A computer-based system for urology and nephrology.

Modern technology offers new opportunities for the storage and manipulation of hospital information. A computer-based system for urology and nephrology has been designed and developed in this centre. It uses a program that allows the analysis of unrestricted non-codified texts and the operation by hospital staff who have had no more than minimal computer training. The potential of such a system is outlined and a comparison is made with other existing systems. Future prospects and potential lines of development are presented.

[Contribution of data processing to hospital archives. Cardiological experience]. / Apport de l'informatique aux archives hospitalières. Expérience cardiologique.

Access to essential information characterising the clinical condition of a patient and the course of that condition is an advance which physicians have long expected from data Processing to meet a certain number of needs: follow up of the patient, organisation of medical secretariat, file selection, help to clinical thought, etc. This typically documentary activity raises a problem of data representation classically solved by the use of clinical information classified beforehand: questionnaires or nomenclatures. This article reports on the use of a truly medical language: REMEDE, a the end of one year's operation in a cardiac department; the automatic processing of 173 coronary angiographies shows the interest, efficiency and flexibility of such a system of automated hospital archives.

[Computer treatment of medical reports: example of the "Remède" system (author's transl)]. / Traitement par ordinateur des comptes rendus médicaux: l'exemple du système "Remède".

Physicians are mostly interested in medical text processing if they can directly interrogate the exact content of each text and not only keys leading to a more or less rough retrieval. Remede is a prototype of a medical documentary language using current medical terms and few syntactic rules. It allows to make reports directly processeable by computers. The paper presents the system runninr for one year in the Service of Cardiology-La Salpêtrière Hospital Paris.

Exploitation of medical records.

The difficulties in fully exploiting correct and valid medical data held in a computer system are presented. The requirements for such a system to answer a physician's request are detailed and related to the clinical user, the computer interface and the technological interface, in particular that relating to adequate software. The technical aspects of hardware and software govern the progress of change and a degree of long-term compatibility is required, to ensure adequate exploitation of clinical data. The various economic aspects of such changes are considered including the importance of economy in supporting harmonious technical changes.

Creation and validation of medical data.

The problems of creating and validating medical data are discussed. These difficulties relate to the structuring of data and its definiton. The necessity for clarity of thought, coherence and logic in data collection is stressed. Difficulty in medical and lay staff training shows that this is a continuing problem. Data validation must be the major province of senior as well as junior doctors. It is an absoulte essential continuing process and without valid data most analyses are not worthwhile because of high error rates and/or too much missing data.

Medical record objectives in relation to clinical problems and user needs.

The difficulties met when clinical record systems are implemented using a computer have many causes. Some difficulties must be first solved by determining user requirements and then a technical solution found. The general considerations involved in setting up medical record objectives, which relate to medical activities, accounting procedures and technical solutions, are discussed. These factors are at the base of many system failures in the past decade.

[New data about oligoblastic leukemias. Apropos of an analysis of 120 cases]. / Données nouvelles sur les leucémies oligo-blastiques. A propos d'une analyse de 120 cas

We studied 120 aptients within the following condition: moderate bone marrow myeloblastosis (blast cells + promyelocytes less than or equal to 50 p. cent); quantitative and/or qualitative medullary insufficiency; preservation of maturation of the granulocytic line without a gap; WBC count less than 20 000/mm-3. Computer analysis pointed out the following results: 1. This group may be differenciated from the group of acute myeloblastic leukemias by: a) a predilection for subjects older than 60 in 73 p. cent of cases; b) male dominance in 70 p. cent of cases; c) a sharply defined improved prognosis with a median of survival of 15 months and with more than 30 p. cent of survivors for more than two years; d) death in 63 p. cent of teh cases is directly due to a complication of bone marrow insufficiency, and only in 14 p. cent of the cases is related to blastic invasion; e) a complete absence of favourable response to intensive chemotherapy. 2. There are five initial prognostic parameters which are of statistical significance: a) the hemoglobin level; b) the sedimentation rate; c) the platelet count, the level of bone marrow cellularity, and age. 3. Multidimensional analysis makes it appear that the whole population obeys a unidimensional phenomenon and depends on a common "biological axis" constituted by the five prognostic factors which are inter-related. 4. The disease nevertheless may be subdivided into three subgroups; a) High inflammatory hypoplastic forms are a very high risk group; b) The group of slowly invasive acute leukemias in young subjects is a bad or moderately poor risk group; c) The forms with a purely qualitative disorder of myelopoiesis with very low evolutive potential. These observations point to: a) The concept of OBL as an entity of a distinctive type including the preleukemic syndrome, the myelo-monocytic leukemias, and the smoldering leukemias; b) The concept of a unique and basic bone marrow disorder which embraces the OBL and the common acute myeloblastic leukemia.