Critical reviews in medical informatics最新文献

Clinical databases are growing rapidly. The clinical database is heavily used for medical research in many settings. This paper discusses design features for medical databases that facilitate their use for research. The database management system should allow complex data structures, have a syntax-facilitating collection of longitudinal data, interface with major statistical software packages, allow an extensive data dictionary, conveniently merge files, facilitate archival documentation, have an associated data entry system that allows complex logical checking, and have coordinated mainframe and microcomputer software.

With the National Library of Medicine serving as the catalyst, the University of Maryland at Baltimore, Campus for the Professions, entered into a major initiative to integrate information management systems in support of the campus missions of education, research, and clinical care. Strategic planning initiated the integration process and continues in an iterative mode. In support of integration, changes were made in the campus organizational structure and in its technological infrastructure. Implementation involves transforming the Information Resources Management Division into an information utility on a phased and incremental basis. Collaboration with the Health Sciences Library is key to this transformation, as are numerous outreach activities.

This paper reviews the state of the art in processing medical language data. The area is divided into the topics: (1) morphologic analysis, (2) syntactic analysis, (3) semantic analysis, and (4) pragmatics. Additional attention is given to medical nomenclatures and classifications as the bases of (automated) indexing procedures which are required whenever medical information is formalized. These topics are completed by an evaluation of related data structures and methods used to organize language-based medical knowledge.

Radiology information systems (RIS) have developed over the past 20 years as a specialized area of medical informatics. Although an increasing number of radiology departments utilize such systems, the majority do not. Perhaps this is because no commercially available system has yet demonstrated its ability to provide cost-effective solutions to the diverse problems of different departments. This review begins with a brief history of RIS to point out some approaches that have proven successful and some that have not. Learning about the historical development of RIS also helps understand many of the features that are found in current systems. The bulk of the article is devoted to a detailed discussion of the functional modules found in RIS, including patient registration and data base management, examination scheduling, process control, film file management, diagnostic reporting, financial packages, and management statistics. These discussions emphasize the wide range of activities and problems found in different radiology departments and the wide range of techniques utilized by RIS. General issues of designing or selecting, installing, operating, and optimizing a RIS are discussed briefly. A final section points out areas for future development and expansion of RIS, giving special attention to the incorporation of digital image information into overall radiology systems.

Four main developments leading to computer modeling of clinical judgment are described in this paper. These include information processing psychology, clinical vs. statistical prediction studies, behavioral decision theory, and Bayesian decision analysis approaches. One clear catalyst in these developments has been the computer, which has been used as an information management tool rather than a data-processing device. Future directions of these efforts are delineated, and problems as well as prospects of computerizing clinical judgment are described.

Currently there is a rapid expansion of work among rehabilitation professionals in applying computer-assisted instructional technology to remediate cognitive deficits resulting from brain injury. The present article presents a framework for relating the various theoretical, empirical, and clinical challenges raised by the coalescence of two such recently emerging disciplines as computer-assisted instruction and cognitive rehabilitation. These challenges are presented from the perspectives of diverse disciplines, including cognitive science, rehabilitation professions, and computer science. A set of guiding principles are derived for evaluating the potential efficacy of currently existing programs and for directing future developmental work in software design, evaluation research, and service delivery.

The microcomputer is creating something of a revolution in many developing nations where historically there has been a lack of access to computer power at all levels of the health sector. For the first time, practitioners and researchers, often trained in computer techniques for developing countries, have access through microcomputers to data and information manipulation in their local workplace. While the history of microcomputers in such settings is short, this article presents early evidence from several countries which indicates the usefulness of various applications. The majority of the applications reported in the literature from clinical and research laboratories is made up of national data base systems and special studies of morbidity and mortality. Secondary applications, including assistance in biographical searches and word and graphics processing, are also reviewed in this article. A summary of the most utilized microcomputer hardware configurations completes the review.

There is great interest at present in incorporating image-management systems popularly referred to as picture archiving and communication systems (PACS) into imaging departments. This paper will describe various aspects of local area networks (LANs) for medical images and will give a definition of terms and classification of devices by describing a possible system which links various digital image sources through a high-speed data link and a common image format, allows for viewing and processing of all images produced within the complex, and eliminates the transport of films. The status of standards governing LAN and particularly PACS systems along with a proposed image exchange format will be given. Prototype systems, particularly a system for nuclear medicine images, will be presented, as well as the prospects for the immediate future in terms of installations started and commercial products available. A survey of the many questions that arise in the development of a PACS for medical images and also a survey of the presently suggested/adopted answers will be given.

The use of computers for the interpretation of the resting electrocardiogram (ECG) is critically reviewed. After a short description of the motives for the application of computers in this field, the processes that are sequentially executed in an ECG data processing system are critically analyzed, i.e., the acquisition and transmission of signals; the wave recognition and measurement phase; the parameter extraction, rhythm analysis, and classification phases; and, finally, the reporting of results as well as serial comparison. Emphasis is given on the evaluation and standardization of measurement and interpretation results of various ECG computer programs, based on the experience of the author as project leader of the International Cooperative Project "Common Standards for Quantitative Electrocardiography" (CSE). An extensive list of references is provided.

Drug information centers (DICs) have existed for more than 20 years in the U.S., with the number growing over this period to approximately 120 centers. Although future growth in the number of centers will be limited, the present activities will become more refined and productive. The present activities of drug information centers can be classified into three general areas: service, education, and research. The scope of the services provided often depends on location and affiliations. Likewise, these same factors may influence involvement in education and research activities. The effectiveness of centers is measured most often in terms of service productivity and perceived value by users. The methods and results of such evaluations are reviewed with discussion of the need to develop more definitive standards of practice.