Computer-based Medical System Research Articles

321 The Darn Technique for Small (< 2 Cm Diameter) Midline Hernias

Abstract Aim Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias <1 cm. A darn is a tension-free repair where, in effect, a “mesh” is hand-woven across the defect in situ. Method Eligible patients undergoing this repair between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm at the widest point measured intra-operatively. Follow up was by telephone. Those who reported possible recurrence or other symptoms in the region of their repair were reviewed in person. Results 47 suture-darn repairs were undertaken. Fifteen operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair. Conclusions The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.

The darn technique for small (< 2cm diameter) midline hernias.

Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias smaller than 1cm. A suture repair implies edge-to-edge or overlapping fascial margins, which necessarily involves tension on the repair. A darn is a tension-free repair where, in effect, a "mesh" is hand-woven across the defect in situ. The darn repair is a modification of the darn techniques for inguinal hernia repair. Eligible patients undergoing this repair at the Royal Infirmary of Edinburgh between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2cm in the widest diameter of the hernia defect measured intra-operatively. Patients were followed up by telephone in 2019. Those who reported possible recurrence or other symptoms in the region of their hernia repair were reviewed in the outpatient clinic. 47 suture-darn repairs were undertaken over the 10-year period. Fifteen of the darn repair operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5cm cranial to the previous repair. The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2cm in maximum dimension.

The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya.

The authors of this paper describe the second phase of the implementation of the Mosoriot Medical Record System (MMRS) in a remote health care facility on the outskirts of Eldoret, Kenya, located in sub-Saharan Africa. We describe of the collaboration between Indiana University (IU) and the Moi University (MU), and the process that led to the development of the computer-based Mosoriot Medical Record System (MMRS) is provided. We then provide the conceptualization and initial implementation of this basic electronic medical record system. We also describe the different processes for assessing the MMRS' effects on health care, including time-motion studies and a strict implementation plan that is necessary for the successful implementation of the system. The MMRS project has many features that make it significant in the domain of CBPR systems. It may serve as a model for establishing similar, basic electronic record systems in the developed and developing world. In developing countries there are few (if any) projects that have attempted to implement such a system. This paper describes the planning, end-user education to new technologies, and time-motion studies necessary for the successful implementation of the MMRS. The system will be used to improve the quality of health data collection and subsequently patient care. It will also be used to link data from ongoing public health surveys and this can be used in public health research programs of the Moi University.

Automated classification of brain tumours from short echo time in vivo MRS data using Gaussian Decomposition and Bayesian Neural Networks

Neuro-oncologists must ultimately rely on their acquired knowledge and accumulated experience to undertake the sensitive task of brain tumour diagnosis. This task strongly depends on indirect, non-invasive measurements, which are the source of valuable data in the form of signals and images. Expert radiologists should benefit from their use as part of an at least partially automated computer-based medical decision support system. This paper focuses on Magnetic Resonance Spectroscopy signal analysis and illustrates a method that combines Gaussian Decomposition, dimensionality reduction by Moving Window with Variance Analysis and classification using adaptively regularized Artificial Neural Networks. The method yields encouraging results in the task of binary classification of human brain tumours, even for tumour types that have seldom been analyzed from this viewpoint.

Respiratory morbidity due to ammonia exposure among the employees of a urea manufacturing industry located in western part of India

Ammonia is produced in the fertilizer industry. The amount of ammonia inhaled by employees of a urea manufacturing industry is very high. It would be interesting to study whether such an amount has any impact on the employees working there for many years. This study explores the magnitude of respiratory morbidity among employees of a urea manufacturing industry and to establish its association with exposure to ammonia. Data was collected related to significant respiratory illnesses of all the employees over a period of 10 years using computer-based medical record system of the industry′s hospital. The results obtained from the data analysis showed that there is no cause and effect relationship between exposure to ammonia and respiratory morbidity. Thus it was advised to the medical authority at industry to go for mass treatment with anthelmintics and that all the employees should be screened for specific allergens and this information should be used while managing respiratory morbidity.

Robust discrimination of glioblastomas from metastatic brain tumors on the basis of single‐voxel 1H MRS

This article investigates methods for the accurate and robust differentiation of metastases from glioblastomas on the basis of single-voxel (1)H MRS information. Single-voxel (1)H MR spectra from a total of 109 patients (78 glioblastomas and 31 metastases) from the multicenter, international INTERPRET database, plus a test set of 40 patients (30 glioblastomas and 10 metastases) from three different centers in the Barcelona (Spain) metropolitan area, were analyzed using a robust method for feature (spectral frequency) selection coupled with a linear-in-the-parameters single-layer perceptron classifier. For the test set, a parsimonious selection of five frequencies yielded an area under the receiver operating characteristic curve of 0.86, and an area under the convex hull of the receiver operating characteristic curve of 0.91. Moreover, these accurate results for the discrimination between glioblastomas and metastases were obtained using a small number of frequencies that are amenable to metabolic interpretation, which should ease their use as diagnostic markers. Importantly, the prediction can be expressed as a simple formula based on a linear combination of these frequencies. As a result, new cases could be straightforwardly predicted by integrating this formula into a computer-based medical decision support system. This work also shows that the combination of spectra acquired at different TEs (short TE, 20-32 ms; long TE, 135-144 ms) is key to the successful discrimination between glioblastomas and metastases from single-voxel (1)H MRS.

A computer-based medical record system and personal digital assistants to assess and follow patients with respiratory tract infections visiting a rural Kenyan health centre

BackgroundClinical research can be facilitated by the use of informatics tools. We used an existing electronic medical record (EMR) system and personal data assistants (PDAs) to assess the characteristics and outcomes of patients with acute respiratory illnesses (ARIs) visiting a Kenyan rural health center.MethodsWe modified the existing EMR to include details on patients with ARIs. The EMR database was then used to identify patients with ARIs who were prospectively followed up by a research assistant who rode a bicycle to patients' homes and entered data into a PDA.ResultsA total of 2986 clinic visits for 2009 adult patients with respiratory infections were registered in the database between August 2002 and January 2005; 433 patients were selected for outcome assessments. These patients were followed up in the villages and assessed at 7 and 30 days later. Complete follow-up data were obtained on 381 patients (88%) and merged with data from the enrollment visit's electronic medical records and subsequent health center visits to assess duration of illness and complications. Symptoms improved at 7 and 30 days, but a substantial minority of patients had persistent symptoms. Eleven percent of patients sought additional care for their respiratory infection.ConclusionEMRs and PDA are useful tools for performing prospective clinical research in resource constrained developing countries.

Development and evaluation of an integrated pharmaceutical education system

There is increasing evidence that patient safety can be improved by the introduction of an integrated computer-based medical care system in hospital settings. In this paper, we describe an integrated pharmaceutical information system (IPIS) in which a patient’s profile including his/her medication records and prescriptions are collected from physician order entry systems and pharmaceutical systems along with the history of patient care in the hospital. Based on an individual patient’s profile the IPIS can provide pharmaceutical education information specifically to meet the patient’s needs. The IPIS has been developed and installed at Taipei Medical University Wanfang Hospital (TMUWFH) since July 2002. Evaluation of the system showed that it can help patients to effectively acquire drug information. This enables them to have a much better understanding of the pharmacological properties of the medicines they are taking, including adverse drug reactions and side-effects. In our opinion the system has the potential to improve both patient safety and treatment outcomes.

The Roles of Computer Self-Efficacy and Outcome Expectancy in Influencing the Computer End-User's Organizational Commitment

This study uses data collected by a survey of computer-based medical information system end-users in a large hospital in the southeastern United States. The theoretical model examined using this data links several antecedents to the end-users’ organizational commitment, mediated by computer self-efficacy and outcome expectancy. These antecedents are past computer experience of the end-user, computer staff support for the computer system, ease of system use, and the degree of system use (i.e., percentage of time the system is used by the end-user). The empirical results indicate that past computer experience and the degree of system use positively influence the end-user’s organizational commitment through both computer self-efficacy and outcome expectancy. These also show that computer staff support and ease of system use positively impact the end-user’s organizational commitment through outcome expectancy. From these results, conclusions and implications for practicing managers are discussed.

Computer Environment for Interventional Neuroradiology Procedures

This article addresses the design and development of a computer-based medical simulation system (NeuroCath) for training and patient-specific planning of interventional neuroradiology procedures. NeuroCath includes three main components: vascular extraction and modeling, instrument navigational simulations, and realistic human-computer interfaces. As the basis of the simulation, the vascular model is constructed from images obtained from different modalities such as X-ray, magnetic resonance imaging, and computerized tomography data. The model takes into account topological, geometrical, and physical properties of the patient’s vasculature. A finite element method–based physical model is constructed to simulate the behavior of interventional radiological instruments and devices within vessels during the interventional radiology processes. Realistic human-computer interfaces are provided in accordance with the actual interventional radiology environment. These interfaces include the video monitors displaying the simulated X-ray images and the haptic apparatus providing physicians with realistic tactile feedback encountered in the catheterization procedures.

A new concept toward computer-aided medical diagnosis--a prototype implementation addressing pulmonary diseases.

The original concept that led to the structuring of a computer-based medical decision support system (DSS) that is able to support a physician's diagnosis is introduced in this paper. The concept's implementation modeled a generic DSS, the core of which are an integrated knowledge/information base (KIB) along with the inference properties of a data evaluator. The KIB encapsulates the necessary medical knowledge and experience in the form of rules and constraints, preemptive tasks, and actual patients' clinical data. The data evaluator handles approved medical subjective and objective criteria for assessing the KIB's data. The data evaluator incorporates a medical standard data gathering and decision process, structured upon the principles of the clinical differential diagnosis methodology and has been integrated in the system by means of both algorithmic and artificial intelligence techniques. The novel model and the resulted computer-based package have been extensively tested under the Pulmonary Department, University Regional Hospital Patras, Patras, Greece.

The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya

Mosoriot Health Center is a rural primary care facility situated on the outskirts of Eldoret, Kenya in sub-Saharan Africa. The region is characterised by widespread poverty and a very poor technology infrastructure. Many houses do not have electricity, telephones or tap water. The health center does have electricity and tap water. In a collaborative project between Indiana University and the Moi University Faculty of Health Sciences (MUFHS), we designed a core electronic medical record system within the Mosoriot Health Center, with the intention of improving the quality of health data collection and, subsequently, patient care. The electronic medical record system will also be used to link clinical data from the health center to information collected from the public health surveys performed by medical students participating in the public health research programs of Moi University. This paper describes the processes involved in the development of the computer-based Mosoriot medical record system (MMRS) up to the point of implementation. It particularly focuses on the decisions and trade-offs that must be made when introducing this technology into an established health care system in a developing country.

End-user perceptions of the impacts of computer self-efficacy and outcome expectancy on job performance and patient care when using a medical information system

The research examines a theoretically sound model linking exogenous variables to dependent variables of interest regarding the use of a computer-based medical information system in a large non-profit hospital. Specifically, the theoretical model links management support, previous system experience, ease of system use and information quality to the medical staff's perceptions of the impact of the computer-based medical information system on the quality of patient care and their job performance, mediated by computer self-efficacy and outcome expectancy. The model was empirically tested using 384 responses to a questionnaire from the medical staff of a large non-profit hospital. The empirical technique employed structural equations with latent variables. The results showed that all the exogenous variables impacted indirectly on the quality of patient care mediated by computer self-efficacy and/or outcome expectancy. Based upon these results, managerial implications, conclusions and directions for future research are provided.

The accuracy of medication data in an outpatient electronic medical record.

To measure the accuracy of medication records stored in the electronic medical record (EMR) of an outpatient geriatric center. The authors analyzed accuracy from the perspective of a clinician using the data and the perspective of a computer-based medical decision-support system (MDSS). Prospective cohort study. The EMR at the geriatric center captures medication data both directly from clinicians and indirectly using encounter forms and data-entry clerks. During a scheduled office visit for medical care, the treating clinician determined whether the medication records for the patient were an accurate representation of the medications that the patient was actually taking. Using the available sources of information (the patient, the patient's vials, any caregivers, and the medical chart), the clinician determined whether the recorded data were correct, whether any data were missing, and the type and cause for each discrepancy found. At the geriatric center, 83% of medication records represented correctly the compound. dose, and schedule of a current medication; 91% represented correctly the compound. 0.37 current medications were missing per patient. The principal cause of errors was the patient (36.1% of errors), who misreported a medication at a previous visit or changed (stopped, started, or dose-adjusted) a medication between visits. The second most frequent cause of errors was failure to capture changes to medications made by outside clinicians, accounting for 25.9% of errors. Transcription errors were a relatively ucommon cause (8.2% of errors). When the accuracy of records from the center was analyzed from the perspective of a MDSS, 90% were correct for compound identity and 1.38 medications were missing or uncoded per patient. The cause of the additional errors of omission was a free-text "comments" field-which it is assumed would be unreadable by current MDSS applications-that was used by clinicians in 18% of records to record the identity of the medication. Medication records in an outpatient EMR may have significant levels of data error. Based on an analysis of correctable causes of error, the authors conclude that the most effective extension to the EMR studied would be to expand its scope to include all clinicians who can potentially change medications. Even with EMR extensions, however, ineradicable error due to patients and data entry will remain. Several implications of ineradicable error for MDSSs are discussed. The provision of a free-text "comments" field increased the accuracy of medication lists for clinician users at the expense of accuracy for a MDSS.

Computer-based medical translator system helps bridge language gap between physician, patient

Computer-based medical translator system helps bridge language gap between physician, patient

Computer-Based Medical Translator System Helps Bridge Language Gap Between Physician, Patient

THE PATIENT does not speak English. In fact, the physician is uncertain what language the patient does speak. Enter, the Multimedia Medical Language Translator. Because it is involved in medicine— and additionally because it was "born" and now is serving in the US military— this translation device naturally is known by its initials. In this case, they are MLT (for Medical Language Translator). <h3>Computer-Based System</h3> And what exactly is the MLT? Distributed as a CD-ROM disc (compact disc read-only memory), MLT is a computer-based system that is run on a laptop-size personal computer. In medical use, it allows the physician to determine which language the patient is familiar with, to ask questions and give directions or explanations in that language (via the recorded voice of a native speaker), and to have the patient's responses translated to English. The phrases available to the physician are designed to elicit brief responses (yes

A Structural Equation Model Of End-User Satisfaction With A Computer-Based Medical Information System

The research presents a theoretical model linking computer self-efficacy and outcome expectancy in a positive fashion to end-user perceptions of satisfaction with an information system. Further, the model proposes that the antecedents of management support, ease of system use, and end-user previous computer experience all have similar positive, meaningful impacts on both computer self-efficacy and outcome expectancy. The theoretical model is tested using 384 responses from hospital staff members of a large, nonprofit hospital in the southeastern United States. The empirical technique used is structural equations with latent variables. The results of the analysis verify the model and indicate that it provides a reasonable representation of end-user satisfaction with an information system. Specifically, the empirical results show that management support, ease of system use, and end-user previous computer experience all have significant, positive impacts on both computer self-efficacy and outcome expectancy. Computer self-efficacy and outcome expectancy are shown to have significant and positive influences on end-user system satisfaction. From these results, managerial implications and future directions for research are discussed.

Making the transition from information systems of the 1970s to medical information systems of the 1990s: The role of the Physician's Workstation

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these systems are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development of a Physician's Workstation which integrates information from multiple existing information systems and discuss how the workstation makes it possible to move from the departmental systems of the present to the computer-based medical record system of the future.

The development of personal computer-based medical consultation system for diagnosis of congenital malformation syndromes using MUMPS

This paper describes a medical consultation system for diagnosis of congenital malformation syndromes. The system consists of a personal computer, NEC PC-98XL (MS-DOS), using SP-MUMPS for the retrieval of knowledge data, and BASIC for the input/output of image data. This system displays pictorial knowledge and is designed so users can build up the knowledge base, as needed, by adding knowledge from medical literature and records of patients actually treated.

Computer Programs to Support Clinical Decision Making-Reply

In Reply.— We agree with Dr Norman that computer-based medical information systems have the potential to improve the quality of medical care. We have also demonstrated that a computer-based ambulatory medical record system (COSTAR) can be used to provide automatic monitoring and feedback that improve physician performance to quality assurance protocols. 1 It should be pointed out, however, that systems such as DXplain have two limitations in improving the quality of care. First, DXplain serves only to remind the physician of plausible diagnoses for a given set of signs and symptoms; the physician must still exercise clinical judgment as to the correct diagnosis. Second, a user of DXplain must enter the signs and symptoms of a given patient into the computer system as a separate and duplicate act, independent of entering the information into a medical record. We believe the full potential of such systems will not be realized until