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The performance of Vitek cards GPS105 with software version VTK-R07.01 for detection of oxacillin resistance in coagulase-negative staphylococci (CoNS) was compared to disk diffusion and PCR detection for mecA. The sensitivity and specificity of the Vitek GPS105 method were 97.6 and 85.5%, respectively.
OBJECTIVE: To determine how well general decision support systems perform given the data collected in an emergency department (ED). METHODS: A convenience sample of 25 patients was selected from those patients having a diagnostic question on presentation to the ED. All interactions with the patients were audiotaped and abstracted into a structured data form. All other data such as written notes, laboratory, and EKG results were also abstracted. All data were entered into two general diagnostic decision support programs (Quick Medical Reference (QMR Version 3.82, Knowledge Base 10-07-1998 Copyright University of Pittsburgh and The Hearst Corporation) and Iliad (Version 4.5 Copyright 1996 Applied Medical Informatics)). The diagnoses generated by the computer programs were compared with the final diagnoses of the ED attending. RESULTS: The final ED diagnosis was found in the differential diagnosis generated by Iliad and QMR 72% and 52% of the time respectively. The final ED diagnosis was found in the top 10 diagnoses 51% and 44% of the time and in the top five diagnoses 36% and 32% of the time for each program respectively. This approximates to the performance of these programs in other clinical settings. CONCLUSIONS: Diagnostic decision support software has the same success in finding the "correct" diagnosis in the ED as in other clinical settings where more extensive clinical data are available. The accuracy is not sufficiently high to permit the use of these programs as an arbiter in any individual case. However, they may be useful, prompting additional investigation in particularly difficult cases.
We evaluate the ability of a microcomputer program (Automatch) to link patient records in our hospital's database (N = 253,836) with mortality files from California (N = 1,312,779) and the U.S. Social Security Administration (N = 13,341,581). We linked 96.5% of 3,448 in-hospital deaths, 99.3% for patients with social security numbers. None of 14,073 patients known to be alive (because they were subsequently admitted) was linked with California deaths, and only 6 (0.1%) of 6,444 were falsely identified as dead in the United States file. For patients with unknown vital status but items in the database likely to be associated with high 3-year mortality rates, we identified death records of 88% of 494 patients with cancer metastatic to the liver, 84% of 164 patients with pancreatic cancer, and 91% of 126 patients with CD4 counts of less than 50. Hospital data can be accurately linked with state and national vital statistics using commercial record linkage software.
The authors describe and illustrate an integrated trio of software programs for carrying out surface-based analyses of cerebral cortex. The first component of this trio, SureFit (Surface Reconstruction by Filtering and Intensity Transformations), is used primarily for cortical segmentation, volume visualization, surface generation, and the mapping of functional neuroimaging data onto surfaces. The second component, Caret (Computerized Anatomical Reconstruction and Editing Tool Kit), provides a wide range of surface visualization and analysis options as well as capabilities for surface flattening, surface-based deformation, and other surface manipulations. The third component, SuMS (Surface Management System), is a database and associated user interface for surface-related data. It provides for efficient insertion, searching, and extraction of surface and volume data from the database.
A software program is described which will enable laboratory managers to calculate, for their laboratory over a 12 month period, the cost of each test or investigation and of components of that cost. These comprise the costs of direct labour, consumables, equipment maintenance and depreciation; allocated costs of intermediate operations--for example, specimen procurement, reception, and data processing; and apportioned indirect costs such as senior staff time as well as external overheads such as telephone charges, rent, and rates. Total annual expenditure on each type of test is also calculated. The principles on which the program is based are discussed. Considered in particular, are the problems of apportioning indirect costs (which are considerable in clinical laboratory work) over different test costs, and the merits of different ways of estimating the amount or fraction of staff members' time spent on each kind of test. The computer program is Crown copyright but is available under licence from one of us (JAS).
BACKGROUND: To increase the sensitivity of measurements of maximal inspiratory pressure (MIP) as a test of inspiratory muscle strength and endurance, software was developed to correct for variation in lung volume. METHODS: Using a body plethysmograph to determine absolute lung volume during each manoeuvre, values for MIP were expressed as a percentage of the pressure "expected" from the unfatigued MIP/lung volume relation in each subject. RESULTS: The method reduced the variance in peak and average pressure during a series of 18 MIP manoeuvres of 10 seconds duration separated by rest intervals of 10 seconds. CONCLUSIONS: The correlation between average pressure and contraction number was improved significantly by the MIP/lung volume correction. This simple correction has many applications in measurements of the MIP.
Recent changes in veterinary medicine have required quantitative epidemiological techniques for designing field surveys, identifying risk factors for multifactorial diseases, and assessing diagnostic tests. Several relevant techniques are brought together in the package of veterinary epidemiological computer software, WIN EPISCOPE 2.0, described in this paper. It is based on Microsoft Windows and includes modules for the design and analysis of field surveys, control campaigns and observational studies, and a simple mathematical model. It provides comprehensive 'Help' screens and should therefore be useful not only in field investigations but also for teaching veterinary epidemiology.
A software package called the Magnetic Resonance Imaging Workbench has been developed to characterize contrast agent uptake in vivo following T1-weighted magnetic resonance (MR) imaging with qualitative analysis of changes in signal intensity or quantitative analysis of changes in contrast agent concentration over time. Various descriptors may be calculated from the analysis of dynamic contrast agent-enhanced MR studies and visualized as false-color overlays, which allow the immediate display and interpretation of information taken from a series of images acquired over time. Qualitative descriptors include onset of enhancement, initial gradient, mean gradient, maximum enhancement, and washout. These parameters can be particularly useful in the investigation of multifocal or widespread disease. Quantitative descriptors include capillary permeability-surface area product, extracellular volume, and T1 and may be used to monitor changes in the disease state and to assess the efficacy of treatment. In addition, they allow comparison of data obtained from different patients, from independent MR studies, or from studies performed with different modalities. Analysis of contrast enhancement during MR imaging in terms of such qualitative or quantitative parameters is a promising new method of data analysis in radiology.
Magnetic resonance (MR) imaging--guided prostate biopsy in a 0.5-T open imager is described, validated in phantom studies, and performed in two patients. The needles are guided by using fast gradient-recalled echo and T2-weighted fast spin-echo images. Surgical navigation software provided T2-weighted images critical to targeting the peripheral zone and the tumor. MR imaging can be used to guide prostate biopsy.
Personal computer (PC) security in the era of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) involves two interrelated elements: safeguarding the basic computer system itself and protecting the information it contains and transmits, including personal files. HIPAA regulations have toughened the requirements for securing patient information, requiring every radiologist with such data to take further precautions. Security starts with physically securing the computer. Account passwords and a password-protected screen saver should also be set up. A modern antivirus program can easily be installed and configured. File scanning and updating of virus definitions are simple processes that can largely be automated and should be performed at least weekly. A software firewall is also essential for protection from outside intrusion, and an inexpensive hardware firewall can provide yet another layer of protection. An Internet security suite yields additional safety. Regular updating of the security features of installed programs is important. Obtaining a moderate degree of PC safety and security is somewhat inconvenient but is necessary and well worth the effort.
A collection of software applications dedicated to clinical x-ray computed tomography (CT) has been developed. These tools are designed for routine and scientific work and represent a complete platform, which is called syngo Explorer. The user can reconstruct, process, and view CT images in a personal computer environment independently of specialized hardware. To manage patient data and to allow full database access, the system uses the syngo platform (Siemens Medical Solutions, Erlangen, Germany), which serves as a framework for the management and visualization of Digital Imaging and Communications in Medicine (DICOM) images. Part of the philosophy behind syngo Explorer is to quickly provide specialized solutions and to be able to respond to user requests at once. Thus, syngo Explorer was built by choosing a modular setup that comprises standard and specific reconstruction algorithms as well as various artifact reduction techniques; it also helps one attain better insights into dose issues. Various raw data formats of commercial CT scanners are supported. Reconstruction algorithms equivalent to those on the manufacturer's scanner console are provided. A non-syngo Windows XP (Microsoft, Redmond, Wash) version of the application is available.
INTRODUCTION AND OBJECTIVES: Quantification of intravascular ultrasound (IVUS) images is essential in ischemic heart disease and interventional cardiology. Manual analysis is very slow and expensive. We describe an automated computerized method of analysis that requires only minimal initial input from a specialist. METHODS: This study was carried out by interventional cardiologists and biomedical engineers working in close collaboration. We developed software in which it was necessary only to identify the media-adventitia boundary in a few images taken from the whole sequence. A three-dimensional reconstruction was then generated from each sequence, from which measurements of areas and volumes could be derived automatically. In total, 2300 randomly selected images from video sequences of 11 patients were analyzed. RESULTS: Results obtained using the proposed method differed only minimally from those obtained with the manual method: for vessel area measurements, the variability was 0.08 (0.07) (mean absolute error [standard deviation] normalized to the actual value; this corresponds to an error of 0.08 mm(2) per mm(2) of vessel area); for lumen area, 0.11 (0.11) (normalized), and for plaque volume, 0.5 (0.3) (normalized). Regions with severe lesions (<4 mm(2)) were correctly identified in more than 90% of cases. Specialist time needed for each reconstruction was 10 (8) minutes (vs 60 [10] minutes for manual analysis; P< .0001). CONCLUSIONS: The computerized method used dramatically reduced the time and effort needed for IVUS sequence analysis, and the automated measurements obtained were very promising.
OBJECTIVE: Given the cost and complexity of genome-wide scans, optimization of study design is of critical importance. Available algorithms only partially satisfy this need. We designed a software package called 'POLYMORPHISM' to meet these needs. METHODS: The program is designed to calculate linkage parameters for both 'single-point' and 'two-point' settings that are applicable also to incompletely informative microsatellite markers. In single-point analysis, the heterozygosity, polymorphism information content (PIC) and linkage information content (LIC) statistics based on marker allele frequencies are provided. In two-point analysis, joint PIC values for two markers, the conditional probability of detecting linkage phase, the frequency of double heterozygotes and the expected number of informative meioses are calculated. RESULTS: Results were obtained using S.A.G.E./DESPAIR (Design of Linkage Studies Based on Pairs of Relatives) in addition to applying this program to a Centre d'Etude du Polymorphisme pedigree-derived genotyping data set, which estimated critical parameters used in a two-stage genome scan. A single nucleotide polymorphism (SNP)-based one-stage genomic screen strategy is also considered. CONCLUSIONS: LIC values are crucial for getting accurate estimates on those parameters that are important for a two-stage genome screening study. Optimization of the cost-effectiveness of an SNP-based genomic screen strategy is possible by modeling a balance between marker information content and marker density.
Advances in microscopy now enable researchers to easily acquire multi-channel three-dimensional (3D) images and 3D time series (4D). However, processing, analyzing, and displaying this data can often be difficult and time- consuming. We discuss some of the software tools and techniques that are available to accomplish these tasks.
Surface and volumetric three-dimensional imaging methods have found application in fields as diverse as diagnostic medical imaging and paleontological research. The acquisition, modeling, classification, and computer graphics rendering of discrete image volumes will be introduced. Applications in diagnosis (craniofacial, orthopedic, cardiovascular, and others) as well as reconstruction methods for generic serial sections will be described. C language software for three-dimensional reconstruction which operates on an IBM PC/AT clone is described.
A software package, MotAn, has been developed for off-line analysis of gastrointestinal pressure recordings. The program has been implemented in the Modula-2 language for use on IBM personal computers. The program includes capabilities for manual or automatic detection of contractions, calculation of frequency and intercontractile intervals, area of contractions, motility index, concordance and cross-correlation analysis for detection of artifact and for propagation analysis. The program has been applied on pressure recordings from the stomach and duodenum as well as on the rectum and the urinary bladder. Besides the basic part of the program, it is possible for the experienced programmer to add new blocks of object code for development of special analysis procedures.
In order to obtain a new diagnostic tool for the early diagnosis of glaucoma, we developed a method based on computerized analysis of the optic disk, cup and neuroretinal rim areas. A fundus camera, a personal computer and a graphic tablet are employed. Suitable software was developed for calculating the areas (disk, cup and rim) providing an index, the rim/disk ratio. The method revealed high repeatability and reproducibility. The simplicity and speed of the procedure make this test suitable for routine clinical use in the early diagnosis of glaucoma.
Urodynamic investigation has undoubtedly been greatly refined and facilitated with the use of the modern generation of microcomputers. Manual techniques of data storage, analysis and interpretation are tedious, time consuming and lead to significant observer-dependent transcription errors. The logical solution to this problem is to develop a specifically designed software programme which would operate in conjunction with the microcomputer system integrated in most modern urodynamic apparatus. We describe here our experiences with the development of just such a system.