RESUMEN
A novel method of interface design--user driven, evidence based experimental design--was developed which approximates the usual clinical way of maturing science and technology in the healthcare domain. The method is user-driven and the clinician remains in control of gathering and evaluating evidence of relevance to the project--as well as specifying the details of the user interface. Information not obtainable from the literature was gained experimentally and used to achieve a deeper understanding of the problem before the design phase. The design was subsequently validated experimentally by ordinary users with no connection to the software or design team. After applying this method to the problem of gaining a satisfactory clinical overview of a single patient's record, we recommend that clinical IT interfaces have clinical logic, sufficient complexity, and are well structured. Developers should use computer power to support "building blocks" such as anatomical problem lists and summaries of history, status and treatment, personal notes, and should support clinical browsing using text and graphics.
Asunto(s)
Sistemas de Registros Médicos Computarizados , Diseño de Software , Interfaz Usuario-Computador , Humanos , Almacenamiento y Recuperación de la Información , Programas InformáticosRESUMEN
BACKGROUND AND PURPOSE: The majority of patients with pancreatic cancer have advanced disease at the time of diagnosis and are not amenable for surgery. Stereotactic radiotherapy (SRT) may be an alternative treatment for patients with locally advanced disease. The effect of SRT was investigated in the present phase-II trial. PATIENTS AND METHODS: Twenty-two patients with locally advanced and surgically non-resectable, histological proven pancreatic carcinoma were included into the trial. The patients were immobilized by the Elekta stereotactic body frame (SBF) or a custom made body frame. SRT was given on standard LINAC with standard multi-leaf collimator. Central dose was 15 Gyx3 within 5-10 days. RESULTS: Evaluation of response was found to be very difficult due to radiation and tumour related tissue reaction. Only two patients (9%) were found to have a partial response (PR), the remaining had no change (NC) or progression (PD) after treatment. Six patients had local tumour progression, but only one patient had an isolated local failure without simultaneous distant metastasis. Median time to local or distant progression was 4.8 months. Median survival time was 5.7 months and only 5% were alive 1 year after treatment. Acute toxicity reported 14 days after treatment was pronounced. There was a significant deterioration of performance status (P=0.008), more nausea (P=0.001) and more pain (P=0.008) after 14 days compared with base-line. However, 8 of 12 patients (66%) improved in performance status, scored less nausea, pain, or needed less analgesic drugs at 3 months after treatment. Four patients suffered from severe mucositis or ulceration of the stomach or duodenum and one of the patients had a non-fatal ulcer perforation of the stomach. CONCLUSIONS: SRT was associated with poor outcome, unacceptable toxicity and questionable palliative effect and cannot be recommended for patients with advanced pancreatic carcinoma.