Development of a portable information system: connecting palmtop computers with medical records systems and clinical reference resources

The portability of palmtop computers makes them an ideal platform to maintain communication between busy physicians and medical information systems. In our academic FHC (Family Health Center) we have developed software that runs on a palmtop computer allowing access to information in the HIS (Hospital Information System) and our FHC's AAMRS (Automated Ambulatory Medical Record System). The resident physicians who staff the hospital and the FHC are frequently at home or otherwise off-site where terminal access is not available. Using a Hewlett-Packard 95LX palmtop computer as the base platform, custom software has been developed to access summary data on in-patients and out-patients. Data is downloaded into a database on a palmtop computer memory card. ASCII data from Medical Information Systems (MIS), is transformed into a database format readable on the palmtop. Our hospital MIS department transmits information daily on our in-patient service (20-30 patients). We also download, weekly, a patient summary on all of our active out-patients in our MUMPS-based AAMRS (2500-3000 patients). Each morning the resident in the Family Practice program updates his palmtop memory card at a central workstation. Palmtop computers with downloaded databases, can be valuable in care of patients when the physical or on-line chart is not easily accessible. They are particularly useful in multi-physician groups when the on-call physician provides care for the patients of other physicians. We have made the palmtop computer even more valuable to physicians by providing an integrated software package.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis and management of the paranoid patient

Patients with symptoms of paranoia often present to primary care physicians. The paranoia may range in severity from a mild and largely incidental finding to a psychotic symptom. In its more severe forms, paranoia may constitute the chief complaint or may interfere with the patient's ability to accept treatment for other medical conditions. After an assessment of the severity of the symptoms and consideration of an organic etiology, initial treatment is often begun with a supportive approach and the prescription of a neuroleptic medication.

Signing out patients for off-hours coverage: comparison of manual and computer-aided methods

This paper evaluates the communication of information to physicians who provide off-hours coverage to inpatients in two Family Practice residency programs.

METHOD

To describe the importance and accessibility of clinical information used by on-call residents in covering hospital patients, we administered a questionnaire. Then following the use of a new computerized sign-out system in one of the programs, residents filled out the same questionnaire again.

RESULTS

Residents felt that a "to do" list and information about the patient's "code status" were the most important data desired from sign-out sheets. However, 69% of residents in both programs felt that provision of this information was normally poor. Nearly all of the residents in Buffalo, using an entirely handwritten sign-out sheet, felt it was in need of improvement. Residents in Pittsburgh, using a summary aided by the hospital's computer print-out, felt this need much less acutely. After implementation of a new computerized sign-out sheet in Buffalo, residents indicated a slightly higher level of satisfaction. The work of data entry and re-entry into the computer was unpopular and inefficient.

CONCLUSION

The present method of transferring information at the end of a work day is not satisfactory for residents. Provision of data summaries from existing hospital information systems is a good first step in improving data transfer. A further study of more comprehensive automated sign-out systems is important, because of the increasing discontinuity of house officer care.

The interferon-induced Mx-homologous protein in people with symptomatic HIV-1 infection

Twenty-six people with symptomatic HIV-1 infection were screened for the presence of interferon (IFN) alpha and IFN alpha antibodies in their sera and the presence of the IFN-induced intracellular Mx-homologous protein in their peripheral blood leukocytes. Eleven people had measurable IFN alpha levels ranging from 1 to 40 IU/ml. None of the sera tested was positive for IFN alpha binding or IFN alpha neutralizing antibodies in the assays employed. Twenty-five of the 26 people had significant levels of the Mx-homologous protein in their peripheral mononuclear cells. The Mx concentrations varied from 0.3 to 6 U/ml in the people studied. IFN alpha-positive people had significantly higher levels of the Mx homolog than IFN alpha-negative people (P less than 0.03). Furthermore, the Mx homolog content in Walter-Reed class 2 people was significantly lower than in Walter-Reed class 5/6 people (P less than 0.01). Our results suggest that the IFN system is activated in more than 90% of the people with lymphadenopathy-associated syndrome, AIDS-related complex and AIDS. Since acid-labile IFN alpha can induce the Mx homolog in vitro endogenously produced IFN alpha seems likely to be responsible for the high Mx homolog levels detected.

Automated health surveillance

A successful health maintenance program requires physicians interested in and knowledgeable about the appropriate health surveillance actions to pursue. But even well-informed physicians need help transforming good intentions into effective health surveillance. An automated health surveillance system was designed and implemented to simplify documentation of health maintenance and remind physicians when actions are overdue. The system has increased insight into the complex process of health promotion and promises to be an important clinical, educational, and research tool.

Intralesional interferon-alpha therapy in advanced malignant melanoma

Fifty-one evaluable patients with histologically proven metastatic melanoma and at least one skin metastasis were treated intralesionally with interferon-alpha (IFN-alpha). Twenty-six of the patients were given highly purified natural IFN-alpha 6 Mio. IU three times per week. Twenty-five patients were given 10 Mio. IU three times per week of a recombinant IFN-alpha 2b (rIFN-alpha 2b). All patients were examined for systemic and local responses to this treatment. The systemic responses consisted of nine objective remissions, each of which lasted from 2 to 18 or more months. There were 24 complete or partial local responses. Forty-two of the 51 patients had at least two skin metastases so that IFN-injected and noninjected tumor sites could be compared. The difference between systemic and local efficacy was highly significant statistically (P = 0.0004). The results show that IFN-alpha has clinically observable antitumor activity in malignant melanoma.

Biochemical and ultrastructural characterization of the 1,4-dihydropyridine receptor from rabbit skeletal muscle. Evidence for a 52,000 Da subunit

The 1,4-dihydropyridine receptor purified from rabbit skeletal muscle contains four polypeptide components of 175,000 Da (nonreduced)/150,000 Da (reduced), 170,000, 52,000, and 32,000 Da (Leung, A. T., Imagawa, T., and Campbell, K. P. (1987) J. Biol. Chem. 262, 7943-7946). A monoclonal antibody specific to the 52,000-Da polypeptide component of the dihydropyridine receptor has been produced and used in immunoprecipitation and immunoblotting experiments to demonstrate that the 52,000-Da polypeptide is an integral subunit of the purified dihydropyridine receptor. Peptide mapping experiments with 32P-labeled dihydropyridine receptor have also demonstrated that the 52,000-Da polypeptide is distinct from and not a proteolytic fragment of the 170,000-Da subunit. Densitometric scanning of Coomassie Blue-stained sodium dodecyl sulfate-polyacrylamide gels of the purified dihydropyridine receptor has demonstrated that the 52,000-Da polypeptide exists in a 1:1 stoichiometric ratio with the 170,000-, 175,000/150,000-, and 32,000-Da subunits of the dihydropyridine receptor. Electron microscopy of the freeze-dried, rotary-shadowed dihydropyridine receptor has shown that the preparation contains a homogeneous population of 16 x 22-nm ovoidal particles large enough to contain all four polypeptides of the dihydropyridine receptor. The particles have two distinct components of similar size which may represent the location in the molecule of the two larger subunits.

[Low-dose alpha-interferon treatment of hairy cell leukemia]

Fifteen patients (36-71 years old) with histologically proven hairy-cell leukemia were treated with a low dose of IFN-alpha. The treatment consisted of 1 million I.U. given daily subcutaneously. After 1 month the dose was reduced in all patients 1 million I.U. thrice weekly. Four of the 15 patients have been splenectomized, with two patients receiving chemotherapy prior to the IFN treatment. All patients exhibited at least one cytopenia. The IFN treatment was well tolerated. Only two of the 15 patients experienced mild fever after the first injection, one patient had apathia and mild somnolence after 2 months of therapy. At present 15 patients can be evaluated: 6-18 months after start of therapy two patients showed a complete response with normalization of both peripheral blood and bone marrow, 10 patients experienced a partial response, while one patient showed a slight response with improvement of the thrombocyte count only. Two patients showed no improvement after 3 months of therapy; these patients are presently being treated with 5 million I.U. IFN-alpha thrice weekly. In spite of the low number of patients these data strongly indicate that IFN-alpha-2 is effective in hairy-cell leukemia at this low dose.

The lithium loading dose method in a clinical setting

The lithium loading dose method developed by Cooper and associates resulted in achievement of therapeutic concentrations in 29 of 30 psychiatric inpatients. Fewer lithium determinations were required than in 30 other inpatients treated with the traditional trial-and-error technique.

Cerebral angiitis and intracerebral hemorrhage associated with methamphetamine abuse. Case report

✓ A case of reversible cerebral angiitis and intracerebral hemorrhage is reported in a methamphetamine abuser. Characteristic radiographic changes were demonstrated by selective cerebral angiography and computerized tomography. These vascular abnormalities disappeared after 1 month of treatment with prednisone, during which time the patient denied further drug abuse.

Dowel pin positioning technique for fixed partial denture working casts

This simple, accurate technique of positioning dowel pins saves the time and effort of working with cumbersome bobby pins, paper clips, anesthetic needles, and sticky wax. No pins are pushed into the impression material that might cause distortion. The method (1) allows the dental laboratory technician to place the dowel pins free hand after the impression has been poured and (2) does away with many problems associated with prepositioning the dowel and stabilizing it with sticky wax before pouring the impression. With this method, there is nothing to vibrate loose, and there is excellent vision and access for teasing stone into all recesses of the impression with a spatula or brush. The heavy body and sticky characteristic of Mortite ensures that the bankers pins will not be dislodged during vibration of stone, and the dowel pins can be precisely located.

The development of a pediatric emergency transport system

This article discusses the role of the pediatric emergency transport system as an outreach modality of the pediatric intensive care unit. Most of the discussion focuses on the Denver model.

The use of synthetic luteinizing hormone-releasing hormone to induce ovulation

The therapeutic use of synthetic luteinizing hormone-releasing hormone (LH-RH) to induce ovulation has been explored. Three dosage schemes have been compared: a single dose of LH-RH, multiple doses of LH-RH, and LH-RH used in combination with human menopausal gonadotrophins (HMG). The results of these three schemes are presented and compared; the last regimen has proved most successful, with a high pregnancy rate, a low incidence of multiple pregnancy and no evidence of ovarian hyperstimulation.

Preparing students for physical restraint

While not encouraging the use of physical restrains on mental patients, the author presents a statement of its continuing use and underscores the need for preparing students for a group of traditional procedures that in some ways are increasingly out of step with our times and aesthetically offensive. Two specific clinical indications for restraint are discussed.

Ego-supportive care in open-heart surgery

Open heart surgery has been shown to have a rate of occurrence of postoperative psychopathological phenomena (9 percent-57 percent) many times greater than that of general surgery (1/1500). These phenomena result from an interplay of organic, environmental, psychological, and social factors which act on the integrative and coping capacity of the ego.

Treatment is accomplished through support of the ego by: 1) establishment of a relationship, 2) reassurance, 3) environmental support, 4) consultative relationships with staff, 5) ventilation of feelings, 6) medical measures in support of somatic function, and 7) anti-anxiety drugs. Such supportive measures are usually effective in bringing about a rapid remission of these psychopathological phenomena.