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A prospective documentation of patients data on an internal and a surgical intensive care unit (ICU) has been transacted. The physician and nursing staff used an online electronic documentation program, which has been developed in Frankfurt. Main emphasis has been placed on the epidemiological data, clinical diagnoses as well as diagnostically and therapy costs. The medical ICU of university hospital of Frankfurt has been analysed since 1992 and the surgical ICU of Städtisches Krankenhaus of Lüneburg since 1994. Up to now data from 2001 patients from Frankfurt are available. Period spent on the ICU was 4.7 +/- 0.16 days (average +/- SEM), mortality was 15%. 47% of the whole group suffered from cardiac disease, of which 211 had an acute myocardial infarction (10.6%), 156 patients a serious ventricular arrhythmia (7.8%) as well as 88 patients an unstable angina (4.4%). Long-term observation revealed a rise of the duration spent on the ICU (from 4.1 +/- 0.17 to 5.5 +/- 0.38 days, P < 0.0002), an increasing number of technical examinations (for example: chest x-ray from 2.25 +/- 0.13 to 4.52 +/- 0.4/patient, P < 0.0001) and a steady mortality between 1992 and 1994. Detailed analysis of patients with acute myocardial infarction showed an impressive reduction of total mortality within the 3 years observed. In Lüneburg data of 1004 patients have been recorded so far. The average time spent on the ICU was 6.4 +/- 0.33 days. 4.1% patients passed away. Neoplasia of gastric intestinal tract (143; 14.2%), femoral neck fracture (64; 6.4%) and ilei (54; 5.4%) have been the most frequent diagnoses. Patients underwent 2.2 +/- 0.12 chest x-rays and 1.4 +/- 0.1 ultrasound investigations. The study shows that an online data processing is practicable and can be integrated in the daily work flow. Furthermore, it can be seen that the collected data play an important role to secure the increasing administrative requisition to the modern medicine in view of costs and quality management.
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Successful settlement of disabled persons in gainful employment is closely contingent on both their training and the working environment present. For those disabled persons who cannot find jobs in the open market, it is possible to work in sheltered workshops. Founded on the initiative of parents of spastic children, the Saarbrücken Reha GmbH, a limited liability company for the sheltered employment of disabled persons, has for several years been employing disabled people in the field of text and data processing. This paper not only outlines some practical examples to illustrate suitable systems but also describes the types of tasks where good results can be achieved by the disabled employees.
The development, present status and future trends in the use of computers in urology in the Federal Republic of Germany are reviewed. The hardware, software required for hospital and private practice and the staff needed are discussed. Proposals are given for the installation and stepwise upgrading of computer systems, from simple text processing units to complex hospital communication systems. Finally new technologies that might considerably change the use of computers in urology are presented.
Several possible procedures are discussed for computerizing clinical research and evaluated with regard to available performance and installation effort, the ratio of which is seen to determine efficiency. Furthermore, a short discussion is dedicated to the interface between clinicians and software experts, an issue of central importance in the achievement of satisfactory solutions.
Data management in hospitals used to be the data management of the hospital-management in the last 15 years, not however the data management the doctors performed. The acceptance for electronic means slowly rising more software is used in the clinics today but still by the doctors privately. Software specialists have registered the growing market available for their products. That is why the danger to accept even unusuable software rises every day, as unexperienced software-beginners as doctors mostly are often relied on offers without being told about their dignity and usefulness.
A computer programme for the digitalis therapy developed by us was tested in 282 patients with heart insufficiency. It helps to control the course of the therapy, to establish the optimum fully effective dose of the individually determined glycoside sensitivity and to decrease significantly the danger of an overdosage.
Several possible procedures were discussed for computerizing clinical research and basic documentation. All approaches were evaluated with regard to available performance and installation effort. Additionally examples for personal computer aided data collection in the field of perinatology, oncology, endocrinology and expert systems were presented.
We report on the development of a data collection form for anaesthesia. The difference between this form and the previously published recommendations is that it does not require any coding of data prior to collection. The anaesthetist completing the form needs no knowledge of data processing. Qualitative data have only to be marked, while quantitative data must be entered as such. So far, more than 90,000 anaesthesias have been collected with the form presented, therefore usefulness may be assumed.
UNLABELLED: Increasing performance figures and the necessity to save expenses oblige transfusion services to automatize their donors' laboratory examination. Sufficient hard- and software for sample distribution and processing is now available. Following aspects should be regarded when switching to automatic serial screening: SAFETY: The identity of blood-donor, donation and laboratory result will be achieved by machine readable labeling and on-line communication between working-stations and central administration. Flexibility: Easy automatic selective laboratory screening will be possible using special barcodes including sample identification and working orders. A modular hardware concept with easily accessible programming control allows it to implement new devices or methods. Ergonomy: Automatic sample processing including selective screening and simultaneous operating robotic sample processors increase working quality, sample output and time benefits. Economy: Improved working conditions will result in saving reagents and compensating staff limitations.
A system for the documentation of radiographic diagnoses is described, based on the "documentation method for radiographic diagnosis" (Formmhold et al 1972) and on the diagnostic information system of the medical faculty of the University of Tübingen. The diagnostic indeces are dictated in relation to the findings and the diagnosis and fed on punched cards into a computer (IBM 1800). Various programmes provide patient-orientated diagnoses for clinical routine, as well as diagnoses-orientated lists of patients for demonstrations, teaching or research.
In a survey of 93 orthopedic clinics or departments conducted in 1985, concerning the use of data processing systems, a total of 64 replies were received. These were not yet affected by the new Federal (German) Hospital Tariffs Regulations and therefore reflect the actual needs of the institutions in question. There is a clear trend toward using data processing for scientific purposes. Data processing systems were already in use in 42 institutions. There are hardly any differences between university clinics and non-university establishments. It is significant that among the key systems used in orthopedic medicine, ICD9 plays a completely subordinate role. This is seen as proof that ICD9 is inadequate for orthopedic purposes. Attention is drawn to a simple diagnostic key used by the Oskar-Helene-Heim. The author also comments on the problems of special documentation departments.
After medial placement of the graft in myringoplasty the remaining air-bone gap within the speech range is on an average approximately 10,- dB. This remaining air-bone gap is, according to secured statistics, on an average approximately 10 dB lower than in a lateral placement of the graft. The bone conduction does usually not change in either operation method. The additional support of meatal skin graft on the underlayed fascia does not have any influence on the audiologic finding. The percentage of the reperforations is in type I with a rate of 18% rather high; both operation methods do not significantly differ.
What clinicians expect from computers is contrasted with the actual potency of computerized data analysis. Different paths of procedure and the resulting chances of satisfactory implementation are discussed in the light of several specific cases. Additionally, examples are given both of highly efficient solutions and of the frequent mis-judgments which occur.