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An interactive consultation multimedia software for orthodontic patients.

Presentation of diagnosis and treatment planning for orthodontic problems by orthodontists is often a hurdle and a nuisance to most patients. The reasons are that it has much content which may be hard to understand without having expert knowledge related to the temporal change in dentofacial structures known as the growth, development and physiological aspects of masticatory apparatus. To complement this, we have developed an interactive consultation multimedia software for orthodontic patients. he design concept of the current software has three aspects. Firstly, since the software is operated by orthodontic patients themselves or by their parents, it enhances the operational feasibility. Secondly, it helps the patients choose the information in which they are interested. Thirdly, it emphasizes audio-visual understanding of orthodontic practice, including terminology. e used a hypertext machine with a 240MB hard disk drive, an 8MB RAM and a 13 inch color monitor. In developing the current software, we also used a video camera, a video color board, a microphone, and an image scanner together with an image recorder, a movie and sound data editing system, image scanning and editing, an image changer, a spread sheet and mathematical software. he current software consists of various multimedia such as images, sounds, characters, and biosignals. The "stack" of the software consists of three parts: a) "General Understanding of Occlusion" b) "Understanding Specific Types of Occlusion Exhibited by the Patient" c) "Orthodontic Terminology" When card A is selected the patient can choose either "Good Occlusion" or "Malocclusion." If "Malocclusion" is chosen, respective occlusal types are shown. The next card provides pathological conditions caused by respective malocclusion, e.g., gingivitis. After selecting card B which asks the patient, "What do your teeth look like?" the following buttons are provided: "Maxillary Protrusion," "Reversed Occlusion," "Crowding," "Open Bite," and "Spaced Arch." After selecting one of these, the card with an explanation of the respective malocclusion is shown according to the patient's physiological age. Finally, after card C is selected, a new card which has a list of orthodontic terminology is presented. Patients can search any term according to their choice to open a new card which gives a detailed explanation. e confirmed that the current consultation multimedia software can provide a comfortable environment to the patients and their families to learn where the orthodontic problems lie and how they could be solved.

Audiovisual Aids↗

Quantification of myocardial perfusion defects using three different software packages.

Software packages are widely used for quantification of myocardial perfusion defects. The quantification is used to assist the physician in his/her interpretation of the study. The purpose of this study was to compare the quantification of reversible perfusion defects by three different commercially available software packages. We included 50 consecutive patients who underwent myocardial perfusion single-photon emission tomography (SPET) with a 2-day technetium-99m tetrofosmin protocol. Two experienced technologists processed the studies using the following three software packages: Cedars Quantitative Perfusion SPECT, Emory Cardiac Toolbox and 4D-MSPECT. The same sets of short axis slices were used as input to all three software packages. Myocardial uptake was scored in 20 segments for both the rest and the stress studies. The summed difference score (SDS) was calculated for each patient and the SDS values were classified into: normal (< 4), mildly abnormal (4-8), moderately abnormal (9-13), and severely abnormal (> 13). All three software packages were in agreement that 21 patients had a normal SDS, four patients had a mildly abnormal SDS and one patient had a severely abnormal SDS. In the remaining 24 patients (48%) there was disagreement between the software packages regarding SDS classification. A difference in classification of more than one step between the highest and lowest scores, for example from normal to moderately abnormal or from mildly to severely abnormal, was found in six of these 24 patients. Widely used software packages commonly differ in their quantification of myocardial perfusion defects. The interpreting physician should be aware of these differences when using scoring systems.

Adult↗

Trends in computer hardware and software.

Previously identified and current trends in the development of computer systems and in the use of computers for health care applications are reviewed. Trends identified in a 1982 article were increasing miniaturization and archival ability, increasing software costs, increasing software independence, user empowerment through new software technologies, shorter computer-system life cycles, and more rapid development and support of pharmaceutical services. Most of these trends continue today. Current trends in hardware and software include the increasing use of reduced instruction-set computing, migration to the UNIX operating system, the development of large software libraries, microprocessor-based smart terminals that allow remote validation of data, speech synthesis and recognition, application generators, fourth-generation languages, computer-aided software engineering, object-oriented technologies, and artificial intelligence. Current trends specific to pharmacy and hospitals are the withdrawal of vendors of hospital information systems from the pharmacy market, improved linkage of information systems within hospitals, and increased regulation by government. The computer industry and its products continue to undergo dynamic change. Software development continues to lag behind hardware, and its high cost is offsetting the savings provided by hardware.

Clinical Pharmacy Information Systems↗

Basics of computer hardware and software.

The basics of computer hardware and software are presented. A computer is a general-purpose electronic counting device used in data processing because of its accuracy and high speed. The physical components of a computer system are called the hardware, which includes the central processing unit and peripheral equipment for data input, output, and storage. Computer capacity is measured by the amount of data that can be stored in main memory and by the computer word size. Performance is indicated by the speed with which instructions are executed. Input devices (e.g., keyboard-type terminals) are the components that accept raw data and convert it into electronic form, and output devices (e.g., video display terminals) present the results of data processing in human-readable form. System software is the set of instructions that facilitate hardware use and allow the application software, which solves specific user problems, to run efficiently. System and application software is written by using various machine and symbolic languages. Milestones in software-development techniques include program subroutine use, modular programming, functional decomposition, structured programming, and structured analysis. Objectives in improving software quality are reducing development costs, making maintenance easier, and making development results more predictable. Because software development has lagged behind revolutionary advances in hardware, the full potential of computers has yet to be realized.

Computer Literacy↗

Melanie II--a third-generation software package for analysis of two-dimensional electrophoresis images: I. Features and user interface.

Although two-dimensional electrophoresis (2-DE) computer analysis software packages have existed ever since 2-DE technology was developed, it is only now that the hardware and software technology allows large-scale studies to be performed on low-cost personal computers or workstations, and that setting up a 2-DE computer analysis system in a small laboratory is no longer considered a luxury. After a first attempt in the seventies and early eighties to develop 2-DE analysis software systems on hardware that had poor or even no graphical capabilities, followed in the late eighties by a wave of innovative software developments that were possible thanks to new graphical interface standards such as XWindows, a third generation of 2-DE analysis software packages has now come to maturity. It can be run on a variety of low-cost, general-purpose personal computers, thus making the purchase of a 2-DE analysis system easily attainable for even the smallest laboratory that is involved in proteome research. Melanie II 2-D PAGE, developed at the University Hospital of Geneva, is such a third-generation software system for 2-DE analysis. Based on unique image processing algorithms, this user-friendly object-oriented software package runs on multiple platforms, including Unix, MS-Windows 95 and NT, and Power Macintosh. It provides efficient spot detection and quantitation, state-of-the-art image comparison, statistical data analysis facilities, and is Internet-ready. Linked to proteome databases such as those available on the World Wide Web, it represents a valuable tool for the "Virtual Lab" of the post-genome area.

Algorithms↗

A software for the description of workplaces.

Three softwares have been designed, the first for job histories, the second for job-exposure matrices, and this, the third and latest, for workplace descriptions. The first two softwares were presented in earlier articles while the current article presents the software for workplace descriptions. Workplace description has been based on the idea that a job is best described by listing its constituent tasks so as to determine associated risks better. The three softwares, the job history software (JHS), the job-exposure software (JES) and the workplace description software (WDS) are interfaced and constitute an integrated professional risk surveillance (PRS) system.

Algorithms↗

Performance of community pharmacy drug interaction software.

OBJECTIVE: To evaluate the performance of computerized drug-drug interaction (DDI) software in identifying clinically important drug-drug interactions. DESIGN: One-time performance test of computer systems using a standard set of prescriptions. SETTING: Community pharmacies or central corporate locations with pharmacy terminals identical to those used in actual pharmacies. PARTICIPANTS: Chain and health maintenance organization (HMO) pharmacies with seven or more practice sites in Washington State. A total of nine different DDI software programs were installed in 516 community pharmacies represented by these chains and HMOs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of software in detecting 16 well-established DDIs contained within six fictitious patient profiles. RESULTS: The software systems failed to detect clinically relevant DDIs one-third of the time. Sensitivity of the software programs ranged from 0.44 to 0.88, with 1.00 being perfect; specificity ranged from 0.71 to 1.00; positive predictive value ranged from 0.67 to 1.00; and negative predictive value ranged from 0.69 to 0.90. For software packages that were installed at different locations, between-installation differences were observed. CONCLUSION: The performance of most DDI-detecting software programs tested in this study was suboptimal. Improvement is needed to advance their contribution to detection of DDIs.

Drug Interactions↗

Contemporary issues in HIM. Software engineering--what does it mean to you?

There have been significant advances in the way we develop software in the last two decades. Many companies are using the new process oriented approach to software development. Companies that use the new techniques and tools have reported improvements in both productivity and quality, but there are still companies developing software the way we did 30 years ago. If you saw the movie Jurassic Park, you saw the perfect way not to develop software. The programmer in the movie was the only person who knew the details of the system. No processes were followed, and there was no documentation. This was an absolutely perfect prescription for failure. Some of you are probably familiar with the term hacker which describes a person who spends hours sitting at a terminal hacking out code. Hackers have created some outstanding software products, but with today's complex systems, most companies are trying to get away from their dependence on hackers. They are instead turning to the process-oriented approach. When selecting software vendors, don't just look at the functionality of a product. Try to determine how the vendor develops software, and determine if you are dealing with hackers or a process-driven company. In the long run, you should get better, more reliable products from the latter.

Engineering↗

On the design of a generic and scalable multilayer software architecture for data flow management in the intensive care unit.

OBJECTIVES: The current Intensive Care Information Systems (IC-ISs) collect and store monitoring data in on automated way and can replace all paper forms by an electronic equivalent, resulting in a paperless ICU. Future development of IC-ISs will now have to focus on bedside clinical decision support. The current IC-ISs are data-driven systems, with a two-layer software architecture. This software architecture is hardly maintainable and probably not the most optimal architecture to make the transition towards future systems with-decision support. The aim of this research was to address the design of an alternative software architecture based on new paradigms. METHODS: State-of-the art component, middleware and agent technology were deployed to design and implement a software architecture for ICU data flow management. RESULTS: An advanced multi-layer architecture for efficient data flow management in the ICU has been designed. The architecture is both generic and scalable, which means that it neither depends on a particular ICU nor on the deployed monitoring devices. Automatic device detection and Graphical User Interface generation are taken into account. Furthermore, a demonstrator has been developed as a proof that the proposed conceptual software architecture is feasible in practice. The core of the new architecture consists of Bed Decision Agents (BDAs). The introduction of BDAs, who perform specific dedicated tasks, improves the adaptability and maintainability of the future very complex IC-ISs. CONCLUSIONS: A software architecture, based on component, middleware and agent technology, is feasible and offers important advantages over the currently used two-layer software architecture.

Computer Systems↗

Computer software.

Software is the component in a computer system that permits the hardware to perform the various functions that a computer system is capable of doing. The history of software and its development can be traced to the early nineteenth century. All computer systems are designed to utilize the "stored program concept" as first developed by Charles Babbage in the 1850s. The concept was lost until the mid-1940s, when modern computers made their appearance. Today, because of the complex and myriad tasks that a computer system can perform, there has been a differentiation of types of software. There is software designed to perform specific business applications. There is software that controls the overall operation of a computer system. And there is software that is designed to carry out specialized tasks. Regardless of types, software is the most critical component of any computer system. Without it, all one has is a collection of circuits, transistors, and silicone chips.

History, 19th Century↗

Physicians' use of computer software in answering clinical questions.

Descriptive data about the use of medical information software were gathered from physicians who were early users of these resources. Eight clinically active internists and medical subspecialists were lent a microcomputer loaded with six commercially available medical information software products. Participants used the software for two weeks to answer questions arising in their practice and completed written questionnaires. They recorded a total of 50 questions (between 3 and 11 per participant per two-week study period). Using the workstation, participants answered 20 questions (40% of the total), partially answered 16 questions (32%), and did not obtain useful information for 14 questions (28%). Participants found answers outside the workstation to 8 of the 14 questions (57%) not answered by using the software. The most common question topic was drug information (16 questions, or 32% of the total). The most common problems encountered using the workstation were retrieval of incomplete information (20 questions, or 40% of the total) and difficulty navigating the software (16 questions, or 32%). Other problems included difficulty translating clinical problems into questions, inappropriate resource selection, inadequate training for using the software, and excessive time required to access information. The study highlights several opportunities for medical librarians and others involved in clinical information management to facilitate the use of computer software for solving clinical problems.

Attitude to Computers↗

[Job stressors in software developers--a comparison with other occupations].

The aim of this study is to investigate the difference in job stressors among software developers, the sales staff and the clerical staff (n = 2,079) in two companies (A Co. and B Co.) using a self-administered questionnaire that included a job stressor scale and the 30-item General Health Questionnaire (GHQ). We developed the job stressor scale based on the interviews with out-patients who engaged in software development and previous studies about job stressors. Factor analysis with a seven-factor solution showed that seven subscales were abstracted from the job stressor scale, namely, quantitative load of work, dissatisfaction with work, demanding work, uneasiness about work, human relations, ambiguity of work and shortage of private time. Each subscale was significantly (r = .313-.442, p < 0.0001) correlated with the GHQ score and proved to be a reliable instrument, as indicated by a Cronbach's alpha of greater than 0.73. Stepwise multiple regression analysis revealed that quantitative load of work and shortage of private time subscale scores were significantly high in software developers in A Co. Software developers in A Co. tended to score higher (P < .10) than the others in demanding work and ambiguity of work subscale. All subscale scores were significantly low in the clerical staff in B Co. There was no significant difference between the sales staff and software developers in B Co. Results of the interviews with out-patients showed that demanding work, hard deadline, ambiguity of work and precarious work would cause trouble in software developers. The implications of these findings with respect to occupational issues related to software developers are discussed.

Adult↗

Evaluation of healthcare software from a usability perspective.

This paper provides a framework for evaluating healthcare software from a usability perspective. The framework is based on a review of both the healthcare software literature and the general literature on software usability and evaluation. The need for such a framework arises from the proliferation of software packages in the healthcare field, and from an historical focus on the technical and functional aspects, rather than on the usability, of these packages. Healthcare managers are generally unfamiliar with usability concepts, even though usability differences among software can play a significant role in the acceptance and effectiveness of systems. Six major areas of usability are described, and specific criteria which can be used in the software evaluation process are also presented.

Evaluation Studies as Topic↗

A microcomputer-based software interface for automatic acquisition of fetal monitoring data.

At University Hospital, interfaces are being designed to link-stand-alone patient care devices to Hospital Information System (HIS). The objective is to have an integrated HIS comprising of data from bedside patient monitors and from stand-alone devices such as infusion pumps, fetal monitors, and pulse oximeters. Interfaces are implemented with standard hardware and software design tools. The feasibility of designing a general purpose interface hardware based on a common microprocessor has been demonstrated for an IMED model 960 infusion pump. The present paper describes the implementation of the software component of the interface using standard microcomputer software packages. The device of choice was the Corometrics model 115 fetal monitor for implementing the software because it is used extensively at University Hospital and has built-in data communication hardware. The Corometrics model 115 fetal monitor was interfaced to an IBM Personal Computer (PC) model XT. Data acquired from the fetal monitor was used to provide data tables and graphs. The feasibility of designing and implementing a software interface capable of acquiring and processing data received from a stand-alone device (fetal monitor) was demonstrated. A description of the important aspects of the interface software design is presented in this paper. This design will eventually be part of the HIS. A brief discussion about the design modifications necessary to acquire data from multiple devices simultaneously is also included.

Fetal Monitoring↗

A database schema for public-domain medical software.

The quantity of public-domain medical software available is huge, and a classification schema may be therefore helpful. We developed a schema that includes identification data (name of the software, author, etc.), description (hardware and software requirements), classification (software category, application domain, etc.) and evaluation data (external quality and internal quality factors). The schema was tested on the public-domain software available at the SCAMC meetings (about 36 Mb). We also classified the software by employing students from a master course in computer science and medical informatics. We stored the high quantity of information collected in a database we developed using Paradox.

Databases, Factual↗

Analyze: a comprehensive, operator-interactive software package for multidimensional medical image display and analysis.

A comprehensive software package, called ANALYZE, has been developed (1) which permits detailed investigation and evaluation of multidimensional biomedical images. ANALYZE can be used with 3-D imaging modalities based on x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, and magnetic resonance imaging. The software is written entirely in "C" and runs on standard UNIX workstations. The ANALYZE package features integrated, complimentary tools for fully interactive display, manipulation and measurement of multidimensional image data. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. It provides an effective shell for custom software prototyping and turnkey applications. This paper provides a general description of this software as well as specific details on the methodology employed to develop it, both conceptual and technical. Applications of the software are illustrated.

Image Processing, Computer-Assisted↗

Open Source software in medical informatics--why, how and what.

'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Database Management Systems↗

The RUMBA software: tools for neuroimaging data analysis.

The enormous scale and complexity of data sets in functional neuroimaging makes it crucial to have well-designed and flexible software for image processing, modeling, and statistical analysis. At present, researchers must choose between general purpose scientific computing environments (e.g., Splus and Matlab), and specialized human brain mapping packages that implement particular analysis strategies (e.g., AFNI, SPM, VoxBo, FSL or FIASCO). For the vast majority of users in Human Brain Mapping and Cognitive Neuroscience, general purpose computing environments provide an insufficient framework for a complex data-analysis regime. On the other hand, the operational particulars of more specialized neuroimaging analysis packages are difficult or impossible to modify and provide little transparency or flexibility to the user for approaches other than massively multiple comparisons based on inferential statistics derived from linear models. In order to address these problems, we have developed open-source software that allows a wide array of data analysis procedures. The RUMBA software includes programming tools that simplify the development of novel methods, and accommodates data in several standard image formats. A scripting interface, along with programming libraries, defines a number of useful analytic procedures, and provides an interface to data analysis procedures. The software also supports a graphical functional programming environment for implementing data analysis streams based on modular functional components. With these features, the RUMBA software provides researchers programmability, reusability, modular analysis tools, novel data analysis streams, and an analysis environment in which multiple approaches can be contrasted and compared. The RUMBA software retains the flexibility of general scientific computing environments while adding a framework in which both experts and novices can develop and adapt neuroimaging-specific analyses.

Algorithms↗