Development assistance to population information activities-- the support of the International Development Research Centre.
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A simple but flexible storage and retrieval system for medical data is described. It functions by providing the user with a proven set of FORTRAN IV subroutines. It has been found that for a wide range of clinical data processing the user only needs to apply three FORTRAN subroutines.
A lung function information system (LFIS) was developed for the data analysis of pulmonary function tests at different locations. This system was connected to the hospital information system (HIS) for the retrieval of patient data and the storage of the lung function variables of patients to generate follow-up reports and to support financial and administrative management. The application programs were developed in such a way that high flexibility was obtained with respect to the patient-computer-technician interaction. The sampled data are stored on a disc to correct earlier decisions, perform recalculations and reanalyse the data for research purposes. When the measurements performed on a patient are authorized, the sampled data are deleted, except for when they are needed for future research. A distributed computer system was chosen to combine the benefits of a centralized system with those of several stand-alone systems. The main tasks of the central unit are to store collected data and computer programs, generate a final lung function report on laser printer and provide a connection to the HIS. In the satellite computers, which are located close to the lung function equipment, the signals and raw data are processed. Furthermore, the satellite computers were in use for program development and several research projects, and for the offline data processing of the lung function measurements from two other hospitals by means of a modem connection. The LFIS improved the quantity and quality of data acquisition. It resulted in an increased capacity of about 50% concerning spirometry, and facilitated time-consuming complex analyses. It also avoided miscalculations and mistakes in reports previously experienced with hand calculations.
Grief is a universal phenomenon, affecting every age and culture. However, the literature reveals that this concept is surrounded with ambiguity and conflicting research findings. There are few studies which focus on the grief of older widows, and none which focuses on the grief of older women whose husbands received hospice care. The purpose of this longitudinal study was to generate a conceptual definition and theory of grief for older adult women using grounded theory methodology. Informants comprised six older widows whose husbands were enrolled in a hospice programme in a southern metropolitan setting in the United States. Each informant was asked to respond to the initial question: "What is your experience in dealing with the loss of your husband?' Interviews were conducted in the widows' homes after the deaths of their husbands during the following three time frames of bereavement: 1-4 months, 7-10 months and 13-16 months. Interviews were audio-taped, transcribed, coded and analysed using the constant comparative method. Oracle, a text-oriented database management computer program, was used to facilitate the creation, storage, coding, analysis and retrieval of data. Cross-comparisons of the findings from the three phases of data collection were made and these findings were compared with the literature. The following core concepts emerged from the data: "being aware', "experiencing distress', "supporting', "coping' and "facing new realities'. Core concepts were combined into a conceptual definition of grief and a grounded theory of grief of older adult women whose husbands experienced hospice care was developed. The results of this study expand our knowledge of the grief process of older widows whose husbands received hospice care and have implications for the development of effective bereavement intervention programmes.
In characterising the forces exerted during laryngoscopy it is accepted that the significant force component is that which is parallel to the axis of the laryngoscope handle. This paper describes a new method of evaluating the forces exerted at laryngoscopy. A laryngoscope handle has been redesigned, incorporating a force-displacement transducer on the handle at the end opposite to where the blade is attached. The device is designed specifically to sense the axial component of force. The blade attachment block has been detached from the sleeve and connected to a steel shaft which forms the new battery compartment. This allows the axial force exerted at the blade during laryngoscopy to be transmitted along this shaft to the sensing transducer. Linear ball bearings have been introduced between the new shaft and the handle sleeve (outer casing). The rolling friction has been reduced to less than 0.1% by diamond-lapping the precision ground surface-hardened rod to produce a mirror finish. Thus, the force transmitted to the transducer is essentially constant regardless of where the load is applied along the blade. The output from the system is directly downloaded to a laptop computer and the data analysed almost instantaneously to determine the duration of laryngoscopy, the peak forces applied, the mean force with its standard deviation and graphic display of the data. Provision has been made for data entry checks, recording patient details and study data, and creating a data base for the storage and retrieval of the study details.
A method of nystagmus analysis has been developed for clinical and research purposes. Optimum flexibility of analysis is indicated to cope with the problematic signals frequently encountered in pathology. Different modes of analysis may be obtained, varying from fully automatic to step-by-step interactive analysis. Artifact detection and rejection is performed by means of regression analysis with some additional condition tests. The default conditions may be modified or inactivated. A variety of output and display facilities may be used, including permanent storage of adequately labelled retrievable nystagmus data.
We describe the fabrication and characterization of cantilevered glass probe arrays. Individual probes have tapered shafts that are 175 microm square at the base and 200 nm square at the pyramidal tip. Each array contains as many as eight probes 10-20 mm long at 450-microm center-to-center spacing, fabricated from a single glass wafer by a combination of dicing and chemical etching. Optical signal losses of individual probes were measured to be of the order of 1 dB/cm. High-density data storage and page-oriented retrieval are the potential applications of the arrays.
Information technology (IT) is an imprecise term currently used to describe computer-based techniques for data manipulation, storage, dissemination, publication, and retrieval. IT possesses several characteristics that promote meaningful learning, including (1) just-in-time, personalized; (2) student-centered versus teacher-centric; (3) self-paced; (4) anytime, anywhere; and (5) discovery (through bibliographic and other information searches). However, if done improperly, IT-based teaching can be counterproductive. Factors to consider when evaluating the effectiveness of IT-based teaching methods include (1) content, (2) learning, (3) delivery support, (4) usability, and (5) technological. IT has been used to support instruction in epidemiology and public health at many levels, ranging from basic computer literacy to hands-on training in epidemiological methods through computer-based problem sets, case workups, outbreak investigations, and tutorials. Online quizzes based on articles selected from practice-oriented journals have been used to promote evidence-based medicine skills, including the critical evaluation of medical claims. As online access and delivery improve, opportunities for substantive online education and lifelong learning through IT have expanded. One of the most novel and comprehensive implementations of collaborative online sharing of educational content in epidemiology and public health is the Epidemiology Supercourse (http://www.pitt.edu/~super1/). More than 9,000 faculty from 118 countries have contributed to an online library of more than 700 lectures with quality control and adherence to accepted pedagogic principles. The goal is to improve teaching and research in epidemiology and public health worldwide. Although the focus is on human medicine, the concepts, methods, and principles can easily be applied to veterinary medicine. The Association for Veterinary Epidemiology and Preventive Medicine (AVEPM) seeks to heighten awareness of issues in veterinary epidemiology and public health education among veterinary educators through various forums, symposia, and workshops. The AVEPM Web site (http://www.cvm.uiuc.edu/avepm/) includes a listing of educational software and Web sites supporting epidemiology and public health education.
This article describes how a medical records department responded to relocating, upgrading a departmental computer system, incorporating severity of illness abstracting, and implementing continuous quality improvement techniques by reengineering along department flowlines over a five-year period. Areas of the department that were restructured were storage and retrieval, record completion, and data collection and reporting functions.
A microcomputer database system for the storage, retrieval, and statistical analysis of data associated with the treatment of haemophilia and other defects of haemostasis is described. The hardware requirements are an IBM compatible PC with both hard and floppy disc drives and a suitable printer. The system was written using Smartware II, a powerful integrated software package which incorporates database, word processor, spreadsheet and communications functions. The programs were written with flexibility in mind and can be readily adapted to accommodate the work patterns of any haemophilia centre. This system has now been operational in the Regional Haemophilia Centre at the Manchester Royal Infirmary since January 1990. Its introduction has led to a marked improvement in the efficiency of patient data handling with significant savings in staff time.
Academic surgical units have a combination of computer needs, including access to the surgical literature, storage and retrieval of patient registry data, laboratory, and research data, generation of reports; statistical analysis of data; and word processing. A system that fulfills these requirements was developed for an academic vascular surgical unit. The system integrates these functions in a multi-user environment and is accessed from menus on multiple terminals in laboratories and offices in three hospitals and in staff members' homes. Databases currently include more than 7000 references to published articles in vascular surgery, a vascular registry consisting of more than 7500 patients, patient data from three integrated noninvasive vascular laboratories, data generated from both clinical and basic research, and a log of resident, fellow, and faculty operative experience. Statistical analysis, using essentially all modern statistical methods including sophisticated log-rank, proportional hazards, and multivariant analyses, can be performed on all databases, either separately or in any combination, without the need to reenter data. An electronic mail and messaging system provides for paperless communication between surgeons, research personnel, and clerical staff.
Dual-energy scanned projection radiography was used to evaluate eight patients with both lytic and blastic metastatic disease in the axial skeleton. The ability to selectively cancel obscuring soft-tissue structures from images resulted in improved conspicuity of involved sites, compared with conventional radiographic studies, despite greater quantum noise and lower inherent spatial resolution. Other desirable features of the technique include a projected format, image enhancement by contrast and brightness optimization, rapid data acquisition, convenient image storage and retrieval, and low radiation dose. Since the majority of osseous metastases involve axial sites, dual-energy scanned projection radiography may be a useful adjunctive modality in the management of oncology patients.
The most important advantage of computer-assisted ECG/VCG interpretation in our center is the enhancement of the diagnostic accuracy of ECG interpretation, as compared to that reported in the literature for the visual analysis of ECGs and VCGs. Favourable side effects are also obtained from the optimization of various functions involved n ECG data processing, like data handling, editing, reporting, storage and retrieval. Improvement of the arrhythmia program and creation of a new pediatric VCG program are currently in progress in our laboratory. Computerized electrocardiography has made us aware of the limitations of conventional, visual reading of electrocardiograms. Thanks to the current efforts towards standardization of the quantitative analysis of ECGs and VCGs and towards optimization of diagnostic criteria, computerized electrocardiography will undoubtedly lead to a generalized improved accuracy of ECG interpretation.
A relational database system was developed to store electrophysiological signals recorded with different Evoked Potentials (EP) recording equipment produced by the Cuban Neurosciences Center. The system has several functions such as storage of EP recording parameters, data retrieval with a flexible query mechanism, database backup, and data transfer from one database to other. A complete set of functions facilitates EP analysis, either for clinical or research purposes. It is also useful as a clinical information management tool.
Computed dental radiography is a filmless system of dental x-ray imaging. It features multiple sensors with receptive areas and image quality that approach the size and resolution of film. The system is able to match the utility of film on levels such as multiple-sized images and printing output. It approaches film in quality of image and diagnostic capacity. In features such as speed of image acquisition, reduction in radiation dose, retrieval of data, and organization and storage of images, the computed dental radiography system surpasses traditional x-ray film.
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Single radial immunodiffusion is a simple inexpensive method for quantitating specific proteins in a heterogenous mixture. However, it has been criticized for its lack of accuracy and repeatability; coefficients of variation of 25% have been reported by some workers. We have adopted several refinements to the single radial immunodiffusion techniques which have appeared in the literature and have made several innovations of our own. Also, as an integral part of the technique, we have developed a computer program that determines the best-fitting curve for a given set of standards, applies this curve to the raw ring-diameters, and corrects the data for plate variation and sample dilution. This program has reduced errors greatly in calculating protein concentration since all data handling beyond the recording of the precipitant ring diameter is by computer. It also allows for the storage, retrieval, and analysis of large volumes of data on many different proteins simultaneously. The overall result of this system has been to decrease the coefficients of variation to below 5% for all the milk and serum proteins tested.