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Professional DOC (PDOC): a software environment for authoring and consulting of electronic documentation. INTERACTIVE DIAGNOSIS and THERAPY: a medical application.

Professional DOC (PDOC) is a software environment for electronic documentation authoring and consulting based on the Hypermedia technology. It allows to manage different kinds of information (pictures, sounds, texts, graphics, video) organized according to hyperstructures. The user-friendliness and effectiveness of its man-machine interface, and its availability on the most common hardware platforms makes it a suitable product for a very broad category of users. INTERACTIVE DIAGNOSIS AND THERAPY is an electronic medical book designed to help general practitioners to make diagnosis and treat patients in their daily clinic practice.

Diagnosis, Computer-Assisted

SCUT: clinical data organization for physicians using pen computers.

The role of computers in assisting physicians with patient care is rapidly advancing. One of the significant obstacles to efficient use of computers in patient care has been the unavailability of reasonably configured portable computers. Lightweight portable computers are becoming more attractive as physician data-management devices, but still pose a significant problem with bedside use. The advent of computers designed to accept input from a pen and having no keyboard present a usable computer platform to enable physicians to perform clinical computing at the bedside. This paper describes a prototype system to maintain an electronic "scut" sheet. SCUT makes use of pen-input and background rule checking to enhance patient care. GO Corporation's PenPoint Operating System is used to implement the SCUT project.

Handwriting

Development of the cardiovascular system: an interactive video computer program.

The major aim of this project is to provide interactive video computer based courseware that can be used by the medical student and others to supplement his or her learning of this very important aspect of basic biomedical education. Embryology is a science that depends on the ability of the student to visualize dynamic changes in structure which occur in four dimensions--X, Y, Z, and time. Traditional didactic methods, including lectures employing photographic slides and laboratories employing histological sections, are limited to two dimensions--X and Y. The third spatial dimension and the dimension of time cannot be readily illustrated using these methods. Computer based learning, particularly when used in conjunction with interactive video, can be used effectively to illustrate developmental processes in all four dimensions. This methodology can also be used to foster the critical skills of independent learning and problem solving.

Cardiology

SCOUT: information retrieval from full-text medical literature.

SCOUT is an expert system designed to aid the practicing physician in searching a full-text database of biomedical literature for information in the domain of oncology. In the clinical setting, an information-retrieval system needs to provide only a few relevant documents that address a patient-specific query. SCOUT models the expertise of an oncologist and an information specialist in a probabilistic inference system; it applies expert heuristics both in selecting the best source of information for a particular question and in developing an effective, source-specific search statement that retrieves only a minimal number of pertinent documents.

Expert Systems

High-performance computing, high-speed networks, and configurable computing environments: progress toward fully distributed computing.

The next several years will see the maturing of a collection of technologies that will enable fully and transparently distributed computing environments. Networks will be used to configure independent computing, storage, and I/O elements into "virtual systems" that are optimal for solving a particular problem. This environment will make the most powerful computing systems those that are logically assembled from network-based components and will also make those systems available to a widespread audience. Anticipating that the necessary technology and communications infrastructure will be available in the next 3 to 5 years, we are developing and demonstrating prototype applications that test and exercise the currently available elements of this configurable environment. The Lawrence Berkeley Laboratory (LBL) Information and Computing Sciences and Research Medicine Divisions have collaborated with the Pittsburgh Supercomputer Center to demonstrate one distributed application that illuminates the issues and potential of using networks to configure virtual systems. This application allows the interactive visualization of large three-dimensional (3D) scalar fields (voxel data sets) by using a network-based configuration of heterogeneous supercomputers and workstations. The specific test case is visualization of 3D magnetic resonance imaging (MRI) data. The virtual system architecture consists of a Connection Machine-2 (CM-2) that performs surface reconstruction from the voxel data, a Cray Y-MP that renders the resulting geometric data into an image, and a workstation that provides the display of the image and the user interface for specifying the parameters for the geometry generation and 3D viewing. These three elements are configured into a virtual system by using several different network technologies. This paper reviews the current status of the software, hardware, and communications technologies that are needed to enable this configurable environment. These interdependent technologies include: (1) user interface and application program construction methodologies, (2) the interprocess communication (IPC) mechanisms used to connect the software modules of the application, (3) the network protocols and interface hardware used by the IPC for communicating between modules running on separate and independent computing system elements, (4) the telecommunications infrastructure that provides the low-level data transfer functions for the networks that connect the geographically distributed elements used by the application, and (5) the nature of the functional elements that will be connected to form virtual systems.

Computer Communication Networks

Visualization of bioelectric phenomena.

Biomedical investigators are currently able to acquire and analyze physiological and anatomical data from three-dimensional structures in the body. Often, multiple kinds of data can be recorded simultaneously. The usefulness of this information, either for exploratory viewing or for presentation to others, is limited by the lack of techniques to display it in intuitive, accessible formats. Unfortunately, the complexity of scientific visualization techniques and the inflexibility of commercial packages deter investigators from using sophisticated visualization methods that could provide them added insight into the mechanisms of the phenomena under study. Also, the sheer volume of such data is a problem. High-performance computing resources are often required for storage and processing, in addition to visualization. This chapter describes a novel, language-based interface that allows scientists with basic programming skills to classify and render multivariate volumetric data with a modest investment in software training. The interface facilitates data exploration by enabling experimentation with various algorithms to compute opacity and color from volumetric data. The value of the system is demonstrated using data from cardiac mapping studies, in which multiple electrodes are placed in an on the heart to measure the cardiac electrical activity intrinsic to the heart and its response to external stimulation.

Algorithms

High-performance computing in radiation cancer treatment.

In 1989 a consortium of the Radiation Oncology and Computer Science Departments at the University of North Carolina, BellSouth Corporation, GTE, and the MCNC was formed in response to the high-speed network initiative proposed by the National Science Foundation and the Defense Advanced Research Projects Agency. One of the purposes of this effort has been to demonstrate that applications exist that require gigabit per second networks. Our consortium, known as VISTAnet, proposed to use real-time radiation therapy treatment planning as the application that would require the use of a gigabit network. The plan was to develop a system that could rapidly calculate and display a three-dimensional radiation dose distribution for any configuration of radiation beams. The gigabit network would be used to tie the dose calculations done with the Cray Y-MP at the Research Triangle to the graphics engine at the Department of Computer Science (Pixel-Planes 5) and the medical workstation at Radiation Oncology. The system would then provide the radiation physician with the capability of considering hundreds of potential treatment plans, instead of the usual two or three, with the goal of arriving at a highly optimized plan within a few minutes.

Computer Communication Networks

Statistical packages for the Macintosh.

These programs represent the entry of the Mac into major statistical computing. We believe that for the physician researcher who is not a statistician, they make the Mac the platform for data analysis. We found that statistics, research design, and data analysis seemed different and much less intimidating to us and our trainees when approached through the Mac. We have reviewed the versions of these programs available at the time of this writing, in May 1992; potential buyers should contact the software publisher for information about more recent upgrades. At this point, our recommendations would be as follows: If you are wedded to SPSS or Minitab, try the Mac versions, and you will be impressed. Otherwise, the choice is between SYSTAT, which has been around long enough to demonstrate its richness and capacity to build on its strengths, and JMP, a brash newcomer, which demonstrates that you can teach an old dog (SAS) new tricks. StatView and SuperANOVA, while endowed with intuitive, easy-to-use interfaces, lack online help--a feature we consider important in a statistics package. We anticipate that the future will lead to simplification of the SYSTAT interface and the addition of more analytic capacities to JMP--and who knows what the next generation of competitors will bring?

Computer Systems

User interactions with the PDQ cancer information system.

Searches by end users and intermediaries on the online PDQ (Physician Data Query) cancer information system were observed. With the National Library of Medicine (NLM) menu-based interface, end users (physicians) averaged fewer steps per question, while with the BRS command-drive interface, intermediaries appeared to be more efficient. Cancer Information Service (CIS) searchers, who have more PDQ experience than end users or intermediaries, made greater use of command stacking to anticipate menu selections. Retrieval was more complete in the NLM system, where both the menus and predefined print formats assisted the searchers.

Databases, Factual

Analysis of the microstructure of the rhythmic tongue movements of rats ingesting maltose and sucrose solutions.

The interlick interval distribution of rats while ingesting maltose under real and sham feeding conditions and while ingesting seven concentrations of sucrose under real feeding conditions was analyzed. The analysis revealed that the licking behavior of rats is organized into bursts of licking at a high rate. These bursts occurred in clusters that were separated by brief (250-500 ms) interruptions. The clusters were separated by intervals that ranged from 500 ms to many hundreds of seconds. Sham feeding increased the length of the meal by increasing the number but not the size of the clusters. Increasing the concentration of sucrose increased monotonically the size of the clusters but varied the number of clusters as an inverted-V-shaped function. This analysis revealed the details of the central nervous system's control over ingestive behavior.

Animals

Closed-loop control of SaO2 in the neonate.

A microprocessor-based device has been designed to control oxygen saturation (SaO2) in neonates by adjusting the inspired air-oxygen mixture (FiO2) delivered by a mechanical blender. The user sets a target SaO2, which the controller attempts to maintain. Alarms are actuated if the neonate's SaO2 is outside predefined limits. SaO2 levels are extracted from a commercial pulse oximeter and analyzed by an eight-bit microprocessing unit (MPU). Delivered percentages of FiO2 are adjusted by a motorized air-oxygen blender. The controller has a menu-driven user interface and can graphically present four-hour trends of the SaO2, FiO2, or blender setting. Sixteen hours of collected data can be stored and later downloaded to a personal computer. A real-time multitasking operating system forms the nucleus of the controller's software. Major tasks that share MPU time are control, filtering, user display, data collection, data archiving, alarm monitoring, and user input. Analog SaO2 levels are read and converted to digital values, which are then filtered to extract noise. A differential control algorithm is used to determine the required FiO2 blender setting. The blender is then adjusted to the new setting, after which the controller waits to repeat the process of sampling SaO2 and adjusting FiO2. System response time and blender increments are adjustable to allow a user to tune the controller to the patient's needs. Alarm conditions of concern within the device are SaO2 and FiO2 sensor disconnection, blender disconnection, and SaO2 limiting errors. In preliminary trials, for a target of 92.0% SaO2, a prototype controller maintained an average of 91.6% with a standard deviation of 5.0% over a one-hour period.(ABSTRACT TRUNCATED AT 250 WORDS)

Analog-Digital Conversion

Rapid prototyping of interactive software for automated instrumentation in rehabilitative therapy.

Rapid prototyping is a quick, efficient way to evaluate new electrical instruments. A hardware interface between a computer and an instrument can be simulated in software. The authors demonstrate the technique of rapid prototyping by developing interfaces for two therapeutic strength-testing devices and an electromagnetic tracker/digitizer. The LabVIEW rapid prototyping software tool was used to create "virtual instruments," which combine to form interfaces. The functions and connections of each virtual instrument are described.

Equipment Design

Literature databases for radiologists.

There are two new computerized radiology literature databases available for those practitioners who require a more sophisticated retrieval system than the Index to Imaging Literature published annually by Radiology. The installation and use of these two products, the floppy disk based PC MASS and the CD-ROM based SilverPlatter Radiology are discussed. The advantages and disadvantages of both desktop programs are compared with the Index and to the telecommunication access of large general medical databases such as MEDLINE.

CD-ROM

Impact of end-user search training on pharmacy students: a four-year follow-up study.

The Alfred Taubman Medical Library at the University of Michigan has offered instruction in online literature searching to third-year pharmacy students as a component of the course "Drug Information and Scientific Literature Evaluation" since 1983. In the spring of 1989, a follow-up study was conducted to assess the impact of instruction on four classes of graduates. Of a pool of 151 graduates, 90 (60%) responded to a mailed questionnaire on their use of information and computerized literature searching. The respondents were divided into four subgroups: end-user searchers, users of intermediaries, end users who used intermediaries, and those who did not use computerized literature search systems. Seventy-two percent of the respondents used some type of computerized literature searching, and 42% performed their own searches. The four subgroups differed in general computer use, familiarity with MEDLINE search terminology, information use, reasons for using or not using literature searching, and characteristics of searches (i.e., type, time frame, amount, and frequency). Training in end-user search systems appears to have had an impact on the continued use of computerized literature searching several years after the formal educational program.

Computer User Training