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Biomedical subjects

T L Lincoln

Publications and source records attributed to T L Lincoln.

At least 19 recordsLinked to original sources
PubMed1999

Re-engineering the clinical laboratory. An overview.

This article provides an overview of processes involved in re-thinking the clinical laboratory. The author, also the Guest Editor of the issue, alludes to the work of the other authors in this issue and provides his own views on this increasingly important subject.

Humans↗
PubMed1998

Global healthcare and the flux of technology.

We begin with the inescapable observation that healthcare informatics is merely one of the many endeavors that is following a turbulent but nearly inescapable path into a digital future. Our objective in this paper is to describe as best we can the overall geography of the general path we appear to be on, to anticipate some of our future checkpoints along the way, to identify some of the roughest transitional passages, and to offer this as one guide among many to those who have volunteered to do the steering into this exciting, electronic unknown.

Delivery of Health Care↗
PubMed1996

Clinical laboratories are laboratories for re-engineering.

The concept of re-engineering rests on computer coordination of information. As a management tool, it has been tested and found to be ambiguous. At best it sharpens laboratory objectives, but at worst it fragments skills and threatens the community attitudes needed for teamwork. Experience with its most fruitful components has long been a part of laboratory management.

Biomedical Engineering↗
PubMed1995

Implementing a low-cost computer-based patient record: a controlled vocabulary reduces data base design complexity.

In order to build a computer-based patient record (CPR) system suitable for use in solo and small group practice settings it is necessary to use development methods that minimize cost. Design complexity is a major source of high cost. Reducing complexity should result in lower development, deployment and maintenance costs as well as higher reliability. We have developed a simplified relational model and have used that model, in conjunction with a controlled vocabulary, to implement a CPR that can capture and store patient examinations and other forms of clinical notes as well as laboratory and other test results. The information can be viewed in a familiar document format and it can accessed for other types of processing using standard Structured Query Language (SQL) techniques. The database, as implemented, uses inexpensive components resulting in a system that is not prohibitively expensive for solo practitioners and small groups. In addition the architecture is scaleable and can accommodate very large numbers of patients and practitioners.

Computer Systems↗
PubMed1995

A document processing architecture for electronic medical records.

An Electronic Medical Record System (EMRS) requires a deep analysis of the clinical workplace and of the character and uses of the medical record itself. Charts are a diverse and useful collection of loosely structured specialized documents, each with an orderly outline, but widely divergent and unpredictable contents--the more critical the case, the more unpredictable the details. This can be achieved by adapting an underlying information architecture that is based on document processing (rather than data processing), using the logic and conventions of text tagging, as in Mosaic, the Standard Generalized Markup Language (SGML), and HyTime.

Medical Records↗
PubMed1994

Preventing postlaminectomy adhesion. A new experimental model.

STUDY DESIGN: The efficacy of various interpositional membranes for prevention of extradural adhesion was investigated by a new animal model that quantified the biomechanical effect of scar formation. Twenty-one dogs were treated with autologous free fat graft, hyaluronic acid or no interpositional membrane after undergoing two-level laminotomy, nerve root exploration, and disk injury. An additional 11 dogs that did not undergo spine surgeries served as control animals. OBJECTIVES: Inter-animal variability in inherent propensity to form scar was first measured before any spine surgery. Twelve weeks after spine surgery, the lumbosacral spine of each dog was harvested en bloc for biomechanical testing of extradural adhesion ultimate load. Scar stiffness coefficient was also calculated. SUMMARY OF BACKGROUND DATA: Adhesion ultimate load was significantly less in the nonoperative control group when compared with the fat graft and no interpositional membrane group, but not when compared with the hyaluronic acid group. A beneficial effect of hyaluronic acid in lowering adhesion ultimate load was demonstrated, although a statistically significant difference from the fat graft and no interpositional membrane groups was not reached. No difference in scar stiffness coefficient was found between the four groups. METHODS: A new experimental model allowing objective biomechanical quantification of the effect of postoperative scar was described. Ultimate load of adhesions to both nerve roots and dura was measured. A biochemical assay that determined collagen content was also used to assess inter-animal propensity to form scar after a standardized surgical insult. Results were compared with other relevant studies. RESULTS: Findings suggest a beneficial effect of hyaluronic acid in decreasing the biomechanical strength of extradural adhesions following laminotomy, nerve root exploration, and disk injury when compared with use of fat graft or no interpositional membrane. These results support other recent investigations that study the use of hyaluronic acid treatment in a laminectomy model. The adverse consequence of intraoperative epidural bleeding was also demonstrated. CONCLUSIONS: The new experimental model described in the current study was reproducible and permitted objective quantification of the effect of postoperative adhesion rather than measuring its mere presence. A beneficial effect of hyaluronic acid treatment and a lack of such beneficial effect of free fat graft interpositional membrane was suggested. The importance of avoiding active epidural bleeding was also evident.

Adipose Tissue↗
PubMed1994

An information model for medical events.

Information gathered during the healthcare process is lost when forced into rigidly structured record-oriented databases. By contrast, content can be difficult to manipulate if stored as unstructured text. Spurred by the requirements of electronic publishing, military procurement and the Internet, new robust standards for structuring documents have been developed and deployed. These standards can provide a foundation for a document-based Electronic Medical Record System. In order to fully exploit this added flexibility, an information model is necessary to define both the direct and contextual content of documents. Once context, as well as fact, are recorded in formal structures, inferential techniques can either selectively extract knowledge and data from documents or aggregate data to create summaries so that all interested and authorized parties have a better chance of meeting their information needs from a single, permanent data source.

Humans↗
PubMed1991

Acquiring a laboratory computer system. Understanding the issues.

This article reviews the issues involved in introducing or upgrading computer automation in the clinical laboratory. The strengths and weaknesses of computers and computer systems are discussed. Information on selecting and educating the laboratory team who will use the computer and analyzing the needs of a particular laboratory is included.

Clinical Laboratory Information Systems↗
PubMed1991

Acquiring a laboratory computer system. Vendor selection and contracting.

The steps involved in acquiring a computer system, from writing the request for a proposal to signing the contract, are discussed. Guidelines for selecting a system include information on the merits of different hardware and software available for use in the laboratory.

Clinical Laboratory Information Systems↗
PubMed1991

Programming languages.

This article focuses on the strengths and shortcomings of application languages as they are used in general purpose computers, on the strategies for their use, and on how they impact laboratory and medical systems. The author describes the reason why we are where we are at the present stage of computer languages and suggests where we might expect to be in the foreseeable future.

Clinical Laboratory Information Systems↗
PubMed1990

Medical informatics: the substantive discipline behind health care computer systems.

The computer is rapidly becoming an interactive workstation for medical research and for clinical decision-making and it has become a preferred instrument for communication and documentation throughout health care. However, when the attempt is made to use the rigid conventions of information processing to impose order on the characteristically volatile and unpredictable phenomena encountered in the clinical setting, deep seated logical issues are uncovered. This challenge has generated the new field of Medical Informatics, one major goal of which is to formulate computer logics that can properly relate the idealized descriptions of disease, the rules for medical practice and the general guidelines for health care to the intricate diversities encountered in the care of individual patients. The Integrated Academic Information Management System (IAIMS) program of the National Library of Medicine provides the most ambitious environment for research in this new endeavor.

Expert Systems↗
PubMed1990

Integrated expert systems and videodisc in surgical pathology: an overview.

We present an overview of our 6-year experience in the design of expert systems for anatomic pathology. Our practical goal is to help practicing pathologists with learning, teaching, and the task of diagnosis by providing them with dynamic expert knowledge by means of a personal computer. This project could only be undertaken by first addressing a scientific goal: to characterize the problem-solving strategies that expert pathologists use in making a diagnosis and to state them in the logical terms of computer science. Our approach has been to build systems first for experimentation and then for use. The result of our work is an integrated computer-based approach that handles expert knowledge as formal relationships and morphologic images and that uses a number of logical strategies to provide multiple perspectives on diagnostic tasks. Configured as a pathologist's workstation, this approach can be expected to enhance the performance of trained general pathologists and pathologists in training. Lymph node pathology has been used as the prototype domain for this research, but care has been taken to seek a generalized authoring and inference structure that can be applied to other areas of pathology by changing the contents but not the structure itself. Excursions into various surgical pathology specialties suggest that the ways the system is constructed and exercised is fundamentally robust. Such computer-based expert systems can be expected to generate a new standard in the practice of pathology--based on the "gold standard" of classical morphology, but including the coordinated use of new methods from immunology and molecular biology in a multidisciplinary approach to diagnosis when these techniques are relevant. The benefits from this technology can be expected to be widespread with the evolution, refinement, and diffusion of these systems.

Artificial Intelligence↗
PubMed1987

Using information tools to improve hospital productivity.

Because of the new reimbursement incentives placed on healthcare institutions, the efficient and effective use of resources is being emphasized more than ever before. In this new environment, decisions must be made with skill and insight, supported by information tools that analyze and manage productivity. By integrating advanced information technology into hospitals' existing information systems, productivity can become a powerful tool to achieve and maintain a competitive advantage.

Efficiency↗