"She," "He," Coexistence, and Bastardy.

Before proposing a solution for the sex bias problems inherent in the generic use of the pronoun he, Spencer (see record 1990-58427-001) reviews some efforts to solve the problem. The attempted solutions are evaluated as "not an improvement ... awkward... jarring ... disturbing" (p. 782), In one case, Spencer notes that coauthors of a book "slip up" twice. To avoid the difficulties and the accompanying unpleasant experiences, Spencer suggests the use of co: "The form is derived from an old Indo-European common form for both male and female English pronouns" (p. 783). While arguing for the "goodness of fit" (p. 783) of co. Spencer acknowledges that "there is currently one exception in our language to this meaning of co-coed, in which the form has been bastardized and debased from its source" (p. 783). A clinical psychologist is assuredly not an expert in psycholinguistics, but one could reasonably argue the following: The concept of bastardy with all of its connotative meaning, including debased, derives from patriarchal, patrilineal, male primary societies and history. In short, it is a sexist concept. Ours is a difficult language to use and avoid the expression of bias. Perhaps we ought to be gentler with those who are trying. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phase I pilot study of the effects of trovafloxacin (CP-99,219) on the pharmacokinetics of theophylline in healthy men

INTRODUCTION: We report on a cost-effective easy-access software developed for the functional integration of the clinical records and history of oncologic patients with the management of the Day Hospital of the Radiotherapy Department of the University Hospital A. Gemelli, in Rome. MATERIAL AND METHODS: The software was designed to archive the clinical records and history of oncologic patients and the relative chemotherapy, to manage the examination scheduling, to draw up nursing files with the planned therapy and to make statistical analyses of the department activity. Five forms are available: the patient form, recording patient data; the admission form, recording the type of therapy (e.g., chemotherapy, tests, medical examinations, etc.), the relative cost and chemotherapy protocol, detailing for instance the type of drug; the nursing file, detailing chemotherapy schedule and the dilution of each drug; the menu, to select and retrieve any record. The minimum configuration requires a 386 Intel CPU, 4 Mb RAM and 4 Mb free on the hard disk. The software is the File Maker Pro 2.1 for Windows which can interact with Apple Macintosh computers. RESULTS: Since October, 1995, we have saved the clinical records of 272 oncologic outpatients (2415 entries in all), with a mean of 201/month. This computer system permitted us to save and retrieve data for both clinical and didactic purposes and to plan our activity. CONCLUSIONS: One year after it was implemented and used in clinical practice, the system is a cost-effective and user-friendly tool for the management of the Radiochemotherapy Day Hospital of our Radiotherapy Department.     

The effects of emotional behaviour on components of the respiratory cycle

Clinical guidelines can be viewed as generic skeletal-plan schemata that represent clinical procedural knowledge and that are instantiated and refined dynamically by care providers over significant time periods. In the Asgaard project, we are investigating a set of tasks that support the application of clinical guidelines by a care provider other than the guideline's designer. We are focusing on the application of the guideline, recognition of care providers' intentions from their actions, and critique of care providers' actions given the guideline and the patient's medical record. We are developing methods that perform these tasks in multiple clinical domains, given an instance of a properly represented clinical guideline and an electronic medical patient record. In this paper, we point out the precise domain-specific knowledge required by each method, such as the explicit intentions of the guideline designer (represented as temporal patterns to be achieved or avoided). We present a machine-readable language, called Asbru, to represent and to annotate guidelines based on the task-specific ontology. We also introduce an automated tool for the acquisition of clinical guidelines based on the same ontology, developed using the PROTEGE-II framework.     

The physician executive and laboratory tests

Sera Central Hospital was founded in 1953 as Sera District Medical Center under the auspices of the neighboring five towns. At that time, the hospital had 3 doctors, 10 nurses, and 20 beds. But now in 1992, we have 12 doctors, 53 nurses and 110 beds. The present medical specialists are physician (4), surgeon (2), orthopedist (3), pediatrician (1), clinical laboratory physician (1), and dentist (1). Although the yearly income and expenditures were well balanced until 1989, thereafter the income began to decrease insidiously and expenditures began to increase year by year. In this symposium titled "Suggestions for Clinical Laboratory Medicine by Experienced Hospital Directors," I must refer to the issue of "Clinical Laboratory Medicine Administrator's Standpoint". Recently, the unaccustomed phrase "Physician Executive" is occasionally heard as the details of medical care become more numerous and more intricate and economic efficiency is strictly persued. From this perspective, the clinical laboratory physician is responsible for managing the laboratory department with well disciplined knowledge and technique. Therefore, training as "Physician Executive" has developed naturally within the field of Clinical Laboratory Medicine. So, I cannot help coming to the conclusion that the management of a hospital, as a matter of course, will be entrusted to a doctor including clinical laboratory physician who can do his best for the citizens, for the patients, and ultimately for ourselves.     

Allocation of surgical procedures to operating rooms

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented.     

Standardizations of clinical laboratory examinations in Japan

In this paper we introduce Japanese activities concerning laboratory examinations by illustrating three major categories. The first is the contribution of JCCLS to ISO/TC212 clinical laboratory testing and in vitro diagnostic test systems, with NCCLS and CEN TC140. The second is the establishment and promotion of JLAC Classification and Coding for Clinical Laboratory Tests by The Japan Society of Clinical Pathology. The third is a clinical data exchange format between healthcare facilities using MML/MERIT-9 standard, started as a Ministry research project.     

Implementing the Nursing Outcomes Classification in a clinical information system in a tertiary care setting

Implementing Nursing-Sensitive Outcomes Classification (NOC) is consistent with the goal of the Department of Nursing at this tertiary care center to include the Nursing Minimum Data Set in the electronic medical record (EMR). This article describes the implementation and evaluation of the NOC in selected patient care units where a clinical information system is used in conjunction with departmental patient care guidelines. In light of identified limitations, the NOC was determined to be useful and comprehensive as measured by the frequency of its use, the positive feedback by staff, and the minimal additions identified for the classification.     

Artificial intelligence or artificial psychologist? Conceptual issues in clinical microcomputer use.

The benefits and boundaries of microcomputer use within clinical psychology are discussed. Psychological software is conceptualized along a continuum of how completely the duties of the clinician are assumed. Record keeping, test scoring, interviewing, test interpretation, integrated report writing, and expert decision-making functions are reviewed for their utility and limitations in the present generation of microcomputer hardware and software. Advantages of personal computer use are most clear in those applications that save time for the psychologist. Other applications that are supposed to substitute for the psychologist in a decision-making, diagnostic, or therapeutic capacity may be more advanced in appearance than in actuality. Software simulation of the expert psychologist remains rudimentary; serious information processing and conceptual obstacles impede future development. Proposed guidelines would increase programmer and provider accountability for the consequences of computer use and would limit the domain of current psychological software to adjunctive capacities. An argument is made for "visible" software in which diagnostic logic and decision rules are explicitly displayed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

网络考试系统中算法的优化

目前网络在教学管理中的作用越来越重要,而在网络教学中,网络考试系统是重要的组成部分之一.如何提高网络考试系统中组卷速度及质量,核心是组卷算法.目前在各种自动组卷算法中,组卷质量较好的是遗传算法,但遗传算法在理论和应用方法上仍有许多亟待完善之处,文中提出了一种优化的改进的遗传算法.     

Psychological perspectives on political change.

Presents a reply by the authors to comments by Sullivan (see record 2007-14606-016) and Webster (see record 2007-14606-017). Both of these comments help to place our article on the red states versus blue states metaphor (Seyle & Newman, see record 2006-11202-001) into a broader context. In particular, both comments make valuable points about the potential for collaboration between psychology, political science, and political action. Sullivan made two points that address this collaboration directly. First, he pointed out that we failed to acknowledge a book by Morris Fiorina and his colleagues. Second, Sullivan disagreed with our claim that psychologists cannot change the system. Webster argued persuasively that we let the Electoral College off too easy. To support his indictment of the Electoral College, he drew on two compelling sources of evidence. First, because of changes in population distribution, electoral votes appear to play more of a role in the outcome of elections than they have at any time in the past. Second, the weighting system used to determine a state's number of electoral votes has the consequence of underrepresenting minority populations. However, we are less optimistic than Webster that this approach might "eliminate red- blue labeling" (p. 703). Thus, we repeat our original suggestion that the best short-term solution for improving political discourse is to encourage the use of the "purple America" approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of an on-line computer for psychophysical testing with the up-and-down method.

Employed an IBM 1620, Model 1 computer associated with a 1710 control system for psychophysical testing. The test operations are divided into (a) acceptance of test parameters, (b) test programing, (c) stimulus presentation, (d) record keeping, (e) rest scheduling, (f) calculation, and (g) test termination. The computer was found to be versatile and flexible. "In the case of the up-and-down method with complementary concurrent series a good estimate exists for the standard error of the estimate of P.50. The on-line computer can use intertrial or interblock times to keep estimates of P.50 and its standard error up to date and terminate testing when the desired level of precision of measurement" is reached. (19 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenges of a care information system reflecting holistic nursing care

In this article two recent developments in the German health care system are outlined. On one side, an increasing economic pressure and legal changes on the German health care system lead to growing computerization in German hospitals. On the other side, a shift from functional to holistic nursing is observed. The question is raised if within the paradigm of holistic nursing computer support is an adequate way to organize and design work. The newly developed German care information system, PIK (Pflegedienst im Krankenhaus--Nursing service in hospital), serves as an example for a program that is structured according to the nursing process. On the grounds of this exemplification it is argued that within the concept of "technology as an option" not only is the design of a program important but also its basic work organization and design. The authors come to the conclusion that computer support of holistic nursing is possible. However, it is shown that some aspects of nursing (for example, intuitive knowledge, which has been identified as an integral part of expert nursing) cannot be formalized and thus cannot be supported by computer systems.     

Concurrent validity of a rule-based system

The purpose of this project was to test the concurrent validity of the diagnoses recommended by a rule-based expert system. Concurrent validity was determined first by comparing the expert system's computerized diagnostic recommendations with that of a Clinical Nurse Specialist (CNS Assessor) who assessed the patient, and secondly by comparing the expert system's candidate diagnoses with those of a panel of 10 clinical nurse specialists (CNS Panel). The expert system rule base for generating diagnoses was programmed for some of the most common nursing diagnoses (Metzger & Hiltunen, 1987) including: alteration in comfort, acute pain; impaired physical mobility; sleep pattern disturbance; impairment of skin integrity and self-care deficit (bathing, feeding, toileting, and dressing). Activity intolerance and potential for infection were also programmed as diagnostic possibilities in the rule base.     

EON: a component-based approach to automation of protocol-directed therapy

Provision of automated support for planning protocol-directed therapy requires a computer program to take as input clinical data stored in an electronic patient-record system and to generate as output recommendations for therapeutic interventions and laboratory testing that are defined by applicable protocols. This paper presents a synthesis of research carried out at Stanford University to model the therapy-planning task and to demonstrate a component-based architecture for building protocol-based decision-support systems. We have constructed general-purpose software components that (1) interpret abstract protocol specifications to construct appropriate patient-specific treatment plans; (2) infer from time-stamped patient data higher-level, interval-based, abstract concepts; (3) perform time-oriented queries on a time-oriented patient database; and (4) allow acquisition and maintenance of protocol knowledge in a manner that facilitates efficient processing both by humans and by computers. We have implemented these components in a computer system known as EON. Each of the components has been developed, evaluated, and reported independently. We have evaluated the integration of the components as a composite architecture by implementing T-HELPER, a computer-based patient-record system that uses EON to offer advice regarding the management of patients who are following clinical trial protocols for AIDS or HIV infection. A test of the reuse of the software components in a different clinical domain demonstrated rapid development of a prototype application to support protocol-based care of patients who have breast cancer.     

On missing the point: A reply to Jaques et al.

Replies to comments by Jaques et al (see record 2005-09346-002) on the author's original article (see record 1980-33168-001). I daresay that virtually every author who must respond to criticism thinks that the critical reader missed the point. In this case, I must join the legion of misunderstood authors. The article is entitled, "Psychological Services in Rehabilitation Medicine: Clinical Aspects of Rehabilitation Psychology." I attempted a very brief overview of the roles and functions of rehabilitation psychologists, not rehabilitation counselors. Somebody missed the point! Further, as I stated both in the abstract and in the summary, I was focusing on traditional clinical and counseling applications. I am a psychologist, and I wrote this particular article for an audience of professional psychologists to try to introduce some of the issues involved in psychological practice in this particular setting. I think that I accomplished that rather straightforward goal, and I hope that some of the readers will now consider rehabilitation psychology as an area of specialization that does utilize the skills learned in traditional clinical and counseling psychology doctoral programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evoked cortical responses and patterned stimuli.

Describes several studies to illustrate the type of work done in dealing with responses evoked by patterned visual stimuli. In each study Ss sat in a "darkened electrically shielded room and viewed patterned stimuli." Visual patterns were illuminated to medium brightness by a strobe lamp approximately 1/sec. "Each time the strobe lamp was fired the computer (a CAT) was triggered, storing a record of the brain's activity occurring during a given period of time following the onset of stimulation." Resultant cortical responses typify those found in adults with normal vision. It is considered "imperative that longitudinal studies be carried out, both to provide evoked-response correlates of maturational processes related to visual perception and to provide normative data for the possible clinical application of this technique." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Automatic text analysis of medical records

Clinical narratives stored in a computerized medical record (PROMED) were automatically analyzed by a computer program (LOGSTORY). No medical knowledge was built into LOGSTORY prior to the analysis. The clinical sample consisted of 5,041 patients and 14,323 diagnoses. The present study concerns 375 diagnoses from general practice and 160 diagnoses from occupational medicine. LOGSTORY reproduced the symptoms, signs, laboratory investigations, anatomy and etiology of diabetes mellitus, obesity and lung diseases. Similarities and differences between the clinical states were automatically recognized and quantified. The extraction of knowledge from the clinical narratives required a problem-oriented medical record. PROMED-LOGSTORY may be useful for self-evaluation, peer review, quality control and research.     

基于网络的企业电子商务运作系统初探

主要介绍宝信公司在以网络/计算机为核心的信息化时代,开发具有冶金特色的以网络为中心的电子商务运作系统,提出了企业电子商务运作系统的战略、方法以及电子商务运作系统的一些技术标准,提供了钢铁企业以网络为中心实现管理创新、技术创新的变革平台的解决方案。     

Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus

BACKGROUND: We attempted to determine the frequency and clinical relevance of antinuclear antibody (ANA) testing and positive ANA test results in patients with cutaneous T-cell lymphoma (CTCL). METHODS: A retrospective chart and computer record review was conducted to determine the frequency of ANA testing in CTCL patients and the rate of seropositivity. Patients with a positive ANA were further examined to define possible explanations of the positive test. RESULTS: Of 381 patients with CTCL, 66 (17%) had ANA tests; 8 of these (12.1%) were found to have an ANA titer greater than or equal to 1:40. Of patients with a positive ANA test, one was found to have chronic cutaneous lupus erythematosus histologically and clinically mimicking CTCL. Others were found to have a comorbid connective tissue disorder, some had apparent drug-induced antinuclear antibodies, and some had no identifiable reason for a positive ANA test. CONCLUSION: ANA seropositivity does not appear to be increased in CTCL patients, and the ANA test remains a useful screening tool for differentiating between CTCL and connective tissue disorders.     

"Telestroke" : the application of telemedicine for stroke

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.