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Several possible procedures were discussed for computerizing clinical research and basic documentation. All approaches were evaluated with regard to available performance and installation effort. Additionally examples for personal computer aided data collection in the field of perinatology, oncology, endocrinology and expert systems were presented.
UNLABELLED: Increasing performance figures and the necessity to save expenses oblige transfusion services to automatize their donors' laboratory examination. Sufficient hard- and software for sample distribution and processing is now available. Following aspects should be regarded when switching to automatic serial screening: SAFETY: The identity of blood-donor, donation and laboratory result will be achieved by machine readable labeling and on-line communication between working-stations and central administration. Flexibility: Easy automatic selective laboratory screening will be possible using special barcodes including sample identification and working orders. A modular hardware concept with easily accessible programming control allows it to implement new devices or methods. Ergonomy: Automatic sample processing including selective screening and simultaneous operating robotic sample processors increase working quality, sample output and time benefits. Economy: Improved working conditions will result in saving reagents and compensating staff limitations.
A system for the documentation of radiographic diagnoses is described, based on the "documentation method for radiographic diagnosis" (Formmhold et al 1972) and on the diagnostic information system of the medical faculty of the University of Tübingen. The diagnostic indeces are dictated in relation to the findings and the diagnosis and fed on punched cards into a computer (IBM 1800). Various programmes provide patient-orientated diagnoses for clinical routine, as well as diagnoses-orientated lists of patients for demonstrations, teaching or research.
In a survey of 93 orthopedic clinics or departments conducted in 1985, concerning the use of data processing systems, a total of 64 replies were received. These were not yet affected by the new Federal (German) Hospital Tariffs Regulations and therefore reflect the actual needs of the institutions in question. There is a clear trend toward using data processing for scientific purposes. Data processing systems were already in use in 42 institutions. There are hardly any differences between university clinics and non-university establishments. It is significant that among the key systems used in orthopedic medicine, ICD9 plays a completely subordinate role. This is seen as proof that ICD9 is inadequate for orthopedic purposes. Attention is drawn to a simple diagnostic key used by the Oskar-Helene-Heim. The author also comments on the problems of special documentation departments.
After medial placement of the graft in myringoplasty the remaining air-bone gap within the speech range is on an average approximately 10,- dB. This remaining air-bone gap is, according to secured statistics, on an average approximately 10 dB lower than in a lateral placement of the graft. The bone conduction does usually not change in either operation method. The additional support of meatal skin graft on the underlayed fascia does not have any influence on the audiologic finding. The percentage of the reperforations is in type I with a rate of 18% rather high; both operation methods do not significantly differ.
What clinicians expect from computers is contrasted with the actual potency of computerized data analysis. Different paths of procedure and the resulting chances of satisfactory implementation are discussed in the light of several specific cases. Additionally, examples are given both of highly efficient solutions and of the frequent mis-judgments which occur.
The present paper describes the microcomputer-based allergy data storage and retrieval system, realized with the relational database system INFORMIX on a Siemens MX2 computer. The main features of the kind and structure of data stored are discussed, as well as some general aspects of data storage. Additionally, the activities of the German Contact Dermatitis Group with regard to computer-based documentation are mentioned.
The authors performed the sequential scintigraphy after intravenous application of 131I-BSP using the scintillation camera. During the first 60 minutes the pictures of the liver and of the mesogastrium were recorded in one-minute intervals on the digital magnetic tape. The following scintigrams were then recorded after 3 and 24 hours after the injection. Choosing the region of interest the authors noted the histograms above the liver and above the mesogastrium, evaluated then the proportion of impulse rate above the liver and mesogastrium in measured intervals and obtained using the digital computer the velocity coefficient of the radioactivity accumulation in the liver as liver chromoexcretive function parameter. The results were compared with the standard test of the 45-minutes retention of the BSP, with the analysis of the curve measured above the temporal region, with the clinical status as well as with the results of other auxiliary examination methods. According to the first experiences gained when examining 91 individuals the described method proves to be very useful.
This article describes an EDP-adequate data collection system which can also be used in the conventional way. The relational data base system used is PROFESSIONAL ORACLE, Revision 5.1.; the requisite hardware consists of 3 IBM-AT-compatible personal computers with a main storage comprising 4 MB, system MS/PC-DOS, and a hard disk of at least 20 MB. The standardized case history compiles the user to collect the data carefully and completely. Besides formulating research problems the system automatically prepares the discharge report. By means of statistical analysis a continuous internal quality assessment was realized.
Under standard conditions deformations in the skeletal system are diagnosed by two X-ray photographs whose planes of projection form a right angle. The degree of deviation from the axis is measured directly on the X-ray photograph with a protractor. The analysis of the position of the axis of a tabular bone is carried out by determining the varus/valgus or ante/recurvation deformities resp. in the a.-p. and lateral rays. The degree of deformation is expressed through the supplementary angle. We asked ourselves whether a diagnostic procedure using X-rays taken in two planes is suitable for substantiating the evidence of a deformation of the axis. Example: If a fracture of the lower leg shows a varus deformity of 20 degrees in the a.-p. and a normal position of the axis in the lateral photograph, the actual angle is 20 degrees. This situation is an expection in that most cases the defect of the axis is a so-called combined defect (dislocation from the axis in both planes). In this case it can maintained that the measurable angle of deviation in the a. -p. and lateral X-ray photographs is smaller than the angle that is actually included by both fragments. We call this angle true angle. If you think of a fractured tubular bone as a cylinder it can be shown in a diagram that its deformation can only occur in one plane (Figure 1). Only from the perspective of a ray falling vertically on the curve k we would be able to determine the true angle directly from the photograph with a protractor.(ABSTRACT TRUNCATED AT 250 WORDS)
A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.
A system for the evaluation of therapeutical effects in rheumatic diseases is presented. This system permits a calculation of two indices: i.e. rheuma-number and "Masszahl" (= only measured values such as range of motion in degrees) which lend themselves to statistical treatment. The result of standardized physical joint examination of patients is recorded on two mark-pages, specially developed for documentation of joint status. The data recorded on the two-mark-pages are then entered into the computer by means of a mark-page-reader. On the basis of these data, the computer, upon the basis of a program specially developed for this purpose, automatically calculates the corresponding amount of negative-points, which parallels the severity of the joint changes, i.e. the rheuma-number ("Rheumazahl"). Separately listed at the end of the status-outprint is the "Masszahl", which is part of the rheuma-number and comprises the measured values (for example, the range of motion measured in degrees). The practicability of this system is demonstrated on the basis of the results of a double-blind-comparison of two antirheumatic-corticosteroid-combinations and an open study with immuno-suppressives in patinets with rheumatoid arthritis.
With a standardized questionnaire we evaluated 1450 orthopedic and general surgery departments. The response rate was 57.2%, 52% of the departments were using computers for different purposes. The favoured system was the MS-DOS system (73%). The computers were mainly used for word processing (58%), statistics (50%), and graphics (39%). For clinical routine the leading use was patient documentation (70%) followed by patient report generation (43%). Other applications (e.g. online use of administrative data (19.4%) or the use of other patient information like blood parameters (10%)) were relatively rarely used. However, most of the users have plans to incorporate these applications in the nearest future. For the out patients care the leading application is private billing (42.5%) and statistics (30%). The majority of the departments (42.6%) only have one PC. Most of the departments use the printer for hard copies and as hard disc a the standard storage medium. The average storage capacity of the used hard discs is 40 to 80 MB. Other peripheral tools like a laser printer, a scanner, or modems are rarely used. Most of the departments invested between 5000 and 15,000,--DM. 33.3% financed the computers only with the official budget of the department. However, 25.8% only used private funds to buy the hard- and software. The distribution according to zip codes showed a slight accommodation in Bavaria and NRW. The amount of new installations showed an almost constant increase from 1975 until 1981. Between 1981 and 1990 there was a significant increase with a small drop in 1986.
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To assure quality and progression of surgical intensive-care therapy appropriate equipment is mandatory to ensure documentation and quality-control. In our hospital data processing of any information concerning the patients treated in the intensive-care unit has become part of the daily routine. This paper presents and discusses the underlying concept.
A brief introduction to the Danish Cytogenetic Central Register (DCCR) is given, and possibilities, principles and problems concerning the establishment and maintenance of a national cytogenetic register are presented. Various data carrier media for registers in general are discussed, of which the magnetic disc is considered most appropriate. General principles for programs capable of performing insertions, deletions and other modifications in the data base are outlined as well as the principles for the programs in the DCCR. The individual records should preferably be identified by aid of a central person registration number (CPR) rather than by name. The data should be stored and sorted by this identification in order to facilitate retrieval of a desired record. The structure of the records is discussed with regard to prevention of the occurrence of certain errors as well as the optimization of processing. Flexibility and economy of space are achieved by using programs able to handle records of unequal length, and problems occurring in connection with this are discussed. The question of how to protect sensitive data is dealt with, and two different methods used in the DCCR are outlined. Programs capable of analyzing karyotypes with the purpose of recognizing various cytogenetic syndromes have been developed for use in the DCCR. Various examples of computing times of typical program runs are presented.
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