Medical informatics = Medecine et informatique最新文献

Hospital emergency units are submitted to a continuous intensive and polyvalent practice of medicine. In addition to the few experienced physicians, the medical staff is often made up of young and unskilled students and residents. The ability to reach at any time a wide and flexible knowledge is of the utmost importance to improve the quality of care given to patients and to perfect bedside teaching. The purpose of this work was to present a computerized system, a kind of shell, using, in combination, artificial intelligence and hypertext/hypermedia tools. A modular architecture is presented integrating two entities: an illustrated encyclopedic hypertext network and several expert modules based on production rules concerning well-limited fields of medicine (basic clinical problem-solving, metabolic and acid-base disorders). An interface using the World Wide Web (WWW) will soon be proposed.

An off-line network system of health and welfare for elderly people using optical memory cards has been established in Isehara city (Japan) since 1991. 2775 citizens have the cards and 24 offices have the terminals. It covers almost one third of people aged over 65 in Isehara city and almost all of the offices concerned with their health and welfare. About a half of holders use optical memory cards every time they visit these offices. The optical memory card holds data including basic data for health and welfare, health check data over 5 years, medical images with scripts and history of welfare services. All the data are used for medical care, health consultation and management of health and welfare services. A card can hold health and welfare data for a lifetime, and it is easy to expand the system. It has been a good experience for us, because the optical memory card system needs co-operation among citizens, medical association and local government, and the experience will help us to expand the system in the future.

Pulse wave velocity (PWV) is related to arterial wall elasticity, which in part is regulated by sympathetic nervous system activity. The present study investigated the potential for the simultaneous use of PWV and heart rate variability using noninvasive recordings in order to provide a quantitative evaluation of the sympathovagal interaction modulating cardiovascular functions. We obtained 10 indices from the PWV and heart rate (HR) time series of 92 healthy subjects (control group) and compared the results with those of 135 patients with diabetes mellitus or vertigo. Five indices were obtained from a PWV series, that is, the mean, the coefficient of variation (CV) during supine rest, those immediately after standing up unaided, and the change of the mean PWVs before and after standing. The rest of the indices were also obtained from the instantaneous HR series. Statistical analyses revealed significant differences in the change of the mean PWVs after standing, the mean and CV of resting HR, the mean and CV of standing HR, and the change of mean HRs in patients with diabetic neuropathy as compared with healthy subjects (p < 0.01). The change of the mean PWV immediately after standing allows for the assessment of peripheral vascular sympathetic functions, provided one uses HR variability indices simultaneously.

The Symbolic Atlas of the brain is a novel software tool which enables the user to store and access non-visual information associated with the brain anatomy. The atlas is potentially capable of storing any information about neuroanatomical objects. The user can construct a number of atlases, each containing a different kind of information related to functionality, pathology, symptoms and other facts. The Prolog database that underpins the storage of knowledge frames provides scope for nearly unconstrained usage and manipulation of the stored data, including reasoning with and about data and complex querying. The access to the stored information is provided in an intuitive way, through a simple 'click' on an anatomical structure either in a two- or three-dimensional atlas, or on an outline of a structure superimposed on a real image slice. A pilot educational and clinical use of the atlas indicates its great potential, especially in the are of education.

A search system for the textbook of urology has been developed and evaluated. The textbook is written in Japanese with 1.4 megabytes of text and has about 1000 pictures. The contents of the textbook can be seen with English or Japanese medical terms. The system contains a dictionary of Japanese medical terms. The dictionary has a network structure based on Japanese ideographic characters. Such a search system is useful for physicians because of its speed and the widely spread medical knowledge of many authors of the textbook.

The paper reviews the contribution of information technology (IT) to diabetes care. An appraisal of this topic with respect to insulin-dependent (type 1) diabetic patients is carried out in view of the landmark findings of the Diabetes Control and Complications Trial (DCCT) which has demonstrated that maintaining tight blood glucose control can delay the onset and slow the progression of the later life complications of diabetes. The review starts with the clinical background and the main features of the control schema in which diabetic patients receive insulin therapy. An overview is then provided of recent IT initiatives in diabetes care, and the application of IT techniques to assist in the diagnosis and characterization of patients with diabetes mellitus is considered. The role of IT approaches for short-term glycaemic control is discussed and the utilization of computers for collecting, viewing and interpreting home monitoring blood glucose data is reviewed; both quantitative and qualitative techniques being considered. In the second paper the role of decision support tools for planning insulin therapy using clinical algorithms, hand-held devices, knowledge-based approaches, telemedicine techniques and interactive simulations is reviewed, and the validation and clinical evaluation of these tools is discussed. The likely impact of the routine clinical application of implantable/non-invasive blood glucose monitoring devices is also considered. Finally, the application of computers as teaching tools is reviewed and the ways in which such educational approaches might be applied for disseminating the benefits of the DCCT trial more widely are discussed.

This paper concludes a review of the contribution of information technology to diabetes care. The role of decision support tools for planning insulin therapy using various clinical algorithms, knowledge-based approaches and interactive simulations is discussed, and certain telemedicine approaches to therapy are considered. The validation and clinical evaluation of these tools is reviewed, as is the likely impact of the routine clinical application of implantable/non-invasive blood glucose monitoring devices. Finally, the application of computers as teaching tools is considered, and ways in which such educational approaches might be applied for disseminating the benefits of the Diabetes Control and Complications Trial more widely are discussed.

Reported here is a personal computer-based registration program of medical consultations in general practice that has been implemented in six communities ('primary health care districts'; total population 112623) in the county of Jönköping, southern Sweden. The program enabled decentralized monitoring and management of the primary health care organization in the communities. The objective of the present paper is to give, from one year's experience of about 137000 recorded visits, a broad overview of the program structure, briefly considering the questions associated with routine registration of medical consultations, to discuss how the system is used for decision and steering support as well as to summarize its overall performance, results and costs in relation to the general utility of accurate information on health service delivery and consumption in the population.

A prototype Expert System, able to assist gynaecologists in diagnosing and classifying cancer of the neck of the womb is designed and implemented. The system is implemented using NeuroShell, an Expert System Building Tool, based on Neural Networks. A neural model, which predicts the possible outcomes of colposcopy and biopsy, based on Pap test results, as well as on information from the patient record, is developed. Such a system is a very useful tool for physicians both as a training tool as well as a forecasting system, while it also has the capability of incorporating new knowledge, provided by each new case it is presented with. Furthermore, a number of different implementations are provided in order to evaluate a comparative study of their performance.

Arden Syntax for Medical Logic Modules is a standard specification for creation and sharing of knowledge bases. The standard specification focuses on knowledge that can be represented as a set of independent Medical Logic Modules (MLMs) such as rules, formulas and protocols. The basic functions of an MLM are to retrieve patient data, manipulate the data, come to some decision, and possibly perform an action. All connections to the world outside an MLM are collected in the data-slot of the MLM. The institution specific parts of these connections are inside the notation of curly brackets ([]) to facilitate sharing of MLM between institutions. This paper focuses on some of the problems that occur in relation to Arden Syntax and connections to a patient database such as database queries. Problems related to possibilities of moving one or several module(s) are also discussed, with emphasis on database connections. As an example, an MLM based Decision Support System (DSS) developed at Linköping University is described.