Designing an outcome-oriented computer decision-support system for cardiovascular ICU--a preliminary report.

This paper describes the conceptual framework and preliminary results of an outcome-oriented decision-support system prototype for the cardiovascular intensive care unit (CVICU). The major characteristics of this design include: (1) its problem-based approach to solving clinical problems; (2) an integrated structure with the hospital information system in terms of its data, model and knowledge bases; (3) proposed alternative modes of interaction that include monitoring and critiquing; (4) and research modules that design, manage, and analyze outcome-based clinical studies. At present, an initial prototype has been implemented on a PC as a set of modules accessible from a main menu. The structural framework of the overall system is fairly well defined but only limited quantitative, statistical and expert knowledge has been captured. The second phase of the project involves porting the prototype to a Unix workstation environment, refining and adding models to the model base, expanding its knowledge bases, reasoning capability, and testing the prototype with actual clinical cases in a real-time fashion.

Computerized database for coronary bypass surgery.

A computer-assisted system has been developed to store, retrieve and analyze medical and surgical data on patients undergoing coronary bypass surgery. The analysis ranges from a simple summary tabulation to a more advanced prognostic evaluation of the risk of coronary bypass in an individual candidate for the operation. Data can be displayed on the terminal's screen or printed in a hard copy and used for clinical or administrative purposes. The system can be operated with no knowledge of computers or programming and requires only minimal typing skills.

Phonetic reduction of names.

The University of Alberta Hospitals, Edmonton, required an efficient phonetic reduction of names for accessing up to one-million patient records. The familiar Soundex methodology was enhanced, to provide some equating of beginning letters but somewhat greater discrimination beyond. The result was a potent 16-bit representation; an appropriate algorithm is provided.

A design for integration.

For nearly two decades, the development of computerized information systems has struggled for acceptable compromises between the unattainable "total system" and the unacceptable separate applications. Integration of related applications is essential if the computer is to be exploited fully, yet relative simplicity is necessary for systems to be implemented in a reasonable time-scale. This paper discusses a system being progressively developed from minimal beginnings but which, from the outset, had a highly flexible and fully integrated system basis. The system is for batch processing, but can accommodate on-line data input; it is similar in its approach to many transaction-processing real-time systems.

Ethanol metabolism in various racial groups.

Eskimos and Indians, according to casual reports, take longer to sober up after an alcoholic debauch than do whites. We studied this apparent difference by administering ethanol to appropriate subjects and determining blood alcohol concentrations at intervals. We found the concentrations fell significantly faster in whites. Neither previous experience of alcohol nor general diet appeared to account for this difference, leaving genetic factors as the indicated cause.