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Integrating digital image management software for improved patient care and optimal practice management.

BACKGROUND: Photographic images provide vital documentation of preoperative, intraoperative, and postoperative results in the clinical dermatologic surgery practice and can document histologic findings from skin biopsies, thereby enhancing patient care. Images may be printed as part of text documents, transmitted via electronic mail, or included in electronic medical records. OBJECTIVES: To describe existing computer software that integrates digital photography and the medical record to improve patient care and practice management. CONCLUSIONS: A variety of computer applications are available to optimize the use of digital images in the dermatologic practice.

Dermatology↗

Clinical experience with a new software-based antitachycardia pacemaker for recurrent supraventricular and ventricular tachycardias.

The Intermedics Intertach 262-12 tachycardia reversion pulse generator was implanted in 14 patients (six male, eight female, mean age at implantation 45 +/- 16 years) with recurrent symptomatic tachycardias. Six patients had atrioventricular (AV) nodal reentrant tachycardia, three patients had orthodromic tachycardia with Wolff-Parkinson-White syndrome, two had circus movement tachycardia via a concealed bypass tract, two had ventricular tachycardia, one patient had atrial flutter. Mean duration of symptoms before implantation was 8 +/- 4 years and mean number of antiarrhythmic drug trials was 3.5 +/- 1. The primary tachycardia response made consisted of autodecremental pacing in one patient, burst pacing in two patients, and adaptive scanning of the initial delay or burst cycle length in eleven patients. The secondary tachycardia response mode consisted of autodecremental pacing in four patients, burst pacing in three patients and burst scanning in four patients. Tachycardia response was automatic in all but one patient with ventricular tachycardia. During a follow-up period of 30.5 +/- 10.6 months, one patient with ventricular tachycardia died from a nonarrhythmic cause. Reinterventions were necessary due to electrode fracture in one patient and due to pacemaker software defect in another one. Two patients underwent surgical cure of their arrhythmia: one patient with atrial flutter and one patient with AV nodal reentry tachycardia, 24 months and 11 months postpacemaker implantation, respectively. Four patients required digitalis to prevent pacing induced atrial fibrillation. Other proarrhythmic effects were not encountered. The pacemaker proved to be a versatile system with reliable tachycardia detection and termination functions. It provided a valuable adjunctive therapy in these selected patients.

Adult↗

Assistant programming software: a new tool for an improved programming of pacemakers.

Programming the new DDD pacemakers is becoming increasingly difficult. One must take into account the pacemaker's complexity, the fact that some parameters are linked to others, and the clinical profile of the patient. This difficult problem will lead to the design of software to assist programming, which will help the implanting physicians in choosing adequate programmed settings adapted to the functioning of the device and to the physiology and pathology of the patient. These programming aides should meet certain basic requirements to make them safe, efficient, and easy to use. One such system designed by ELA Médical, "Programming Assistant" is herein described. The preliminary results of an initial study on the acceptance of this programming aide among physicians involved in cardiac pacing are given and discussed.

Adult↗

Loss of atrial signal detection with increasing sensitivity settings: a software problem and its practical solution.

A logic error in the software of Cosmos II results in apparent malsensing of atrial signals at high rather than low sensitivity settings. The paradoxical function was found in 54 out of 87 units tested (= 62%) if the atrial sensitivity was increased and in 54 out of 87 units tested (= 62%) if the atrial sensitivity was increased and the ventricular refractory period was lengthened beyond critical limits that could be defined individually. The problem inherent in both unipolar (66%) and bipolar systems (54%) is attributed to a summation of a physiological signal and internal noise, which has to be detected at the atrial level within a specific timing window to disable atrial sensing for the next pacing cycle. The malfunction virtually disappears if the ventricular refractory period does not exceed 210 msec. It is recommended, therefore, that Cosmos II pacemakers be left at their nominal ventricular refractory value (200 msec).

Adult↗

Population analysis on the microcomputer: a system of software packages.

"This paper describes a system of versatile software packages that has been developed by the author for population analysis on IBM-compatible microcomputers using PC or MS DOS. The series includes programs for the production of life tables, the analysis of spatial patterns and temporal trends in mortality, population projections, stationary-state population simulations and demographic planning, cohort survival estimates of net migration, and the analysis of migration matrices. Each of the programs in the series is discussed in terms of its principal analytical features, associated conceptual and methodological issues, and potential applications. The programs are intended for use both as basic research and planning tools and as instructional aids in university-level-courses. The programs and related documentation are available on a set of four 360K diskettes." (SUMMARY IN FRE)

Cohort Studies↗

Development of a computer-assisted learning software package on dental traumatology.

The development of computer-assisted learning software packages is a relatively new field of computer application. The progress made in personal computer technology toward more user-friendly operating systems has stimulated the academic community to develop computer-assisted learning for pre- and postgraduate students. The ability of computers to combine audio and visual data in an interactive form provides a powerful educational tool. The purpose of this study was to develop and evaluate a computer-assisted learning package on dental traumatology. This program contains background information on the diagnosis, classification, and management of dental injuries in both the permanent and the deciduous dentitions. It is structured into chapters according to the nature of the injury and whether injury has occurred in the primary or permanent dentition. At the end of each chapter there is a self-assessment questionnaire as well as references to relevant literature. Extensive use of pictures and video provides a comprehensive overview of the subject.

Computer-Assisted Instruction↗

Identification of dental implants through the use of Implant Recognition Software (IRS).

AIM: To develop computer software to allow general dental practitioners and others to identify unidentified implants in patients' mouths using a range of criteria. METHODS: Internet searches for implant manufacturing companies worldwide in all languages using terms: dental implants, dental implant manufacturers and dental implant companies. Once identified, all relevant information including images regarding dental implant products was collected even that for discontinued products. A program was then devised using key design factors to enable identification of individual implants. RESULTS: The searches produced details for 87 implant manufacturers based in 21 countries with 231 different implant designs. The resultant program has been successfully trialled and used in both general dental practice and for forensic identification. CONCLUSION: The program developed provides a valuable adjunct to the identification of implant systems present in patients' mouths.

Dental Implants↗

Measuring nonmedical psychiatric treatment interventions with statistical software.

This article addresses, from both research and political perspectives, the issue of quantifying data on nonmedical psychiatric treatment activity in large residential treatment settings. It presents a method of collecting this type of data that includes the use of readily available statistical software. It describes the methodology in detail and examines the variables. The system has had an impact on treatment, administration, and personnel at the facility.

Ancillary Services, Hospital↗

Three-layer volume conductor model and software package for applications in surface electromyography.

On comparing multichannel surface electromyographic measurements of the m. biceps brachii with simulations performed with a previously developed two-layer volume conduction model, we found substantial discrepancies. To incorporate an apparent distorting effect of the skin tissue, the model was extended to three layers. This new model describes the potential resulting from an eccentric bioelectric source in a finite, cylindrical, and anisotropic volume conductor consisting of three layers, representing muscle, subcutaneous fat, and skin tissue. This contribution presents the governing mathematical equations of the three-layer volume conductor model as well as our approach to their solution. A comparison of various models shows that the three-layer model best describes measured potential distributions. Furthermore, we present the "ANVOLCON" (analytical volume conductor) software package. This package has been developed to facilitate the use of the model for scientific and educational purposes and is freely available from http://www.mbfys.kun.nl/knf

Action Potentials↗

MarCell software for modeling bone marrow radiation cell kinetics.

Differential equations were used to model cellular injury, repair, and compensatory proliferation in the irradiated bone marrow. Recently, that model was implemented as MarCell, a user-friendly MS-DOS computer program that allows users from a variety of technical disciplines to evaluate complex radiation exposure. The software allows menu selections for different sources of ionizing radiation. Choices for cell lineages include progenitor, stroma, and malignant, and the available species include mouse, rat, dog, sheep, swine, burro, and man. An attractive feature is that any protracted irradiation can be compared with an equivalent prompt dose (EPD) in terms of cell kinetics for either the source used or for a reference such as 250 kVp x rays or 60Co. EPD is used to mean a dose rate for which no meaningful biological recovery occurs during the period of irradiation. For human as species, output from MarCell includes: risk of 30-day mortality; risk of whole-body cancer and leukemia based either on radiation-induced cytopenia or compensatory cell proliferation; cell survival and repopulation plots as functions of time or dose; and 4-week recovery following treatment.

Animals↗

A software tool for the quantitative evaluation of 3D dose calculation algorithms.

Current methods for evaluating modern radiation therapy treatment planning (RTP) systems include the manual superposition of calculated and measured isodose curves and the comparison of a limited number of calculated and measured point doses. Both techniques have significant limitations in providing quantitative evaluations of the large number of dose data generated by modern RTP systems. More sophisticated comparison techniques have been presented in the literature, including dose-difference and distance-to-agreement (DTA) analyses. A software tool has been developed that uses superimposed isodose plots, dose-difference, and DTA distributions to quantify errors in computed dose distributions. Dose-difference and DTA analyses are overly sensitive in regions of high- and low-dose gradient, respectively. The logical union of locations that fail both dose-difference and DTA acceptance criteria, termed the composite evaluation, is calculated and displayed. The composite evaluation provides a method for the physicist to efficiently identify regions that fail both the dose-difference and DTA acceptance criteria. The tool provides a computer platform for the quantitative comparison of calculated and measured dose distributions.

Algorithms↗

Time-domain modeling of peripheral auditory processing: a modular architecture and a software platform.

A software package with a modular architecture has been developed to support perceptual modeling of the fine-grain spectro-temporal information observed in the auditory nerve. The package contains both functional and physiological modules to simulate auditory spectral analysis, neural encoding, and temporal integration, including new forms of periodicity-sensitive temporal integration that generate stabilized auditory images. Combinations of the modules enable the user to approximate a wide variety of existing, time-domain, auditory models. Sequences of auditory images can be replayed to produce cartoons of auditory perceptions that illustrate the dynamic response of the auditory system to everyday sounds.

Auditory Perception↗

Application of SmartGene IDNS software to partial 16S rRNA gene sequences for a diverse group of bacteria in a clinical laboratory.

Laboratories often receive clinical isolates for bacterial identification that have ambiguous biochemical profiles by conventional testing. With the emergence of 16S rRNA gene sequencing as an identification tool, we evaluated the usefulness of SmartGene IDNS, a 16S rRNA sequence database and software program for microbial identification. Identification by conventional methods of a diverse group of bacterial clinical isolates was compared with gene sequences interrogated by the SmartGene and MicroSeq databases. Of 300 isolates, SmartGene identified 295 (98%) to the genus level and 262 (87%) to the species level, with 5 (2%) being inconclusive. MicroSeq identified 271 (90%) to the genus level and 223 (74%) to the species level, with 29 (10%) being inconclusive. SmartGene and MicroSeq agreed on the genus for 233 (78%) isolates and the species for 212 (71%) isolates. Conventional methods identified 291 (97%) isolates to the genus level and 208 (69%) to the species level, with 9 (3%) being inconclusive. SmartGene, MicroSeq, and conventional identifications agreed for 193 (64%) of the results. Twenty-seven microorganisms were not represented in MicroSeq, compared to only 2 not represented in SmartGene. Overall, SmartGene IDNS provides comprehensive and accurate identification of a diverse group of bacteria and has the added benefit of being a user-friendly program that can be modified to meet the unique needs of clinical laboratories.

Bacteria↗

Direct identification and susceptibility testing of gram-negative bacilli from BACTEC bottles by use of the MS-2 system with updated bacterial identification software.

The Abbott MS-2 system (Abbott Laboratories, Diagnostic Division, Irving, Tex.), equipped with updated bacterial identification software (version 03.02), was used to perform both direct identification and susceptibility tests on gram-negative bacilli from positive BACTEC blood culture bottles. Ninety-eight of 101 Enterobacteriaceae strains, one strain of Acinetobacter calcoaceticus, and two strains of Pseudomonas aeruginosa were correctly identified by following a direct inoculation procedure. One Enterobacter sakazakii isolate was misidentified as Enterobacter cloacae. Ninety-seven percent of 936 direct susceptibility results were identical to the results obtained by using the standard MS-2 susceptibility procedure. Only five tests yielded a sensitive-direct and a resistant-standard MS-2 susceptibility result.

Bacteria↗

Identification and characterization of multiple species of vancomycin-resistant enterococci, including an evaluation of Vitek software version 7.1.

A total of 374 clinical isolates of Enterococcus spp. were characterized to determine the species distribution and vancomycin resistance. The ability of the Vitek system (bioMerieux Inc, Hazelwood, St. Louis, Mo.) to identify enterococci to the species level and to recognize vancomycin resistance by using computer software version 7.1 was evaluated. Conventional methods were used for identification and agar dilution was used for susceptibility testing, the results of which were as follows (presented as number of vancomycin-resistant isolates/number of members of that species identified): 219/234 E. faecium, 9/112 E. faecalis, 2/3 E. mundtii, 0/1 E. durans, 0/1 E. hirae, 0/1 E. raffinosis, and 0/1 E. avium. Ten enterococci were in the vancomycin-intermediate category (six E. gallinarum, two E. casseliflavus, and one each of E. faecium and E. faecalis). The Vitek GPI card correctly identified 98% of E. faecium isolates, 99% of E. faecalis isolates, and only two isolates of other enterococcal species. The GPS-TA card was 98% sensitive and 95% specific for the detection of vancomycin resistance, generating a total of four very major (1.6%) and five minor errors (1.3%).

Drug Resistance, Microbial↗

Rapid identification of mycolic acid patterns of mycobacteria by high-performance liquid chromatography using pattern recognition software and a Mycobacterium library.

Current methods for identifying mycobacteria by high-performance liquid chromatography (HPLC) require a visual assessment of the generated chromatographic data, which often involves time-consuming hand calculations and the use of flow charts. Our laboratory has developed a personal computer-based file containing patterns of mycolic acids detected in 45 species of Mycobacterium, including both slowly and rapidly growing species, as well as Tsukamurella paurometabolum and members of the genera Corynebacterium, Nocardia, Rhodococcus, and Gordona. The library was designed to be used in conjunction with a commercially available pattern recognition software package, Pirouette (Infometrix, Seattle, Wash.). Pirouette uses the K-nearest neighbor algorithm, a similarity-based classification method, to categorize unknown samples on the basis of their multivariate proximities to samples of a preassigned category. Multivariate proximity is calculated from peak height data, while peak heights are named by retention time matching. The system was tested for accuracy by using 24 species of Mycobacterium. Of the 1,333 strains evaluated, > or = 97% were correctly identified. Identification of M. tuberculosis (n = 649) was 99.85% accurate, and identification of the M. avium complex (n = 211) was > or = 98% accurate; > or = 95% of strains of both double-cluster and single-cluster M. gordonae (n = 47) were correctly identified. This system provides a rapid, highly reliable assessment of HPLC-generated chromatographic data for the identification of mycobacteria.

Algorithms↗

Pseudo-outbreak of Enterococcus durans infections and colonization associated with introduction of an automated identification system software update.

Enterococci are an important cause of hospital-acquired infections. Since 1989, there has been an increase in the number of nosocomial enterococcal infections caused by strains resistant to vancomycin in the United States. Although many enterococcal species can colonize humans, only Enterococcus faecalis, E. faecium, E. raffinosus, and E. casseliflavus have been implicated in clusters of infection. In January 1996, the Centers for Disease Control and Prevention received a report of an outbreak of vancomycin-resistant enterococci in which 31 of 84 (36.9%) isolates were identified as E. durans. Twenty-nine isolates identified as E. durans were identified to the species level after the introduction of an automated identification system software update (Vitek gram-positive identification card, version R09.1) for the identification of species of gram-positive organisms. When seven isolates initially reported as E. durans were identified to the species level by alternate methods, they were found to be E. faecium. Subsequently, isolates identified as E. durans by the automated system were reidentified by using a rapid streptococcus test, and no further enterococcal isolate has been confirmed as E. durans. Automated microbial analysis is a potential source of error that is not easily recognized. When laboratory findings are discordant with expected clinical or epidemiologic patterns, confirmatory testing by alternate methods should be performed.

Anti-Bacterial Agents↗

Evaluation of AMPLILINK software for the COBAS AMPLICOR system.

The use of AMPLILINK version 1.0 software was evaluated for the operation and control of one COBAS AMPLICOR instrument and for two COBAS AMPLICOR instruments run simultaneously to perform and detect nucleic acid amplification reactions. A total of 3,384 results were analyzed. The initial accuracy of the results was 99.91%. Three errors of omission of transfer of data from the COBAS AMPLICOR to the AMPLILINK system were observed. Two of these errors were from a single specimen, where both the analyte and internal control results were not transmitted. These errors did not interfere with the correctness of any other data. There were no interruptions of runs, and no data were mixed. AMPLILINK increased convenience, saved labor, and was found to be a very useful addition for clinical laboratories performing molecular-diagnostic procedures with the COBAS AMPLICOR system.

Evaluation Studies as Topic↗