been little change in the proportion of patients with findings indicating metabolic acidosis who have received appropriate care.
Abstract: A program that uses the HELP system to screen laboratory data automatically for potentially life-threatening situations has been developed, implemented, and evaluated at LDS Hospital The CLAS program uses decision logic to screen automatically laboratory data being stored to the patient database for the presence of life-threatening conditions If such a condition is detected, a message is stored in a computerized file The message is displayed the next time the HELP system is used to review the alerting patient’s laboratory data
87 citations
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49 citations
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TL;DR: It is concluded that physicians will readily enter data directly into a computing system when they are given appropriate tools, and that they consider the computer-based problem list to be a valuable improvement over its paper counterpart.
Abstract: We developed a computer-based outpatient medical record system to facilitate direct physician interaction with the clinical computing system at the Beth Israel Hospital in Boston. During the 2 years since the medical record system was installed, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners have entered 15,121 active problems and 1996 inactive problems for 3524 patients, as well as 12,651 active medications and 1894 discontinued medications for 3430 patients. Another 20,321 items were entered on health-promotion and disease-prevention screening sheets, and with the help of automatic updating by the computer, an additional 21,897 entries on screening sheets were made for 8686 patients. Clinicians wrote 10.9 +/- 12.8 (mean +/- SD) words per problem when they were working at the computer, as compared with 4.3 +/- 2.5 words per problem when they were writing in the paper medical record. We conclude that physicians will readily enter data directly into a computing system when they are given appropriate tools, and that they consider the computer-based problem list to be a valuable improvement over its paper counterpart. Use of a computer-based medical record system has obvious benefits for data management and patient care.
37 citations
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TL;DR: Clinical applications have been available to improve the use of antibiotics and increase infection control since 1983 and these applications and the essential features of the HELP system are described.
Abstract: The HELP hospital information system, now under development for more than 20 years, has become an essential part of the daily operation of LDS Hospital, a 500-bed tertiary-care facility in Salt Lake City, Utah. The overall goal of the system is to provide decision-making capabilities for medical personnel and thus improve patient care. Since 1983, clinical applications have been available to improve the use of antibiotics and increase infection control. This article describes these applications and the essential features of the HELP system.
31 citations
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27 citations
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TL;DR: Both treated groups had improved significantly more than the control group at the end of the treatment period and 2 months later, and both treated groups did not differ from each other at either time.
Abstract: We performed a randomized controlled study to evaluate computer-based cognitive behavioral therapy in 36 patients who met Research Diagnostic Criteria for major or minor depression. Patients were randomly assigned to the computer, to a therapist, or to a control group placed on a waiting list. As determined by three measures of depression (the Beck inventory, the Hamilton rating scale, and the Symptom Checklist-90-R), both treated groups had improved significantly more than the control group at the end of the treatment period and 2 months later. The treated groups did not differ from each other at either time.
17 citations
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TL;DR: In this paper, an expert system, Melanie (medical electrophoresis analysis interactive expert), was developed to analyze and interpret protein maps. But it is not suitable for the analysis of protein expression and regulation.
Abstract: We developed an expert system to analyze and interpret protein maps. This system, Melanie (medical electrophoresis analysis interactive expert), can distinguish between normal and cirrhotic liver and identify various types of cancer on the basis of protein patterns in biopsy specimens. Our findings suggest that some diseases associated with toxic compounds or modifications of the human genome can be diagnosed by expert systems that analyze protein maps. The combination of protein mapping and computer analysis could result in a clinically useful "molecular scanner". The massive amount of information analyzed and stored in such studies requires new strategies, including centralized databases and image transmission over networks. Increased understanding of protein expression and regulation will enhance the importance of the human genome project in medicine and biology.
14 citations
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TL;DR: Computer-based problem-solving exercises in immunology were developed to determine how students gather and process information, and how organized and focused their knowledge was, and whether proper knowledge links between conceptual domains existed.
Abstract: Although gathering and processing information are essential to medical problem solving, little is known about what strategies students use to gather information or how they use their cognitive skills to solve problems. We have developed computer-based problem-solving exercises in immunology to determine how students gather and process information. Graphic representations of students' search paths through different problems were developed to visualize how organized and focused their knowledge was, how well their organization related to critical concepts in immunology, where serious misconceptions (confusion or erroneous models) occurred, and whether proper knowledge links between conceptual domains existed. With rapid generation and interpretation of information on patterns and difficulties in problem solving, it should become possible to develop a specific and personal approach to each student's educational needs.
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TL;DR: The purpose of this paper is to identify the information that builders must make available to permit health care practitioners to exercise their clinical judgment in interpreting and applying the output of computing systems.
Abstract: Builders of expert systems have generally accepted the principle that computer software should not be subject to government regulation if health care practitioners can be expected to interpret and apply the systems intelligently. The purpose of this paper is to identify the information that builders must make available to permit health care practitioners to exercise their clinical judgment in interpreting and applying the output of computing systems.
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TL;DR: Analysis of the requirements for information management in the various segments of the health care delivery system indicates that the needs of the various user groups overlap, arguing that an integrated information system should be shared between groups.
Abstract: Analysis of the requirements for information management in the various segments of the health care delivery system indicates that the needs of the various user groups overlap, arguing that an integrated information system should be shared between groups. Trends in health care policy suggest that the health care database should be global in scope, not limited to one health care facility. The design of an integrated health care information system that permits local autonomy requires a new approach to systems architecture.
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IBM1
TL;DR: The classic algorithms for similarity searching and sequence alignment are described and good performance of these algorithms is critical to searching very large and growing databases.
Abstract: A large-scale effort to map and sequence the human genome is now under way. Crucial to the success of this research is a group of computer programs that analyze and compare data on molecular sequences. This article describes the classic algorithms for similarity searching and sequence alignment. Because good performance of these algorithms is critical to searching very large and growing databases, we analyze the running times of the algorithms and discuss recent improvements in this area.
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TL;DR: It is concluded that with a well-designed graphic interface, physicians without training in the use of computers can easily learn to manipulate and analyze medical images.
Abstract: We report the use of an interactive graphics-oriented workstation to explore quantitative information extracted from medical images. At the University of California at Los Angeles, a Macintosh II personal computer operates as a stand-alone system and images are imported from a central PACS (picture archiving and communication system) server through an Ethernet network. The image-analysis program contains a complete set of general-purpose tools for image manipulation and processing, as well as specific tools for clinical analysis of cardiac and vascular images obtained by various techniques. Most of these features were designed to communicate information through color-coded graphic displays. Ten novice users were given a brief introduction to the program and asked to perform eight analytic tasks. The overall success rate was 95%, and the subjects considered the program easy to use without a manual or formal training. We conclude that with a well-designed graphic interface, physicians without training in the use of computers can easily learn to manipulate and analyze medical images.
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TL;DR: A four-part format consisting of administrative data, a patient synopsis, a chronological medical record, and a detailed medical record is proposed, to make it easier to locate information in the medical record and facilitate computerization.
Abstract: Over the centuries, the medical record has become stereotyped. Reconsidering the purpose and organization of this document leads me to propose a four-part format consisting of administrative data, a patient synopsis, a chronological medical record, and a detailed medical record. The patient would be identified only in the administrative data section, leaving the rest of the record available for management, outcome, and cost studies, and protecting the patient's privacy. Adoption of this four-part format would make it easier to locate information in the medical record and would facilitate computerization. If the phraseology could be standardized, the new format would also allow easier data flow from one medical record to another and permit the construction of standardized disease profiles. Data on individual patients could then be compared with standardized profiles to identify deficiencies and redundancies in patient care.
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TL;DR: In this article, the authors report on two computer assisted learning programs, one for the prevention of relapse in former heroin users and the other for the promotion of controlled drinking in early-stage problem drinkers.
Abstract: In recent years, the psychological treatment of drug addiction has been dominated by an emphasis on learning theory and an interest in minimal and self-administered treatment. The computer provides the consummate medium for bringing these components together. This paper reports on two computer-assisted learning programs, one for the prevention of relapse in former heroin users and the other for the promotion of controlled drinking in early-stage problem drinkers. The need for this type of technology is supported by mounting evidence that drug and alcohol misusers prefer self-help to psychotherapy and that most addicts who manage to overcome their addiction do so on their own.
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TL;DR: This is a clinical data entry program that shows much hard work and a good deal of promise and strikes at the core of one of today's greatest frustrations.
Abstract: Basically, this is a clinical data entry program. Billing is added for convenience. It would be fine for a practitioner working in an institution with an existing billing department. You could certainly use it in a private office as an all-purpose workhorse, but you'd need to apply the criteria I listed in a recent article in this jouranl [1] to rate the accounts receivable section when it's complete. Dr. Bryner says he has done this and finds my criteria met by this package. The program shows much hard work and a good deal of promise. It strikes at the core of one of today's greatest frustrations. What's more, Dr. Bryner is dedicated to improving it as he goes along. The system is sold by Clintrac, Inc., 814 Main St., Yreka, CA 96097. The company is an IBM Business Partner. The current price is $14,000. It is only sold directly by the vendor, who has four employees and has sold four systems as of January 22, 1991. Extra costs are assessed for additional users ($1,500 each), specialty modules ($2,000 each), and support (12% of price per year). Updates are included in the support price. IBM is arranging to lease the system. The current version number is 2.0B.
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TL;DR: A method for assessing health care technology that models the demand on the clinician's attention exerted by patients' data (diagnostic and therapeutic) can provide a means for simultaneously reducing the cost and improving the quality of health care.
Abstract: A method for assessing health care technology that models the demand on the clinician's attention exerted by patients' data (diagnostic and therapeutic) can provide a means for simultaneously reducing the cost and improving the quality of health care. The attentional demand exerted by patients' data can be measured by the amount of uncertainty in the data. Uncertainty can be expressed mathematically by the concept of entropy in information theory.