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PubMed1988

PaperChase: computerized bibliographical retrieval for the physician.

PaperChase is a computer program that permits any physician or scientist to search the National Library of Medicine's MEDLINE data base of references to the biomedical literature. Written for the clinician rather than for the search librarian, PaperChase permits the user to search the entire MEDLINE collection of over 5,000,000 references published in 4,000 biomedical journals dating back to 1966. PaperChase is now available throughout the world to anyone who has a computer terminal or personal computer, and a modem. No special training is needed for a successful search. There is no user's manual. Users can search by title word, Medical Subject Heading, author's name, journal title, year of publication, language of publication, or any combination of the above. Users can read abstracts online, and they can request that a photocopy of the full text of any article be mailed to them.

Abstracting and Indexing↗

PubMed1989

Computers for the continuing education of practicing physicians.

Computer-based medical education became practical with the wide-spread availability of personal computers and the ease of dialing in to a central computer via standard telephone lines with a modem. Continuing education credits can now be earned from the privacy and convenience of the physician's home or office via the computer. A variety of courses are available from national medical organizations, medical schools, and medical publishers. While examples can give a flavor of the type of courseware available, only hands-on use can help you decide if this style of education fits yours.

Computer-Assisted Instruction↗

PubMed1998

[Delivery with epidural analgesia (a preliminary report)].

UNLABELLED: In the last decade delivery by continuous epidural analgesia (CEA) has become a golden standard in most modem perinatal centers. The aim of this study is to find the effect of CEA on the quality of labor, mode of delivery and the condition of mother and fetus after delivery. The study is prospective and includes 15 parturients. CEA was delivered with 0.25% solution of Marcaine. RESULTS: The average age of the parthers was 23 +/- 5.05 years and their body weights 63 +/- 9.82 kg. 13 of the women were nulliparous and 2 multiparous. All were delivered vaginally normally. The average length of the first period of labor was 4 Hours (+/- 3.18 h) and of the second period 20 minutes (+/- 11.06) q which is different from data from current literature. Labor was estimated in the cases with i.v. infusion of oxytocin. Apgar scores of the newborns was 8-10 points. We can conclude that deliveries with CEA are eutocic, shorter and promote and excellent psychoemotional state of the parturients.

Adult↗

PubMed1998

Psychological interventions in general hospitals: background, current status and clinical guidelines.

PURPOSE: To promote the systematic development, interests, practice, research and clinical applications of health psychology in general hospitals in Hong Kong and the mainland of China. DATA SOURCES: The targets and aims of therapeutic work with patients in pain, cancer patients, child and adolescent patients, patients with chronic illnesses, the elderly, and patients requiring organ transplantation are highlighted. STUDY SELECTION: The psychological interventions described are experiences derived from routine clinical services carried out in the Clinical Health Psychology Unit where the authors are affiliated, and can be seen as an example of a more comprehensive psychological intervention program for physically ill patients in Hong Kong. RESULTS: Psychological interventions have intrinsic values in reducing patients' distress and sufferings. The services are also an integral part of modem day comprehensive patient care with positive effects on treatment effectiveness and eventual illness outcome. CONCLUSIONS: Physical illnesses affect a person physically as well as psychologically. Psychological care in general hospitals is cost effective and beneficial in reducing undue psychological complications precipitated by physical afflictions as well as in promoting better overall outcomes.

Chronic Disease↗

PubMed1998

Telematic system for monitoring of asthma severity in patients' homes.

Despite advances in the treatment of asthma the morbidity and mortality of this disease has increased significantly in the past several years. Recent studies have shown that monitoring of asthma severity in the patient home especially combined with patient education can reduce incidence of asthma exacerbation and subsequent hospitalization. The existing methods for home asthma monitoring are limited by four factors; they completely rely on a patient's ability to document and to evaluate test results; there is no easy way for a physician to review data in a timely manner; they use imprecise tools for evaluation of asthma severity and they don't provide clinical decision support tools. The goal of this study is to develop and to evaluate a telematic system for asthma severity monitoring which will minimize patients' efforts in performing self-testing at their homes and allow prompt reciprocal exchange of all relevant information between patients and health care providers. In our setting, patients use portable spirometer and pocket-sized palmtop computer for data exchange. Our system allows daily serial monitoring of asthma severity at patients' homes using Forced Vital Capacity test and symptom diary. The results of the tests become available for physicians review immediately after completion of self-testing procedures via Web browser. The results can be transmitted from patients' homes (or any other remote location) to the medical records database via landline or wireless networks in several minutes. Each time the remote server receives patient's results, it invokes the application which tests the validity of data, analyzes parameters trends and dispatches corresponding messages for the patient and, if necessary, for physicians. Such an approach provides constant feedback loop between asthma patient and physician. The system has been tested in 10 healthy volunteers and asthma patients. Patients participated in the study from two to 21 days. The test results showed that the system provides reliable reciprocal exchange of all relevant information between a physician and asthma patient in home settings. Average transmission time from the patient's palmtop to the remote central data repository was about 1 minute for 14.4 Kbps landline modem, 6 minutes for cellular network and 8 minutes for RAM Mobile network. After transmission, the test results were immediately available for review at our web site.

Asthma↗

PubMed1999

Remote microscopy through the internet.

A fully robotic microscope Axioplan2 (Zeiss) and CCD camera (RGB-Sony) mounted on this microscope have been connected to a computer dedicated as an Internet server. This server is available by means of an Internet browser with an interpreter of the Java programming language. We have used Java technology for remote control this full-motorized telemicroscope. The Java program for microscope control is automatically downloaded and started when the user selects the Web site of the corresponding microscope server with his Internet browser. At the client's side, there is no need for any additional software except for what is included in Netscape Navigator 3.0, Microsoft Explorer 3.0 or its later versions. Our remote microscope can be remotely controlled from any place in the world through the Internet. The user can move the microscope stage, change the magnification or can execute any other microscope operations by pressing the related buttons of the downloaded telemicroscopy client program. The microscope server receives the commands from the client program, executes the operation on the microscope and after every new command distributes the next microscope image to the connected telemicroscopy clients. There are also software modules which allow marking a field of interest in the image and discuss. Every Internet user can control the remote microscope and discuss the images with others who have direct access to the Internet on-line, or are connected by modem or ISDN. The quality of the transferred microscopic images and response time is sufficient for practical use. No complicated installation processes are necessary and the system is easy to use. The system design makes every pathologist, who is the Internet user, to be a possible consultant.

Internet↗

PubMed1999

Data compression methods for EEG.

Modem brain research experiments require the recording of large amounts of high-accuracy EEG data. Sampling frequency, bit resolution and number of channels are significantly larger than in routine clinical measurements. Because of this, the need of efficient signal compression has emerged. This paper presents a survey of available methods and explores some techniques, both lossy and lossless, for compressing EEG signals.

Algorithms↗

PubMed1999

Telepathology in neurosurgery.

In most tumor cases of neurosurgery, we need to have a rapid section diagnostic of the tumor during the course of surgery. When we have received the results that diagnose the exact dignity of the tumor, we devise the operation strategy for the continuing course of surgery. The tissue sample is sent by taxi to the pathological institute in Heidelberg. It takes approximately 45-60 min until we receive the results by telephone. Many centers are far away from a pathological institute and the patient may need to be re-operated on there. In stereotaxy it is still more important. We need approximately 15-25 specimens during a stereotaxy, so we can be sure we have a sample with some of the tumor tissue present. With direct contact to a pathological institute we could reduce this dramatically. We prepared a methylen blue slide and used a histological microscope with a video camera attached to it and a digitizer interface for digitized pictures. By use of a modem we send the pictures by telephone line to the pathological institute, where they are assessed. We currently have direct contact with a pathologist so they can tell us from which part of the tumor we should send the other histological pictures. The procedure takes about twenty minutes. By using this procedure the distance to the pathological institute is irrelevant. The system costs approximately $10,000, covering the cost mostly of the microscope and the camera (but we already had the microscope) and can be built by anybody with minimal requirements.

Brain Diseases↗

PubMed1999

An intelligent, interactive platform for ophthalmic teaching, telemedicine, and telecollaboration: design considerations and prototype construction.

The development of technologies permitting processing, compression, and transmission of digital images and image sequences enables powerful methodologies for local and remote medical teleconsultation. We are developing a slit-lamp-based ophthalmic augmented reality (image overlay) environment incorporating features to permit real-time, interactive teaching, telemedicine, and telecollaboration. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of anterior segment and retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously stored retinal photographic and angiographic images onto the real-time fundus image. Our algorithms facilitate shared control of pointing, drawing, and measuring functions registered with the retinal image video stream and direct audio communication between an examiner (student, generalist) and remote observer (instructor, specialist). Bandwidth and video compression considerations limit the frame rate and latency for video stream transmission. Excellent and acceptable performance are demonstrated in model eyes over a local area network and through a modem connection, respectively. These studies represent the first investigations towards the design and implementation of an intelligent platform for ophthalmic telemedicine and telecollaboration.

Algorithms↗

PubMed1999

BRAVO/TeleTrend: a comprehensive WWW-based neuromonitoring system for the neurosurgery ICU.

This paper describes BRAVO/TeleTrend--a comprehensive client/server-based system for remote access, review and analyses of continuously acquired multiparametric physiological data from Intensive Care unit (ICU) patients. The system is designed as a distributed three tier model and implemented in Java (Sun Microsystems). TeleTrend is a data review package, which interfaces to existing physiological bedside monitors such as the BRAVO suite of products (Nicolet Biomedical, Madison, WI) and the vital signs monitors compatible with the Unity Network (Marquette Electronics, Milwaukee, WI). It does not transfer over the web the entire patient record, which can be hundreds of megabytes. Instead, it provides tools to view a compressed representation of the raw data in a trend display and to zoom into the raw data if needed. Thus, it eliminates the need for a high-bandwidth Internet connection and makes possible the use of a slower modem access to the vast amount of physiological data acquired per patient. In addition, TeleTrend features a rule-based module capable of generating clinical alerts, which is a potentially useful tool for neurointensivists and other critical care personnel. Finally, TeleTrend is intended as a multi-user, semi real-time telemedical application, which features built-in white-board and chat components. These components allow several physicians at different locations around the world to simultaneously view and brainstorm over critical chunks of continuously recorded raw and trend data. By allowing the end-user user to switch on-the-fly from monitoring patients in one ICU to those in another, and by integrating an HL7 interface TeleTrend steps over the boundaries of a single ICU. Thus, it can be provide a medical enterprise-wide solution to the remote access of an important component of the electronic patient medical record. Currently in house validation, verification and alpha testing of the system are underway.

Electroencephalography↗

PubMed1999

Medcast: evaluation of an intelligent pull technology to support the information needs of physicians.

This study reports the initial results of an evaluation of Medcast, a commercial medical information service that uses intelligent pull technology to deliver medical information to practicing physicians. Medical news, CME, and other information are transferred by modem nightly to the physician's computers where this information can be accessed at a convenient time. A survey was faxed to 195 subscribers to the system. A total of 73 (39%) responded. The results indicate that prior to implementation of the Medcast system, almost 40 percent of the respondents did not use their computers for professional activities because of time constraints, costs and computer literacy problems. After implementation of Medcast, almost 70 percent of the respondents used the system two or more hours per week. Ninety percent of the respondents felt that use of the system has enhanced their practice. These findings have important implications for future efforts to implement medical informatics applications to support the information needs of practicing physicians. Experience with intelligent pull technology that is relatively easy to use may be a good way to break down attitudes and barriers to the use of computer systems to support clinical practice and may prepare physicians for a wider use of the Internet to support their future information needs.

Alabama↗

PubMed1999

Phage therapy: past history and future prospects.

Bacterial viruses (bacteriophages, also called "phages") can be robust antibacterial agents in vitro. However, their use as therapeutic agents, during a number of trials from the 1920s to the 1950s, was greatly handicapped by a number of factors. In part, there were certain limitations inherent in phage physiology (e. g. narrow host range, and rapid clearance from the body); in part there were technological limitations in the era (e.g. lysogeny not yet discovered); but the greatest limitation was the highly inadequate scientific methodologies used by practitioners at the time (e.g., their failure to conduct placebo-controlled studies, to remove endotoxins from the preparations, and to re-confirm phage viability after adding sterilizing agents to the preparations). In recent years, well-controlled animal models have demonstrated that phages can rescue animals from a variety of fatal infections, while non-controlled clinical reports published in Eastern Europe have shown that phages can be effective in treating drug-resistant infections in humans. This encouraging data, combined with the fact that drug-resistant bacteria have become a global crisis, have created a window of opportunity for phage therapy to be tested anew, this time using modem technologies and placebo-controlled designs. If successful, it can be used as a stand-alone therapy when bacteria are fully resistant to antibiotics, and as a valuable adjunct to antibiotics when the bacteria are still susceptible.

Administration, Oral↗

PubMed1999

[YAG laser capsulotomy in secondary cataract].

UNLABELLED: The purpose of the study is to evaluate the modern possibilities of performed by laser YAG in secondary cataract. MATERIAL AND METHOD: We performed a study on 200 eyes with secondary cataract operated in the University Eye Hospital from Cluj-Napoca during 1991-1997. RESULTS: We had 95 male and 105 female, with age between 30-90 years old. The capsular fibrosis was present in 86% of the cases. Secondary cataract was present in 13.33% of the cases with PC-IOL. Functional results showed a visual acuity between 0.7-1 in cases from the 50 cases review after 1 week after YAG Laser. CONCLUSIONS: 1. Secondary cataract is the most frequent complications of PC-IOL which influence the visual acuity. 2. YAG laser capsulotomy is a modem, efficient and non-invasive method to solve the secondary cataract.

Adult↗

PubMed2000

Java-based remote viewing and processing of nuclear medicine images: toward "the imaging department without walls".

UNLABELLED: In nuclear medicine practice, images often need to be reviewed and reports prepared from locations outside the department, usually in the form of hard copy. Although hard-copy images are simple and portable, they do not offer electronic data search and image manipulation capabilities. On the other hand, picture archiving and communication systems or dedicated workstations cannot be easily deployed at numerous locations. To solve this problem, we propose a Java-based remote viewing station (JaRViS) for the reading and reporting of nuclear medicine images using Internet browser technology. METHODS: JaRViS interfaces to the clinical patient database of a nuclear medicine workstation. All JaRViS software resides on a nuclear medicine department server. The contents of the clinical database can be searched by a browser interface after providing a password. Compressed images with the Java applet and color lookup tables are downloaded on the client side. This paradigm does not require nuclear medicine software to reside on remote computers, which simplifies support and deployment of such a system. To enable versatile reporting of the images, color tables and thresholds can be interactively manipulated and images can be displayed in a variety of layouts. Image filtering, frame grouping (adding frames), and movie display are available. Tomographic mode displays are supported, including gated SPECT. RESULTS: The time to display 14 lung perfusion images in 128 x 128 matrix together with the Java applet and color lookup tables over a V.90 modem is <1 min. SPECT and PET slice reorientation is interactive (<1 s). JaRViS could run on a Windows 95/98/NT or a Macintosh platform with Netscape Communicator or Microsoft Intemet Explorer. The performance of Java code for bilinear interpolation, cine display, and filtering approaches that of a standard imaging workstation. CONCLUSION: It is feasible to set up a remote nuclear medicine viewing station using Java and an Internet or intranet browser. Images can be made easily and cost-effectively available to referring physicians and ambulatory clinics within and outside of the hospital, providing a convenient alternative to film media. We also find this system useful in home reporting of emergency procedures such as lung ventilation-perfusion scans or dynamic studies.

Humans↗

PubMed1999

[The hysteroscopic diagnosis of endometrial carcinoma].

Panoramic hysteroscopy as a testing method was introduced into the Department of Obstetrics and Gynaecology at the Medical University--Plovdiv in 1995. For four years the authors have performed 308 panoramic hysteroscopies. With 19 of these cases (6.17%) the diagnosis cancer of the endometrium has been confirmed histologically, too. Using the advantages of this method within the complex of modem screening testing methods for early diagnosing of this kind of cancer, the authors have described its typical hysteroscopic image.

Carcinoma↗

PubMed1999

Are dermatologists in private practice interested in teledermatological services?

Diagnosing dermatologic skin conditions can be difficult, especially in pigmented skin lesions. Therefore, the consultation of an expert via teledermatology could prove vital. For this purpose, a rapid transfer of medical data including high resolution images is essential. This transfer can be performed with a variety of modern telecommunication technologies, including ISDN, highspeed-ISDN, Internet, and Intranet. As the levels of both communication software and camera-systems can be quite different, our survey investigated the equipment of 84 dermatologists in private practice. A questionnaire was distributed on computer equipment, operating system software, and any image documentation systems used, as well as required telecommunications equipment and possible applications of tele-dermatology. This survey showed a response rate of 54% and proves that dermatologists in private practice are interested in telemedicine services. Most dermatologists surveyed use Windows 95 operating software and 74% have access to modern ISDN modems or PC-cards. Dermatologists currently prefer applications with low-tech communication hardware and software requirements. Consultation of dermatological centers was the favored application with 59%. Our survey clearly demonstrates that a high percentage of dermatologists in private practice would use tele-dermatology. In our experience, for the excellence of this service an image documentation system is essential to provide the tele-dermatological expert with standardized images with constant illumination.

Dermatology↗

PubMed1999

Multimedia and children in Turkey.

Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available.

Child↗

PubMed2000

eMedicine Otolaryngology: an online textbook for ENT specialists.

A new online publishing effort, eMedicine Otolaryngology-Facial Plastic Surgery (FPS), is a comprehensive textbook now being developed on the Internet (www.emedicine.com). This book is one of a series of 15 electronic textbooks written by a worldwide panel of authors and editors, and it is distributed free of charge to anyone with a computer and a modem. Advantages of online textbooks such as eMedicine Otolaryngology-FPS are that they provide readers with easy accessibility to reliable, up-to-date information, and they allow authors to quickly edit and revise editorial content and supplement traditional text with sound, graphics, and video. An ambitious undertaking, eMedicine Otolaryngology-FPS represents a significant advance in the way medical information is written, edited, and distributed. Although it is unlikely that electronic textbooks will replace traditional textbooks any time soon, these types of publishing efforts will continue to proliferate.

Humans↗