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PubMedDate not supplied

AIDA and medical courseware.

For more than a decade the Department of Medical Informatics has offered one-week training courses on the subject of computer applications in medicine and health care. Since 1983 two courses are given at a rate of one course every two weeks. One course is on programming and problem solving and consists of three modules of increasing complexity in techniques and methods in programming and structured system development. This course focusses on only some aspects of medical informatics: the development of a medical information system, and the problems occurring in the process of automation. These aspects, however, are dealt with in detail. To this end the students are trained in using the programming system MUMPS and the fourth-generation software package AIDA. The second, introductory course is an intensive training on several distinct areas of man-machine interactions. It contains lessons in the fields of communication and recording; storage and retrieval and databases; computation and automation; recognition and diagnosis; and therapy and control. This paper describes the use of AIDA in developing and maintaining lessons for the latter course, and the assistance of AIDA for teaching purposes in the former course.

Computer User Training↗

PubMed1985

The computer-based anesthetic monitors: the Duke Automatic Monitoring Equipment (DAME) system and the microDAME.

From 1972 to 1983 the Duke University Department of Anesthesiology designed, built, and maintained most of its own operating room patient monitoring equipment. Construction of a new hospital facility in 1980 provided the opportunity to design and test a new computer-based system, the Duke Automatic Monitoring Equipment (DAME) System. The system consist of microcomputer-based instrumentation on monitoring carts, which communicate with a central minicomputer that allows selection of different software monitoring packages based on the needs of the patient. Multiple problems, including frequent total monitoring failures during surgery, plagued the DAME System in its first year of operation. Despite resolution of many of these problems, user acceptance was poor because of the large size and weight of the monitoring carts, the inadequate quality of displayed physiological waveforms, and inability to overcome the difficulties of the man-machine interface. Because the remaining problems could not be rectified with the existing monitoring carts, a new generation of monitors was designed. The smaller, multiprocessor microDAME was designed to be as automatic and user tolerant as possible. It would omit much of the flexibility that had proved undesirable in the DAME system. When the microDAME was nearly completed, however, departmental research in that area ceased. It remains for others to apply our experiences to further improve operating room patient monitors.

Anesthesiology↗

PubMed1989

Digital image display station performance requirements based on physician experience with a prototype system.

The authors report on observations of and interviews with physicians using a prototype digital image display and reporting station. While the users generally agree that image quality is clinically satisfactory, they are unanimous in their opinion that improvements in the man-machine interface are required before case review by this mechanism is clinically acceptable in a production environment. A model image and information user interface is presented. It was developed in answer to the needs of radiologists and referring physicians operating in the imaging department of a community acute-care facility. In such an environment images and related information must be communicated quickly and often simultaneously to different parts of the department and hospital. The user interface with the management system and the management system itself must address the varied functions and the needs of both the medical and clerical staff. Image enhancement processes, for example, must be restricted to those that quickly provide significantly more perceivable diagnostic information. Little-used processes that may occupy significant portions of the display and the console's computing power must be trimmed or eliminated.

Computer Systems↗

PubMed1990

The artificial substitution of missing hands with myoelectrical prostheses.

The fitting of upper-extremity amputees requires special efforts, and its significance has been increased by the development of myoelectrically controlled prosthetic arm. Although an artificial hand only represents a relatively modest substitute for the missing hand of human beings, the efforts of designers and the achievements of manufacturers should not go unnoticed. Because of the development of myoelectrically controlled prosthetic arm, the amputee's standard of function can be improved and a cosmetic and functional solution provided. For control of the electromechanical hand, muscular potentials are received from the residual limb surface, amplified in the electrodes, and transmitted as control signals to the distal area. An important factor in providing a successful fitting is a reliable man-machine connection. This article summarizes the historic development and state of the art of the myoelectrically controlled arm prosthesis. The components and technical evaluations of the Myobock system as well as the procedures for fitting and fabricating a below-elbow prosthesis have been improved recently. A critical analysis of adaptive hands suggests that the prospects for the future are good.

Adult↗

PubMed1998

[Virtual operations on real patients].

The tremendous amount of available medical digital data requires media for intuitive information perception. Virtual reality (VR) presents a technique for processing the visual data from various diagnostic modalities. From a synthetic patient model, the required compact information can be generated. The patient model is the basis for planning and processing of surgical procedures. Stereoscopically visualized 3-D reconstructions of, for example, tomographic scans are used for virtual operations. Today, prototypical tools for the virtual training of certain surgical procedures are known. Possible VR applications in surgery range from the combination of virtual and real data (augmented reality) and intraoperative computer assistance (navigation) to remotely performed operations (telerobotics). In particular, the optimization of the man-machine interface to integrate VR applications in operating theaters is required.

Computer Systems↗

PubMedDate not supplied

How can usability measurement affect the re-engineering process of clinical software procedures?

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated hospital information system, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.

Evaluation Studies as Topic↗

PubMed1997

An example of usability measurement in clinical software procedures.

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated Hospital Information System, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.

Attitude of Health Personnel↗

PubMed1995

X-HUSAR, an X-based graphical interface for the analysis of genomic sequences.

Management and analysis of nucleotide and protein sequence and structure data constitute a traditional area of bioinformatics. Since the analytical programs are frequently developed by researchers, rather than software engineers, they tend to suffer from idiosyncratic and non-ergonomic man-machine interfaces. We report on HUSAR, our 140+ collection of third-party, as well as in-house developed or adapted, sequence manipulation and analysis tools, well integrated into the UNIX operating system environment and accessible via consistent menu-aware interface. Most of the HUSAR programs can be completely specified by UNIX command-line options; they can thus be run in batches or combined into pipes. Adding such a program into the HUSAR environment is almost a 'plug-and-play' exercise. HUSAR has been recently complemented with a graphical client interface, X-HUSAR, to support users on UNIX platforms with X11 windowing systems. The whole X-HUSAR interface is based on a single generic program, COMLIGEN, and a number of specific configuration files. COMLIGEN interprets those files and renders appropriate windows, menus, and other interactive elements, which help the end user in selecting application programs and specifying their options. Efforts of extending both HUSAR and X-HUSAR are roughly linear to the size of the collection.

Animals↗

PubMed1998

Robotic three-dimensional positioning of a stimulation electrode in the brain.

Functional stereotactic cerebral operations are currently performed with straight electrodes. After physiological exploration, correction of the initial target is frequently necessary and requires multiple penetrations of the brain. This paper describes a robotic three-dimensional electrode probe that can reach targets located within a cylindrical volume from a single approach trajectory. It has been mounted on the neurosurgical robot Minerva, and includes a string electrode, which can protrude out of the side window of a straight cannula and offers a high intrinsic accuracy of 0.25 mm. A simple man-machine interface allows the surgeon to select reference and target points and to activate the probe from a graphics workstation. This paper also analyzes the accuracy of the probe as well as of the whole operating system, food gelatin being used to simulate brain matter.

Brain↗

PubMed1983

Automated analysis of abnormal electroencephalograms.

This paper presents a critical review of various attempts at computerized analysis of abnormal electroencephalograms (EEGs). A description of normal and abnormal EEGs from the viewpoint of the clinician is presented at first, along with guidelines used in the visual detection and quantification of EEG abnormalities, followed by a brief review of some important computerized methodologies for clinical EEG analysis. Automated detection and quantification of epileptogenic EEG transients and seizures are reviewed next, and digital computer (software) as well as hardwired systems are presented. Computerized techniques for the quantification of abnormal EEGs in cerebrovascular disorders and coma, metabolic disorders, and for the localization of brain lesions and tumors are presented as well. Future directions and the general problem of man-machine agreement are elaborated upon.

Brain Diseases↗

PubMed1996

Experimental telemanipulation in endoscopic surgery.

Today's rigid endoscopic instruments limit the intracorporeal mobility of the surgical tool and are a severe impediment for the further spread of endoscopic techniques in operative medicine. Since 1992 flexible, steerable instruments with additional links for pivoting and rotating the tip have been developed and experimentally evaluated. The latest versions of this series of instruments are equipped with electromotors for better handling. The next aim in this development is a fully mobile telemanipulator with six motion axes dedicated to use in endoscopic surgery. Its first tests are planned for 1995. For successful operation of an electric telemanipulator, the man-machine interface (MMI) is of cardinal importance. For the definition of surgical requirements for the MMI, a conventional master-slave manipulator designed for technical application was modified for use in guiding a laparoscopic instrument. Master and slave sites of the system were 1.3 km apart and linked by means of a fiber-optic cable. Using this modified telepresence system, remote laparoscopic cholecystectomy was feasible in a phantom model. In a standardized test series using a test parcours, different parameters of the control system were modified, and their influence on the execution time of the parcours tasks was recorded. Well-suited parameter configurations were found and allowed experimental verification and completion of the important aspects of our concepts for development of an endoscopic manipulator MMI.

Cholecystectomy, Laparoscopic↗

PubMed1992

XELE--a polypeptide model-building program for a graphics workstation.

A model-building program, XELE, for use in protein crystallography has been written in C under UNIX on a graphics workstation. This program makes full use of the X Window system to display the electron density distribution and to manipulate the polypeptide model, and therefore is named XELE. It utilizes a fast three-dimensional rendering package, Dorè, and is portable to other types of graphics workstations. A part of the program for the man-machine interface uses the library of X Window and X Toolkit, and therefore is highly interactive. The structure analysis program package, PROTEIN, is also implemented in an interactive mode using X Window, and has been interfaced with XELE.

Computer Graphics↗

PubMed1987

[Statistical indices of 201Tl distribution in the myocardium].

A study was made of the diagnostic potentialities of a histogram analysis of scintigraphic count distribution on myocardium scans using 201Tl in 9 patients with dilated cardiomyopathy, 12 patients with coronary heart disease and 6 patients with primary pulmonary hypertension. Scans were recorded 10 min., 4 and 24 h after a single administration of 201Tl at rest in the front-forward, 45 degrees left forward oblique and left lateral projections. The heart area on a scan was marked by hand. Count distribution was represented by an intensity histogram. An array of 243 scans was processed independently by 2 operators of different professional skill. A man-machine classification procedure with algorithm teaching was implemented. The author showed a possibility of group distinction by scintillation count distribution in the heart area on myocardium scans using 201Tl, the distinguishing information being within the interval of 41-80% of maximum intensity in this area. Automatic marking of the heart area on a scan was found necessary to have an entirely automated system for distinguishing groups of examinees.

Adolescent↗

PubMed1990

Integrated Broadband Communication (IBC) requirements of people with special needs.

In order to make the benefits of the Integrated Broadband Communication (IBC) services available to the largest possible part of the population, special attention should be given to user groups with special needs, such as elderly and handicapped people. For some of these groups the IBC services will facilitate their members socio-economic integration and offer them the opportunity to satisfy some of their everyday needs (e.g. video-telephony for the inter-personal communication of hearing impaired people). For some other categories (e.g. people with motor or sensory impairment), special design considerations are needed at a very early stage of technical development, in order to ensure that they are not prevented from using future sophisticated telecommunication services (e.g. by incorporating appropriate man-machine interaction techniques in general purpose terminals, adapting the user interface of terminals, etc.). This paper gives an overview of the work that is currently taking place within the framework of the Research and development on Advanced Communication in Europe (RACE) programme.

Communication Devices for People with Disabilities↗

PubMed1978

MEDLINE searching and retrieval.

The development of MEDLINE searching philosophy and methodology is described. Searcher requirements and capabilities in moving from a batch-mode linear operation to the iterative searching and retrieval provided by the random access mode of MEDLARS II are discussed. A detailed tutorial on searching methodology for individual queries is covered. Elements of search formulation include requestor interview, query analysis, presearching, technics of selecting terminology, formulation logic, adapting indexing protocol in the search, on-line man-machine interface, and retrieval analysis. Similar searching technics are utilized in producing the two basic types of MEDLINE publications, recurring bibliographies (RBs) and literature searches (LSs). RBs are co-operative ventures between the NLM and professional organizations or other government agencies. LSs are NLM sponsored non-recurring bibliographies on a topic of current but also general interest to the medical community. All publications are produced through the retrieval and publication systems of MEDLARS II and graphic arts composing equipment. At the beginning of the 1978 publication year there were 27 RBs in routine production including Index Medicus. Through 1977, over 375 LSs had been produced.

MEDLARS↗

PubMed1987

Resistance to computerization. An examination of the relationship between resistance and the cognitive style of the clinician.

The introduction of computer technology into the health care environment has been fraught with difficulty. The literature has identified that while there are many applications that have been successfully implemented, there are many others that have met significant resistance. As such, the diffusion of computer technology has been scattered and uneven in the health care arena. Some scholars attribute the problems of resistance to structural variables such as value conflicts, power conflicts, and ones that involve the man-machine interface. Other view the resistance as process-oriented, citing such key factors as inadequate training, lack of user involvement, and discomfort due to organizational change. It is held here that the essence of resistance to computerization in clinical settings is based upon the difference between the cognitive style of the user and that required by the computer. It appears that since the decision-making methods of the user tend to favor intuitive processes, he or she becomes more resistant to using a system that forces qualitative information into quantitative niches. This study examines the cognitive style of two groups of health care providers within a hospital, and attempts to provide insight into how personal decision-making processes are related to resistance to computerization. It is suggested that a more thorough understanding of this relationship will enhance the ability of health care facilities to implement new systems in the future.

Adult↗

PubMed1996

[Computerized anesthesia record. How far have we gone?].

There are more and more computerized anaesthetic records becoming available from various constructors. However, the setting up and operation of such a product depends on the development of concepts in computing. The second technological breakthrough, currently underway, is challenging principles which had seemed accepted up until now. The technical development concerns computer processing units, RAM or ROM. The development in software influences the operation of networks, multiple task and object programming. The graphic interface becomes the centre of this second revolution. All of these developments should be included in the proposed computerized anaesthetic records. Three factors determine the realisation of such a product: control of the data collecting process, the man-machine interface and the utilisation of storing data. The computerized anaesthetic record should be of open conception, allowing communication with all of the data bases and providing an interface with all the monitors and ventilators used in operating and recovery rooms. Now is the time to install the infrastructure network in operating and recovery rooms and to be thinking of acquiring the new generations of computerized anaesthetic records.

Anesthesiology↗

PubMed2000

Parallel man-machine training in development of EEG-based cursor control.

A new parallel man-machine training approach to brain-computer interface (BCI) succeeded through a unique application of machine learning methods. The BCI system could train users to control an animated cursor on the computer screen by voluntary electroencephalogram (EEG) modulation. Our BCI system requires only two to four electrodes, and has a relatively short training time for both the user and the machine. Moving the cursor in one dimension, our subjects were able to hit 100% of randomly selected targets, while in two dimensions, accuracies of approximately 63% and 76% was achieved with our two subjects.

Biofeedback, Psychology↗