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[User-oriented programs for semi-automated evaluation of radio in vitro tests].

Most of the programmes for the evaluation of radio in vitro tests proceed from the anticipation that the best method should give an approximation of standard values by a curve as perfect as possible. According to our experiences this demand, however, is not decisive for a good standard curve, as in principle all standard values can be incorrect. The application of relatively simple linearising transformations and an additional curve (recovery of a normal serum) guarantees the necessary precision in the programme described. After a short description of the contents of the system, the programme for the assessment of CPBA - methods is shown, by help of which the sample changer - calculator-system determines the absolute concentration of the substance to be measured. This makes the starting point for the more complex RIA programme which methodologically takes into consideration the special problems of these tests.

Diagnosis, Computer-Assisted

Quantitative electroencephalography and anatomoclinical principles of aphasia. A validation study.

No single technology in isolation can provide a full view of the anatomoclinical principles evident in the clinical populations we study. The dynamic nature of quantitative electrophysiology makes it an ideal complement to anatomic and metabolic imaging. The statistical conundrum it has presented may be resolved by the approach incorporated in CART. The intent of this study was to examine QEEG and CART in the evaluation of the neurologic bases of a well-defined behavioral disorder like aphasia. The combined power of QEEG and CART yielded objective electrophysiologic methods to predict aphasia that rival the reliability of the language examination. Such success is unprecedented. This success allows us to incorporate QEEG and CART into our technological armamentarium and to return to the evaluation of less well-understood disorders with confidence in both our findings and anatomoclinical principles we derive from them.

Adolescent

Formalized decision-support for cardiovascular intensive care.

The massive volume of hemodynamic data routinely available within the Cardiovascular Intensive Care Unit (CVICU) can adversely affect the quality, relevance and timing of hemodynamic management decisions on patients after cardiac surgery. Yet, at the same time, the lack of appropriate treatment-outcome data and access to prior CV case histories deprives the clinician of any opportunity to improve personal decision-making skill and assess the effectiveness of various treatment methods. This paper presents a formalized decision-support model for CVICU that incorporates expert and quantitative knowledge, as well as prior outcome and case experience to augment the clinician's decision-making capability. This includes the proposed use of optimal hemodynamic patterns derived from outcome analysis as therapy goals, expert rules and trend analysis to interpret incoming data, standardized protocols based on predefined hemodynamic patterns from clinical cases, and access to the database for similar case comparison. Most importantly, the model suggests an integrated approach where the clinical database is not only a documentation source for the patient, but can also serve as an outcome research database where clinical experience can be formalized and combined with expert knowledge to influence future therapy decisions. At present, a prototype is being developed at the CVICU of the University of Alberta Hospitals on a Unix platform using ART-IM, C and Ingres. Once implemented, the prototype will be evaluated on a small group of CV patients for its effectiveness and acceptability to clinicians.

Cardiovascular Diseases

Expert system design in hematology diagnosis.

A two-part study was designed to test the hypothesis that sufficient information is available from a modern hematology analyzer (the Coulter STKS) to reach a reliable intermediate conclusion which can be used as input to the next decision-making level in the design of a high-performance expert system for hematology diagnosis. In phase one, we analyzed the performance of three probabilistic systems (using Bayes' rule) which interpret STKS data: a control system which took the traditional approach of classifying cases into specific diagnoses, and two test systems which were designed to reach only an intermediate conclusion but not a final diagnosis. One of the test systems classified cases into "textbook categories" of disease and the other utilized defined diagnostic patterns. The systems were tested with 150 cases. The pattern approach ranked the correct choice first in 141 of 150 cases (94%). In phase two, we abandoned Bayes' rule, reformulated the pattern approach into a heuristic classification system, and tested its reliability on 820 cases. The algorithm of the reformulated system was able to classify all 820 cases into the same predominant pattern as a panel of three experienced laboratory hematologists.

Algorithms

Selection of patients for programmed ventricular stimulation: a clinical decision-making model based on multivariate analysis of clinical variables.

OBJECTIVE: This study was conducted to assess the utility of clinical variables in predicting the inducibility of sustained ventricular arrhythmias in a heterogeneous group of patients undergoing programmed ventricular stimulation. METHODS: Variables were considered in a simulated chronologic order to determine the incremental information added by the signal-averaged electrocardiogram (ECG) and left ventricular ejection fraction. All patients undergoing baseline programmed ventricular stimulation for induction of ventricular tachyarrhythmia during a 30-month period were included in the study. Fourteen historical, ECG, signal-averaged ECG and left ventricular wall motion variables were evaluated for their ability in predicting inducibility of a sustained ventricular arrhythmia, a "positive" event, at programmed ventricular stimulation. RESULTS: On univariate analysis of the clinical variables, comparison between patients with positive or negative results showed significant differences in 10 of the 14 clinical variables: major cardiac diagnosis, history of ventricular tachycardia, myocardial infarction by history or ECG, all five signal-averaged ECG variables, left ventricular ejection fraction and presence of left ventricular aneurysm. On multivariate analysis, five independent variables were determined to be important: history of ventricular tachycardia, historical or ECG evidence of myocardial infarction, history of loss of consciousness, filtered QRS duration on the signal-averaged ECG and left ventricular ejection fraction. However, with sequential multivariate analysis, a model based only on historical and conventional ECG data was found to do as well as a model that included signal-averaged ECG and left ventricular ejection fraction data. CONCLUSIONS: Routinely available noninvasive historical, ECG, signal-averaged ECG and left ventricular wall motion variables can be used to accurately predict the outcome of programmed ventricular stimulation. The majority of the predictive power was obtained with the routine model, using only historical and ECG data. The signal-averaged ECG and left ventricular wall motion analysis added no significant incremental information.

Aged

PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

Computer User Training

A physician's workstation designed for NASA and earth-based applications.

One of the prime missions for NASA is the safety and care of astronauts. In addressing this challenge, a tool has been developed which has great potential for earth-based applications. The multimedia physician's workstation is the result of 13 years of planning and technical revolution in the field of computer science. Today, we have the hardware and the software to make a major change in the office-based practice of physicians. By offering the online features of a medical library as well as a complete multimedia medical record system, we are now in a position to introduce advance decision support technology that can be used on a daily basis for routine outpatient care. The system supports a new platform for patient education and offers the doctor an opportunity to share his expertise with his patient and their family. Although NASA will need several more years before this technology can be applied to a remote space environment, we plan to introduce this system into the doctor's office as an initial test of its feasibility. The basic design and general specifications of this multimedia workstation/office system are described and illustrated as they currently exist.

Aerospace Medicine

[A system to aid decision-making. Application to automatic interpretation of vectorcardiograms].

This paper presents a complete and autonomous system for the automated diagnosis (heuristic approach). The system was worked out by means of a small computer. A flexible, evolutive, quasi-universal system is achieved through original procedures. A specialised language enables the users to describe diagnoses and their criteria in symbolic form. A suitable compiler translates this symbolic writing into an interpretable object program. This, with the Interpreter program, constitutes the 'Automated Diagnosis Program'. Our data are vectorcardiograms recorded according to the Frank orthogonal system. After an interactive pre-processing process, 180 parameters--mostly spatial--are computed. The data, the computed parameters and additional information are stored in a data bank. Finally, the medical interpretation is automatically selected from 125 possibilities. The user could also utilise a data bank interrogation language.

Computers

A multi-scale fusion model based on multi-phase contrast-enhanced CT for predicting pancreatic cancer resectability.

Purpose.Develop a multi-scale fusion model (MSFM) based on multi-phase contrast-enhanced computed tomography (CECT) to predict pancreatic cancer (PC) resectability, thereby assisting expert decision-making.Methods.This retrospective study enrolled 280 patients with PC from four institutions, which were randomly divided into a training cohort (202 patients) and an independent test cohort (78 patients). Three-phase CECT images (arterial, venous, and delayed phases) were used for modeling. The MSFM comprises two sub-networks: (1) a multi-phase fusion network for extracting cross-phase shared fusion features, (2) a phase-specific branch network for capturing phase-specific features; and a post-fusion strategy to generate the final predictive score by integrating the shared fusion features and three groups of phase-specific features. Additionally, a human-machine fusion deep learning model (HMfDL) was constructed by fusing the predictive score of the MSFM with expert assessments.Results.In the independent test, the MSFM achieved an AUC (area under the receiver operating characteristic curve) of 0.8385 (95% CI: 0.7521-0.9249), accuracy of 84.62%, sensitivity of 72.00%, and specificity of 90.57%. This performance outperformed single-phase models (AUC range: 0.7638-0.7781), two-phase models (AUC range: 0.7826-0.7864), and ten states-of-the-art classifiers (AUC range: 0.7404-0.7796). The HMfDL further improved the performance, reaching an AUC of 0.8626 (95% CI: 0.7853-0.9400), accuracy of 91.03%, sensitivity of 80.00%, and specificity of 96.23%. Notably, the HMfDL corrected 58.82% of misdiagnosis made by experts.Conclusions. The MSFM effectively fuses multi-phase CECT to enable highly accurate predictions of PC resectability, and provides valuable support for expert decision-making through HMfDL.

Humans

Towards computer analysis of pulmonary infiltration.

A feasibility study is described to provide quantitative texture measures to distinguish between normal lung, alveolar infiltrates and interstitial infiltrates. Advanced computer imaging technology and decision making processes were applied to distinguish between these textural patterns. The results, based on computer extracted quantitative measures, show an excellent separation of the three classes considered with 95% accuracy in the training phase and 90% accuracy in the testing phase.

Diagnosis, Computer-Assisted

The Bin Area Method: a computationally efficient technique for analysis of ventricular and atrial intracardiac electrograms.

Recent studies have reported a significant false positive rate in delivery of therapy by implantable antitachycardia devices utilizing detection algorithms based on sustained high rate. More selective decision schemes for the recognition of life-threatening arrhythmias have been recently proposed that use analysis of the intrinsic electrogram rather than rate alone. Morphological discrimination of abnormal electrograms using correlation waveform analysis (CWA) has been proposed as an effective method of intracardiac electrogram analysis, but its computational demands limit its use in implantable devices. A new method for intracardiac electrogram analysis, the bin area method (BAM), was created to detect abnormal cardiac conduction with computational requirements of one-half to one-tenth those of CWA. Like CWA, BAM is a template matching method that is sensitive to conduction changes revealed in the electrogram morphology and is independent of amplitude and baseline fluctuations. Performance of BAM and CWA were compared using bipolar right ventricular and right atrial electrode recordings from 47 patients undergoing clinical cardiac electrophysiology studies. Nineteen patients had 31 distinct monomorphic ventricular tachycardias (VTs) induced (group I), thirteen patients had paroxysmal bundle branch block of supraventricular origin (BBB) induced (group II), and 19 patients had retrograde atrial activation during right ventricular overdrive pacing (group III). (One patient was common to all three groups, and two patients were common to groups II and III.) Using the ventricular electrogram, both BAM and CWA distinguished VT from sinus rhythm in 28/31 (90%) cases, and BBB from Normal Sinus Rhythm (NSR) in 13/13 (100%) patients. Using the atrial electrogram, both BAM and CWA distinguished anterograde from retrograde atrial activation in 19/19 (100%) patients. BAM achieves similar performance to CWA with significantly reduced computational demands, and may make real-time analysis of intracardiac electrograms feasible for implantable pacemakers and antitachycardia devices.

Algorithms

An approach to quality and performance control in a computer-assisted clinical chemistry laboratory.

A locally developed, computer-based clinical chemistry laboratory system has been in operation since 1970. This utilises a Digital Equipment Co Ltd PDP 12 and an interconnected PDP 8/F computer. Details are presented of the performance and quality control techniques incorporated into the system. Laboratory performance is assessed through analysis of results from fixed-level control sera as well as from cumulative sum methods. At a simple level the presentation may be considered purely indicative, while at a more sophisticated level statistical concepts have been introduced to aid the laboratory controller in decision-making processes.

Chemistry, Clinical

On the evolution of the physiological model.

Most of us who have concerned ourselves with models can perceive outlines like those above to catalog the future evolution of the expository function of models. In the context of a single class of computerized mathematical models of respiratory physiology, we can observe at once the burgeoning interest among scientists, and the similarities between model activity and the general organization of scientific information for use. Although physiological models have become quite advanced in their subject control, there is relatively little coordinated activity in the mechanization of the purposes and philosophical potential of automata. The outlines, however, are visible. An assiduous pursuit of the notion of "explanation" by machine is a major evolutionary step next to occur. It appears to us that various diagrams similar to Figures 5 or 6 can be created and investigated in terms of their relation to the human mind and in terms of formalizing rules for traversing from one plane to the next. The evolution of models will require program-making programs which can decide when and how to aggregate for deductive inference, and how far to penetrate top-down for explanation. The rules for identifying "second order" effects must be established. The decision to ignore or use these rules will be crucial. These are the means whereby the systems are traversed from plane to plane. In a word, models need to synthesize the means to ignore, "forget," and gloss over; only then will we have useful tools for taking informed action in physiology, diagnosis in medicine, or the writing of "scholarly" reviews.

Computers

Automated Classification of Lymphoma Subtypes From Histopathological Images Using a U-Net Deep Learning Model: Comparative Evaluation Study.

BACKGROUND: Accurate classification and grading of lymphoma subtypes are essential for treatment planning. Traditional diagnostic methods face challenges of subjectivity and inefficiency, highlighting the need for automated solutions based on deep learning techniques. OBJECTIVE: This study aimed to investigate the application of deep learning technology, specifically the U-Net model, in classifying and grading lymphoma subtypes to enhance diagnostic precision and efficiency. METHODS: In this study, the U-Net model was used as the primary tool for image segmentation integrated with attention mechanisms and residual networks for feature extraction and classification. A total of 620 high-quality histopathological images representing 3 major lymphoma subtypes were collected from The Cancer Genome Atlas and the Cancer Imaging Archive. All images underwent standardized preprocessing, including Gaussian filtering for noise reduction, histogram equalization, and normalization. Data augmentation techniques such as rotation, flipping, and scaling were applied to improve the model's generalization capability. The dataset was divided into training (70%), validation (15%), and test (15%) subsets. Five-fold cross-validation was used to assess model robustness. Performance was benchmarked against mainstream convolutional neural network architectures, including fully convolutional network, SegNet, and DeepLabv3+. RESULTS: The U-Net model achieved high segmentation accuracy, effectively delineating lesion regions and improving the quality of input for classification and grading. The incorporation of attention mechanisms further improved the model's ability to extract key features, whereas the residual structure of the residual network enhanced classification accuracy for complex images. In the test set (N=1250), the proposed fusion model achieved an accuracy of 92% (1150/1250), a sensitivity of 91.04% (1138/1250), a specificity of 89.04% (1113/1250), and an F1-score of 90% (1125/1250) for the classification of the 3 lymphoma subtypes, with an area under the receiver operating characteristic curve of 0.95 (95% CI 0.93-0.97). The high sensitivity and specificity of the model indicate strong clinical applicability, particularly as an assistive diagnostic tool. CONCLUSIONS: Deep learning techniques based on the U-Net architecture offer considerable advantages in the automated classification and grading of lymphoma subtypes. The proposed model significantly improved diagnostic accuracy and accelerated pathological evaluation, providing efficient and precise support for clinical decision-making. Future work may focus on enhancing model robustness through integration with advanced algorithms and validating performance across multicenter clinical datasets. The model also holds promise for deployment in digital pathology platforms and artificial intelligence-assisted diagnostic workflows, improving screening efficiency and promoting consistency in pathological classification.

Humans

Characteristics of the software for computer applications in medicine.

The requirements of clinical medicine which have tended to make the design and implementation of software for hospital computer systems more difficult than that elsewhere, are discussed in this paper. Specific constraints on the software for selected computer-assisted activities in a hospital environment are examined in considerable depth. It is shown that since some of these activities have counterparts elsewhere, hospital computing can benefit from the accumulated experience in dealing with similiar problems in business and scientific environments. The argument is put forward that developing countries, with their characteristic problem of acute shortage of skilled manpower in both medicine and computing, should initially concentrate on applying computers to these activities alone. Furthermore, medical education in such countries should incorporate programmes relating to computer technology in general and the software aspects in particular.

Computers

Computer assisted instruction for preoperative and postoperative patient education in joint replacement surgery.

This article describes a comprehensive system for preoperative and postoperative patient education. The system offers a cost-effective method of instruction which encourages patient interaction and practice with decision making. The system was designed for patients undergoing total joint replacement surgery and includes two preoperative lessons, and a third lesson presented postoperatively at the bedside. The computer lessons were developed using data collected by a patient assessment instrument, and collaboratively with input from a nurse clinical specialist, orthopedic surgeon, physical therapist, and computer programmer. In this project, several advantages for using computer assisted instruction for preoperative and postoperative patient education were identified.

Computer-Assisted Instruction