Medical computing over the World Wide Web: use of forms and CGI scripts for constructing medical algorithm Web pages.

The development of the World Wide Web has led to an explosion of educational and clinical resources available via the Internet with minimal effort or special training. However, most of these Web pages contain only static information; few offer dynamic information shaped around clinical or laboratory test findings. In this report we show how this goal can be achieved with the design and construction of Medical Algorithm Web Pages (MAWP). Specifically, using Internet technologies known as forms and CGI scripts we demonstrate how one can implement medical algorithms remotely over the Internet's World Wide Web. To use a MAWP, one enters the URL for the site and then enters information according to the instructions presented there, usually by entering numbers and other information into fields displayed on screen. When all the data is entered, the user clicks on the SUBMIT icon, resulting in a new Web page being constructed "on-the-fly" containing diagnostic calculations and other information pertinent to the patient's clinical management. Four sample applications are presented in detail to illustrate the concept of a Medical Algorithm Web page: Computation of the alveolar-arterial oxygen tension difference using the alveolar gas equation; Computation of renal creatinine clearance; drug infusion calculation (micrograms/kilogram/minute); Computation of the renal failure index.

Controlled trial of Giardia lamblia: control strategies in day care centers.

BACKGROUND: Strategies for control of Giardia lamblia in day care differ in numbers of children treated and in costs to parents and day care operators. The effectiveness of these strategies has not been systematically evaluated. METHODS: We conducted a prospective randomized controlled trial comparing three strategies for control of Giardia in infant-toddler day care centers: Group 1, exclusion and treatment of symptomatic and asymptomatic infected children; Group 2, exclusion and treatment of symptomatic infection only; Group 3, exclusion and treatment of symptomatic infection, treatment of asymptomatic infection in the center. The study included 31 day care centers with 4180 child-months of observation. Giardia prevalence was determined before intervention and 1, 2, 4, and 6 months later; new infants and toddlers were tested on admission. RESULTS: Initial Giardia prevalences were 18% to 22% in the three groups. Giardia was identified in 10.5% of 676 new infants and toddlers entering study day care centers during the 6-month follow-up. Giardia prevalences by intervention group were 8%, 12%, and 7% at 1 month, and 7%, 8%, and 8% at 6 months. CONCLUSIONS: The stricter intervention resulted in greater cost in terms of child day care and parents' work days lost, but did not result in significantly better control of Giardia infections in this day care environment.

Diarrheal illness among infants and toddlers in day care centers: effects of active surveillance and staff training without subsequent monitoring.

From October 1981 to September 1984, the authors conducted a three-year longitudinal study of diarrhea among infants and toddlers attending day care centers in Maricopa County, Arizona. In the third year of study, they evaluated the effects on diarrhea rates of staff training without external monitoring and of active surveillance conducted throughout the study. From 21 study day care centers, they randomly selected 10 ("intervention day care centers") to receive staff training in procedures to reduce transmission of infectious diarrhea. Continuing active surveillance in the 10 intervention and 11 control day care centers found no difference between diarrhea rates in intervention day care centers in the pre- and posttraining years and no difference between diarrhea rates in the two groups of centers either before or after the training intervention. Biweekly family-based surveys during the two months after training also demonstrated no difference between infant-toddler diarrhea rates in intervention and control day care centers. These surveys found the 21 study day care centers to have significantly higher diarrhea rates than did day care homes or households not using day care, but significantly lower rates than day care centers not included in the active surveillance. Continuous surveillance without training was associated with a significant decrease in diarrheal illness during the course of longitudinal study. One-time staff training without subsequent monitoring did not result in additional decreases and did not lower day care center diarrhea rates to the levels observed in day care homes and households not using day care.