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Microelectronics and computers in medicine.

Microelectronics and computers are in use in virtually every aspect of modern medicine. Computers are used widely in medical research, where an important need is for better microelectronic sensors for data acquisition. In medical practice, data collection from patients as well as subsequent storage, retrieval, and manipulation of data are enhanced by the computer. In medical decision-making computers improve accuracy, increase cost-efficiency, and advance understanding of the structure of medical knowledge and of the decision-making process itself. Powerful new noninvasive diagnostic instruments including x-ray tomographic scanners and ultrasonic imaging systems are based on computers. The efficiency and scope of clinical laboratory procedures and advanced analytical instruments are greatly increased by computerization, and careful application of computers has improved the interpretation of diagnostic tests, such as the electrocardiogram, and monitoring of critically ill patients. The powerful sensory, computational, memory, and display capabilities of microcomputer systems and their compact size offer new opportunities to relieve functional deficiencies associated with loss of limbs, paralysis, speech impediments, deafness, and blindness.

Clinical Laboratory Techniques↗

A web-based approach for electrocardiogram monitoring in the home.

A Web-based electrocardiogram (ECG) monitoring service in which a longitudinal clinical record is used for management of patients, is described. The Web application is used to collect clinical data from the patient's home. A database on the server acts as a central repository where this clinical information is stored. A Web browser provides access to the patient's records and ECG data. We discuss the technologies used to automate the retrieval and storage of clinical data from a patient database, and the recording and reviewing of clinical measurement data. On the client's Web browser, ActiveX controls embedded in the Web pages provide a link between the various components including the Web server, Web page, the specialised client side ECG review and acquisition software, and the local file system. The ActiveX controls also implement FTP functions to retrieve and submit clinical data to and from the server. An intelligent software agent on the server is activated whenever new ECG data is sent from the home. The agent compares historical data with newly acquired data. Using this method, an optimum patient care strategy can be evaluated, a summarised report along with reminders and suggestions for action is sent to the doctor and patient by email.

Data Collection↗

Documenting the activity and effectiveness of a regional drug information center.

The methods of data collection, storage, and retrieval used by the Rocky Mountain Drug Consultation Center (RMDCC) are described. To substantiate that drug information services provided by RMDCC are clinically useful and have a beneficial effect on therapy, data on medication-related problems and case outcomes, as well as demographic data, are stored in an IBM PC-XT using a system that allows searching and linkage of any number of recorded categories. Data were compiled on 28,081 inquiries from health-care professionals and consumers during 1985 and 1986. Analysis revealed that (1) medication-related problems are common (involving 34% of consumer inquiries), especially among the elderly; (2) a positive effect on therapy was made in the majority (76%) of problem cases; and (3) consumers were given drug information by their physician or pharmacist in fewer than half of the cases in which medications were prescribed and dispensed. A computer-based system to assist in analyzing information can be an important asset in documenting the activity and effectiveness of a regional drug information center.

Colorado↗

A voice-entry data management system: application in monoclonal antibody research.

A computerized system for the management of hybridoma cell growth data using voice input is described. The system permits the storage, retrieval, and analysis of data for hybridoma cells secreting monoclonal antibodies. It consists of a local system residing on a professional computer interfaced to a mainframe processing system. The local system uses voice-input to facilitate data entry while data flagged for retention is stored on the mainframe. The system permits the investigator to monitor thousands of candidate cell lines until selection for specific antibody production is completed. All record-keeping aspects of hybridoma cell culture from establishment through freezing and storage of selected cell lines can be accomplished by personnel without computer expertise.

Antibodies, Monoclonal↗

Estimating human exposures to environmental pollutants: availability and utility of existing databases.

Information about human exposures to environmental agents is a crucial component of informed decisions about protection of public health. Results from an inventory of exposure-related databases are used to examine the value of exposure information for risk assessment, risk management, surveillance of status and trends, and epidemiologic studies. Findings indicate that current and future exposure-related databases should include (1) standardized procedures for the collection, storage, analysis, and reporting of data; (2) an enhanced ability to compare data over time, i.e., conduct comparison studies of "old" and "new" methods; (3) mechanisms for coordination and cooperation among public and private-sector organizations with respect to the design, maintenance, exchange, and review of information systems; (4) measurements of actual exposures and dose for relevant human populations; and (5) data collection, storage, and retrieval methods that permit easy manipulation of information for both model building and testing.

Data Collection↗

A computer based system for collection, storage, retrieval and reporting accession information in a veterinary medical diagnostic laboratory.

Substantial data collected from large numbers of accessions, the need for comprehensive reporting of negative as well as positive laboratory findings, and the necessity for obtaining rapid diagnostic correlations prompted the development of a computer based system of accession data management for collection, storage, rapid retrieval, reporting, concording, and administrative compiling in a state-university Veterinary Medical Diagnostic Laboratory.

Animal Diseases↗

Dimensions of time in illness: an objective view.

It is almost impossible to try to represent and analyze clinical data in the absence of a temporal dimension. The temporal aspect is especially important when automated decision support is used for patient care over substantial periods. This paper emphasizes the crucial role that tasks of temporal reasoning and temporal maintenance play in modern medical information and decision support systems; it also discusses the implications of providing automated support to clinicians who must perform such tasks as part of broader clinical tasks (for example, monitoring and therapy). Temporal reasoning tasks mainly involve intelligent analysis of time-oriented clinical data, and temporal maintenance tasks focus on effective storage and retrieval of these data. Both types of tasks, however, are highly relevant for such applications as patient monitoring, proper use of therapeutic guidelines, assessment of the quality of guideline use, and visualization and exploration of time-oriented biomedical data. Scientists in medical informatics should view the integration of these two areas as a major research and development goal. This paper demonstrates one approach to integration by presenting the concept of a temporal mediator, which combines temporal reasoning and temporal maintenance. Use of the temporal mediator in several clinical tasks is also presented and discussed.

Databases, Factual↗

History of cardiovascular imaging procedures (as developed and/or applied in German cardiology).

The value of the four main imaging tools: radiology, magnetic resonance imaging, echocardiography and nuclear cardiology depends in the first place on physical properties which determine the spatial, temporal and density resolution and second on the conditions under which the relevant information can be obtained with respect to the diagnostic or therapeutic problem, the comfort of the investigation, the degree of invasivity and the expenses. For several decades radiology was the only available method that allowed a look into the body. Thereby, all relevant information about diseases amenable to any surgical or conservative therapy could be attained. Parallel to the progress of cardiovascular surgery, angiocardiography could provide the anatomic and functional characteristics of congenital and acquired heart diseases. The basic principles for the measurement of total heart size, volume and shape were established already before contrast injection--initially by hand--showed the internal architecture of the heart cavities and the circulatory system. With the invention of film changers, the fundamental knowledge about all kinds of malformations of the heart and vessels was gained. Further technical progress made the procedures faster by cineangiocardiography, more comfortable by simultaneous biplane operation and easier to handle by videotechniques, allowing electronic data processing, storage and retrieval in bright operating theaters. Computer technology favored flexible image processing which, like digital subtraction and functional angiocardiography, could reduce the amount of contrast material to be injected and thereby improve the compatibility, due to better nonionic contrast material and shorter study times. Finally, computer tomography with cross sectional, or spiral data collection enabled a dynamic three-dimensional reconstruction and visualization of the beating heart and to display selected information in 'measures and numbers'. Inspite all these successes, the 'stain' of invasivity remains. Strong competition arose first in echocardiography, which--after some pioneering activities in Germany in the late 1950s--flourished in the 1970s, after being reimported from the US. Most of the rapidly increasing number of ultrasound technologies--from M-mode, via various 2D linear and sector scanning procedures in combination with continuous, pulsed and/or color Doppler methods, new contrast-echo modalities and finally 3D volume scanning procedures--can be applied without any harm in all age groups and from each competent practitioner with comparably small and cheap equipment. Only oesophageal and intravascular approaches retain a touch of invasivity. Consequently not much room remains for other techniques except those, like MRI, which can differentiate tissue properties better and with higher resolution and give unlimited access to all intrathoracic organs noninvasively. Under these conditions the indications for nuclear cardiology are restricted to the small field of myocardial perfusion and metabolic studies, whereas transit time measurements and radionuclide ventriculography are practically obsolete.

Cardiology↗

On-line analysis of neuromuscular bioelectric potentials.

A computer system is presented which provides for on-line data capture and analysis of evoked end-plate potentials and action potentials, and on-line data capture with off-line analysis of spontaneously occurring miniature end-plate potentials at the end-plate region of the neuromuscular junction. Sampling of evoked waveforms begins after an adjustable delay following the stimulus. Spontaneously occurring waveforms are captured by 'freezing' the contents of a circular buffer. The software provides MENU selectable support functions including storage and retrieval of data and calculated parameters, analog and digital display of waveforms, data calibration and gain modification, data editing, file management, and hardcopy output. Calculated parameters of the waveform are optionally placed in a data base file by the analysis programs. The data base may be used for editing, arithmetic operations, and subsetting of variables as well as statistical analysis and plotting of any selected variables.

Action Potentials↗

EURISWEB--Web-based epidemiological surveillance of antibiotic-resistant pneumococci in day care centers.

BACKGROUND: EURIS (European Resistance Intervention Study) was launched as a multinational study in September of 2000 to identify the multitude of complex risk factors that contribute to the high carriage rate of drug resistant Streptococcus pneumoniae strains in children attending Day Care Centers in several European countries. Access to the very large number of data required the development of a web-based infrastructure - EURISWEB - that includes a relational online database, coupled with a query system for data retrieval, and allows integrative storage of demographic, clinical and molecular biology data generated in EURIS. METHODS: All components of the system were developed using open source programming tools: data storage management was supported by PostgreSQL, and the hypertext preprocessor to generate the web pages was implemented using PHP. The query system is based on a software agent running in the background specifically developed for EURIS. RESULTS: The website currently contains data related to 13,500 nasopharyngeal samples and over one million measures taken from 5,250 individual children, as well as over one thousand pre-made and user-made queries aggregated into several reports, approximately. It is presently in use by participating researchers from three countries (Iceland, Portugal and Sweden). CONCLUSION: An operational model centered on a PHP engine builds the interface between the user and the database automatically, allowing an easy maintenance of the system. The query system is also sufficiently adaptable to allow the integration of several advanced data analysis procedures far more demanding than simple queries, eventually including artificial intelligence predictive models.

Child↗

Age, breed and seasonal patterns in the occurrence of ten dairy cow diseases: a case control study.

A total of 5,990 occurences of the diseases abomasal displacement, cystic graafian follicles, endometritis, hypocalcemia, ketosis, mastitis, metritis, ovarian hypofuction, pyometra and retained placenta were included in a case control study. The study was based on a hospital population of Holstein, Ayrshire, Guernsey and Jersey cows who were at least two years of age. The data were retrieved from computer storage of material abstracted for the Veterinary Medical Data Program. The transcription of data from original case records to these abstracts was examined as a source of error. An attempt was made to define each of the diseases by reference to random samples of the clinical records. Using the log-odds method, trends were noted for the youngest cows to be at increased risk of the reproductive diseases and for the Guernsey cows to be at increased risk of the uterine diseases. There was a tendency for peaks in disease occurrences in the winter (as opposed to summer) months.

Abomasum↗

Automated data acquisition and analysis of neural evoked potentials.

A software system to collect, analyze and store trains of neural evoked potentials is presented. Real-time waveform capture permits sampling of a variable-duration data window of 6 to 399.6 ms with a sample delay accurately adjustable up to 1 001 ms (20 microseconds resolution). The digitized representation of each waveform is stored for individual analysis. Off-line processing determines 17 parameters of each waveform, including an arrow-selected amplitude and time. Individual processing of waveforms preserves all degrees of freedom for statistical analysis across waveforms. Ensemble averages may optionally be formed from the individual waveforms with processing performed on the averaged responses. The software provides MENU-selectable support functions including stimulus-to-artifact timing, storage and retrieval of data and calculated parameters, digital display of waveforms, data calibration and gain modification, table referenced data editing, file management, simple statistics, hardcopy output, and optional database interfacing with output formatted for compatibility with a statistics package (SAS).

Animals↗

International migration and medical credentialling.

The Single European Act of July 1987, coupled with various other regional and national laws, the purposes of which open borders to the free movement of peoples, goods and services, is soon to be put into operation. Although awaited with much eagerness and expectation, there is also a need for strategic planning in order adequately to address new and possibly ominous legal and medical practice problems. In the United States, a National Practitioner Data Bank, which went into full operation in September 1990 was created to monitor physicians, nurses and other health care providers involved in negligence actions which result in the payment of moneys by settlement or by verdict, and to prevent those whose licences have been suspended, revoked or restricted in any fashion in one state from practising in another based upon reciprocity licensure or board certification criteria. In order to protect patients from abuse by uncredentialled individuals or dangerous clinicians, and further to protect institutions from liability incurred by inadequate credentials checks or through ostensible liability, the creation of a practitioner data bank utilizing modern data gathering, storage and retrieval methods is proposed for the European Community. It should be created under the auspices of the United Nations--possibly through the World Health Organization which already accredits medical education and training programmes--and should be charged with creating uniform standards of professional practice; certifying professionals; and serving as a credentials' clearing house for the health care industry.

Credentialing↗

Gene Expression Omnibus: NCBI gene expression and hybridization array data repository.

The Gene Expression Omnibus (GEO) project was initiated in response to the growing demand for a public repository for high-throughput gene expression data. GEO provides a flexible and open design that facilitates submission, storage and retrieval of heterogeneous data sets from high-throughput gene expression and genomic hybridization experiments. GEO is not intended to replace in house gene expression databases that benefit from coherent data sets, and which are constructed to facilitate a particular analytic method, but rather complement these by acting as a tertiary, central data distribution hub. The three central data entities of GEO are platforms, samples and series, and were designed with gene expression and genomic hybridization experiments in mind. A platform is, essentially, a list of probes that define what set of molecules may be detected. A sample describes the set of molecules that are being probed and references a single platform used to generate its molecular abundance data. A series organizes samples into the meaningful data sets which make up an experiment. The GEO repository is publicly accessible through the World Wide Web at http://www.ncbi.nlm.nih.gov/geo.

Animals↗

[Multicenter psychopharmacologic research and the data bank].

The indications and the characteristics of the multicenter clinical trials are considered and the BLIPS/BDP system is showed in detail as developed at the Institute of Clinical Psychiatry of the University of Pisa within the cooperation with the National Institute of Mental Health (NIMH-USA) at the Center for Clinical Psychopharmacology Data Documentation (CCPDD). The characteristics of the BLIPS/BDP system in the storage, retrieval and documentation of data derived from clinical trials on psychotropic drugs are reported. Finally, examples are given of the large number of possible utilizations of the BLIPS/BDP Data Bank documenting its flexibility and versatility and the extent of its possibilities.

Clinical Trials as Topic↗