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CD-based image archival and management on a hybrid radiology intranet.

This article describes the design and implementation of a low-cost image archival and management solution on a radiology network consisting of UNIX, IBM personal computer-compatible (IBM, Purchase, NY) and Macintosh (Apple Computer, Cupertino, CA) workstations. The picture archiving and communications system (PACS) is modular, scaleable and conforms to the Digital Imaging and Communications in Medicine (DICOM) 3.0 standard for image transfer, storage and retrieval. Image data is made available on soft-copy reporting workstations by a work-flow management scheme and on desktop computers through a World Wide Web (WWW) interface. Data archival is based on recordable compact disc (CD) technology and is automated. The project has allowed the radiology department to eliminate the use of film in magnetic resonance (MR) imaging, computed tomography (CT) and ultrasonography.

Compact Disks↗

A computer system automatic analysis of vectorcardiograms.

This computer system performs the analysis of orthogonal electrocardiograms for vectorcardiographic (VCG) display and classification. The data acquisition can be performed 'on-line' with the complete analysis in 'real-time', or off-line by processing a magnetic tape. The original computational methods for beat averaging and wave recognition are described. Some features, such as the quality of the visual display of the VCG traces, the availability of a measurement matrix allowing the quantitative analysis of the VCG and the use of a data bank for storage, retrieval and statistical studies make this system very efficient for clinical purposes, introducing the concept of 'Computer Assisted Vectorcardiography'.

Diagnosis, Computer-Assisted↗

PEPTY: a knowledge-based program for assisting medical reasoning in peptic diseases.

PEPTY is a program developed with the aim of providing a diagnostic and therapeutic assistance in managing peptic diseases. Its theoretical basis is an accurate analysis of current concepts in peptic disease diagnosis and treatment. This was done by reviewing recent literature and consulting skilled gastroenterologists. The decision tree includes three sections dealing with diagnostic, therapeutic and monitoring problems. The diagnostic section starts by evaluating clinical data from patient history and physical examination; the diagnostic hypotheses given at this level are refined and eventually confirmed by further information in the following section. Here the decision tree becomes modular in that a proper therapeutic and monitoring pathway is defined for four disease classes: gastroduodenal peptic ulcer and duodenitis, gastro-oesophageal reflux, erosive gastritis, and chronic antral gastritis. In the therapeutic section a cost-benefit analysis of possible therapeutic choices is always performed, but the final decision is made by the user. Complications, side effects and treatment efficacy are also considered and the program finally suggests the appropriate maintenance treatment. Patient data display, storage and retrieval, and explanation facilities are supplied. The system can provide a 'second opinion' in the medical practice and may be a useful learning tool for medical students.

Artificial Intelligence↗

The Wilmer Information System. A classification and retrieval system for information on diagnosis and therapy in ophthalmology.

The Wilmer Information System is a computerized medical information system used for the storage and retrieval of data pertaining to patient demographics, diagnosis, and therapy. The heart of the system is an expandable, hierarchical code based on International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes and Physicians' Current Procedural Terminology procedure codes. Customized coding sheets containing highly specific diagnosis and procedure codes have been designed for each subspecialty area in ophthalmology. Interactive database management software facilitates data entry and retrieval. The system can be used to search for patients who meet very specific criteria, or to produce cumulative visit reports and summary statistics.

Computers↗

The future of health informatics.

Whatever a future vision for health informatics entails, it must take into account the evolving nature of the field, a growing trend towards primary and preventive care and the explosive growth in global networking as exemplified by the Internet. While, historically, storage and retrieval of data has been the main target for information systems development, the need to capture knowledge itself is becoming the focus for development. In parallel, education in health informatics for tomorrow's healthcare professionals is now essential. The Asia Pacific Association for Medical Informatics (APAMI) is a regional group of the International Medical Informatics Association (IMIA). While the newest of the IMIA regional organizations, its growth and activities in the Asia Pacific region aim to advance health informatics. Its triennial conferences act as a means of promoting and monitoring the growth of our field in this region, APAMI itself is a part of the future of health informatics.

Asia↗

A framework for genetic service provision for haemophilia and other inherited bleeding disorders.

This framework document offers guidance to patients, doctors, nurses, laboratory scientists, funders and hospitals on the provision of clinical and laboratory genetic services for haemophilia. With recent advances in molecular laboratory techniques it is now possible to give the vast majority of individual patients and family members very reliable genetic information. To enable these genetic data to be used for both the optimal treatment of patients with inherited bleeding disorders and for appropriate reproductive decisions in carriers, there needs to be a clear and robust framework for systematically acquiring the necessary clinical, personal, family and laboratory information upon which decisions can be made. This document provides guidance on the range and standards of clinical and laboratory genetic services which should be offered to patients and their families. Included are arrangements for genetic counselling and testing (including consent and confidentially issues), management of early pregnancy, standards for laboratory genetic services, as well as advice on data storage, security and retrieval.

Adult↗

Use of medical information in school planning.

Student health information is essential for determining the effect of a health problem on school performance. The sharing of information that is pertinent to a child's individual needs requires judgment on the part of both physicians and school personnel. There must be mechansims for communication and a plan for storage and retrieval of data that is both accurate and accessible. There must be a mutual desire among the professionals to establish a close relationship that is responsive to the needs of the children they serve.

Child↗

Future of computerised electrocardiography.

The advent of computerised electrocardiography has been of prime importance for the storage and retrieval of data, but none of the available systems is of universal application for analysis of patterns. Future needs require hierarchical systems of increasing degrees of complexity, depending on the source of requests, and there should be appropriate provision for review by cardiologists before the final report is issued.

Computers↗

Using a CompuCyte Pathfinder to evaluate cytotechnology student diagnostic performance.

OBJECTIVE: To determine whether the Pathfinder Cytology System facilitates comparison of initial student diagnoses to rescreener diagnoses; provides a platform for collection, storage and retrieval of data on student screening performance; and generates a student screening "score." STUDY DESIGN: Using two CompuCyte Pathfinder units networked to a PC server and printer, eight cytotechnology students prescreened 1,224 gynecologic cases and entered their results into the Pathfinder database. Five staff cytotechnologists rescreened the cases and entered their diagnoses. The database containing the initial and rescreen diagnoses were transferred to a modified scoring grid that computed a screening "score" for each of the students. RESULTS: Student diagnoses matched cytotechnologist target diagnoses in 1,107 to 1,224 total cases (90.4%). Of these 1,107 cases, 996 (81.3%) were reported as "within normal limits" (negative) by both student and cytotechnologist, and 111 (9.1%) were target diagnosed as abnormal (atypical squamous cells of undetermined significance [ASCUS] or above) by both student and cytotechnologist. Of 117 remaining cases, 112 (9.2%) were considered minor discrepancies (one-step discrepancy--e.g., benign cell change-reactive vs. ASCUS--favor reactive), and 5 (0.4%) were considered significant discrepancies (two or more diagnostic categories of difference between student and cytotechnologist-within normal limits vs. low grade squamous intraepithelial lesion). The modified scoring grid developed by CompuCyte for this study was able to compute a numerical score for each student. CONCLUSION: Our preliminary assessment indicated that Pathfinder will facilitate evaluation of student performance. The system shows potential for eliminating the "paper trail" and manual dotting required for traditional student evaluation and, with the addition of a scoring program, may be standardized for use in both educational and clinical settings.

Automation↗

Poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown origin: favorable subsets of patients with unknown-primary carcinoma?

PURPOSE: The objectives of this study were to assess clinical outcomes and prognostic factors in unselected, consecutive patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA). PATIENTS AND METHODS: The 1,400 patients analyzed were referred to our unknown-primary tumor (UPT) clinic from January 1, 1987 through July 31, 1994. Clinical data from these patients were entered into a computerized data base for storage, retrieval, and analysis. Survival was measured from the time of diagnosis; survival distribution was estimated using the product-limit method. Multivariate survival analyses were performed using proportional hazards regression and by recursive partitioning. RESULTS: Nine hundred seventy-seven patients were diagnosed with unknown-primary carcinoma (UPC) and 337 of these patients had PDC or PDA. No clinical differences were identified among patients with PDC, PDA, or UPC patients with other carcinoma or adenocarcinoma subtypes. PDC patients enjoyed better survival than PDA patients. Poor cellular differentiation was not an important prognostic variable. Variables predictive of survival included lymph node metastases, sex, number of metastatic sites, histology (PDC v PDA), and age. Although chemotherapy did not appear to influence survival for the entire group of PDC or PDA patients, a subset of patients with good prognostic features experienced median survival durations of up to 40 months. CONCLUSION: The long median survival and chemotherapy responsiveness of UPC patients with PDC and PDA could not be confirmed. However, subpopulations with prolonged median survival durations could be defined, and the value of chemotherapy in this group remains to be determined. Identification and exclusion of treatable or slow-growing malignancies may account for the poor survival of the PDC and PDA patients reported in this study.

Adenocarcinoma↗

GENESRCH: a computer program for restriction fragment analysis.

We describe a program GENESRCH which has been written to enable the design of efficient restriction fragment analysis of DNA from patients with hereditary disorders. The program identifies homology of DNA sequences up to 20 base pairs in length, calculates the fragment sizes and indicates the position of enzyme restriction sites within the gene of interest. GENESRCH is written in the BASIC language and will run on any IBM-compatible PC with a parallel printer. A hard disc is recommended for efficient storage and retrieval of data. An example of the use of the program is cited.

Base Sequence↗

A patient registry for orthopedic surgery.

Identification of patient subpopulations for retrospective clinical studies, documentation of residents' clinical experience, and other administrative purposes can be difficult and time consuming. The problem of identification is exacerbated when a teaching program involves several hospitals or when the desired subpopulation is not adequately defined by standard diagnosis or procedure codes used by the institution. A useful patient registry system is reported here for the storage and retrieval of data on orthopedic patients treated by surgical residents at a major teaching hospital and its affiliates. The registry uses a simple, yet powerful encoding scheme to describe patient entries. In addition to a multidimensional encoded description based on SNOMED, the system supports the entry of free text to provide greater detail. This combination gives the patient registry both power and versatility.

Hospital Information Systems↗

Developmental anatomy of the Drosophila brain: neuroanatomy is gene expression.

On-line databases of anatomical information are being compiled for a number of genetically manipulable organisms, including the fruit fly, Drosophila melanogaster. Based on the success of the molecular databases that preceded them, they face formidable problems in data cataloguing, storage, and retrieval. The prospect for such databases, which is apparent already, is to alter permanently the approach to neuroanatomy in such species. Experience with Drosophila indicates the possibility to arbitrate controversies over and, in some cases, to redefine the borders drawn in the brain by conventional neuroanatomical methods. Two publications in this issue of Journal of Comparative Neurology by Nassif et al. and by Hartenstein et al. highlight one of the first demonstrations of a further opportunity in Drosophila. In some cases, it is already possible to suggest how individual cellular elements--neurons, tracts, and neuropil regions--might be traced from the time when they first express a precocious marker, such as the product of the fasciclin-II gene, through the metamorphic pupal stage, and into the adult. In this way, it becomes possible to identify the structures of the adult brain from the time of their first emergence in the embryo and to follow their transitional positions throughout the course of development. Critical in this process is the neuroanatomical organization of the larval brain, which contains not only the fully functional central nervous system of the larva but also the developing elements of the adult brain, because this holds the key to understanding both the cellular elements that are inherited from the embryo and the elements that are in the process of forming the adult nervous system.

Animals↗

Databases for congenital heart disease: A beginner's guide.

We discuss the reasons for collecting data on operations for congenital heart defects. Computerized databases facilitate the collection, storage, and retrieval of such data. We outline the basic criteria for selecting a suitable database to cater to the particular needs of a surgeon or a department and stress the importance of the accuracy of the data held in a database. We explain the relative advantage of simple versus complex database systems. We conclude with a summary of the steps required for a practicing congenital heart surgeon to set up and operate a simple database. Copyright 2000 by W.B. Saunders Company

Journal Article↗

Microfiche data reduction for the EEG laboratory.

A convenient, low cost microfiche system for the random access, storage and retrieval of EEG data is described. Some of the more important advantages of microfilm in an EEG laboratory are: enormous data reductions; reduced operating costs; simplified records handling; improved communications between electroencephalographers; and access to an expanding number of inexpensive publications and reference materials.

Electroencephalography↗

NCBI GEO: mining millions of expression profiles--database and tools.

The Gene Expression Omnibus (GEO) at the National Center for Biotechnology Information (NCBI) is the largest fully public repository for high-throughput molecular abundance data, primarily gene expression data. The database has a flexible and open design that allows the submission, storage and retrieval of many data types. These data include microarray-based experiments measuring the abundance of mRNA, genomic DNA and protein molecules, as well as non-array-based technologies such as serial analysis of gene expression (SAGE) and mass spectrometry proteomic technology. GEO currently holds over 30,000 submissions representing approximately half a billion individual molecular abundance measurements, for over 100 organisms. Here, we describe recent database developments that facilitate effective mining and visualization of these data. Features are provided to examine data from both experiment- and gene-centric perspectives using user-friendly Web-based interfaces accessible to those without computational or microarray-related analytical expertise. The GEO database is publicly accessible through the World Wide Web at http://www.ncbi.nlm.nih.gov/geo.

Animals↗