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Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital.

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.

Computers↗

Philosophies for the design and development of clinical decision-support systems.

Little significance is attached by medical informatics workers to the many practical issues which affect the development of clinical decision-support systems. We examine the current state of research in clinical decision-support, the characteristics and motivations of developers, and the perceptions of intended end-users. Factors which adversely affect the success of systems are highlighted and pointers to good practice discussed. We then propose a coherent approach to system development, consisting of requirements analysis, software design, implementation, testing, evaluation and maintenance.

Computer Systems↗

BIOESTIM: software for automatic design of estimators in bioprocess engineering.

This paper describes BIOESTIM, a software package devoted to on-line estimation in bioprocess engineering. BIOESTIM enables bioengineers automatically to design state and parameter estimators from a minimal knowledge of the process kinetics. Such estimators allow development of software sensors capable of coping with the lack of reliable instrumentation suited to real-time monitoring. The estimator building procedure through BIOESTIM starts up from a dynamical material balance model of the bioprocess. This model, supplied by the user, is next completed by other information with no requirement for numerical values: the user has only to specify available measurements, coupled reactions and the known yield coefficients. On the base of this knowledge, BIOESTIM proceeds to symbolic algebraic manipulations on the model in order to study estimation possibilities and check identifiability of yield coefficients. When the design of an estimator is possible, the corresponding equations are automatically generated. Moreover, these estimators are stored in a user-specified file which is automatically interfaced with a specialized simulation software including data treatment and numerical integration packages. Thus, the user can simulate the estimator performances under various operational conditions using available experimental measurements. A typical example dealing with microbial growth and biosynthesis reactions is given in order to illustrate the main functional capabilities of BIOESTIM. BIOESTIM has been designed and written in a modular fashion. The module dealing with estimators design makes use of symbolic computation; it is written in Mathematica and runs on every computer on which this language is available.

Algorithms↗

PACS for radiology conferences--improvement of application software.

The introduction of PACS in a radiology department means that most functions that are available in the film-based system must be included. One important function is the radiology conference. The handling and application programs of digital workstations are normally not developed for demonstrations of many images in a limited time. This paper describes a workstation with specially designed software for radiology conferences. The application is separated in preparation and presentation of the cases to be demonstrated. Very fast image handling is achieved during the conference because the function is based on the principle of prefetching of the selected images. The images are presented on a large screen with high resolution. The experiences of digital radiology conferences are good. However, reference films from previous examinations create extra work because they have to be shown on the conventional lightbox.

Computer Terminals↗

A newly developed spinal simulator.

A number of studies indicate poor intra-therapist and inter-therapist reliability in the performance of graded, passive oscillatory movements to the lumbar spine. However, it has been suggested that therapists can be trained to be more consistent in their performance of these techniques if given reliable quantitative feedback. The intention of this study was to develop equipment, analogous to the lumbar spine that could be used for both teaching and research purposes. Equipment has been updated and connected to a personal IBM compatible computer. Custom designed software allows concurrent and accurate feedback to students on their performance and in a form suitable for advanced data analysis using statistical packages. The uses and implications of this equipment are discussed.

Calibration↗

Nutrient requirements for dairy cattle of the National Research Council versus some commonly used ration software.

The first edition of the Nutrient Requirements of Dairy Cattle was published by the National Research Council (NRC) in 1945. The current document is the sixth revised edition, published in 1989, and it appears that we are a few years from another edition being in print. Software designed to evaluate and formulate rations for dairy cattle commonly determine nutrient requirements using the NRC as a standard. However, the generation of new knowledge in dairy nutrition occurs more rapidly than the release of the NRC publication, and the developers of the software often modify the requirements based on more recently published research, geographical peculiarities, or factors not explicitly considered by NRC. The first step in evaluating or formulating rations is the prediction of dry matter intake (DMI). The primary variables used by NRC to predict DMI are body weight (BW) and fat-corrected milk (FCM) yield; however, developers of software programs often use different equations based on personal preference, availability of research data with given equations, and incorporation of other factors in addition to BW and FCM yield. The additional factors are included to provide a more dynamic estimation of DMI and, therefore, reduce the difference between predicted and actual DMI. Nutrients required for maintenance, lactation, and growth must be consumed in adequate quantities (e.g., kilograms or calories), but the dietary concentration of nutrients for a given animal group may differ because of DMI. Even when nutrients are fed above the requirements, dietary concentrations of nutrients may be important in some situations to minimize the risk of underfeeding caused by variability in the nutrient composition of feedstuffs and to account for interactions of certain nutrients (e.g., minerals). New research discoveries need to be incorporated into ration formulation strategies promptly, and the strategies used for ration formulation need to be dynamic.

Animal Nutritional Physiological Phenomena↗

Immunization entry at the point of service improves quality, saves time, and is well-accepted.

OBJECTIVE: Computer-based immunization tracking is a routine part of many pediatric practices; however, data quality is inconsistent and entry often relies on dedicated data entry personnel and is time-consuming, expensive, or difficult. The purpose of this study was to evaluate data quality, nursing satisfaction, and reduction in documentation burden after the introduction of a point-of-service immunization entry system in an inner-city pediatric primary care center. DESIGN: Prospective preintervention and postintervention study. METHODS: Visit records from all pediatric nonurgent care visits for patients <5 years old were collected during a 2-week period before (preintervention) and after (postintervention) the introduction of a computer-based immunization entry system. Nurses used software designed to allow rapid entry during immunization preparation followed by printing 2 adhesive labels for documentation. Satisfaction was evaluated using an 8-question survey administered 3 months after the intervention. RESULTS: One hundred forty-seven (63.6%) of 231 preintervention and 132 (51.4%) of 257 postintervention children received at least 1 immunization (immunized) during the study visit. Gender and mean age were similar for immunized children in the 2 groups. In the preintervention group, 56 (37.9%) of 147 immunized children had at least 1 dose missing (a total of 128 of 343 doses administered) from the immunization tracking database compared with none in the postintervention group. Medical record review showed that 92.6% of preintervention and 91.4% of postintervention children were on-schedule after the study visit. However, missing data lead to the misclassification of preintervention children-only 68.4% were reported by the database to be on-schedule. All 9 nurses reported using the program all the time to enter immunizations, 89% said that the program required somewhat or a lot less time, and 100% strongly recommended continued use of the program. All 9 nurses also reported that they would be somewhat or very unenthusiastic about the system if labels were not available. During the 12 months after introduction of the system, 8273 forms containing immunization information were printed, preventing nurses from having to write >101,000 dates. CONCLUSIONS: Immunization entry by nurses at the time of immunization preparation improves the quality of tracking data, reduces misclassification of immunization needs, saves time, and can be well-accepted. It is likely that poor data quality in some tracking systems has led to falsely low immunization coverage estimates. Systems such as the one in this study can improve quality and should be integrated into routine clinical practice.

Boston↗

Computer systems for dental practice management. A new generation of independent dental software.

A new generation of computer programs for dental patient management eliminates total dependence on the vendor for programming support. The software design enables information collected with the dental system to be transferred to popular off-the-shelf programs designed for business. A simplified example is used to illustrate for practitioners the advantages of this type of data structure management. Programs designed on this basis offer optimum performance and expandibility for both present and future needs.

Computer Systems↗

[The use of mathematical modelling in improving the orthodontic treatment of end defects of the dental arches].

Mathematical modelling allowed to use specially designed software package for calculation of the necessary number of variants of dimensions of denture carcass while planning the orthodontic treatment. This could be done for each patient individually, thus ensuring the correct choice of orthodontic technique to replace the end defects of the dentition.

Computer Simulation↗

Multi centre systems analysis study of primary health care: a study of socio-organizational and human factors.

The information management systems to support health programmes are inadequate. As computers become cheaper and more powerful, their application in the strengthening of the information infrastructure becomes more feasible. However, the high cost of specialized applications software limits their potential, especially in developing countries. A multi-centre systems analysis, (a descriptive study using a questionnaire), was made of District Health Sites in developing countries to analyse whether a common specialized application software design for implementation at a primary health care centre was feasible. Responses to the questionnaires by physicians at the primary health centres were compared between district health sites using contingency tables. Significant inter-site differences in social factors existed, respondents had no prior experience, but with near unanimity (98%) accepted the idea of computer assistance in their work. However, general reservations (31%) and fears (26%) about computer interference in the doctor-patient relationship were expressed. The human factor must be considered in interface design and training before implementation.

Attitude of Health Personnel↗

Can computerization of linen management save real dollars?

Software designed for linen management is readily available to linen managers. Each has a variety of features and benefits. It is important that the linen manager discover a system that will return the type of information he or she is looking for and deliver it with minimum effort and maximum efficiency. Software systems can, indeed, prove beneficial to linen managers in bringing a new level of control to circulating linen at the hospital facility.

Bedding and Linens↗

Markov chain Monte Carlo linkage analysis of a complex qualitative phenotype.

We tested a new computer program, LOKI, that implements a reversible jump Markov chain Monte Carlo (MCMC) technique for segregation and linkage analysis. Our objective was to determine whether this software, designed for use with continuously distributed phenotypes, has any efficacy when applied to the discrete disease states of the simulated data from the Mordor data from GAW Problem 1. Although we were able to identify the genomic location for two of the three quantitative trait loci by repeated application of the software, the MCMC sampler experienced significant mixing problems indicating that the method, as currently formulated in LOKI, was not suitable for the discrete phenotypes in this data set.

Chromosome Mapping↗

Technology and the future of medical equipment maintenance.

Maintenance of medical equipment has been changing rapidly in the past few years. It is changing more rapidly in developed countries, but changes are also occurring in developing countries. Some of the changes may permit improved maintenance on the higher technology equipment in developing countries, since they do not require onsite expertise. Technology has had an increasing impact on the development of medical equipment with the increased use of microprocessors and computers. With miniaturization from space technology and electronic chip design, powerful microprocessors and computers have been built into medical equipment. The improvement in manufacturing technology has increased the quality of parts and therefore the medical equipment. This has resulted in increased mean time between failures and reduced maintenance needs. This has made equipment more reliable in remote areas and developing countries. The built-in computers and advances in software design have brought about self-diagnostics in medical equipment. The technicians now have a strong tool to be used in maintenance. One problem in this area is getting access to the self-diagnostics. Some manufacturers will not readily provide this access to the owner of the equipment. Advances in telecommunications in conjunction with self-diagnostics make available remote diagnosis and repair. Since components can no longer be repaired, a remote repair technician can instruct an operator or an on-site repairman on board replacement. In case of software problems, the remote repair technician may perform the repairs over the telephone. It is possible for the equipment to be monitored remotely by modern without interfering with the operation of the equipment. These changes in technology require the training of biomedical engineering technicians (BMETs) to change. They must have training in computers and telecommunications. Some of this training can be done with telecommunications and computers.

Equipment Failure↗

A PC-based Braille library system for the sightless.

This paper presents a novel multiclient braille reading system developed around a single low cost personal computer. The system primarily addresses the needs of the Braille libraries, where different texts are needed to be read by different users simultaneously. Moreover, the system can simultaneously cater to different texts written in different languages. This feature makes it specially suitable for use by multilingual nationalities. The major advantage of this system is its low cost, compared to the other systems available and is specially attractive for the developing or underdeveloped countries. The paper describes the system, first from the user point of view and then presents the hardware and software design details. The system performance has been evaluated by the sightless users and has shown encouraging results.

Blindness↗

Computer systems for dental practice management: a new generation of independent dental software.

A new generation of computer programs for dental patient management eliminates total dependence on the vendor for programming support. The software design enables information collected with the dental system to be transferred to popular off-the-shelf programs designed for business. A simplified example is used to illustrate the practitioners the advantages of this type of data structure management. Programs designed on this basis offer optimum performance and expandability for both present and future needs.

Computer Systems↗

An integrated system for measuring static and dynamic accommodation with a Canon Autoref R-1 refractometer.

An integrated system is described which we have found useful for efficiently collecting and analyzing both static and dynamic accommodation data using the Canon Autoref R-1 refractometer. The system consists of hardware modifications and software designed to both facilitate the measurement of accommodation and to process the resulting data. Several features of the Canon R-1, which may not be evident to some users, are also described. A program written in Microsoft C/C++ running under DOS, and designed for use on a PC, is available from the authors upon request.

Accommodation, Ocular↗

An automated system for bedside verification of the match between patient identification and blood unit identification.

BACKGROUND: The administration of blood to the wrong patient remains the leading cause of acute hemolytic transfusion reactions and subsequent death. A process control system for blood administration was developed that verifies, at the bedside, the match between barcoded patient identification and blood unit identification. STUDY DESIGN AND METHODS: The system is composed of 1) a portable bedside scanner that reads barcoded patient identification and blood unit identification, 2) a host computer system capable of accepting transfusion data from the bedside scanner, 3) printed documentation of the transfusion episode, and 4) audit trail monitoring of whether all steps in the automated patient and blood unit identification process have been performed. Software design, development, and validation protocols followed industry standards. RESULTS: A pilot study was performed over a 2-month period evaluating the blood administration process using the computerized bedside transfusion identification system prototype for transfusions in 39 oncology patients. CONCLUSION: This system controls the blood administration process and includes bedside verification of the match between patient identification and blood unit identification.

Blood Transfusion↗