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An algorithm to fit the Gompertz function to growth curves.

An algorithm to fit the Gompertz growth function is presented. This algorithm is easy to program on a microcomputer. The algorithm is based on employing a searching technique to solve a set of equations derived from the Gompertz function. Its application may prove valuable when access to a computer mainframe is difficult. Such a method may be useful in construction of a specific growth curve in biology, or as a managerial tool in livestock enterprise, as well as in the clinical treatment of tumors. Demonstration of the successful application of this algorithm in experimental livestock growth data are presented.

Algorithms↗

Births, gestation and birthweights in South Tees 1990-1996.

BACKGROUND: The UK government has specified that all health authorities are to develop local health improvement programmes. Birthweight and gestational age are important health determinants, and therefore indicators of the health status of children in a community. They also have important resource implications for health and social services. Data regarding birthweight and its relationship to gestational age are not routinely available. This paper describes the results of the measurement of the birthweights and gestational ages of children born to residents in a UK health district, and their relationship with deprivation. METHODS: Routinely collected birthweight and gestational age data for children born to parents resident in the South Tees district during the period 1990-1996 inclusive were downloaded from the community child health department mainframe computer. The data were analysed and compared with national standards. RESULTS: The analysis showed that, despite the high levels of deprivation, birthweights were close to or slightly above average for most gestational ages. However, when compared with the average district in England and Wales, 8 per cent more low-birthweight children, of which 42 per cent were less than 28 weeks gestation, were born in the area. Materially deprived mothers were more likely to give birth to pre-term and light for gestational age infants. CONCLUSIONS: This study has shown that it is now possible to use routine sources of information to monitor local trends in birthweight and gestation, and their relationship with deprivation.

Birth Weight↗

A data management program for the Electra 800 automatic analyser.

The Electra 800 automatic coagulation analyser rapidly performs most chronometric coagulation tests with high precision. To facilitate data handling, software, adaptable to any PC running under MS-DOS, was written to manage the analyser. Data are automatically collected via the RS232 interface or can be manually input. The software can handle 64 different analyses, all entirely 'user defined'. An 'electronic worksheet' presents the results in pages of ten patients. This enables the operator to assess the data and to perform verifications or complementary tests if necessary. All results outside a predetermined range can be flagged and results can be deleted, modified or added. A patient's previous files can be recalled as the data are archived at the end of the day. A 120 Mb disk can store approximately 130,000 patient files. A daily archive function can print the day's work in alphabetical order. A communication protocol allows connection to a mainframe computer. This program and the user's manual are available on request, free of charge, from the authors.

Autoanalysis↗

Hypernatremia in the intensive care unit: an indicator of quality of care?

OBJECTIVE: To assess the frequency of hypernatremia in patients who were admitted to an intensive care unit (ICU) and to determine the correlation of hypernatremia with the clinical outcomes, durations of the patients' stays in the ICU, and other clinical variables. DESIGN: Retrospective survey. SETTING: University teaching hospital. PATIENTS: All patients (total, 389) who were admitted to the medical ICU of the department of internal medicine during 1 yr. MEASUREMENTS: The database of our hospital's mainframe computer was searched for sodium values > or = 150 mmol/L that were registered in the year 1995. These data were then matched with the registration numbers of all patients who were admitted to our medical ICU between January 1 and December 31, 1995. In this way, we identified all patients in whom hypernatremia was present at admission or those who developed hypernatremia in the course of their stay in our ICU. The prevalence and duration of hypernatremia (defined as a serum sodium concentration of > or = 150 mmol/L or more) were determined; the correlation of hypernatremia with clinical outcome, duration of ICU stay, Acute Physiology and Chronic Health Evaluation II scores, and other clinical variables were evaluated; and changes in fluid administration in response to hypernatremia and fluid regimens in the period preceding hypernatremia were examined. MAIN RESULTS: Of a total of 389 patients who were admitted in 1995, hypernatremia was present at admission in 34 patients (8.9%). The average duration of hypernatremia in these patients was 16.2 (range, 4-56) hrs. A total of 22 patients (5.7%) developed hypernatremia in the course of their stay in the ICU. The average duration of hypernatremia in this group was 34.7 (range, 4-89) hrs. Moderately elevated levels of sodium had been detected in most of these patients (n = 21) in the days before the development of severe hypernatremia; however, adjustments in fluid infusion aimed at preventing the occurrence of hypernatremia were either lacking (n = 7) or inadequate (n = 11). Hospital-acquired hypernatremia vs. hypernatremia present at admission to the ICU was associated with a higher mortality rate (32% vs. 20.3%, respectively; p < .01). CONCLUSIONS: Despite frequent measurement of sodium levels in patients in the ICU, hypernatremia is a relatively common occurrence. Initial treatment of hypernatremia is often inadequate, and sometimes treatment is delayed. The development of hypernatremia is associated with adverse outcomes for patients developing hypernatremia in the ICU. Hypernatremia could potentially be used as an indicator of quality of care in the medical ICU.

APACHE↗

Medical students' contribution to the development of a smoke-free hospital policy in a university medical centre: a relevant learning experience.

In a research methodology course, second-year medical students conducted a survey on 'Enforcing a Smoking Ban in the Soroka Medical Center: a Survey of Hospital Employees on Facilitating Factors and Obstacles'. They defined the study objectives and design, developed the study instrument, carried out the survey, coded and entered the data into mainframe computers, analysed the computer output, and prepared oral and written reports. The aims of the project were twofold: to survey employees' attitudes to a hospital smoking ban and to train medical students in the planning and conduct of a research project on public health or preventive medicine. Twelve students conducted a cross-sectional survey of 208 hospital employees (10% of the hospital staff). Employees were surveyed regarding smoking status, interest in quitting smoking, knowledge of the law banning smoking in public places, knowledge of the health effects of passive smoking, attitudes towards a hospital smoking ban and potential obstacles to its implementation. The students rated the course as excellent. They gained important research skills, as well as practical medical and public health experience through active participation in the design and execution of a study project with public health implications. At the first meeting of the hospital committee appointed to enforce a smoke-free hospital, the students' findings were reported in full, and their recommendations have guided policy decisions.

Health Policy↗

Quantitative morphology of human cirrhotic livers. Part II: The statistically adequate morphological classification of liver cirrhosis. Multivariate analysis from quantified data of form.

In a previous report, we developed methods by which to quantify various patterns of cirrhosis. A set of parameters were used: (i) the mean nodular radius; (ii) the coarseness; (iii) the mean septal thickness; and (iv) the degree of nodular separation. This was applied to 70 cirrhotic livers in an attempt to establish a reproducible classification, and the data were subjected to four-dimensional cluster analysis (Ward method) using a mainframe computer. Five clusters appeared: cluster A, fine nodules, thin septa; cluster B, coarse nodules, relatively thin septa; cluster C, fine nodules, thick septa; cluster D, extremely coarse nodules; and cluster E, coarse nodules, thin septa and incomplete nodulation. Of these, cluster A was considered to correspond to the nutritional type of Gall, cluster B to posthepatitic type (Nagayo's Type B), cluster C to postnecrotic type (Nagayo's Type A) and cluster E to the subtype of posthepatitic cirrhosis with incomplete nodulation (Miyake's Type BI). Cluster D comprised cases with extremely coarsened nodules. The reproducibility of this clustering was fully ensured by linear discriminant analysis. Another discriminant analysis, the canonical, allowed us to visualize the separation of clusters in a two-dimensional (2-D) scatter diagram. We thus managed to establish a most adequate classification from a geometric and statistical point of view.

Humans↗

Fourteen years' experience of management and use of the perinatal data-base system.

Since 1973, we have been recording the data of all obstetric cases in our department in our original data-base system, which was created on the mainframe computer at the Tokyo University Hospital Computer Center. The purposes of this system are mainly for making summaries of patients, for retrieving information of cases to provide data for clinical investigations, and for collecting statistics. The data records consist of 225 items, including different kinds of perinatal information. Our data-base system has been useful in improving perinatal medicine, in clinical investigations, and in our daily work. But after 14 years of experience with it, we recognize the system has problems, namely: 1) How to summarize perinatal data to be used as a substitute for a patient history chart, and 2) How to update the data-base with a little change in format according to improvements of perinatal medicines.

Female↗

Microcomputers and microprocessors in urology: present and future.

Urology departments have a heavy outpatient workload requiring efficient secretarial, appointments and records services. Microcomputers are relatively inexpensive and can facilitate efficient routine clinical and research work. Unlike mainframe computers, formal training is not usually required, a simple introduction being sufficient for the enthusiast. An Apple computer is used in this department for word processing incorporating standard letters, paragraphs and phrases. With more sophisticated programs urological screening by computer interrogation could be linked to an appointments system to coordinate investigations, minimising hospital visits. Microprocessors can facilitate a wide variety of measurement recording and data handling. Urodynamic measurements can be computed and graphs superimposed to facilitate interpretation.

Computers↗

Data storage and retrieval by implantable pacemakers for diagnostic purposes.

The functions of many of today's dual-chamber pacemakers are performed using custom microprocessors that are similar to those used in mainframe computers. The data storage and transmission capabilities of these microprocessor-controlled pacemakers can be used to record, process, and transmit information regarding the patient, pacemaker, or patient/pacemaker interaction. The limitations of such data processing systems depend upon (1) quantity and quality of incoming information, (2) software routines for data collection, and (3) the amount of available random access memory (RAM). Data obtained can be useful in patient management and follow-up, particularly in the areas of optimization of programming, monitoring of disease progression, assessment of pharmacologic therapy, and pacemaker troubleshooting. Anticipated advances in data collection capabilities will allow increasingly sophisticated analysis that will complement, and may in some cases, supplant the Holter monitor recording in evaluating some aspects of rhythm and/or pacemaker behavior in selected patients.

Adult↗

Use of microcomputer for histopathology: system using IBM PC and dBaseIII.

A microcomputer program for use in the storage and retrieval of histopathology records is described. The program was written using dBaseIII, a commercially available data management system. The program provides for efficient storage and rapid retrieval of pathology reports and facilitates clinical research. Downloading of data on to a mainframe computer is possible.

Computers↗

Microcomputer simulation as an aid in analyzing data and teaching the principles of glomerular dynamics.

This report describes a simple program, written in BASIC language, that closely emulates a previously published network thermodynamic model of glomerular dynamics. While the latter requires the SPICE 2 simulation program and a mainframe computer for its execution, the present program operates on any IBM-compatible microcomputer. It has equal utility as an aid in the interpretation of laboratory studies of glomerular dynamics and as a tool for teaching the intricacies of the control of glomerular function. The program is available in 'user friendly' format that obviates the need for any expertise in the use of computers.

Computer Simulation↗

Antiulcer prescribing program in a state correctional system.

OBJECTIVE: To describe a formulary antiulcer agent prescribing program developed as the result of a drug use evaluation (DUE). Program implementation, methods, cost impact, and results of a follow-up DUE are provided. BACKGROUND: The institution is a 51,000-bed correctional system consisting of 40 separate units each containing an ambulatory care clinic. Medication orders are transmitted via mainframe computer system to one of four pharmacies, which collectively dispense an average of 4000 medication orders (30 days' supply) per day. METHODS: Results from the antiulcer agent (cimetidine, ranitidine, sucralfate) DUE revealed that the agents studied were prescribed in dosages and durations exceeding criteria developed by the Pharmacy and Therapeutics Committee. A program designed to reduce dosages to maintenance therapy after eight weeks at treatment dosage was developed by the Pharmacy and Therapeutics Committee with staff physician input. Antiulcer agent use and expenditures were followed and a follow-up DUE was completed seven months after program implementation. Antacid use and frequency of upper gastrointestinal studies that were ordered were followed. RESULTS: The follow-up DUE showed the mean daily dosage for prescribed histamine2-receptor antagonists decreased (cimetidine from 694 to 454 mg, ranitidine from 280 to 183 mg) and the mean duration of therapy decreased from 14 to 10 months. The percentage of patients with potentially significant drug interactions decreased from 14.2 to 6.5 percent. The mean number of antiulcer agents dosage units dispensed per month decreased by 24,461 units, resulting in a projected annual savings of $327,273. There were no identifiable clinically important changes in the use of antacid products or prescribing of upper gastrointestinal studies. CONCLUSIONS: A cost-savings program sponsored by the pharmacy and therapeutics committee decreased costs, corrected prescribing to more closely meet preset criteria, and produced no discernable unfavorable effect on patient care.

Adult↗

Spectral analysis of airflow sounds in patent versus occluded tracheostomy tubes: a pilot study in tracheostomized adult patients.

Cannula occlusion is a life-threatening postoperative complication of tracheostomy. Current management largely relies on nursing care for prevention of fatalities because no proven mechanical, machine-based support monitoring exists. The objective of this paper was to address the problem of monitoring the state of cannula patency, based on analysis of airflow acoustic spectral patterns in tracheostomized adult patients in the patent and partially occluded cannula. Tracheal airflow sounds were picked up via a condenser microphone air-coupled to the skin just below the tracheal stoma. Signal output from Mic was amplified, high-pass filtered, digital tape-recorded, and analyzed on a mainframe computer. Although airflow frequencies for patient cannulae were predominantly low-pitched (0.1 to 0.3 kHz), occluded tubes had discrete high-pitched spectral peaks (1.3 to 1.6 kHz). These results suggest that frequency analysis of airflow sounds can identify a change in the status of cannula patency.

Adult↗

A decade of change in obesity surgery. National Bariatric Surgery Registry (NBSR) Contributors.

BACKGROUND: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade of 1986 through 1995, as observed in the IBSR data. METHODS: All data submitted to the IBSR during the decade were transferred to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (chi2) test for gender. RESULTS: There has been a steady increase over the decade in mean patient weight. The operations used have changed from predominantly 'simple' operations to more frequent use of 'complex' operations. Within the categories of 'simple' and 'complex', an increase in the variety of operations occurred. As a group, patients with 'simple' operations have been heavier, more often male and public pay patients than those who have undergone 'complex' operations. One year weight loss was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to study the relative merits of the operations used. The reported incidence of operative mortality and serious complications (leak with peritonitis, abscess and pulmonary embolism) remained low. CONCLUSIONS: These observations and their implications can be summarized in three statements which relate to action for improved patient care in the beginning of the new century: (1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread use of both 'simple' and 'complex' operations with increased modifications of standard RGB and VBG procedures emphasizes the need for standardized long-term data and analyses regarding both weight control and postoperative side-effects.

Adult↗

Sodium serum levels in hypoalbuminemic adults at general medical wards.

Hypoalbuminemia may cause interstitial edema and hemodilution, which we hypothesized may influence serum sodium levels. Our purpose was to compare serum sodium levels of hospitalized adults with or without hypoalbuminemia. All sodium and albumin serum levels of 142 adults hospitalized at general medical wards over a six-month period were searched at a University Hospital mainframe computer. Relevant laboratory data and clinical details were also registered. Hypoalbuminemia was defined by serum albumin concentration < 3.3 g/dl Fisher, Mann-Whitney, and Student's t tests were applied to compare groups with or without hypoalbuminemia. Ninety-nine patients, classified as hypoalbuminemic, had lower blood hemoglobin (10.68 +/- 2.62 vs. 13.54 +/- 2.41), and sodium (135.1 +/- 6.44 vs. 139.9 +/- 4.76 mEq/l) and albumin (2.74 +/- 0.35 vs. 3.58 +/- 0.28 g/dl) serum levels than non-hypoalbuminemic (n = 43). Pearson's coefficient showed a significant direct correlation between albumin and sodium serum levels (r = 0.40) and between serum albumin and blood hemoglobin concentration (r = 0.46). Our results suggest that hypoalbuminemic adults have lower serum sodium levels than those without hypoalbuminemia, a phenomenon that may be at least partially attributed to body water retention associated with acute phase response syndrome.

Female↗

Artificial neural networks: application to electrical stimulation of the human nervous system.

Artificial neural networks are used increasingly in applications such as graphic pattern recognition, which are difficult to address with conventional statistical methods. In the management of chronic pain, graphic methods are used routinely; patients describe their patterns of pain using "pain drawings." The authors have previously reported an automated, computerized pain drawing methodology, which has been used by patients with implanted spinal cord stimulators to represent a technical goal of the procedure, the overlap of pain by stimulation paresthesias. Standard linear discriminant statistical methods have shown associations between stimulation parameters and electrode positions as independent variables and technical outcome and relief of pain as dependent variables. The authors have applied artificial neural networks to the problem of optimizing implanted stimulator adjustment. A data set of 3000 electrode combinations obtained in 41 patients was used to develop a linear discriminant statistical model on a mainframe computer and to train artificial neural networks on a personal computer. The performance of these two systems on a new data set obtained in 10 patients was compared with that of human "experts." The best neural network model was marginally better than the linear discriminant model; the variance in patient ratings was predicted by these models to a degree that the human experts were unable to predict. The authors anticipate expanding the role of these models and incorporating them into expert systems for clinical use.

Journal Article↗

Cost cutting using radio frequency inventory control.

Bar coding should be a staple in every hospital by now--but it's not. The author tells how bar coding and the use of radio frequency transmission of inventory data direct to their mainframe computer has saved them time and money.

Computer Communication Networks↗

The future of cost accounting systems in healthcare.

The development of cost accounting/cost management programs provides one of the most exciting systems development opportunities for healthcare professionals. Despite countervailing factors, the requirement for cost management information is here to stay. The current status of systems development can be described as a positive step by a majority of institutions. To address system requirements, there are currently 16 mainframe computer, 20 minicomputer and 29 microcomputer software programs available. The availability of these software resources identifies numerous alternatives for future cost accounting/cost management applications. For the question has become, not "if" you require a cost management application, but rather what kind.

Accounting↗