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Operating room scheduling by computer.

The surgical operating room schedule has been produced automatically for more than 2 years in our large teaching hospital. In order to apply computer technology to the complex surgical scheduling problem a special programming approach was devised. We discuss this approach under the headings of Expand, Sort, Order and Assign. Consistent, reliable schedules, unaffected by weekends and holidays, are produced by a clerk trained to use a computer terminal. Our program is adapttable to other institutions once the scheduling parameters and operating priorities are delineated.

Anesthesiology

Readers' forum: experiences with a system. The implementation of a completely operational computer system in a cardio-thoracic department.

Wythenshawe Hospital is a large general district hospital with more than 1000 beds, situated approximately 9 miles south of Manchester. The Cardio-Thoracic department, housed in the new section of the hospital which was completed in 1973, is the major centre for cardiothoracic surgery in the greater Manchester area. It also receives any major accident cases which require treatment within the Intensive Therapy Unit. This paper describes a Patient Data Display System and the methods used to introduce the concept of such a system, to doctors, nurses, laboratory and paramedical staff, and the manner in which these staff were trained in the use of computer terminals. Principles underlying the need for and requirements of such a system are also discussed. Six months after hardware commissioning the system was fully operational throughout the whole department.

Computers

Automatic recognition of inter-ictal epileptic activity in prolonged EEG recordings.

A method of automatic recognition and quantification of inter-ictal epileptic activity in the human EEG had previously been developed and tested using short recordings from awake subjects. This paper describes the adaptation of the method for use during overnight recordings in free-moving unattended patients, in combination with the already existing seizure monitoring system. EEG s were recorded from scalp and sphenoidal electrodes, using cable telemetry and a PDP-12 computer. The spike and sharp wave recognition method allowed the on-line analysis of 16 channels. A section of the 16-channel EEG including 1 sec before and 1 sec after each detected spike was saved on digital magnetic tape. Upon completion of the monitoring session, the tape was played back on the EEG machine, giving a discontinuous tracing of spike sections; this constituted a highly concentrated view of the inter-ictal epileptic activity, in traditional paper form. The spike sections were further analyzed by computer to determine and display on the computer terminal the spatial and temporal distributions of the epileptic activity, providing a complete synopsis of the recording. Several examples of the type of information available from this anslysis are discussed in detail. False detection rates are given for 34 six hour recordings, indicating a high vari ability in the performance, mainly because of artefacts. It is concluded that the final computer displays could only be trusted after visual inspection of the EEG sections provided on paper. The variety of morphologies of artefacts appeared to preclude a total automatic elimination.

Electroencephalography

The rubber circle: a technique for analyzing computed tomography scans.

The authors describe a technique for automated analysis of lesions demonstrated by computed tomography. A seed circle may be superimposed on a lesion by an operator controlled program. By selecting density limits, the program will then automatically outline a particular area of abnormal density and calculate the statistics of the pixels within that area. The information may be viewed on the computer terminal or recorded on the printer. The system may be superimposed on first generation EMI scanners without additional hardware. The time for obtaining the information roughly approximates that of systems employing manually operated cursors.

Computers

Use of a computer for producing microbiological reports and for data storage and processing.

A simple 'fail-safe' system is described that produces microbiology reports on a computer teleprinter and stores results on the magnetic tapes and discs of a computer for instant retrieval and epidemiological analysis. The system, which has been in operation for over a year, involves the use of a modified conventional NCR request form. The top portion, which is completed manually by the laboratory staff, is coded by writing numbers in hatched boxes. The data thus written on to the bottom portion are transcribed by punch operators on to paper tape and this data input is verified by double punching. The reports are normally produced automatically by the computer terminal telprinter, but in case of mechanical failure the manually completed request forms can be returned to wards and outpatient departments. The system permits a wide choice of options for epidemiological analysis, and six programmes are described, one of which produces a digest of the overall percentage antibiotic sensitivities of organisms from various sites.

Computers

The CASE system for cancer education.

A Computer-Assisted-Self-Evaluation (CASE) program in oncology is described. The program is based on motivation by immediate, informative feedback, and involves the computer-guided interaction of a student with a series of microfiche cards. The computer leads the student through a series of 16 questions and associated explanations and recommendations based on the answer choices. Since all textual materials are placed on microfiche cards, the computer is only required to print simple, prearranged sentences and comments. As a result four students, using different CASE topics, can time-share the same computer terminal. This time-sharing capability, together with the large but compact, low cost information storage afforded by the use of microfiche, makes the cost of this system comparable to that of conventional study aids. The use of the CASE system as an educational aid and self-tutoring mechanism has been well accepted by faculty and students.

Attitude

A quantitative comparison of traditional reading of the EEG and interpretation of computer-extracted features in patients with supratentorial brain lesions.

The EEGs of adult patients with suspected supratentorial brain lesions were recorded on paper and on magnetic tape, using a small computer. The spectra of 16 channels were computed on a 40 sec sample. For each channel, a ratio of the type (delta + theta)/(alpha + beta) was computed and displayed on the computer terminal, a measure of the asymmetry in slow wave activity between homologous areas of the head was also displayed. This display is called a canonogram. It is believed to be a meaningful representation of the important characteristics of the EEG in the presence of supratentorial lesions. In order to assess the clinical value of the canonogram, the presumed localization of the lesion obtained from the interpretation of the traditional EEG and from that of the canonogram were compared to the known location of the lesion is a group of 87 subjects. The comparison was made quantitative by the use of a structured report encoding the traditional interpretation and that of the canonogram as well as the reference data (unequivocal surgical, radiological and clinical localizing evidence). The results varied among the anatomical regions: whereas in the frontal and occipital regions the EEG was slightly more accurate than the canonogram, both methods were similar in the temporal areas and the canonogram seemed more accurate in the centro-parietal regions. An attempt was made to interpret these differences. Furthermore, three readers read the cononograms and gave very consistent interpretations. These results show the reliability and value of this simple computer display for the particular type of EEG studied.

Adult

Development of ocularity domains and growth behaviour of axon terminals.

Ontogenetic development of ocularity domains--stripes, patches and layers in cortex, colliculus superior and lateral geniculate nucleus--is the result of organization that may either be intrinsic to the postsynaptic structure or induced to it by the afferents. A specific type of axonal growth behaviour that was recently proposed as a basis for ontogenetic development of retinotopy is sufficient to account also for ocularity domains. No intrinsic organization in the postsynaptic structure is required. The latter merely serves as a propagating medium for markers carried by the presynaptic terminals. Computer simulations demonstrate the mechanism to be complete and consistent.

Animals

A strategy for development of computerized critical care decision support systems.

It is not enough to merely manage medical information. It is difficult to justify the cost of hospital information systems (HIS) or intensive care unit (ICU) patient data management systems (PDMS) on this basis alone. The real benefit of an integrated HIS or PDMS is in decision support. Although there are a variety of HIS and ICU PDMS systems available there are few that provide ICU decision support. The HELP system at the LDS Hospital is an example of a HIS which provides decision support on many different levels. In the ICU there are decision support tools for antibiotic therapy, nutritional management, and management of mechanical ventilation. Computer protocols for the management of mechanical ventilation (respiratory evaluation, ventilation, oxygenation, weaning and extubation) in patients with adult respiratory distress syndrome ((ARDS) have already been developed and clinically validated at the LDS Hospital. These protocols utilize the bedside intensive care unit (ICU) computer terminal to prompt the clinical care team with therapeutic and diagnostic suggestions. The protocols (in paper flow diagram and computerized form) have been used for over 40,000 hours in more than 125 adult respiratory distress syndrome (ARDS) patients. The protocols controlled care for 94% of the time. The remainder of the time patient care was not protocol controlled was a result of the patient being in states not covered by current protocol logic (e.g. hemodynamic instability, or transport for X-Ray studies). 52 of these ARDS patients met extra corporal membrane oxygenation (ECMO) criteria. The survival of the ECMO criteria ARDS patients was 41%, four times that expected (9%) from historical data (p less than 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel

Future-event schemas and certainty about the future: automaticity in depressives' future-event predictions.

The proposition was tested that depressives make predictions about the future based on a pessimistic future-event schema. Participants varying in depression predicted whether positive and negative events would happen to them (or to an average person) in the future by pressing yes or no at a computer terminal as quickly as possible, either under a concurrent attentional load or under no such load. As hypothesized, depressives predicted more negative events and fewer positive events than did mild depressives or nondepressives and showed greater automaticity in their predictions. That is, the attentional load did not increase depressives' response latencies for either negative or positive events, even though it did so reliably for both mildly depressed and nondepressed individuals. Depressives may thus possess a highly developed future-event schema that operates efficiently in enabling future-event predictions.

Adult

Computerized clinic scheduling system at the University of Michigan Medical Center.

The University of Michigan Medical Center has a flexible computerized clinic scheduling system that handles approximately 750,000 visits per year at the main hospital and satellite locations. The system includes a wide variety of fully integrated functions, including appointment booking, multiple and series scheduling, wait and reschedule lists, routine reminder notices, routine requests for medical records and radiology reports, no-show follow-up, and managerial reporting at multiple levels of detail. The system is extremely flexible, and allows separate scheduling specifications for every physician and all other resources within the system. The system is available at any of the approximately 1,800 computer terminals throughout the Medical Center, and is regularly used at approximately 400 terminals.

Academic Medical Centers

[The effect of training with computer equipment on the visual analyzer of 1st-grade pupils].

Examination are carried out on 64 school children Ist class from school "104", town of Sofia where computer training on mathematics and mother tongue is introduced in the frames of pedagogic experiment. The studies are performed parallelly at traditional and computer lessons, realized in two variants (with one and two school hours daily). In order to establish the functional status of the visual analyzer during computer training the following methods are used: studying the distance of the nearest point for clear vision (punctum proximum), stability of clear vision, threshold of the electric eye sensitivity, critical frequency of fusing of the light flickerings. A full preliminary ophthalmological examination is made by "Vision test", as well as chronometric control of each student to establish the real time of work with computers. Taken into consideration are also the data for illumination of the working places in the computer studies and class rooms where the traditional school hours are held. The analysis of the data received shows that the computer training (1 and 2 computer lessons daily) with schoolchildren, Ist class, has no unfavourable effect on the functional status of the visual analyzer in the limits of study hours up to 25 minutes.

Accommodation, Ocular

Electromagnetic fields: biological and clinical aspects.

Our entire biosphere is immersed in a sea of man-made electromagnetic fields (EMF). Occupational and public health data suggest that these fields may be a health hazard, possibly involving cancer and fetal loss. This paper reviews the history and pertinent physics of electromagnetic fields and presents evidence from the authors' work, and that of others, of biological interaction with living systems. Epidemiological data suggesting EMF hazards are reviewed including a discussion of possible risks associated with Hawaii's Lualualei transmitter site, TV and FM antennas in high-density population areas, fields surrounding electric power transmission and computer terminals, and the plan to route a major highway through the near-field of an operating Omega signal-source. In the face of current public fear and controversial research reports about long-term EMF exposure, suggestions are presented for public policy about these local sources of concern, as well as for the EMF risks common to any similarly developed areas.

Electromagnetic Fields

A minirecord: an aid to continuity of care.

A simple, low cost computerized minirecord system (minimal essential record) has been in full operation for two years in the Medical Clinic of The Johns Hopkins Hospital. The primary objective of the minirecord system is to permit rapid retrieval of current information concerning Medical Clinic patients. The system provides a computer-printed listing of problems and medications in the front of each chart and on-line display of this information at strategically located computer terminals. The information is generated via existing simple systems with minimal additional effort and with the use of any terminology deemed appropriate. Chart review revealed that minirecords were actually present in 92% of the charts and that significant improvement occurred in the recognition of a subsequent visit of clearly defined problems and therapies noted on the initial minirecord. Current modifications will replace the separate minirecord and encounter form (registration and visit note) with a single form that will facilitate completion an updating. The rapid availability of this information provides a mechanism for coordinating continuing care in a university hospital system that is otherwise inevitably fragmented and composed of multiple health care providers.

Comprehensive Health Care

Determining the radiation exposure from visual display terminals used in dentistry.

Computers are rapidly becoming incorporated into all aspects of dentistry, including administrative, didactic and research functions. Of particular concern for dentists are women of childbearing age who are regularly employed as receptionists and secretaries in private dental practices and teaching institutions. Thermoluminescent dosimeter pellets of lithium fluoride were attached directly to the surface of 10 VDT's of varying age and from different manufacturers. The purpose was to compare the amounts of radiation emitted from personal computers that are commonly used in dental practices and teaching institutions. All of the machines tested met USNRC regulations for safety by emitting only negligible amounts of radiation.

Adult