Thomas L. Lincoln

Immunoblastic sarcoma: a clinical description.

We reviewed the clinical records of 33 patients with Immunoblastic Sarcoma in order to further describe this disease clinically. Several common features were found. Thirty percent of the patients had a history of a prior immune disease or lymphoproliferative malignancy. Forty‐four percent of the patients tested had a diffuse hypergammaglobulinemia. Lymphopenia (less than 1,000/mm3) was found in 45%, and anemia occurred in 73%. At initial presentation, 30% of the cases were clinically staged as either stage I or II, whereas 70% were found to be stage III or IV. Forty‐nine percent of the patients had systemic symptoms at presentation. The median survival was 14 months. Advanced stage of disease, lymphopenia, and presence of systemic symptomatology were associated with significantly decreased survival times (p <.05). We conclude that IBS is a clinical entity often associated with prior immune disease and/or diffuse hypergammaglobulinemia.

Childhood lymphoma-leukemia. I. correlation of morphology and immunological studies

Acute lymphocytic leukemia of childhood (ALL) is a heterogeneous disorder. Furthermore, the related lymphomas have been separated arbitrarily according to clinical presentation. This study is based on a combined clinical, morphological (cytological) and immunological evaluation of 49 cases of childhood lymphoma or leukemia. We have identified three separate groups, which in the past have not always been clearly distinguished, but which do appear to have distinctive clinical and cytological features: 1) convoluted lymphocytic lymphoma/leukemia, of probable T cell origin (7 cases), usually associated with thoracic involvement; 2) small noncleaved follicular center cell (FCC) (Burkitt‐like) lymphoma/leukemia, of B cell origin (6 cases), usually associated with abdominal involvement; 3) a heterogeneous (ALL) group (36 cases). This study demonstrates that differentiation of these three entities can often be made on the basis of cytological examination and the features of clinical presentation. It remains to be determined whether these sub‐groups, and other more subtle variations in surface marking (E rosettes) and morphology within the ALL group, reflect important differences in behavior pertinent to selection of therapy.

The electronic medical record: a challenge for computer science to develop clinically and socially relevant computer systems to coordinate information for patient care and analysis

Abstract Creating a Patient Centered Information System (PCIS) or Electronic Medical Record System (EMRS)—the former terminology emphasizing the clinical purpose, the latter the missing product—is now viewed by the health care community as necessary to coordinate modern patient care in a manner that can control costs. However, despite 25 years of significant effort, the distance between the information systems available today in health care and what will be needed to fulfill this promise in the future remains very large. Success depends on achieving three goals that are generally in conflict: (1) giving the users the full scope of features and detail needed to create and use electronic clinical records for decision making, (2) providing the speed and reliability necessary for their online use, and (3) preserving system security and patient confidentiality. The vendors of the current generation of Hospital Information Systems (HIS) are being asked to supply these new capabilities before most have fully suc...

Medical informatics: The substantive discipline behind health care computer systems

The computer is rapidly becoming an interactive workstation for medical research and for clinical decision-making and it has become a preferred instrument for communication and documentation throughout health care. However, when the attempt is made to use the rigid conventions of information processing to impose order on the characteristically volatile and unpredictable phenomena encountered in the clinical setting, deep seated logical issues are uncovered. This challenge has generated the new field of Medical Informatics, one major goal of which is to formulate computer logics that can properly relate the idealized descriptions of disease, the rules for medical practice and the general guidelines for health care to the intricate diversities encountered in the care of individual patients. The Integrated Academic Information Management System (IAIMS) program of the National Library of Medicine provides the most ambitious environment for research in this new endeavor.

Healthcare information architecture: elements of a new paradigm

An Electronic Medical Record (EMR) must provide a secure, permanent archive for an individuals medical records and also function as a multi-purpose database that supports the complex, varied activities of patient care. Meeting these objectives requires unusual flexibility in how data are retrieved and processed. Semantic and referential integrity must preserved both over time and as chunks of information are exchanged with other systems. Relationships between data entries must determined dynamically based on actual events, rather than statically through application design. Distributed data requires that new forms of system security be incorporated into an EMR at a structural level, with an emphasis on the labeling of elements to be secured behind a security barrier, with audit trails to document necessary overrides and monitor for suspicious use. A modular information architecture is proposed that integrates requirements for structure, content, processing and security.

An historical perspective on clinical laboratory information systems

The clinical laboratory environment represents a microcosm in which practical solutions to operational problems in medical informatics have gone hand in hand with the development of laboratory instrumentation and computer technologies. These achievements follow a typical pattern in technological development, leading from the specific to the inclusive. The history of laboratory computing offers insights, not only for the past, but also for the future.

“HIS-Treck -- the next generation”: an introduction to future hospital information systems

The ship by health care organizations to integrated care with an outpatient emphasis requires the development ofa new generation of multifaceted electronic medical record systems to coordinate these services. This paper introduces the context ofpresent day health care computing to set the stage for Dr. Essins paper on our proposed paradigm shifr fiom record processing to document processing, using mark up language technologies. We believe that such document oriented systems can be designed to be both distributed and secure with respect to patient and institutional con9dentiality.