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PubMedDate not supplied

Structure and software tools of AIDA.

AIDA consists of a set of software tools to allow for fast development and easy-to-maintain Medical Information Systems. AIDA supports all aspects of such a system both during development and operation. It contains tools to build and maintain forms for interactive data entry and on-line input validation, a database management system including a data dictionary and a set of run-time routines for database access, and routines for querying the database and output formatting. Unlike an application generator, the user of AIDA may select parts of the tools to fulfill his needs and program other subsystems not developed with AIDA. The AIDA software uses as host language the ANSI-standard programming language MUMPS, an interpreted language embedded in an integrated database and programming environment. This greatly facilitates the portability of AIDA applications. The database facilities supported by AIDA are based on a relational data model. This data model is built on top of the MUMPS database, the so-called global structure. This relational model overcomes the restrictions of the global structure regarding string length. The global structure is especially powerful for sorting purposes. Using MUMPS as a host language allows the user an easy interface between user-defined data validation checks or other user-defined code and the AIDA tools. AIDA has been designed primarily for prototyping and for the construction of Medical Information Systems in a research environment which requires a flexible approach. The prototyping facility of AIDA operates terminal independent and is even to a great extent multi-lingual. Most of these features are table-driven; this allows on-line changes in the use of terminal type and language, but also causes overhead. AIDA has a set of optimizing tools by which it is possible to build a faster, but (of course) less flexible code from these table definitions. By separating the AIDA software in a source and a run-time version, one is able to write implementation-specific code which can be selected and loaded by a special source loader, being part of the AIDA software. This feature is also accessible for maintaining software on different sites and on different installations.

Database Management Systems↗

PubMed1995

A portable software tool for computing digitally reconstructed radiographs.

PURPOSE: To develop a portable software tool for fast computation of digitally reconstructed radiographs (DRR) with a friendly user interface and versatile image format and display options. To provide a means for interfacing with commercial and custom three-dimensional (3D) treatment planning systems. To make the tool freely available to the Radiation Oncology community. METHODS AND MATERIALS: A computer program for computing DRRs was enhanced with new features and rewritten to increase computational efficiency. A graphical user interface was added to improve ease of data input and DRR display. Installer, programmer, and user manuals were written, and installation test data sets were developed. The code conforms to the specifications of the Cooperative Working Group (CWG) of the National Cancer Institute (NCI) Contract on Radiotherapy Treatment Planning Tools. RESULTS: The interface allows the user to select DRR input data and image formats primarily by point-and-click mouse operations. Digitally reconstructed radiograph formats are predefined by configuration files that specify 19 calculation parameters. Enhancements include improved contrast resolution for visualizing surgical clips, an extended source model to stimulate the penumbra region in a computed port film, and the ability to easily modify the CT numbers of objects contoured on the planning computed tomography (CT) scans. CONCLUSIONS: The DRR tool can be used with 3D planning systems that lack this functionality, or perhaps improve the quality and functionality of existing DRR software. The tool can be interfaced to 3D planning systems that run on most modern graphics workstations, and can also function as a stand-alone program.

Radiographic Image Enhancement↗

PubMed1995

Ontology-based configuration of problem-solving methods and generation of knowledge-acquisition tools: application of PROTEGE-II to protocol-based decision support.

PROTEGE-II is a suite of tools and a methodology for building knowledge-based systems and domain-specific knowledge-acquisition tools. In this paper, we show how PROTEGE-II can be applied to the task of providing protocol-based decision support in the domain of treating HIV-infected patients. To apply PROTEGE-II, (1) we construct a decomposable problem-solving method called episodic skeletal-plan refinement, (2) we build an application ontology that consists of the terms and relations in the domain, and of method-specific distinctions not already captured in the domain terms, and (3) we specify mapping relations that link terms from the application ontology to the domain-independent terms used in the problem-solving method. From the application ontology, we automatically generate a domain-specific knowledge-acquisition tool that is custom-tailored for the application. The knowledge-acquisition tool is used for the creation and maintenance of domain knowledge used by the problem-solving method. The general goal of the PROTEGE-II approach is to produce systems and components that are reusable and easily maintained. This is the rationale for constructing ontologies and problem-solving methods that can be composed from a set of smaller-grained methods and mechanisms. This is also why we tightly couple the knowledge-acquisition tools to the application ontology that specifies the domain terms used in the problem-solving systems. Although our evaluation is still preliminary, for the application task of providing protocol-based decision support, we show that these goals of reusability and easy maintenance can be achieved. We discuss design decisions and the tradeoffs that have to be made in the development of the system.

Artificial Intelligence↗

PubMed2004

Argument-based medical ethics: a formal tool for critically appraising the normative medical ethics literature.

Although there are critical appraisal tools for other genres of the medical literature, there currently is no formal tool for physicians to use in their critical appraisal of the normative medical ethics literature. We present a formal assessment tool for the critical appraisal of the normative medical ethics literature that incorporates the intellectual standards of argument-based medical ethics and evidence-based medicine. We draw on the intellectual standards of argument-based ethics, ethical analysis and argument, and the literature on evidence-based medicine. The tool involves 4 questions about normative medical ethics papers: (1) Does the article address a focused ethics question? (2) Are the arguments that support the results of the article valid? (3) What are the results? (4) Will the results help me in clinical practice? Obstetrician-gynecologists can use this tool to appraise the normative literature of ethics in obstetrics and gynecology formally.

Ethical Analysis↗

PubMed2004

Meeting the Accreditation Council for Graduate Medical Education competencies using established residency training program assessment tools.

BACKGROUND: Most existing residency evaluation tools were constructed to evaluate the Accreditation Council for Graduate Medical Education (ACGME) competencies. METHODS: Before ACGME's six competency based assessment requirements for resident performance were developed, we created a residency evaluation tool with 5 domains important to successful surgical resident performance. Reliability was determined after 6 months of use. Factor analysis assessed whether the evaluation tool was a construct-valid measure of the ACGME competencies. RESULTS: Three hundred forty-three evaluations for 36 surgical residents were tested. The original evaluation tool was highly reliable with an overall reliability of 0.97. Factor analysis defined 4 new combinations of questions analogous to 4 of the ACGME competencies: professionalism (reliability 0.95), patient care (reliability 0.93), medical knowledge (reliability 0.92), and communication (reliability 0.92). The new competency clusters were correlated with each other to a moderate degree. CONCLUSIONS: Our locally developed tool demonstrated high reliability and construct validity for 4 of 6 ACGME competencies. The correlation between factors suggests overlap between competencies.

Accreditation↗

PubMed2005

A survey of tools and methods used by certified professional ergonomists.

A survey of Certified Professional Ergonomists (CPEs) was conducted to gather information on the types of basic tools, direct and observational measurement techniques, and software used by practitioners. The motivation for the survey was to better understand what types of tools and methods practitioners use, their opinions of these tools, and to potentially gain an understanding of the constraints or preferences that influence this selection. Reasons for using or not using a selection of tools were also surveyed. Of 578 surveys that were delivered to CPEs and Associate Ergonomics Professionals, 308 were returned for a response rate of 53%. The respondents tended to be biased towards physical ergonomics, as the survey primarily focused on this area of ergonomics. A high percentage of respondents reported using tape measures, video cameras, stopwatches and digital cameras. The most commonly used observational methods were those involving manual materials handling, whereas the most commonly used direct measurement tools were pinch and grip dynamometers and push/pull gauges. The frequency and type of checklists, software, and anthropometric data used are summarized.

Certification↗

PubMed2006

A new software tool for 3D motion analyses of the musculo-skeletal system.

BACKGROUND: Many clinical and biomechanical research studies, particularly in orthopaedics, nowadays involve forms of movement analysis. Gait analysis, video-fluoroscopy of joint replacement, pre-operative planning, surgical navigation, and standard radiostereometry would require tools for easy access to three-dimensional graphical representations of rigid segment motion. Relevant data from this variety of sources need to be organised in structured forms. Registration, integration, and synchronisation of segment position data are additional necessities. With this aim, the present work exploits the features of a software tool recently developed within a EU-funded project ('Multimod') in a series of different research studies. METHODS: Standard and advanced gait analysis on a normal subject, in vivo fluoroscopy-based three-dimensional motion of a replaced knee joint, patellar and ligament tracking on a knee specimen by a surgical navigation system, stem-to-femur migration pattern on a patient operated on total hip replacement, were analysed with standard techniques and all represented by this innovative software tool. Segment pose data were eventually obtained from these different techniques, and were successfully imported and organised in a hierarchical tree within the tool. FINDINGS: Skeletal bony segments, prosthesis component models and ligament links were registered successfully to corresponding marker position data for effective three-dimensional animations. These were shown in various combinations, in different views, from different perspectives, according to possible specific research interests. INTERPRETATION: Bioengineering and medical professionals would be much facilitated in the interpretation of the motion analysis measurements necessary in their research fields, and would benefit therefore from this software tool.

Aged↗

PubMed2004

The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN).

BACKGROUND & AIMS: Nutrition screening tools (NST) identify individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutritional support. The aims of this study were to design, pilot and evaluate a NST based on four nutritional parameters (weight, height, recent unintentional weight loss and appetite) recommended by the British Association for Parenteral and Enteral Nutrition as the minimum required to identify patients with nutritional problems. METHODS: A dietitian assessed the nutritional status of 100 patients admitted to the general medical wards. Results from the study were used to design a NST. The concurrent validity of the screening tool was then assessed, by comparing it with a nutritional assessment by an experienced dietitian in 100 patients admitted to acute medical and elderly care wards. The inter-rater reliability of the screening tool was also assessed using three nurses and 26 acute medical patients. RESULTS: All four nutritional parameters were required to identify all at-risk patients. There was good agreement between the screening tool and the dietitian's assessment (kappa = 0.717) and inter-rater reliability was reasonable (mean kappa = 0.66). CONCLUSION: The screening tool was valid and reliable in identifying medical patients at risk of malnutrition and was quick and simple to use.

Appetite↗

PubMed2005

Identification of animal species by protein radioimmunoassay of bone fragments and bloodstained stone tools.

In forensics and archaeology, it is important to distinguish human from animal remains and to identify animal species from fragmentary bones and bloodstains. We report blind tests in which a protein radioimmunoassay (pRIA) was used to identify the species of six bone fragments lacking morphological specificity and 43 bloodstained lithic tools, knapped experimentally and soaked in blood of known animal and human origin. The submitters of the bone fragments and the bloodstained tools each listed a number of possible species, from which the testers selected the best match with the pRIA results. All six bone fragments were correctly identified: three humans, a deer, a dog, and a cow. Forty-three tools were stained with blood from a wide variety of species including ungulates, carnivores, a fish, and a bird. On 40 of these 43, at least one species (or blood-free control) was identified correctly. Some of the tools were stained with blood of two different species. A mixture of sheep and musk ox blood was correctly identified; in several other mixtures, only a single species was detected. Two tools with human blood and one with human sweat were correctly reported as human. There was a single false positive (one of three controls reported as weakly bovine) and no false negatives. We conclude that the pRIA technique shows a high degree of accuracy in discriminating human from animal bone fragments and bloodstains and in identifying animal species.

Animals↗

PubMed2005

Assessing team performance in the operating room: development and use of a "black-box" recorder and other tools for the intraoperative environment.

BACKGROUND: The objective of this research was to develop a digital system to archive the complete operative environment along with the assessment tools for analysis of this data, allowing prospective studies of operative performance, intraoperative errors, team performance, and communication. Ability to study this environment will yield new insights, allowing design of systems to avoid preventable errors that contribute to perioperative complications. STUDY DESIGN: A multitrack, synchronized, digital audio-visual recording system (RATE tool) was developed to monitor intraoperative performance, including software to synchronize data and allow assignment of independent observational scores. Cases were scored for technical performance, participants' situational awareness (knowledge of critical information), and their comfort and satisfaction with the conduct of the procedure. RESULTS: Laparoscopic cholecystectomy (n = 10) was studied. Technical performance of the RATE tool was excellent. The RATE tool allowed real time, multitrack data collection of all aspects of the operative environment, while permitting digital recording of the objective assessment data in a time synchronized and annotated fashion during the procedure. The mean technical performance score was 73% +/- 28% of maximum (perfect) performance. Situational awareness varied widely among team members, with the attending surgeon typically the only team member having comprehensive knowledge of critical case information. CONCLUSIONS: The RATE tool allows prospective analysis of performance measures such as technical judgments, team performance, and communication patterns, offers the opportunity to conduct prospective intraoperative studies of human performance, and allows for postoperative discussion, review, and teaching. This study also suggests that gaps in situational awareness might be an underappreciated source of operative adverse events. Future uses of this system will aid teaching, failure or adverse event analysis, and intervention research.

Cholecystectomy, Laparoscopic↗

PubMed2006

Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review.

To improve assessment and management of pain in nonverbal older adults with dementia, an effective means of recognizing and evaluating pain in this vulnerable population is needed. The purpose of this review is to critically evaluate the existing tools used for pain assessment in this population to provide recommendations to clinicians. Ten pain assessment tools based on observation of behavioral indicators for use with nonverbal older adults with dementia were evaluated according to criteria and indicators in five areas: conceptualization, subjects, administration, reliability, and validity. Results indicate that although a number of tools demonstrate potential, existing tools are still in the early stages of development and testing. Currently, there is no standardized tool based on nonverbal behavioral pain indicators in English that may be recommended for broad adoption in clinical practice.

Aged↗

PubMed2005

Learning needs analysis: the development of a tool to support the on-going professional development of multiple sclerosis specialist nurses.

Continuous professional development (CPD) is essential in modern day nursing. Learning needs analysis (LNA) is an important element of CPD. This paper describes the development of a LNA tool for multiple sclerosis specialist nurses. The tool contains an empirically developed LNA schedule and uses a blend of both subjective and objective exercises to help the nurse formulate a comprehensive learning plan. The tool is organised into four phases: phase 1, focuses on the knowledge and skills necessary to the fulfillment of work-based objectives; phase 2, involves a more in-depth assessment of particular areas of professional knowledge; phase 3, examines learning strategies; and phase 4, involves the development of a learning plan. The tool has been implemented throughout the UK via local trainers. While the tool was developed for a specialist nurse population the principles upon which it is based are likely to be transferable to other nursing contexts.

Attitude of Health Personnel↗

PubMed2005

Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment.

OBJECTIVE: We compared four nutritional screening tools, the Nutrition Risk Classification, the Mini-Nutrition Assessment-Short Form, the Malnutrition Screening Tool, and the Nutrition Risk Score in terms of their ability to predict postoperative wound and infectious complications when adjusted for the effects of other risk factors for postoperative infection. METHODS: The 8-mo study was performed on 430 patients undergoing abdominal surgery. Data on the Nutrition Risk Classification, Mini-Nutrition Assessment-Short Form, Malnutrition Screening Tool, Nutrition Risk Score, and risk factors for postoperative complications were collected for all patients. Patients were followed until 30 d after surgery. Nutritional screening tools were compared for their ability to predict postoperative complications by using the area under the receiver operating characteristic curve. Multivariable adjustment for other risk factors was done with multiple logistic regression analysis. RESULTS: The Mini-Nutrition Assessment-Short Form, Nutrition Risk Score, and Nutrition Risk Classification had the larger receiver operating characteristic areas. Only the Nutrition Risk Classification was significantly related to the occurrence of postoperative complications (odds ratio 2.92, 95% confidence interval 1.62 to 5.26) after adjusting for other risk factors of postoperative infection. The other remaining risk factors were serum albumin level and operative time. CONCLUSIONS: The Nutrition Risk Classification seems to be the best nutritional screening tool for use in predicting postoperative infectious and wound complications.

Abdomen↗

PubMed2006

A computer-based information-tool for chronic pain patients. Computerized information to support the process of shared decision-making.

OBJECTIVE: Assessment of the use of a computerized information-tool in the context of a shared decision-making process with chronic pain patients. METHODS: In the scope of a prospective and randomized study on shared decision-making with Fibromyalgia patients, a total of 75 patients had access to computer-based information about their illness. Fibromyalgia is a condition of chronic wide-spread pain, belonging to rheumatism, which mainly affects mature female patients. The majority of the patients in our study are female (93%) with an average age of 50 years. The computer-based information-tool provided the patients with detailed information about pathogenesis, typical symptoms, treatment options and prognosis. Six evaluative questions were posed to the participants concerning the assessment of the information presented, the handling of the programme, the need for an introduction to the programme, the quality of the layout and the assessment of the length of time spent in front of the computer and the assessment of the usefulness of such a tool in general practitioners' offices. Furthermore, psychological self-assessment questionnaires were filled out by the participants. RESULTS: The patients highly appreciate the possibility of using computer-based information-tools and endorse the implementation of such tools in general practitioners' offices. CONCLUSION: Computerized information leads to a better understanding of the illness and the treatment options on the part of the patient. PRACTICAL IMPLICATIONS: For further practical use it is crucial to provide an introduction to the handling of a computer to unskilled patients.

Chronic Disease↗

PubMed2002

An evaluation of Superthumb and the Kneeshaw device as manual therapy tools.

This research evaluated two hand-held tools (Superthumb and Kneeshaw device) that have been developed in order to reduce hand pain associated with the performance of manual therapy. Two studies were conducted: one evaluated the ability to perceive elastic stiffness with the devices and the other evaluated physiotherapist and patient comfort when the devices were used to apply a mobilisation to the lumbar spine. In the first study we found that the two tools and the pisiform grip provided equivalent ability to detect small differences in elastic stiffness, however the tools introduced a bias so that the stiffness stimuli felt stiffer than when assessed with the pisiform grip. In the second study we found that the two tools were substantially less comfortable than the pisiform grip, for both patient and therapist, when a therapist applied a Grade III mobilisation to the lumbar spine. The results suggest that neither tool, in its current form, is suitable for clinical practice.

Adult↗

PubMed2003

Rapid learning of sequential tool use by macaque monkeys.

Earlier reports have described monkeys in their natural habitat as being capable of purposefully using tools for activities such as obtaining food. However, little is known regarding the extent of macaque monkeys' ability to understand the functional meaning of objects as tools. We have trained Japanese macaques in tool-use behavior to demonstrate their abilities to solve stick problems involving the use of a novel tool and a sequential combination of different tools. Results suggest that macaque monkeys have cognitive abilities, such as (1). flexibility in applying previous experience in accordance with the requirements of the learning situation, (2). the foresight needed to conduct a series of acts in a continuous sequential manner and the ability to internally plan the necessary strategy.

Adaptation, Psychological↗

PubMedDate not supplied

Assessment of published reliability studies for cervical spine range-of-motion measurement tools.

OBJECTIVE: To assess the reliability of tools to measure cervical spine range of motion in clinical settings and discuss the necessary components for reliability studies. DATA SOURCES: Database searches included Bandolier, Bath Information and Data Services including Index of Scientific and Technical Proceedings, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, English National Health Care Database, MEDLINE, Occupational Therapy Index, Physiotherapy Index, and Rehabilitation index for English language articles from 1966. In addition, citations were searched. STUDY SELECTION: Studies were selected that assessed the tool for intraobserver or interobserver reliability, evaluated it on movements of flexion/extension, lateral flexion, or rotation, and measured range of motion of the whole cervical spine. DATA EXTRACTION: All papers were read by one nonclinical researcher with a data extraction sheet. A consultant rheumatologist and a physiotherapist were each asked to read a sample of the papers to give a clinical viewpoint. DATA SYNTHESIS: Evidence for the reliability of measurement tools was assessed qualitatively based on the quality of the study designs, appropriateness of analysis, and strength of the reliability based on reported intraclass correlation coefficients (the most appropriate analysis technique for reliability studies of this nature). Measurement tools were found to have not been fully tested for reliability, particularly in terms of adequate sample size and appropriate analysis techniques. There were also wide variations in the research design, including the protocol for movement, the characteristics of observers and study population, whether warm-ups were allowed, whether the movement was active or passive, and time intervals between repeated measurements. CONCLUSION: Although a range-of-motion device has shown promise in reliability and has many advocates, its practicality for clinical use is questionable. Further work must be performed on all measurement tools. Researchers need to produce more rigorous studies and consider the issues discussed here.

Cervical Vertebrae↗

PubMed2001

Evaluation of a leaf position optimization tool for intensity modulated radiation therapy of head and neck cancer.

BACKGROUND AND PURPOSE: Since 1996, patients are treated at Ghent University Hospital with a multi-segment technique using MultiLeaf Collimators. The segments were obtained by using the Beam's eye view projections of the planning target volume (PTV) and the organs at risk (OARs), after which the segments weights were optimized. To investigate if optimization of the leaf positions would further improve the intensity modulated radiation therapy (IMRT) plans, a tool optimizing leaf positions and segment weights simultaneously, was developed. This tool is called SOWAT, which is the acronym for segment outline and weight adapting tool. MATERIAL AND METHODS: The tool evaluates the effects of changing the position of each collimating leaf of all segments on the value of the objective function. Only changes that improve the value of the objective function are retained. Between December 1999 and January 2001, 30 head and neck patients were treated with IMRT. Two patient groups were distinguished: pharyngeal and laryngeal tumors (n=17) and sinonasal tumors (n=13). A specific set of physical endpoints was evaluated for each group. Dose statistics of the treatment plans without and with SOWAT were analyzed. RESULTS: When using SOWAT for the pharyngeal and laryngeal cases, the PTV dose homogeneity increased with a median of 11% (range 2-27%), while the maximum dose to the spinal cord was decreased for 14 of the 17 patients. In four plans where parotid function preservation was a goal, the parotid mean dose was lower than 26 Gy in one plan without SOWAT, and in four plans with SOWAT. For the sinonasal tumors, the PTV dose homogeneity increased with a median of 7% (range 1-14%). SOWAT lowered the mean dose to 53 of the 63 optic pathway structures (retina, optic nerve and optic chiasm). SOWAT leaves the number of segments unchanged and has little or no effect on the delivery time. CONCLUSIONS: SOWAT is a powerful tool to perform the final optimization of IMRT plans, without increasing the complexity of the plan or the delivery time.

Algorithms↗