Medical informatics = Medecine et informatique最新文献

There is a fundamental need for accurate, timely and relevant information for health service planning; the increasing focus on a primary care led NHS has made the collection of information from general practitioners a priority. A collaborative project between general practitioners and public health physicians in Wales has developed methodologies for the extraction and analysis of routinely collected data from general practices across Wales. Four commonly used computer systems have been investigated. This paper outlines the methodologies used and describes the problems encountered and their solutions.

Requirements exist clinically for quantitative analysis of facial swelling. A quick and non-invasive measurement of facial volume is desirable. The acquisition of three-dimensional images, corresponding to spatial models of patients' facial surfaces, has been facilitated using a Spatial Vision System (SVS) developed by Thorn EMI Central Research Laboratories (UK). The SVS acquires four video images (two step pairs) and constructs a three-dimensional surface representation using stereo matching of spatial features acquired using 'speckled' illumination. Pre- and post-operative binary volumetric images are then spatially aligned using surface matching algorithms. Accuracy of registration is optimized using Match Volume Excavation. Segmentation of post-operative swelling is achieved by volume differencing in combination with morphological erosion. Volumetric quantification is achieved using a method of three-dimensional region growing, giving the number of connected voxels in the image volume from a user selected seed point. Accuracy of image acquisition has ben quantified by imaging a range of hemispherical phantoms of known volumes. The mean error in repeated measurement of volume was found to be within 3.5%. The perception of temporal changes in facial swelling is highly subjective. Further work is being undertaken to develop and Enhanced Reality visualization tool in which graphical swelling annotations are combined with real-time patient images.

Recent advances in telecommunication technology have permitted the implementation of tools for Computer Supported Cooperative Work (CSCW) based on real time transmission of different information types between two or more stations. The present paper describes methods for the design of both synchronous and asynchronous CSCW procedures suitable for the medical application area and specifically for the purpose of medical consultation and more generally, remote diagnosis support. The experimental implementation of such a CSCW system built upon a Personal Computer/Windows platform is detailed as an example of such a low-cost system suitable for adoption in a wide-range of medical teleconsultation applications.

Simulation is characterized by strong learning potential, providing the basis for a new category of systems, the simulation-based learning systems. To strengthen the learning potential of these systems, models are needed not only of the actual system being imitated, but also of the operational expertise required to carry out manipulations of the simulated system, inherently linked to learning. In this paper, an architecture is reported aimed at supporting the organization of multimodal simulation resources to induce skills learning. This architecture is based on distinct layers, allowing independent representation of learning and simulation components. Its applicability has been demonstrated by means of a paradigm, including simulation of X-ray imaging procedure, as well as authoring of learning scenarios pertaining to such procedures.

Patient tests in hospital environments involve a significant percentage of hospital resources. The patient must occupy some of his/her time, personnel and equipment have to be allocated, co-operation between hospital laboratories and departments must be ensured, tests should be performed within rigid time limits and the results should be ready before due times imposed by doctors, nurses or other medical personnel. From the patient's point of view there must be almost no distress, while hospital management wants as much equipment utilization as possible. In the present paper we propose a system for efficient scheduling of patient tests, while obeying all temporal and managerial limitations as well as observing all medical procedures. This system, which we call HOSTESS, uses a new approach, the dynamic distributed scheduling for managing the patient test requests in large hospitals, with many laboratories that perform a multitude of tests. The system is designed as a modular expandable application, in order to perform efficiently under heavy loads. Doctors, nurses, laboratory technicians and other personnel enter their requests and HOSTESS creates consistent schedules for every equipment needed in the required tests.

Packy & Marlon, an interactive video game designed to improve self-care among children and adolescents with diabetes, was evaluated in a six-month randomized controlled trial. In the game, players take the role of animated characters who manage their diabetes by monitoring blood glucose, taking insulin injections, and choosing foods, while setting out to save a diabetes summer camp from marauding rats and mice who have stolen the diabetes supplies. Study participants were patients aged 8 to 16 from two separate diabetes clinics. Each participant received a Super Nintendo video game system at an initial clinic visit and was randomly assigned to receive either Packy & Marlon (treatment group, N = 31) or an entertainment video game containing no diabetes-related content (control group, N = 28). Participants were interviewed and a parent filled out a questionnaire at baseline, three months, and six months. The findings in this study indicate that well-designed, educational video games can be effective interventions. There was improvement in the treatment group relative to the control group in terms of diabetes-related self-efficacy (p = 0.07), communication with parents about diabetes (p = 0.025), and self-care behaviours (p = 0.003), and a decrease in unscheduled urgent doctor visits (p = 0.08). There were no significant differences between the groups in knowledge about diabetes or in glycated haemoglobin (HbA1c) levels. Since participants in the study were in general well-controlled patients who were receiving excellent medical care, future research is contemplated involving youngsters who are not under good glycaemic control.

Of the physiological subsystems involved in glucose metabolism, all have now been modelled with continuous-time compartmental models except the gut. To address this omission, three progressively more complex models of the conversion of food by the gut into the rate of appearance of glucose in plasma were identified, using two different sample input foods which were tested on a type 1 diabetic patient. The minimal model that achieved a reasonable match with measured values had one compartment. Two model parameters specific to the food modelled were glycaemic value (grams of glucose per gram of food), and the fractional turnover rate, corresponding to a combination of the gastric emptying time constant and other rate limiting metabolic processes. Parameters specific to the individual were compartmental volumes, specifically for the glucose distribution space. It was only possible to achieve an adequate model prediction with a one compartmental model by explicitly incorporating transport delay into the model. By combining this model with models of insulin production and glucose disposal, the glycaemic response of an identified food may also be predicted for patients with type 2 diabetes mellitus. This predicted responses, along with the predicted response for bread or glucose, enables calculation of the Glycaemic Index for the food from its glycaemic value, time constant, and transport delay, along with the insulin production and glucose disposal model parameters for the individual patient. These three minimal model parameters therefore embody all the information of the Glycaemic Index, and more, allowing a continuous prediction of the effect of eating a given food over time. Together with a means of combining the parameters of individual foods into a combination set for a composite meal, this minimal model could enable diabetic patients to predict the time course of glycaemic action for a meal and to adjust treatment accordingly.