Twenty-five-year experience with ventricular septal defect in infants and children.

Three hundred eighty-one children with isolated VSD were catheterized from 1960 through 1985, 228 of whom were first catheterized in the first year of life. Defect size was defined by the right-to-left ventricular systolic pressure ratio. Patients with small VSD had a good outcome, with no pulmonary vascular disease. Seventy-five percent of patients with moderate VSDs did not require surgery, and 58% had normal pulmonary artery pressures documented on a second catheterization. Of those patients with large VSDs who underwent serial catheterizations in the first year of life before surgery, 62% had partial closure, and pulmonary vascular resistance rose in 21%. None developed pulmonary vascular disease after surgery. Fewer large-restrictive than nonrestrictive VSDs required surgery in infancy (12% vs 51%; p less than 0.005), and more closed enough to never require surgery (62% vs 27%; p less than 0.005, chi square). Surgery is rarely necessary for patients with small and moderate-sized VSDs in the first year and is usually never necessary because of the expected decrease in size. Few patients with large-restrictive VSDs have an increase in pulmonary vascular resistance, many defects decrease in size, and most patients never need surgery. Patients who have a nonrestrictive VSD have an excellent prognosis with appropriate management.

Clinician use of a pediatric cardiology database on a microcomputer.

A pediatric cardiology database was designed and implemented on a microcomputer using the MEDUS/A (Harvard School of Public Health) database management system. This database has potential utility in the areas of clinical research, patient management, and administration. Initial uses of the system include a study of ventricular septal defects, and automation of pacemaker clinic and cardiac catheterization laboratory records. Clinicians with little or no programming experience can alter the database structure and tailor complicated applications to their particular needs. Preliminary evaluation of the system is presented.

QUICK (QUick Index to Caduceus Knowledge): using the INTERNIST-1/CADUCEUS knowledge base as an electronic textbook of medicine.

QUICK (QUick Index to Caduceus Knowledge), is a prototypical user-friendly access system which adapts the INTERNIST-1/CADUCEUS knowledge base for use as an electronic textbook of medicine. The QUICK program can be used both as a diagnostic aid and a teaching tool in the field of internal medicine. A preliminary evaluation of a prototypical version of QUICK was conducted in order to identify its strengths and weaknesses. QUICK was made available to the medical housestaff at three Pittsburgh area teaching hospitals for a period of 2 months. Most users felt QUICK was educational and wanted future access to the system. An examination of log files revealed the users' most frequently encountered difficulties. Using the INTERNIST-I knowledge base as an electronic textbook expands the project's intended audience by providing clinical support for a broad group of diagnostic problems.