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A low cost ECG central station for intensive care.

A electrocardiogram (ECG) central station has been developed for the Intensive Care Unit at Christchurch Hospital. The system allows the selection and display of four ECGs selected from seven bedside monitors in the Unit. It also provides for automatic display, hard copy and audio alarm of ECG from any monitor which has detected an alarm condition--irrespective of whether that channel was being displayed prior to alarm detection. The system comprises a control unit (based on an 8085 microprocessor) and a mobile ECG station (4-channel ECG monitor, ECG recorder and computer terminal). Over the three years since its installation, the central station has been used 24 hours a day by medical and nursing staff and has proven to be a valued and reliable instrument in an intensive care environment.

Electrocardiography

[Dynamic EEG mapping--an imaging procedure for studying perceptive, motor and cognitive brain performance].

The spatial pattern and time course of cortical activation can be studied when the event-related desynchronization in 30 EEG recordings is being quantified, averaged over about 60 events and displayed in form of maps with integration times of 125 ms (8 maps/s). This method was named dynamic mapping and used for investigating cortical activation pattern during the following tasks: Planning and execution of voluntary self-paced thumb movements, tactile stimulation of the foot sole and recognition of words, displayed shortly on a computer terminal. All these experiments resulted in localized activation pattern.

Cognition

Full-text medical literature retrieval by computer. A pilot test.

A pilot test of a full-text, medical literature retrieval service demonstrated its capabilities for on-line search and retrieval of references, abstracts, and/or full-text journal articles. During a three-month test period, more than 500 health care professionals conducted 9,377 searches using computer terminals located in seven different health care sites. Searches were initiated for purposes of patient care, medical education, research, or for browsing. The majority of responders to a questionnaire given during the test period said they would continue to use the service during the pilot test, and only about 1% reported the search process difficult to use or not "user-friendly." It is predictable that with a comprehensive data base, full-text medical literature retrieval can be very useful for medical practice, medical education, and research.

Consumer Behavior

A minirecord: an aid to continuity of care.

A simple, low cost computerized minirecord system (minimal essential record) has been in full operation for two years in the Medical Clinic of The Johns Hopkins Hospital. The primary objective of the minirecord system is to permit rapid retrieval of current information concerning Medical Clinic patients. The system provides a computer-printed listing of problems and medications in the front of each chart and on-line display of this information at strategically located computer terminals. The information is generated via existing simple systems with minimal additional effort and with the use of any terminology deemed appropriate. Chart review revealed that minirecords were actually present in 92% of the charts and that significant improvement occurred in the recognition of a subsequent visit of clearly defined problems and therapies noted on the initial minirecord. Current modifications will replace the separate minirecord and encounter form (registration and visit note) with a single form that will facilitate completion an updating. The rapid availability of this information provides a mechanism for coordinating continuing care in a university hospital system that is otherwise inevitably fragmented and composed of multiple health care providers.

Comprehensive Health Care

Comparative aspects of chronic pain in the head and neck versus trunk and appendages: experiences of the Multidisciplinary University of North Carolina Pain Clinic.

The interdisciplinary University of North Carolina Pain Clinic, in existence since 1973, is a coordination center for research, pre and postdoctoral and resident training, and clinical services. It functions primarily as a tertiary care center for outpatients as a component of the North Carolina Memorial Hospital. Inpatient consultations and therapy direction are carried out on request. Approximately 400 new patient visits and 1,200 consults and return visits are made yearly. The clinic is administered by codirectors from the Departments of Oral and Maxillofacial Surgery and Anesthesiology. Consultants to the clinic include the disciplines of psychiatry, neurosurgery, family medicine, pathology-oral pathology, dentistry, physical therapy, social work and nursing. Support staff includes a head nurse, half-time transcription and half-time general secretary and a financial technician. Facilities consist of an 8-room clinic dual equipped for patient care and clinical research. An adjacent conference room is used for research and patient presentation conferences. In addition to routine examining and interview rooms, a minor procedure operating room is equipped with resuscitation equipment, suction, oxygen, anesthesia machine, a physiologic monitoring system with polygraph, a cryosurgical unit and a radiofrequency lesion generator. A second room is equipped for neurosensory studies of peripheral nerve functions including a battery of tactile-mechanical and thermal threshold stimuli tests, as well as nerve conduction and EMG. A system for psychophysical testing is available through tie-in with a computer, which is located in an adjacent laboratory used for data analysis and also subhuman primate experiments. Another room is equipped with psychophysiologic training equipment, particularly EMG biofeedback. A computer terminal on line to the University IBM 360 is located in the Pain Clinic for use in entering patient-research data. A library with dictating space is available for use by consultants, postdoctoral trainees, and residents.

Chronic Disease

Ergonomics in the electronic library.

New technologies are changing the face of information services and how those services are delivered. Libraries spend a great deal of time planning the hardware and software implementations of electronic information services, but the human factors are often overlooked. Computers and electronic tools have changed the nature of many librarians' daily work, creating new problems, including stress, fatigue, and cumulative trauma disorders. Ergonomic issues need to be considered when designing or redesigning facilities for electronic resources and services. Libraries can prevent some of the common problems that appear in the digital workplace by paying attention to basic ergonomic issues when designing workstations and work areas. Proper monitor placement, lighting, workstation setup, and seating prevent many of the common occupational problems associated with computers. Staff training will further reduce the likelihood of ergonomic problems in the electronic workplace.

Computer Terminals

Rural hospitals set the pace for computerized documentation?

Automated documentation for rural health organizations can be prohibitively expensive. A system is described which can integrate existing admission, discharge and transfer systems. Using "pen pads" permits bedside automation without the capital cost of bedside computer terminals. Both improved patient care and nursing staff satisfaction should result.

Documentation

Retinal periphlebitis in multiple sclerosis.

BACKGROUND: The ocular and visual manifestations of multiple sclerosis are varied. The most uncommon is sheathing of the veins, periphlebitis. METHODS: A 39-year-old white female presented with primary visual complaints of contrast problems on a computer terminal. The patient was lost to follow up for 4 years, however, upon return a clinical diagnosis of multiple sclerosis was confirmed. Six years after the initial presentation, ophthalmoscopic exam of both eyes revealed marked focal sheathing of the retinal veins in the periphery, and associated hemorrhages in the right eye. RESULTS: During follow-up, the left eye became further involved developing hemorrhages and a retinal hole, which was treated. The visual consequence of the multiple sclerosis as a result of further exacerbations were bilateral centrocecal scotomas and midly reduced visual acuity. CONCLUSIONS: Multiple sclerosis should be considered in the differential diagnosis of patients with retinal periphlebitis.

Adult

Effect of hydrochlorothiazide, enalapril, and propranolol on quality of life and cognitive and motor function in hypertensive patients.

The effect of hydrochlorothiazide, propranolol, and enalapril on cognitive and motor function and quality of life (QOL) in hypertensive patients was studied. Patients > or = 55 years of age with asymptomatic essential hypertension were included in a randomized, double-blind, placebo-controlled, crossover study. Subjects discontinued their previous antihypertensive agents and started hydrochlorothiazide 25 mg, extended-release propranolol hydrochloride 120 mg, enalapril maleate 10 mg, or placebo. One capsule was taken for three days and then the dosage was doubled for the remainder of a four-week period. Subsequent crossover treatments were begun without a washout period. In each treatment phase, a battery of psychometric tests was used to assess cognitive and motor function and quality of life; all tests but one were self-administered via computer terminal. Pulse rate and blood pressure were recorded, and compliance was monitored by capsule count. Sixteen of 30 patients interviewed completed the trials; one additional patient was evaluated after receiving all treatments except hydrochlorothiazide. Mean +/- S.D. age of the subjects was 66 +/- 6.1 years; 10 were black and 7 white; 9 were men. Except for the hydrochlorothiazide group, blood pressure in the active treatment groups did not differ significantly from placebo; hydrochlorothiazide significantly reduced systolic but not diastolic blood pressure compared with placebo. Compared with placebo, hydrochlorothiazide was associated with fewer incorrect responses in a test of complex reaction time and with greater discriminant reaction time response rates; otherwise, no difference between groups was noted in cognitive or motor performance. There were no significant differences between active treatments and placebo on individual QOL measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

Determining the radiation exposure from visual display terminals used in dentistry.

Computers are rapidly becoming incorporated into all aspects of dentistry, including administrative, didactic and research functions. Of particular concern for dentists are women of childbearing age who are regularly employed as receptionists and secretaries in private dental practices and teaching institutions. Thermoluminescent dosimeter pellets of lithium fluoride were attached directly to the surface of 10 VDT's of varying age and from different manufacturers. The purpose was to compare the amounts of radiation emitted from personal computers that are commonly used in dental practices and teaching institutions. All of the machines tested met USNRC regulations for safety by emitting only negligible amounts of radiation.

Adult

A user-friendly biological workstation.

Learning methods developed by artificial intelligence research teams are very efficient for biological sequences analysis but they need running on large computers accessed by terminals. These computers are interfaced with standard displays involving long and unpleasant alphanumerical data handling. The "biological work station" is a personal computer with a color graphic screen providing a user-friendly interface for the artificial intelligence learning programs running on large computers. It provides to biologist a graphical convenient tool for sequence analysis built with efficient man-machine communication methods such as multiwindows, icons and mouse selection. It allows the biologist to edit and display sequences in an efficient and natural way, showing off directly on color pictures the data and the results of learning programs.

Biology

Computer assisted quantitation of terminal hepatic vein connective tissue in the rat.

Computer assisted image analysis has been used to quantify the cellular and extracellular connective tissue component of rat liver terminal hepatic venules, in control animals and those exposed to 40% ethanol in drinking water. A significant relationship existed between the size of the terminal hepatic venule and the amount of connective tissue it contained in 14 of 15 controls and 17 of 18 ethanol exposed rats. Thickening of the terminal hepatic vein wall assessed to be present in ethanol treated rats by direct observation was confirmed by image analysis in all cases (p < 0.01). Significant differences between treated and control livers (p < 0.05) were detected by image analysis when not apparent to human observers. Sensitive quantitative assessment of terminal hepatic vein wall thickening was thus achieved by computerized analysis of liver sections.

Animals

Terminal illness.

Computers proliferate in almost every workplace of today. Unfortunately, society seems to have been more interested in mass-producing computer systems than in the health and comfort of the humans who interact with them. The unhappy consequence has been a growing rate of computer-related injuries. Nursing worksites are far from immune to this "terminal" illness; the health hazards associated with radiation, stress and workplace design have brought ill health to nurses and to other workers. But like other health problems, computer-related illness can be avoided through preventive care.

Computers