Publications

1984
Slack WV. A history of computerized medical interviews. MD Comput 1984;1(5):52-9, 68.
Leviton A, Slack WV, Bana D, Graham JR. Age-related headache characteristics. Arch Neurol 1984;41(7):762-4.Abstract
A computerized headache interview was completed by 255 children, adolescents, and adults. Children did not differ from adults in the frequency of auras or prodromes. Young children were more likely than older patients to have brief headaches and headaches that tended to occur on weekdays, and to feel "great" after a headache. They were less likely than older patients to acknowledge multiple kinds of headaches, headaches located on one side of the head or posteriorly, and such concomitant occurrences as blurring, photophobia, irritability, frustration-anger, light-headedness, trouble with concentration, numbness-tingling, and lack of appetite. We do not know how much these differences can be attributed to age-related differences in language, physiology, or medical care selection factors.
Leviton A, Slack WV, Masek B, Bana D, Graham JR. A computerized behavioral assessment for children with headaches. Headache 1984;24(2):182-5.
1983
Bennett SE, Lawrence RS, Fleischmann KH, Gifford CS, Slack WV. Profile of women practicing breast self-examination. JAMA 1983;249(4):488-91.Abstract
The monthly practice of breast self-examination (BSE) can result in the early diagnosis of breast cancer. To explore factors that influence women's habits in the practice of BSE, we interviewed 616 women using an interactive computer program. We found that these women were more likely to practice BSE on a frequent basis if they were living with their sexual partner, had been shown how to perform BSE, and were confident in their examination technique. Women with a maternal history of breast disease were also more likely to practice monthly BSE. Unlike past reports that women with formal education beyond high school practice BSE more frequently than less-educated women, our study showed no association between monthly BSE practice and formal education. Contrary to our hypothesis that BSE practice was associated with the practice of other preventive health activities, our study did not demonstrate such a relationship. These findings suggest that demonstrating BSE at the periodic health examination may help increase the number of women practicing BSE on a frequent basis.
Horowitz GL, Jackson JD, Bleich HL. PaperChase: computerized bibliographic retrieval to answer clinical questions. Methods Inf Med 1983;22(4):183-8.
Horowitz GL, Jackson JD, Bleich HL. PaperChase. Self-service bibliographic retrieval. JAMA 1983;250(18):2494-9.Abstract
During the past three years, from terminals within Beth Israel Hospital, Boston, 3,654 persons used a computer program called PaperChase to search the medical literature. While performing 39,022 searches, these persons had 1,976,421 references displayed and selected 449,690 of them for printing. Throughout this period, the program underwent continual modification. Each year the number of searches increased--from 10,678 to 11,541 to 16,803. Each year the percentage of new users who were unsuccessful decreased--from 16 to 13 to 11. By the end of the third year, 549 people had completed 20 or more searches. PaperChase enables people to search the medical literature themselves, and thus provides a new experience in computerized bibliographic retrieval. When made available without charge in a teaching hospital, PaperChase is widely used.
1982
Pope RA, Mattson CJ, Janousek JP, Slack WV. A computer-based i.v. admixture system. Methods Inf Med 1982;21(2):65-9.
Moore MJ, Bleich HL. Consulting the computer about acid-base disorders. Respir Care 1982;27(7):834-8.Abstract
A computer program was developed at Beth Israel Hospital in Boston to offer consultation to health care personnel treating patients with electrolyte and acid-base disorders, as the diagnosis of these disorders involves consideration of numerous factors and performance of tedious calculations. In order to obtain the necessary diagnostic information, the computer conducts a dialogue between itself and the person seeking its advice. The program then allows the computer to generate an evaluation note, which lists the diagnostic possibilities, explains the pathophysiology, recommends treatment, and provides references to the medical literature. The entire transaction, from data entry to printing, takes about 4 minutes. The computer program also compensates for entry of inconsistent data and for lack of data. Our experience with the program has revealed that it has favorably influenced patient care in a number of cases and has helped our staff better understand the pathophysiology and treatment of electrolyte and acid-base disorders.
1981
Porter D, Leviton A, Slack WV, Graham JR. A headache chronicle: the daily recording of headaches and their correlates. J Chronic Dis 1981;34(9-10):481-6.
Bana DS, Leviton A, Slack WV, Geer DE, Graham JR. Use of a computerized data base in a headache clinic. Headache 1981;21(2):72-4.
Leeming BW, Porter D, Jackson JD, Bleich HL, Simon M. Computerized radiologic reporting with voice data-entry. Radiology 1981;138(3):585-8.Abstract
The accurate, voice entry of radiologic reports into a computer takes significantly longer than entry by keyboard. Careful speech and considerable patience are required to avoid an unacceptably high error-rate. With improvements in the future, this technology may compete with the conventional technology.
Horowitz GL, Bleich HL. PaperChase: a computer program to search the medical literature. N Engl J Med 1981;305(16):924-30.Abstract
This report describes PaperChase, a computer program that permits users to search medical literature by author's name, journal of publication, title word, or medical subject heading (MeSH term), as indexed by the National Library of Medicine. PaperChase was installed in the medical library of Beth Israel Hospital in Boston, with a data base of 400,000 references--nearly all the articles shelved there. During the first year of operation, 1032 medical students, house officers, practicing physicians, and other library users, without formal instruction or user's manual, conducted 8459 searches and displayed 399,821 references, 97,769 of which they selected for printing. Among users who conducted an initial search, 49 per cent returned to complete five or more searches, and 14 per cent returned to complete 20 or more. The large number of satisfied users and the low installation and operating costs suggest that PaperChase could be a valuable means of providing widespread computerized bibliographic retrieval.
1979
Leeming BW, Simon M, Jackson JD, Horowitz GL, Bleich HL. Advances in radiologic reporting with Computerized Language Information Processing (CLIP). Radiology 1979;133(2):349-53.Abstract
Computerized Language Information Processing (CLIP) is a system of radiologic reporting in which the user interacts with a computer keyboard and cathode-ray tube terminal to generate coded reports. The hierarchical medical classification on which the code is based permits rapid on-line compilation of reports of any degree of complexity. The system provides organized sets of pre-assembled statements that are rapidly accessed and modified for each examination. Although the reports are printed in English, they are held in the computer as a succinct code that is eminently suited for permanent storage and rapid retrieval.
1978
Bloom SM, White RJ, Beckley RF, Slack WV. Converse: a means to write, edit, administer, and summarize computer-based dialogue. Comput Biomed Res 1978;11(2):167-75.
Rabinowitz SH, Lown B, Slack WV. Recourse to a computer for teaching the proper use of nitroglycerin. Am Heart J 1978;96(5):703-4.
Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 1978;28(8):754-62.Abstract
Data from 694 patients hospitalized with stroke were entered in a prospective, computer-based registry. Three hundred and sixty-four patients (53 percent) were diagnosed as having thrombosis, 215 (31 percent)as having cerebral embolism 70 (10 percent) as having intracerebral hematoma, and 45 (6 percent) as having subarachnoid hemorrhage from aneurysm or arteriovenous malformations. The 364 patients diagnosed as having thrombosis were divided into 233 (34 percent of all 694 patients) whose thrombosis was thought to involve a large artery and 131 (19 percent) with lacunar infarction. Many of the findings in this study were comparable to those in previous registries based on postmortem data. New observations include the high incidence of lacunes and cerebral emboli, the absence of an identifiable cardiac origin in 37 percent of all emboli, a nonsudden onset in 21 percent of emboli, and the occurrence of vomiting at onset in 51 percent and the absence of headache at onset in 67 percent of hematomas.
1977
Fisher LA, Johnson TS, Porter D, Bleich HL, Slack WV. Collection of a clean voided urine specimen: a comparison among spoken, written, and computer-based instructions. Am J Public Health 1977;67(7):640-4.Abstract
In an effort to compare different methods of instructing patients, 99 women 18-25 years of age were given computer, spoken, weitten, or no instructions for the collection of a clean voided urine specimen. The group who received computer instructions was the most uniform in its performance (P less than 0.002, F-test) and reported the fewest procedural problems (P less than 0.02, Fisher test). In addition, this group had fewer contaminating bacteria than the group who received written instructions (P less than 0.03 , Mann-Whitney test). The group who received no instructions had more bacteria (P less than 0.0001, Mann-Whitney test) than any of the other groups. The effectiveness of the computer instruction was probably related to numerous attributes, including the individualized quality of the dialogue, self-pacing, self-testing, and privacy.
Slack WV. The patient's right to decide. Lancet 1977;2(8031):240.
Reich PR, Geer DE, Bleich HL. A computer program for the diagnosis of hematologic disorders. Am J Hematol 1977;3:127-35.
Beckley RF, Bleich HL. Paper chase: a computer-based reprint storage and retrieval system. Comput Biomed Res 1977;10(4):423-30.

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