Medical informatics in the intensive care unit: state of the art 1991

Intensive care medicine requires timely, accurate, and integrated patient records to provide the highest quality patient care. Computerized patient records offer the best method to achieve these needs. The expectations of society for medical progress through increased use of computers is growing. For optimal use of computers in the ICU there must be a harmonious collaboration between medical informaticists, physicians, nurses, therapists, and administrators. The future use of computers in ICU care will be evolutionary rather than revolutionary. We are on the frontier of some exciting times in the next decade as computers become commonplace in the clinical care process rather than an unusual event. This paper discusses the progress and challenges of computers in the ICU.

Using the HeadMaster with Macintosh, Apple II, and MS-DOS computers

When it was first introduced, the Prentke Romich HeadMaster allowed a person with good head control to access a Macintosh computer. The hardware and software combination allowed the user with a disability to type, to pull down menus, and to print, but only on the Macintosh. The HeadMaster itself provided an excellent replacement for the mouse. The keyboard software, however, could be difficult to use and would not work with some programs.

In the past 2 years, new hardware and software options have made the HeadMaster a much more valuable tool for the general computer user with a disability. This article discusses these options and their strengths and weaknesses. This information may assist the therapist prescribing alternative access equipment in making appropriate hardware and software choices.

A random allocation system with the minimization method for multi-institutional clinical trials

This paper describes the random allocation system used to perform precise and rapid treatment assignments in multi-institutional clinical trials. This system is based on sophisticated randomization procedures, according to Pocock and Simon's minimization method and Zelen's method for institution balancing. The major advantage of randomized treatment assignments with this system is to balance treatment numbers for each level of various prognostic factors over the entire trial and at the same time balance the allocation of treatments within an institution. Therefore, the randomized treatment assignments by this system can prevent degrading of the statistical power of a particular treatment factor. This system is designed to run on a small-sized notebook computer and therefore can be set up beside a telephone for registration, without occupying a large space. At present, this system is conveniently being used in two clinical trials.

The epidemiology of inflammatory bowel disease in children: a pilot project

A major study about the epidemiology of inflammatory bowel disease in children was planned. A pilot study of pre-morbid variables among 42 children with the disease was undertaken. Conducting a pilot study was an essential component of the research process, both in refining the data collection instrument and in maximizing the use of technology. Results of the pilot study are described and the way in which they were used to prepare a better major study are discussed.

The use of personal computers in hospital infection control

The storage, retrieval and analysis of hospital infection data is best performed by using computers. Many laboratory mainframe systems have infection control modules and there are some commercial programs for personal computers (PCs). An alternative is to use business and statistical PC software. Because of their large customer base these programs are reliable and easy to use yet extremely sophisticated and flexible, and they can be easily customized for use in infection control. Many combinations of software and hardware are available but the ones described here have been used successfully for several years at the Prince of Wales Hospital in Hong Kong.

Human factors. The missing element in computer technology

Technology is currently more difficult to learn and use than it should be. However, with more attention to human factors, technology will be easier to use in the future. For more information about human factors in computer systems, the reader is referred to two very comprehendible texts: Ben Shneiderman's (1987) Designing the User Interface: Strategies for Effective Human-Computer Interaction or Baecker and Buxton's (1987) Readings in Human-Computer Interaction: A Multidisciplinary Approach. In addition, there is an extensive body of literature on the general subject of human factors.

FDA regulation of computerized cytology devices

When talking about computerized cytology devices, a "different" aspect of quality assurance must be addressed. Any medical device intended for in vitro diagnostic use in the United States must be cleared or approved by the Food and Drug Administration (FDA): the May 28, 1976, Medical Device Amendments to the Federal Food, Drug and Cosmetic Act granted authority to the FDA to regulate medical devices. The FDA regulatory process as it relates to computerized cytology devices is discussed. This includes an explanation of the differences between the two types of documents used to clear a medical device: (1) premarket notification [510(k)] and (2) premarket approval (PMA) application. Devices intended for "research use only" are also discussed. A computerized cytology device of current interest, the "automated Pap smear reader," is used as an example to further discuss performance and software considerations.

Principles of interfacing computers to medical equipment

Table 3 shows a comparison of the interface standards considered. RS232 has the advantages of availability, flexibility and low cost. Variants on the standard overcome its limitations in data-rate and distance. The Centronics parallel standard is available on most personal computers and is particularly suitable for high data-rates over short distances. Other PC standards such as SCSI are special-purpose interfaces and therefore more difficult to use. GPIB is a robust and well-specified standard often used for the control of laboratory instruments.

So you think you need a computer?

Nurses undertaking research projects, a degree or diploma will find a computer an invaluable addition to their lives. However, the bewildering range of products and the complexity of design can be daunting for first time buyers. This article summarises those computers best suited to your needs.

Laboratory evaluation and use of the Engström metabolic computer in the clinical setting

Laboratory evaluation and use of the Engström metabolic computer (EMC) in a clinical setting are described. The accuracy of the EMC was tested using an inert gas dilution technique. Mean errors in oxygen consumption (VO2) and CO2 production compared with predicted values were less than 2% of predicted, and generally less than 1%, but with an SD of less than or equal to 5.1%. At an FIO2 of greater than or equal to 0.7, the errors in VO2 were erratic and generally greater than 15%. The apparatus has the facility to assume an RQ in the calculation of VO2 and the errors in measured VO2 were less than 1% up to an FIO2 of 0.8.

The medical device data language for the P1073 medical information bus standard

A new object-oriented Medical Device Data Language (MDDL) has been developed by the P1073 Medical Information Bus (MIB) Standard Committee, under the auspices of the Engineering in Biology and Medicine Society (EMBS) of the Institute of Electronic and Electrical Engineers (IEEE). The MDDL treats devices, host computers, persons and parameters as objects, and provides methods for describing and passing messages between objects. An elegant method of specifying parameter attributes incorporates the inheritance and encapsulation qualities common to object-oriented languages. Existing standards for device, parameter and attribute nomenclatures are used to represent MDDL components whenever possible. The MDDL provides a rich and extensible method for standardized host-device communications.

Cross-sectional transmission electron microscopy of silicon LSI circuits and Josephson junction devices

Cross-sectional transmission electron microscopy (XTEM) has been used to diagnose silicon LSI circuits and Josephson junction devices. For LSI circuits, some typical failure problems have been presented. For Nb-Si-Nb Josephson junction, microholes in the thin silicon layer have observed, and they are responsible for the short circuiting of these devices.

Vowel and consonant recognition of cochlear implant patients using formant-estimating speech processors

Vowel and consonant confusion matrices were collected in the hearing alone (H), lipreading alone (L), and hearing plus lipreading (HL) conditions for 28 patients participating in the clinical trial of the multiple-channel cochlear implant. All patients were profound-to-totally deaf and "hearing" refers to the presentation of auditory information via the implant. The average scores were 49% for vowels and 37% for consonants in the H condition and the HL scores were significantly higher than the L scores. Information transmission and multidimensional scaling analyses showed that different speech features were conveyed at different levels in the H and L conditions. In the HL condition, the visual and auditory signals provided independent information sources for each feature. For vowels, the auditory signal was the major source of duration information, while the visual signal was the major source of first and second formant frequency information. The implant provided information about the amplitude envelope of the speech and the estimated frequency of the main spectral peak between 800 and 4000 Hz, which was useful for consonant recognition. A speech processor that coded the estimated frequency and amplitude of an additional peak between 300 and 1000 Hz was shown to increase the vowel and consonant recognition in the H condition by improving the transmission of first formant and voicing information.