User metaphors for health care professional workstations.

The problem encountered by health care professionals and software developers has been a lack of demonstrable visions (prototypes) for Computer-based Patient Record (CPR) and Clinical Information System (CIS) applications. This deficiency has resulted in a quest for and consideration of models, metaphors, and mind maps for the Healthcare Professional Workstation (HPW)--the access mechanism for the CPR and the CIS. The familiar physician desktop and traditional paper-based metaphors are not adequate for all aspects of clinical information processes. In the clinical care environment, the flowsheet is a transporting metaphor because many different applications and tasks can be 'transported' into the flowsheet. 3D Rooms, Gopher and Genes are familiar and transporting metaphors to be exploited for HPWs. Using transporting metaphors for HPW software emphasizes commonality and de-emphasizes diversity. Each model and metaphor has an associated mind map. Only the mental model, mental metaphor or mind map for HPW software is important. Metaphors communicate real-world analogies, and communication is at the core of what defines usability. A mind map facilitates communication by building a model in the user's mind. The barriers to HPWs are not technical; they are related to economics, ownership of patient information, liability and information standards.

The Physician Data Query (PDQ) cancer information system.

PDQ is an online database that provides information about the prognosis and treatment of all major types of cancer. It represents a major effort by the NCI to communicate advances in cancer treatment using computer technology, and serves as a major component of the Institute's program to reduce cancer mortality nationwide. PDQ utilizes a modern large-scale computer to provide processing speed, a general purpose database management system to provide retrieval and display functions, and commercial telecommunication networks to provide online access to up-to-date information on cancer treatment. A series of user-friendly menus allow searching, browsing, and displaying without having to learn a specialized search language. PDQ is accessible through the National Library of Medicine's computer system via a computer terminal or personal computer and is available to the medical community at over 2000 medical libraries and centers and through individual access codes. PDQ is also available as an online database under a special license agreement with NCI through two medical information systems produced by commercial database vendors: BRS/Saunders' COLLEAGUE and Mead Data Central's MEDIS.

Moderate dose methotrexate, vincristine, asparaginase, and dexamethasone for treatment of adult acute lymphocytic leukemia.

Thirty-eight adults with acute lymphocytic leukemia (ALL), 24 previously untreated and 14 previously treated, were entered into a study in which sequential, moderate-dose methotrexate and asparaginase were added to vincristine and dexamethasone (MOAD) for remission induction therapy. Eighteen of 24 previously untreated patients (75%) and 11 of 4 previously treated patients (79%) achieved a complete remission (CR). Once in CR, patients were given remission continuation therapy, which included intravenous high-dose methotrexate that was used without prophylactic cranial irradiation and without intrathecal methotrexate because of its potential activity alone as prophylaxis against central nervous system (CNS) leukemia. The median duration of CR was 11.1 mo (range 0.7-55.9+) and median survival 17.0 mo (range 0.4-55.9+) for the 24 previously untreated patients. The median duration of CR was 7.5 mo (range 1.9-55.3+) for the 14 previously treated patients. Only 2 of 24 previously untreated patients (8.3%) developed CNS leukemia at 3.3 and 42.7 mo from start of MOAD. None of the previously treated patients developed CNS leukemia as the initial site of relapse. MOAD is useful as induction therapy for previously untreated adults with ALL, as well as for previously treated patients, and is superior to other regimens that we have used for the treatment of adult ALL.

Current concepts in the management of small cell carcinoma of the lung.

Small cell carcinoma of the lung should be viewed as a widely disseminated disease in all patients. Therefore, systemic treatment with intensive combination chemotherapy should now be considered as the primary and initial treatment modality. The role of radiation therapy for local or involved-field needs to be re-examined to determine if such localized therapy following intensive combination chemotherapy offers any benefits in response rate or survival duration. The role of immunotherapy is not established, and further controlled studies are necessary to define such a role, if any does exist. Prophylactic whole brain irradiation may be useful to avoid neurologic complications, however, it does not appear to improve response rate or survival duration. A randomized study needs to be done to see whether prophylactic whole brain irradiation following complete remission alters the occurrence rate of brain metastases. Response rates up to 100% and disease free survivals greater than one year have been reported. Therefore, a realistic potential for cure exists for some patients with this particular type of lung cancer.

Cost analysis of leukemia treatment: a problem-oriented approach.

A Problem Oriented List of Charges (POLC) can be used to obtain information about the cost of treatment of a single medical problem in patients with several coexisting medical problems. To prepare a POLC, each charge item is associated with one of the patient's problems. POLCs were compiled from the Problem Oriented Medical Records (POMRs) of patients with Acute Non-Lymphocytic Leukemic (ANLL). From the POLCs at was apparent that the treatment of granulocytopenia and thrombocytopenia and their sequelae were the most costly problems associated with ANLL. The projected cost of treatment for all problems for 11.5 months (the median survival of patients with ANLL treated with a single chemotherapeutic agent at this institution) was $40,022. By extending the POMR into the area of Medical reimbursement with a POLC, charge incurring activities can be coupled to the results of patient care. Only by directly coupling, in the original medical record, the reasons for, the charges for, and the results of medical care, can cost data be appropriately interpreted.