International journal of clinical monitoring and computing最新文献

{"title":"Introduction of knowledge bases in patient's data management system: role of the user interface.","authors":"M C Chambrin,&nbsp;P Ravaux,&nbsp;A Jaborska,&nbsp;C Beugnet,&nbsp;P Lestavel,&nbsp;C Chopin,&nbsp;M Boniface","doi":"10.1007/BF01142440","DOIUrl":"https://doi.org/10.1007/BF01142440","url":null,"abstract":"<p><p>As the number of signals and data to be handled grows in intensive care unit, it is necessary to design more powerful computing systems that integrate and summarize all this information. The manual input of data as e.g. clinical signs and drug prescription and the synthetic representation of these data requires an ever more sophisticated user interface. The introduction of knowledge bases in the data management allows to conceive contextual interfaces. The objective of this paper is to show the importance of the design of the user interface, in the daily use of clinical information system. Then we describe a methodology that uses the man-machine interaction to capture the clinician knowledge during the clinical practice. The different steps are the audit of the user's actions, the elaboration of statistic models allowing the definition of new knowledge, and the validation that is performed before complete integration. A part of this knowledge can be used to improve the user interface. Finally, we describe the implementation of these concepts on a UNIX platform using OSF/MOTIF graphical interface.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 1","pages":"11-6"},"PeriodicalIF":0.0,"publicationDate":"1995-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF01142440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18782169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical evaluation of the 'head-up' display of anesthesia data. Preliminary communication.","authors":"F E Block,&nbsp;D O Yablok,&nbsp;J S McDonald","doi":"10.1007/BF01142442","DOIUrl":"https://doi.org/10.1007/BF01142442","url":null,"abstract":"<p><p>To solve the problem of monitoring the patient during administration of anesthesia, a commercially available head-up display (HUD) was evaluated during one day of surgery at the Ohio State University Hospitals. This monitor is mounted on a headband worn by the anesthesiologist. It projects a monochrome image of monitor data directly into one eye. Eleven anesthesiologists tested the device. Most users were able to adjust to the monitor in about fifteen minutes. Nine of the testers expressed a desire to evaluate the monitor further. Their major complaints were that the connecting cable between the HUD and its computer was too short, the resolution of the monitor was inadequate, and the data on the screen were not organized in a familiar way. If these problems could be corrected, most users believed that this HUD could be a valuable tool to aid the anesthesiologist in the operating room.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 1","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"1995-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF01142442","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18782171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data processing in prehospital emergency medicine.","authors":"P Felleiter,&nbsp;M Helm,&nbsp;L Lampl,&nbsp;K H Bock","doi":"10.1007/BF01142445","DOIUrl":"https://doi.org/10.1007/BF01142445","url":null,"abstract":"<p><p>Information about the use of data processing systems in prehospital emergency medicine were collected, using a questionnaire sent to all German rescue helicopter bases. Twenty-seven of the 42 German rescue helicopter bases returned the questionnaire. At present, only 15 of them take advantage of electronic data processing. All of them enter their data manually by keyboard, automatic data transfer by means of a bar code reader is available at one base only. The stored data are used for statistical analysis (n = 15), quality assessment (n = 10), administration (n = 10), research (n = 9) and education (n = 7). Based on the data of this survey, one fifth of those who replied use their computer only for administrative purposes, the other also manage patient and mission data with their computer systems. Today, documentation of a rescue mission consists of patient data, vital data, mission data and information about the procedures carried out. The use of a computer system, however, requires more time and work than a handwritten record, when most of the data have to be entered manually using a keyboard. Future developments may include automated data transfer and digitization of handwritten documents to decrease the workload of the staff. For the automation of data transfer, configuration and synchronisation a standardized interface in all medical devices is required. There is a clear need for the use of data processing systems in emergency medicine.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 1","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"1995-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF01142445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18782174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coding medical concepts: a controlled experiment with a computerised coding tool.","authors":"J H Hohnloser,&nbsp;F Pürner,&nbsp;P Kadlec","doi":"10.1007/BF02332688","DOIUrl":"https://doi.org/10.1007/BF02332688","url":null,"abstract":"<p><p>In clinical routine there is a growing need to encode medical concepts with available standard coding systems. The coding process can be time consuming and may significantly add to daily paperwork, particularly regarding patients with multiple diagnoses and in busy clinical environments with a high turnover of patients. We have developed a generic computerised encoding tool--the PADS encoder--to ensure rapid, correct and complete coding of diagnoses in daily routine. The tool is integrated into an electronic patient record system (PADS, Patient Archiving & Documentation System) and takes full advantage of the user friendly Macintosh interface. The tool was tested in a controlled experiment by 18 clinicians who encoded a total of 666 medical concepts in each protocol (study protocol vs. control). The following positive findings were significantly associated with the use of the computerised coding tool: the number of correctly encoded medical concepts was higher (99.55% vs. 86.1%), coding errors were lower (0% vs. 10.81%), more modifier codes were encoded correctly (increase by up to 43%), less coding errors were made (decrease by up to 43%), the overall rate of correctly encoded and complete main and modifier codes was increased by 31.27% (97.29% vs. 66.02%), coding time was reduced by 50%. This paper presents data to suggest that a computerised coding tool can produce more complete data of higher quality and can save time compared with the traditional approach to encode medical concepts.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 3","pages":"141-5"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF02332688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19563348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive segmentation of burst-suppression pattern in isoflurane and enflurane anesthesia.","authors":"T Lipping,&nbsp;V Jäntti,&nbsp;A Yli-Hankala,&nbsp;K Hartikainen","doi":"10.1007/BF02332690","DOIUrl":"https://doi.org/10.1007/BF02332690","url":null,"abstract":"<p><p>In this paper a developed novel algorithm for adaptive segmentation of Burst-suppression EEG is presented. The algorithm can detect bursts, suppression and artifacts, dividing the signal into corresponding segments. A compact representation of burst-suppression EEG, useful in monitoring long-term recordings, is presented. In the second part of the paper the burst-suppression patterns of isoflurane and enflurane anesthesia are compared. It is found that bursts as well as suppression segments are shorter in enflurane anesthesia while the coefficient of variability of the segment lengths is similar for the two anesthetics.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 3","pages":"161-7"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF02332690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19563350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of the Sixteenth Annual Conference on Computers in Anesthesia, Nashville, Tennessee, October 25–28, 1995","authors":"Bradley E. Smith, C. Beattie, D. G. Hess","doi":"10.1007/BF02332692","DOIUrl":"https://doi.org/10.1007/BF02332692","url":null,"abstract":"","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 1","pages":"175-187"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF02332692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"52294382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical non-invasive measurement of effective pulmonary capillary blood flow.","authors":"S M Winter","doi":"10.1007/BF02332687","DOIUrl":"https://doi.org/10.1007/BF02332687","url":null,"abstract":"<p><p>Since traditional pulmonary function testing is centered on measurements of air flow and lung volume, a method to assess the pulmonary circulation might improve our ability to evaluate diseases that impact upon pulmonary hemodynamics. We have developed a PC based application that rapidly calculates pulmonary blood flow. Subjects rebreath a mixture of 10% argon and 3.5% freon for 20 seconds. Gas concentrations at the mouth are monitored by a clinical mass spectrometer and signals are acquired and processed with off-the-shelf hardware. To test the accuracy and reproducibility of this technique, patients with pulmonary artery catheters were assessed by standard thermodilution methods and the rebreathing test. Measurements using this non-invasive technology closely corelate with invasive thermodilution methods (r = 0.980) and show equivalent reproducibility (average standard error = 2.5%). This application of signal processing technology can extend the role of pulmonary function testing to include routine evaluation of the pulmonary circulation.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 3","pages":"121-40"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF02332687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19563347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computer assisted data analysis in intensive care: the ICDEV project--development of a scientific database system for intensive care (Intensive Care Data Evaluation Project).","authors":"P G Metnitz,&nbsp;P Laback,&nbsp;C Popow,&nbsp;O Laback,&nbsp;K Lenz,&nbsp;M Hiesmayr","doi":"10.1007/BF02332689","DOIUrl":"https://doi.org/10.1007/BF02332689","url":null,"abstract":"<p><strong>Introduction: </strong>Patient Data Management Systems (PDMS) for ICUs collect, present and store clinical data. Various intentions make analysis of those digitally stored data desirable, such as quality control or scientific purposes. The aim of the Intensive Care Data Evaluation project (ICDEV), was to provide a database tool for the analysis of data recorded at various ICUs at the University Clinics of Vienna.</p><p><strong>Settings: </strong>General Hospital of Vienna, with two different PDMSs used: CareVue 9000 (Hewlett Packard, Andover, USA) at two ICUs (one medical ICU and one neonatal ICU) and PICIS Chart+ (PICIS, Paris, France) at one Cardiothoracic ICU. CONCEPT AND METHODS: Clinically oriented analysis of the data collected in a PDMS at an ICU was the beginning of the development. After defining the database structure we established a client-server based database system under Microsoft Windows NI and developed a user friendly data quering application using Microsoft Visual C++ and Visual Basic;</p><p><strong>Results: </strong>ICDEV was successfully installed at three different ICUs, adjustment to the different PDMS configurations were done within a few days. The database structure developed by us enables a powerful query concept representing an 'EXPERT QUESTION COMPILER' which may help to answer almost any clinical questions. Several program modules facilitate queries at the patient, group and unit level. Results from ICDEV-queries are automatically transferred to Microsoft Excel for display (in form of configurable tables and graphs) and further processing.</p><p><strong>Conclusions: </strong>The ICDEV concept is configurable for adjustment to different intensive care information systems and can be used to support computerized quality control. However, as long as there exists no sufficient artifact recognition or data validation software for automatically recorded patient data, the reliability of these data and their usage for computer assisted quality control remain unclear and should be further studied.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 3","pages":"147-59"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF02332689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19563349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double burst monitoring during surgical degrees of neuromuscular blockade: a comparison with train-of-four.","authors":"H Kirkegaard-Nielsen,&nbsp;H S Helbo-Hansen,&nbsp;P Lindholm,&nbsp;I K Severinsen,&nbsp;K Bülow","doi":"10.1007/BF01207198","DOIUrl":"https://doi.org/10.1007/BF01207198","url":null,"abstract":"<p><strong>Unlabelled: </strong>With double burst stimulation (DBS) it is possible to monitor more profound degrees of neuromuscular blockade than with train-of-four stimulation (TOF). It may therefore be indicated to change between DBS and TOF stimulation during moderate to profound degrees of neuromuscular blockade. Consequently, the aim of the study was to evaluate and compare the twitch height of the first twitch (D1) in DBS and the twitch height of the first twitch (T1) in TOF stimulation during moderate to profound degrees of neuromuscular blockade. Thirty-three patients scheduled for gynaecological laparotomy under general anaesthesia were studied. Mechanomyography was used for neuromuscular monitoring. The T1 twitch height before atracurium was administered served as the control twitch height (T1 control). T1 control was considered as 100%. A constant degree of neuromuscular blockade was maintained at a T1 twitch height at a point between 4 and 11% of T1 control, using a continuous infusion of atracurium. Sequences of 16 DBS and 16 TOF stimulations were given. Two different DBS patterns were examined: DBS3,350/50, (3 stimuli at 50 Hz followed 0.75 sec later by 3 stimuli at 50 Hz), and DBS3,380/40, (3 stimuli at 80 Hz followed 0.75 sec later by 3 stimuli at 40 Hz). The data were analysed by the method described by Bland and Altman. The D1 repeatability coefficients of 1.72% for DBS3,350/50 and 1.20% for DBS3,380/40 were significantly greater than the repeatability coefficient of 1.02% for T1 (p <0.05). The D1 bias of 16.7% for DBS3,350/50 was significantly less than the D1 bias of 25.7% for DBS3,380/40 (p <0.05). The limits of agreement between D1 and T1 were 0.1 to 33.3% for DBS3,350/50 and 2.9 to 48.5% for DBS3,380/40.</p><p><strong>In conclusion: </strong>The repeatability of responses to DBS and TOF stimulations during moderate to profound degrees of neuromuscular blockade where only one twitch is consistently present is satisfactory. The responses to DBS were greater than responses to TOF as indicated by a positive bias of DBS. The limits of agreement between DBS and TOF responses were so wide that they cannot be used interchangeably.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 4","pages":"191-6"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF01207198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19789402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of skin incision followed by alfentanil on catecholamine levels and on the T-wave amplitude of ECG during isoflurane anaesthesia.","authors":"P A Annila,&nbsp;L Lindgren,&nbsp;P Loula,&nbsp;M Scheinin,&nbsp;A M Yli-Hankala","doi":"10.1007/BF01207200","DOIUrl":"https://doi.org/10.1007/BF01207200","url":null,"abstract":"<p><p>Haemodynamic, ECG T-wave amplitude and plasma potassium changes and plasma catecholamine responses to skin incision followed by alfentanil were studied in 24 ASA I patients. Propofol and vecuronium were used without anticholinergics for induction of anaesthesia followed by isoflurane in 02/air. End-tidal isoflurane concentration was kept constant (0.7%) for 30 min before the skin incision. Five min after the skin incision alfentanil 30 mu g kg-1 was given. Blood samples for catecholamines and plasma potassium concentrations were drawn from right ventricle of the heart one minute before and after the skin incision and two minutes after alfentanil. Heart rate, systolic and diastolic arterial pressures increased after the skin incision (P < 0.001), and decreased after alfentanil (P < 0.001). Plasma adrenaline and noradrenaline concentrations increased slightly after the skin incision (P < 0.05 and P < 0.01, respectively). Noradrenaline levels continued to increase after alfentanil (P < 0.001) despite totally abolished haemodynamic responses to the skin incision. ECG T-wave amplitude changes, measured as R/T ratio, did not correlate to the changes in plasma catecholamine levels: both rapid increases and decreases in R/T ratio were seen. No plasma potassium changes were seen during the trial. T-wave changes, occurring in seconds after the skin incision, are probably produced by a direct catecholamine release from cardiac sympathetic nerve endings.</p>","PeriodicalId":77181,"journal":{"name":"International journal of clinical monitoring and computing","volume":"12 4","pages":"205-11"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF01207200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19789404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}