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The Population Health Information System: data analysis and software.

This article describes the software developed in the process of creating the Population Health Information System. The software can be applied to a range of administrative data and provides standardized data on the health status and health care use of populations by generating population-based rates of discrete events. The standardized approach permits construction of a comprehensive, comparative picture for residents of defined geographic regions. The addition of a user friendly graphic interface will permit regional planners to do their own data analyses and allow out-of-province researchers to adopt the system for their own uses.

Community Health Planning

Faculty authoring of course-specific software for disadvantaged nursing students using LinkWay: a case study.

This article adds to the literature on the use of hypermedia systems for software development in nursing education by describing design and authoring considerations in the construction of course-specific remediating software. In 1991, under the guidance of an instructional designer, faculty members developed LinkWay folders on aspects of the endocrine system for remedial use by students in Project Get Ahead in Nursing at Southern Illinois University at Edwardsville. Existing content outlines were modified according to design criteria, including representing information graphically, making the software translation interactive, embedding visual prompts and cues, and conforming to a specific design protocol. The use of LinkWay in facilitating the implementation of both procedural of both procedural and screen protocol is discussed, and several screen templates are presented, including menus, multiple choice, short answer, multiple choice browsing, and end-of-section evaluation. Current project status and conclusions for remediation using a hypermedia approach are discussed.

Computer-Assisted Instruction

VA's Integrated Imaging System on three platforms.

The DHCP Integrated Imaging System provides users with integrated patient data including text, image and graphics data. This system has been transferred from its original two screen DOS-based MUMPS platform to an X window workstation and a Microsoft Windows-based workstation. There are differences between these various platforms that impact on software design and on software development strategy. Data structures and conventions were used to isolate hardware, operating system, imaging software, and user-interface differences between platforms in the implementation of functionality for text and image display and interaction. The use of an object-oriented approach greatly increased system portability.

Computer Graphics

Technical development of an implantable cochlear prosthesis in Canada.

A new cochlear implant device is currently being developed by a group of research teams in Canada. This is an update on the progress of this development, including a brief description of the cochlear electrode array, the implantable stimulator, and the software development for the speech processor.

Cochlear Implants

[Computerized three-dimensional reconstruction of human embryos and their organs using the "NIH image" software].

Three-dimensional structures of human embryos and their internal organs were reconstructed on a CRT from their serial histological sections using a free computer software system "NIH Image." It was possible to rotate the computer images on CRT and to make cut models on any desired plane. In addition, various developmental changes could be animated by artificial "morphing" between the models at different stages. Computer graphic modeling should be of great value in the study of normal and abnormal morphogenesis. The "NIH Image" software is freely available via computer networks and has a lot of advantages over previously developed software programs used for three-dimensional reconstruction.

Computer Graphics

[Semi-automated quantification of MRI high signals observed in multiple sclerosis].

MR T2 Weighted sequences on the brain demonstrate disseminated "high signal zones" (HSZ) in patients with Multiple Sclerosis; these morphological alterations are corresponding to the plaques. From the very beginnings of MR in 1981, everybody recognizes the main importance of this fact. MR appears as the most sensible exploration in patients with M.S. But the signal alteration is not specific; the clinical considerations and the evolution are requested. The aim of this work is to give a reference tool for evolutive evaluation of the disease. A work station with a specially developed software are presented. The HSZ thresholding is partially automatic. The edition of a cerebral mapping is developed. These results are discussed.

Humans

The present and future medicolegal importance of record keeping in anesthesia and intensive care: the case for automation.

The anesthesia record is often crucial to successful defense in a meritless claim, because the adversarial role of the plaintiff's medical expert witness requires an attack on the record. Likewise the record may be pivotal in determining whether a defense should even be mounted as an alternative to an early settlement, because the failure of meaningful, supportive, or exculpatory documentation raises serious questions about the quality of care rendered. Advancing technology has made possible revolutionary changes in real-time monitoring and data recording. Concepts favoring the development and adoption of automated record systems for anesthesia are outlined through historic medicolegal perspectives on record keeping in general and computerization of the monitoring and recording methods in specific as a means of providing the best medicolegal evidence in defense of the anesthesiologist's performance. The analogy is often made between the successful development and acceptance of the flight data recorder and cockpit voice recorder combination in aviation and ongoing software development for automated recordkeeping and the quest for its use and professional acceptance in both anesthesia and intensive care settings.

Anesthesiology

Linear regression software for intraocular lens implant power calculation.

Regression equations for the calculation of intraocular lens power are popular. Because some of the variables in cataract surgery are surgeon-specific, every surgeon should ideally have a personalized formula. We have developed software enabling those with access to IBM-compatible microcomputers to develop equations based on their own data.

Computers

Economic analysis of immunization programmes.

Two economic analyses of immunization programmes, one from Denmark and one from Kenya, are described with emphasis on practical problems in relation to the collection of data. The Danish study was performed by a study group with participation of experts within health economics and epidemiology and a specifically designed computer programme was developed. The Kenyan study was performed by the management unit of the Kenyan immunization programme using standard computer software developed by WHO (EPICost) and without external assistance. Both studies yielded results of significant relevance for the dialogue with the administration and politicians.

Child

Constructing clinical applications: the GALEN approach.

A common problem for developers of clinical applications is coping with the diversity of medical language. Medical language as it is used all over the world varies widely, while the referents for these words stay essentially the same. Software developers must reconcile this diversity with the practical necessity of producing applications that are usable in a variety of hospitals, while ensuring that information can be shared between applications. Existing approaches center around coding and classification schemes, but these approaches must be supplemented by a range of sophisticated terminological services in order for the language barriers to be overcome. To address this, the GALEN project is developing an application called the Terminology Server to provide such a range of terminological services (e.g., conceptual and multilingual services). The software is built upon a re-usable core model of medical terminology. This paper reports on the development of a clinical application called the SCUI (Structured Clinical User Interface) which draws on these GALEN technologies and illustrates an innovative approach to the construction of future clinical applications. The SCUI was specifically developed and tested in the context of infectious diseases to satisfy the demands made by the medical intensive care unit on the Geneva Hospital's microbiology laboratory.

Clinical Laboratory Information Systems

POLLUX: a program for simulated cloning, mutagenesis and database searching of DNA constructs.

Computer support for research in biotechnology has developed rapidly and has provided several tools to aid the researcher. This report describes the capabilities of new computer software developed in this laboratory to aid in the documentation and planning of experiments in molecular biology. The program, POLLUX, provides a graphical medium for the entry, edit and manipulation of DNA constructs and a textual format for display and edit of construct descriptive data. Program operation and procedures are designed to mimic the actual laboratory experiments with respect to capability and the order in which they are performed. Flexible control over the content of the computer-generated displays and program facilities is provided by a mouse-driven menu interface. Programmed facilities for mutagenesis, simulated cloning and searching of the database from networked workstations are described.

Base Sequence

NUMEDICS: a system for on-line data processing in nuclear medicine.

A multiterminal system --NUMEDICS--has been developed to study the problems of on-line acquisition, processing, and display of scintigraphic data. The hardware-software configuration of NUMEDICS permits simultaneous and independent operation of terminals in the Division of Nuclear Medicine, the Physics Research Laboratory, and the Cyclotron Laboratory of the Massachusetts General Hospital. This paper describes the hardware and software developments in NUMEDICS which have been proven to be of value in clinical and research applications. These features are illustrated by applications to the evaluation of left ventricular performance, three-dimensional imaging, and functional imaging of rCBF.

Nuclear Medicine

Critical care medicine in cyperspace: Internet resources and techniques for the intensivist.

The internet, is an informational tool of impressive proportions and capabilities. New software developments puts the use of this informational technology into the hands of all physicians. The use of Internet informational resources allows the intensivist to stay abreast of new developments in critical care medicine, communicate in a matter of seconds with colleagues half a world away, acquire medically related software, access remote database structures, obtain continuing medical education, and in the near future to "see' patients and obtain physiological data in real time. This tutorial will introduce the Internet and it's current tool suite.

Computer Communication Networks

Topographical brain electrical activity mapping on an IBM-compatible personal computer.

A new system for computing brain electrical activity maps on a standard IBM-compatible computer has been developed. The EEG is recorded using a CED1401 intelligent laboratory interface and stored in the computer; colour coded maps are generated using software developed in Turbo PASCAL and displayed on the EGA graphics screen. An acceptable computation time of 1.2 s for a 64 x 64 map displayed as a 128 x 128 pixel image has been achieved by incorporating assembly language routines and a maths coprocessor. The system may be readily upgraded as improved hardware becomes available and further software can be added. In addition to triggering auditory, visual and somatosensory stimulators, it provides the potential for the generation of complex stimuli for cognitive experiments by means of mass RAM and digital-to-analogue converters.

Brain Mapping

Photo CD and medical archives.

Most people involved in medical photography and illustration are aware of the difficulties of efficient archiving and retrieval of picture information. The recent developments in Photo CD now enable cost effective storage of high resolution images. Applications already exist for easy archive management and new software developments make it simple to tailor standard systems for professional people in very specific fields without the necessity of commissioning programmers and system developers with the consequential cost implications.

Archives

Automated identification by computer of the mass spectra of drugs in urine or serum extracts.

Gas chromatography/mass spectrometry (GC/MS) is the method of choice for confirming the presence of drugs tentatively identified in urine or serum by thin-layer chromatography, gas chromatography, or immunoassay. One of the most widely used GC/MS systems is the Hewlett-Packard (HP) Model 5970 mass selective detector equipped with a work station programmed in Pascal. Searching of mass spectra after a GC/MS run must be done manually, and this can take hours, especially when there are many peaks in a chromatogram to check. I have developed software that allows the unattended searching of all peaks in a run, using a forward search algorithm with a custom-made drug library developed over a period of 5 years, and a reverse search with a 1600+ drug library from HP or another in-house drug library. Using these libraries with the two algorithms maximizes the chances of finding a drug peak and identifying it correctly. Individual searches take about 5 seconds each. Overall search time of nearly 200 mass spectra per run takes about 40 minutes, including printing time. This software has proven to be both labor saving and effective in positively identifying drugs.

Electronic Data Processing

A computer-assisted electrocardiographic analysis system: methodology and potential application to cardiovascular toxicology.

An automated analysis of electrocardiographic (ECG) waveforms, based on a precise one-dimensional analysis of features within a generalized computer-enhanced ECG waveform, has been developed in our laboratory. ECG signals are monitored, amplified, and recorded using standard techniques. The recorder output signal is distributed to a microcomputer system. Software developed for the microcomputer slows the signal playback rate and permits operator review of the slowed signal for arrhythmia analysis. The analysis program identifies and superimposes 10-40 individual ECG complexes, depending on the heart rate, and generates an "ensembled" waveform. Operator interaction permits delineation of specific points on the displayed waveform and calculation of heart rate and duration of components within the ECG complex. The primary advantages of this system include (1) extensive automation--computer support decreases analytical time, increases precision, and permits rapid screening of large numbers of animals; (2) enhanced sensitivity--the use of functional parameters should provide a more sensitive index of toxicity than morphological parameters; (3) broad utility--this system provides the capability to utilize a variety of animals, both anesthetized and unanesthetized, ranging in age from fetuses to geriatrics, and permits studies of block as well as longitudinal design; and (4) ease of replication--standardization of equipment and techniques facilitates replication by other laboratories.

Animals