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[Qualitative approach to the attitudes and expectations of doctors during the process of computerising primary care].

OBJECTIVE: To find the attitudes and expectations of doctors during the process of computerising primary care (PC). DESIGN: Qualitative investigation through discussion groups. PARTICIPANTS: Thirty-one doctors from the two PC regions of Gipuzkoa. METHOD: Intentional stratified sampling by regions and by experience in using a computer in the consulting-room. Five discussion groups with recording and transcription of the contents with prior authorisation and guarantee of confidentiality. Qualitative analysis of the notes and transcriptions with the help of computer back-up. Validation through sending of results to participants and discussion between the authors. RESULTS: Introducing computers into PC consulting-rooms had repercussions both on the ordering and contents of the information recorded. The effort < > was not accompanied by subsequent evaluation. Notable deficiencies in management of the computerising process were perceived. Computer use created additional symbolic effects for both patients and doctors. CONCLUSIONS: Computerising PC is a process whose repercussions on medical care are far from neutral and so require rigorous discussion and evaluation. Defining step-by-step and measurable objectives, transparency in management and the promotion of evaluative research would all favour the effective development of projects to computerise PC.

Adult↗

From mainframe to micro: decentralization of perinatal epidemiology.

To evaluate the feasibility of analyzing large perinatal datasets on smaller computers, the 1980 National Natality Survey was downloaded first to a minicomputer and then to a microcomputer. Operating system utilities were used to minimize programming and storage requirements. Accuracy was confirmed by comparing descriptive statistics with published values derived on mainframes. Based on a typical analytic problem, implementation on the microcomputer compared favorably to implementation on the minicomputer. Our results suggest that the microcomputer may be a practical alternative to the mainframe for perinatal epidemiological analysis.

Computers↗

Design and implementation of a biomedical image database (BDIM).

We developed a biomedical image database (BDIM) which proposes a standardized representation of value arrays such as images and curves, and of their associated parameters, independently of their acquisition mode to make their transmission and processing easier. It includes three kinds of interactions, oriented to the users. The network concept was kept as a constraint to incorporate the BDIM in a distributed structure and we maintained compatibility with the ACR/NEMA communication protocol. The management of arrays and their associated parameters includes two distinct bases of objects, linked together via a gateway. The first one manages arrays according to their storage mode: long term storage on optionally on-line mass storage devices, and, for consultations, partial copies of long term stored arrays on hard disk. The second one manages the associated parameters and the gateway by means of the relational DBMS ORACLE. Parameters are grouped into relations. Some of them are in agreement with groups defined by the ACR/NEMA. The other relations describe objects resulting from processed initial objects. These new objects are not described by the ACR/NEMA but they can be inserted as shadow groups of ACR/NEMA description. The relations describing the storage and their pathname constitute the gateway. ORACLE distributed tools and the two-level storage technique will allow the integration of the BDIM into a distributed structure, Queries and array (alone or in sequences) retrieval module has access to the relations via a level in which a dictionary managed by ORACLE is included. This dictionary translates ACR/NEMA objects into objects that can be handled by the DBMS.(ABSTRACT TRUNCATED AT 250 WORDS)

Database Management Systems↗

Evaluation of clinical decision aids--more to think about.

Validation and clinical testing of medical decision aids is a hot topic at present. We state a few main points which, in our opinion, have not received the attention they deserve. Our main concerns have to do with the statistical design and analysis of field evaluation studies; with long-term effects; and with the interplay between medicine and the software industry. The points represent our reaction to a recent symposium on the topic, published in this special issue. We take the opportunity to supplement the papers at hand in various ways and, where we see a risk of misconceptions or poor practice becoming cemented, try to point out the proper course.

Decision Making, Computer-Assisted↗

A model for integration and continuous development of standards for tumour documentation using relational database techniques and extensible markup language.

In oncology various international and national standards exist for different aspects of a disease. These standards, maintained by different organisations, have multiple relationships with each other. A common data dictionary like UMLS would facilitate the reorganisation of such relationships when a new version of a standard is published. While the modelling of relationships usually is restricted to types having a relevant frequency, there are often relationships which are expressed in texts like definitions or explanations. Such texts are a very important supplement for the acceptance and the safe use of coding systems, but often are neglected when implementing coding systems in computerised systems, because they are costly to implement. This paper discusses potentials when integrating various sources in a common, database based dictionary enhanced by XML (Extensible Markup Language) techniques.

Databases as Topic↗

Surfing the web and parkinson's law.

The World Wide Web accounts for much of the popular interest in the Internet and offers a rich and variegated source of medical information. It's where you'll find online attractions ranging from "The Visible Human" to collections of lawyer jokes, as well as guides to clinical materials. Here's a basic introduction to the Web, its features, and its vocabulary.

Computer Communication Networks↗

Formal classification of medical concept descriptions: graph-oriented operators.

A crucial component of a medical concept representation system is the classifier. It requires features that are not sufficiently supported by current logic based formalisms like description logics and conceptual graphs. Those features are, for instance, the representation of partitive and spatial relations and their impact on subsumption. This paper introduces graph oriented classification operators for a concept representation language with normal forms. Emphasis is on the separation of generic and partitive relations and on the mutual interdependence of subsumption and part-whole. For that purpose operators are given for formal subsumption, formal part-whole, subsumptive part-whole and part-sensitive subsumption. These operators are based on the formal structure of concept descriptions and on explicitly introduced generic and partitive relationships between their constituents.

Abstracting and Indexing↗

Gálapagos: computer-based support for evolution of a convergent medical terminology.

Current controlled medical terminologies fall short of the needs of informatics application developers. To overcome the limitations of current medical terminologies, many groups are independently enhancing existing terminologies to meet their local needs. With proper computer-based support, local enhancements can be used as evolutionary stepping stones toward a convergent medical terminology. Gálapagos is a collection of applications that can take local enhancements from multiple sites, identify conflicting design decisions, allow developers to reconcile the conflicting designs, and efficiently disseminate updates tailored specifically for compatibility with locally enhanced terminologies. This paper describes an initial proof-of-concept of the Gálapagos programs using data generated during concurrent SNOMED enhancement by Kaiser Permanente and the Mayo Clinic.

Medical Informatics Computing↗

Training residents in medical informatics.

BACKGROUND AND OBJECTIVES: A number of medical educators have called for an increased emphasis on medical informatics training, but few family practice residency programs have provided more than cursory teaching efforts in this area. This paper provides an overview of approaches to medical informatics education that have been implemented with some success by "pioneer" programs. A comprehensive review of the literature reveals many promising teaching applications of informatics tools, such as palmtop computing devices, e-mail, decision support software, and videoconferencing. However, barriers to the advancement of informatics training in residency remain, including low rates of computer ownership and use among residents, a lack of information regarding faculty computer skills, and lack of collaboration among programs teaching informatics. Based on the literature review and tempered by expert recommendations, an eight-step process for developing or refining a family medicine informatics curriculum is proposed: 1) conduct a needs assessment 2) review expert recommendations, 3) enlist faculty and local institutional support, 4) espouse a human-centered approach, 5) integrate informatics training into the larger curriculum, 6) provide easy access to computers, 7) provide practical training, and 8) measure and report educational outcomes.

Computer Literacy↗

Teaching medical informatics to biomedical engineering students: experiences over 15 years.

The Departments of Biomedical Engineering and Medical Informatics at Linköping University in Sweden were established in 1972-1973. The main purpose was to develop and offer courses in medicine, biomedical engineering and medical informatics to students in electrical engineering and computer science, for a specialization in biomedical engineering and medical informatics. The courses total about 400 hours of scheduled study in the subjects of basic cell biology, basic medicine (terminology, anatomy, physiology), biomedical engineering and medical informatics. Laboratory applications of medical computing are mainly taught in biomedical engineering courses, whereas clinical information systems, knowledge based decision support and computer science aspects are included within the medical informatics courses.

Biomedical Engineering↗

Structure characteristics of QMSOC and the relevant operators.

This article presents a further description on the background, significance, and structure characteristics of Quantitative Medicine Simulation and Operation by Computer (QMSOC). Also some basic operators were recommended for calculations of biomedical events such as estimation of substance concentrations, exploration of etiology, evaluation of biomedical effects, etc. At last some differences of QMSOC from other artificial intelligent systems in the medical field were discussed.

Computer Simulation↗

New media.

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Computer Communication Networks↗