Libris Britannia 4/science library(b).zip/science library(b)/MEDICAL/H417A.ZIP/MANUAL.LZH/SHAREMAN.ASC

Text File | 1993-10-12 | 55KB | 1,287 lines

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      ║                             MEDPAS                             ║
      ╠════════════════════════════════════════════════════════════════╣
      ║    Copyright (c) iDRSystems Ltd. 1992. All rights reserved.    ║
      ║                   This is NOT a licensed copy.                 ║
      ╚════════════════════════════════════════════════════════════════╝

        MEDPAS is distributed through Shareware for EVALUATION purposes
         only. Full copyright remains with the authors, iDRSystems Ltd.


═════════════════════════════════════════════════════════════════════════════
     If you intend to use MEDPAS after evaluation, or retain it after the
        trial period of 30 days, you MUST register with iDRSystems Ltd.
                 or its distributor, Cambridge Technologies.
══════════════[ Please read the registration form for details ]══════════════
#
                        ESSENTIAL READING


      After the initial screen, you will be presented with a
copyright screen, which asks :

      "Are you using this program as a substitute for the
       professional judgement of a physician ?"

Please read this carefully. You must answer 'NO' to the question in
order to continue, any other answer will exit the program. Continued
use will assume you have read and understood the question, and have
replied in the negative.

      It is important that these instructions are fully understood.
'MEDPAS' is not an expert system, and should not be used as such.
It is also not a diagnostic tool, and should not be used as such.
It is not a medical reference, and should definitely not be used
as such.

      Although all medical information is correct and factual in the
areas where it is pertinent, the authors are unable to, and will
not, assume any responsibility for its use in reality, as they have
no control of the circumstances under which it may be interpreted
or applied. The practice of medicine, even in seemingly simple
areas, is a highly personal and complicated procedure. There is no
place for a mechanical relationship between patient and adviser.
At least, not within our present abilities with either medicine or
electronics.

      It is unequivocably recommended, therefore, that no medical
decision, other than to seek further help from a qualified
physician, is based upon the contents hereof.

  'MEDPAS' SHOULD ONLY BE USED AS AN EDUCATIONAL ADJUNCT TO THE
   PROFESSIONAL ADVICE AND HELP THAT IS THE PROPER DOMAIN OF THE
   QUALIFIED PHYSICIAN. IT SHOULD NEVER BE USED IN ANY WAY AS A
   REPLACEMENT FOR IT.
#
                        PHILOSOPHY OF MEDPAS


For the majority of people the human body is a reliable and
enduring machine that continues to function with the minimum of
conscious maintenance and repair. At times, however, it may falter,
when disease and illness affect its well being and integrity. It is
at those times that most of us then turn our attention to the
fragile vulnerability of this marvellous biological mechanism which
we inhabit. It is also at those times that we are perhaps least
able to be objective in our assessment of its correct needs, and
to realise the limited extent of knowledge we possess about
ourselves.

      In recent years, however, this has been changing. There has
ben a growing awareness and curiosity of the functioning of our
bodies. A need for understanding, of greater personal control and
a desire to prevent disease through an increase in knowledge seems
much more prevalent than even a decade ago.

      The World Health Organisation has defined health as a state of:

      '...complete physical, mental and social well-being and not
          merely the absence of disease and infirmity.'

      An emphasis on the positive rather than passive approach to
health is being asked for. It indicates an increased need for
information and knowledge of our bodies and the way they react to
illness and disease. It is our hope that 'MEDPAS' will achieve, in
some part, the above objective and enable the extension of
individual competence in the formation of decisions taken with
regard to personal health.

      It is not within the aims of 'MEDPAS' to diagnose and treat
medical illness, nor is it meant as a reference source, or, indeed,
to replace in any way the unique and highly complex skills of a
physician. Its 'raison d'etre' is merely to educate, to inform and
to try to raise in some small way the level of awareness that each
individual should posses about the intricate structure of their
body, both in illness and in health.
#
                        THE PROGRAM


'MEDPAS' is not a single program but rather a collection of
'chapters' which have been annealed to form a single entity under
the control of a central unit, the master menu. It is menu driven
throughout with context-sensitive help whenever a decision is
required.

      Installed throughout 'MEDPAS' are two TSR's, or Terminate and
Stay Resident programs, which are available almost anywhere through
their own hot keys. These are a dedicated dictionary and a notepad.
The dictionary is memory resident and therefore immediate in
its response with no disc access. The notepad is a full screen,
free form, text entry pad with basic wordprocessing facilities.
It is meant to make notes, reminders or cross references where
they are not available. NEITHER OF THE TSRs ARE ENABLED IN THIS
VERSION BUT WILL BE AVAILABLE IN THE REGISTERED ONE. Once the program
is exited, the TSRs will be automatically cleared from memory.

      The main body of the program is divided into ten sections.
Each section may be chosen only from the master menu and will
default to it upon exiting. Each section is fully explained in the
contents section of this manual.

                        OVERVIEW

MEDPAStm is essentially a menu driven suite of individual
chapters, all of which are controlled through a master menu, to
which the program defaults  upon exiting from any of the sections.
At the present time there are ten chapters available from the menu,
each available for selection by cursor key movement and pressing
<CR> for confirmation.

      If working from dual floppies, you are then prompted for the
correct data disc to be inserted into Drive B.  The choice made may
be changed by pressing the <DEL> key, and another made.  Once the
correct disc is inserted, pressing <CR> again will allow entry to
the chosen section. Hard disc users will not, of course, require any
prompting for a change of disc.

      On entering a new chapter, a suitably apt quotation will appear
on screen while the body of the section is being loaded.  This should
take between 2 and 5 seconds on a floppy system, according to the
size of the loading chapter, when a prompt to press any key will
appear to signal the end of initialisation and allow progress into
the chapter proper.

      While in the master menu, pressing <Esc> will end the program
and return control to DOS. The same key is used in the individual
chapters to return control to the master menu.

      To facilitate quick movement within the program, all program
direction points have been configured for single key entry, and
type ahead has been allowed.
#
                        STRUCTURE


The package runs from a master menu which accesses ten separate
sections; these are


     SYMPTOM ANALYSIS              NUTRITION
     HOMETESTS                     GENETICS
     CHILD DEVELOPMENT             OBESITY
     INFECTIOUS DISEASES           MEDICAL SHORTHAND
     MEDICAL RECORDS               DISEASE LIBRARY


     In addition to the main sections, there are 3 permanently
resident features available throughout. These are accessed with
dedicated hot keys and consist of;


               ON-LINE DICTIONARY
               ON-LINE NOTEPAD
               CONTEXT-SENSITIVE HELP SCREENS
#
                        UTILITIES


These consist of context-sensitive help, run-time flags,
a dictionary and a notepad. All are accessed through hot keys.
In this version the dictionary and notepad are unavailable but will
be included in the latest registered version.


CONTEXT SENSITIVE HELP

To preserve screen layout and prevent clutter, decision
functions have not been installed on the screen.  They have,
however, been made available throughout the package in the form of
context sensitive help screens.  Once the nature and purpose  of
each section has been appreciated, then progress through the
program can be made without further recourse to the manual.

    <Alt><F1> calls up the help screen, which appears as a window
in the centre of the screen.  Pressing the SPACEBAR clears it,
returning to the original screen.

     It is not necessary to clear the help screen before
progressing through the program.  If the help screen is active,
then pressing one of the detailed keys will automatically clear it
and process the selected decision.

HELP COMMANDS

            <Alt><F1>.....Call up a help screen.
            SPACEBAR......Remove the help screen.


RUN-TIME FLAGS

Each screen has 2 additional information attributes in the
upper corner boxes.

      The box in the top left displays availability of cursor  keys,
left/right/down/up, or Pg Up/Pg Dn keys as relevant to each
section.  Thus if data is scrollable up or down, then up and down
arrows will appear in the box.  Pg Up/Pg Dn keys are presented as
triangles.

      The box in the top right corner displays progress action, if
any wait state is entailed by displaying a flashing character such
as;
     L indicates Loading,
     R indicates Returning,
     X indicates Exiting.


ON-LINE DICTIONARY

Throughout the package, specific care has been taken to
explain any medical terms where their use has been unavoidable.
However, at times it has been felt that their use is necessary,
whether for educational purposes or to prevent lengthy repetition
of explanations.  In such cases the word has been defined in a
memory resident dictionary accessible though pressing the <Alt> and
<F1> keys together.

      Pressing <Alt><F1> gains access to the dictionary.  This opens
the area to the left of the main title, producing the prompt,
<Def.>.  Now type in the word which you wish to look up and end
with <CR>.  The input will accept just 3 characters as the minimum,
although it is suggested that the majority of the word is entered.
Some words may only be present in the dictionary in a single form,
therefore endings denoting plural or single, or adverb
constructions should be left out.  Thus the word MACULE may be
present in the text as MACULE, MACULAR or MACULES, although the
dictionary only contains it in the form MACULE, the entry in the
input requiring only MAC, but preferably MACUL.

      If the word is not found, the area to the right of the title
informs you, otherwise the screen is replaced by the dictionary
screen and the definition is displayed.  Once in the dictionary,
you may browse backwards or forwards by using the cursor keys.

      If another definition is required, pressing <Alt><F3> will
return you to the input area where the word maybe entered again.
If <Alt><F3> is pressed on an empty definition input, the
dictionary is entered at the beginning in the Browse mode. The
definitions may be viewed by using the cursor keys to scroll
through the entries. To return to the main screen, press <Esc>.

DICTIONARY COMMANDS

            <Alt><F3>.....Opens the dictionary
            Cursor keys...Cursor keys to scroll the dictionary.
            <Esc>.........Leaves the dictionary.


ON LINE NOTEPAD

In order to maintain a paper free environment, whenever a
cross  reference is made in the package, easy access to the
reference has usually been enabled whilst remaining in the main
section. In places, however, this has not been possible and
consequently a jotter may be necessary to note a reference or
comment. This has been provided with a notepad facility which is
memory resident and accessible throughout with a hot key.

      To access the notepad, press <END> and the screen will clear
to the required page.

      Input is limited to a single page. Just type in the memo as
you would in a wordprocessor. There are simple editing facilities
available which enable control of the input.

      To exit the notepad, press <END>. The notes will stay
resident throughout the program but will be lost upon exiting
MEDPAStm, ie pressing <Esc> when in the Master Menu.

NOTEPAD COMMANDS

            <Alt><f5>....To Access and Leave the Notepad
            <Ctrl><f1>...Deletes a character at the cursor and left
                         justifies the rest of the line to the cursor
            <Ctrl><f3>...Deletes the line on which the cursor is situated.
            <Ctrl><f5>...Deletes the page.
            Cursor keys..To move the  cursor as required.
#
                          SYMPTOM ANALYSIS


To use this section to full advantage it is necessary first
to understand the way it has been presented and the nature of its
underlying structure.

      An analysis of the presenting symptoms in a surgery was
undertaken by the authors over a period of 3 months.  The major
revelation showed a persistent recurrence of certain groups of
affliction which accounted for over 80 percent of the total
presentations.

      A large number of the less common classes of presentation
have been incorporated into the other main sections of the package,
but the main symptom presentations have been gathered here under
Symptom Analysis.  The total symptomatology has been collated and
subdivided into 31 main classes of symptom.

      Each class of symptoms has been researched to produce the most
common and likely ailments associated with it to represent the
diagnostic likelihood of disease processes contained in this
section.  We have also added those disease processes which may not
be as common but are easily distinguished by a simple question and
answer sequence.  Each end list of diseases was then separated into
single items by a pathway of symptomatology which, of necessity,
would require no more than simple observation and the ability to
reason in order to follow.


DIAGNOSTIC POSSIBILITY

The diagnostic likelihood at the end of each pathway is not
given as a certain cause of the preceding symptoms, nor as the only
probability of disease presence.  It is given as a statistically
common probability, given the scope of the questioning and the
validity of the answers.

     It has been calculated that the conditions covered in this
section should give a probability of 75 to 80 percent in covering
each symptom class.  We have specifically avoided the ambivalence
of terminating a sequence of questioning with exhortations to see
a doctor for further explanation or diagnosis as an unsatisfactory
and frustrating response.

      This is not an expert system, as all possibilities are not
covered, and therefore cannot be expected to provide an answer for
every possibility, and fruitless pathways have, therefore, been
excluded. This section is presented on the assumption that it is
not used as an expert system but rather as a precursive adjunct to
the irreplaceable expertise that only a professional can supply.


STRUCTURE

After entering the section, the control screen is presented
which lists the 31 symptom classes available in this section.
Choice is made by using the cursor keys and pressing <CR>.

     The beginning of each class is prefaced with an introductory
text which is scrollable with the cursor keys.  This text contains
some background information on the particular symptom, together
with some anatomy and acts as a preface to the main body of the
particular class chosen.

      To proceed into the analysis section from the introduction,
press <spacebar>.

      Once in the analysis proper, questions designed to refine the
symptomatology further are presented requiring a yes or no answer.
Reply by pressing <Y> or <N>, and confirm with a <CR>.

      A question can be tagged by pressing <Alt><T>, when it will
appear in the top window and remain visible throughout the
interrogation sequence, or until a different question is tagged.
At any time in the interrogation, the sequence can be interrupted
and control returned to the marked question by pressing <Alt><T>.
This is particularly useful if a decision point is ambivalent and
backtracking is foreseen, although other uses may equally be
served. Once return is made by using <Alt><G>, then that question
is unmarked automatically unless <Alt><T> is pressed again.

      To return one step in the sequence, press <Backspace>, when
the pathway will backtrack one step until the first decision node
is reached. This, or further progress, will have no effect on the
marked question even though it may be in the pathway used.

      On reaching the endpoint, the screen changes to display the
diagnostic likelihood and the relevant disease is shown.  Scrolling
is available with the cursor keys.

      To return to the selection screen, press <Alt><F10> at any
time in the interrogation.

      The dictionary and notepad are available throughout. All
decision screens have an attendant help screen by pressing
<Alt><F1>.


SYMPTOM ANALYSIS COMMANDS

            <Alt><F1>.....Help screen.
#
                        HOME TESTS


Whenever a temperature is taken, or a pulse felt, a medical
test is being performed. Both the action itself and the basic rules
applied to evaluating the results are simple and well known to the
majority of people. Once the rules are grasped and the action
performed several times, most people would find it difficult to
accept that what they had done was other than simple and logical.


INTERNAL CHANGES

Most illnesses produce not only external signs and changes
in our bodies but internal manifestations as well. In fact, often a
disease may produce only intra-corporeal changes for a long time
before external manifestations are apparent. Although the majority
of these processes require specialised techniques and knowledge to
detect and evaluate, there are still many that require nothing more
than an open mind and a few simple pieces of apparatus to perform.
In recognition of the growing interest of the individual in such
procedures, more and more equipment is being made available to
enable home testing to become possible.

      This section is all about that possibility. We have tried to
extract, classify and provide the context for the more useful and
less error prone procedures that may be safely and quickly
performed at home by the average person.


NOT A DIAGNOSIS

It is perhaps moot to suggest here that, apart from a few
specific cases, a medical test, whether done at home, the surgery or
in the laboratory, is not a diagnosis. It provides part of the
picture, sometimes a very important part, but not the whole. Although
a physician would probably perform a laboratory investigation for
confirmation of a clinical supposition, the home test, because of
the nature of its simplicity, works the other way. It can be a
very useful tool to indicate the possibility of a disease and
suggest that further investigation, by a physician, would be
appropriate. Alternatively, once an illness is present, it can be
used as a monitor of its progress or condition.


STRUCTURE

Entry into the home test section starts with an introductory
screen which then prompts to press any key to continue in to the main
menu.

      The dictionary and notepad become available at this point by
pressing <Alt><F3> or <Alt><F5> respectively. Pressing <Esc> will
return control to the master menu. Help screens are activated with
the <Alt><F1> key combination.

       The overall structure presents a series of menus, each line
ending with one of the 50 or so individual tests. Each test is
detailed with description and relevance as well as referencing
associated diseases. All mentioned diseases, approximately 100 in
this section, can be called up from within the related test and
displayed separately. In addition, a glossary, available from the
primary menu, allows quick access to an individual test through a
cross referenced index of both tests and diseases.


PRIMARY MENU

The main menu screen is broken up into a scrollable overview in
the top window and a menu of the 11 main categories of tests available,
together with entry into a glossary which acts as a reference index
to the whole section. Pressing the appropriate character, and
confirming with a <CR>, will activate the associated section.
After leaving this screen, pressing <backspace> will effect a
return to the main menu for further selection.


SECONDARY MENU

Upon selection of a test category, the screen changes to a
secondary menu.  This details the actual tests available under that
heading.  The text is scrollable with the cursor keys, but choice
of test is made by pressing the appropriate character, selected
from the menu, which actually calls up the individual tests.


INDIVIDUAL TESTS

Each test screen has four components. The main window on the
left describes the test itself and is scrollable with the cursor
keys. A small window on the right details the apparatus required to
perform the test, while the window immediately underneath contains
the name of the test.  The test category is seen in the title spot
at the top of the screen.


ASSOCIATED DISEASES

The bottom window details diseases mentioned in the context
of the test, each one being available for look-up by pressing the
associated key.  Doing so changes the screen to present the chosen
disease, which is scrollable with the cursor keys, if necessary.
Pressing <backspace> returns control to the previous screen, as it
also does when in the test screen and in the secondary menu.


GLOSSARY

If the glossary is chosen from the main menu, the page changes
to present a scrollable index of all the tests and diseases in a
cross referenced list detailing the subject and its reference point
in the section. Scrolling is achieved with the cursor keys for single
line scroll or with the Pg Up/Pg Dn keys to page alphabetically,
the active reference appearing in yellow.  Pressing <CR> identifies
the choice in the botom window and pressing <CR> again processes
it.  Control is then passed to the relevant test screen which acts
independantly, the only difference being that <backspace> returns
to the glossary rather than returns a step in the menu progression.

     <Esc> leaves the home test section and returns control to the
master menu.


HOME TEST COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
                           CHILDHOOD DEVELOPMENT


A screening and early assessment program for the developing
child is nowadays a standard feature in most areas. Although a
comprehensive assessment of a child's physical, mental, social or
emotional abilities is reliant upon a trained professional, each
parent, consciously or unconsciously, is continually assesing their
own children as a by-product of the care and love bestowed upon
them. In order to formalize some of that parental assessment, this
section offers a few guidelines in normal standards.


GROWTH TABLES

The growth tables have been presented in full, as measurement
is something we all do, although their assessment has been
deliberately left out. Height and weight are easily measurable
whilst the head circumference requires a soft tape placed around
the head, above the ears, and encompassing the forehead and occiput
on a flat plane.

      There are so many factors which influence physical growth, such
as parents' size, racial characteristics, diet, environment and the
presence of any disease, that the tables have simply been presented
using only percentile charts. The latter are mean representations
of a population study in each particular characteristic. Thus the
3rd percentile in height for a given population represents the
height at which 3 percent of the population measure less, the 50th
percentile representing the mean.

      In any large population area there will be smaller groups which
differ from the general mean and present their own different
statistics. The figures given are a general representation and
should not be treated specifically.

      It is suggested that if a child falls outside the 3rd and 97th
percentiles, and bearing in mind the parental sizes, this should
simply be taken as an indication for further professional
assessment rather than an abnormality. More important, however, is
not the primary measurement but rather a change or deviation from
a previous series of grades, an observation which would warrant a
full professional assessment.


DEVELOPMENT

The developmental measurements have combined the seperate
vocal, manipulative, aural, motor and sensory characteristics to
present a generalised picture that any parent can easily observe,
without any special skills, in their child. They have been grouped
under the ages associated with their occurrence in easily compared
stages. These assessments have rather more temporal significance
and should a child fail in more than about 25 percent of the
observations then further professional help should be sought. As
a corollary, if a child manages more than 25 percent of the group
above, then it may be considered as advanced  for its age.


STRUCTURE

Entry into the section presents the introductory screen with
a choice of accessing either growth tables or developmental
assessment. Pressing the appropriate key will continue into the
required section.

      If developmental assessment is chosen, the screen changes to
present age related subgroups labelled from A to K. Pressing the
appropriate character progresses to a scrollable screen detailing
the relevant assesments for that age group. To enable reselection,
press <backspace>. To return to the main menu press <Alt><F10>.

      Growth tables are presented on a single screen with a selection
menu at the top. The large window below will show reference
measurements of weight, height and head circumference at the 3rd,
50th and 97th percentiles, while the lower window shows the mean
measurements in a scrolling form. A flashing R or Q in the top rght
corner will indicate which window is active, ie Reference or Quick
lookup.

      The selection line will allow a choice to be made between the
reference table or quick table, then ask for a choice of male or
female. The ages represented in both tables increase from birth to
2 years in monthly increments, then to 16 years in 2 monthly
increments. The reference table requires scrolling the age groups
with the cursor keys and confirming the choice with pressing <CR>,
the measurements appearing in the appropriate area. The quick table
scrolls the measurements visible in the window with cursor key
control, all three components being updated at the same time.
Pressing <backspace> will return one step in either table's
selection line.

DEVELOPMENT COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
                         INFECTIOUS DISEASE


Diseases of infection are probably the single most common cause
of illness. The causative agent may be bacteria, virus, rickettsia,
mycoplasma, protozoa or fungus all of which cause a systemic
disease. Agents such as lice or fleas are said to cause an
infestation as they normally remain on the skin and do not enter
the body.

      Most infections caused by bacteria, virus and fungus are
nowadays treatable with drugs such as antibiotics and antifungals.
Few treatments, however, are available for the viral infection,
although there is an increasing armory of immunisations and
vaccinations available for their prevention.


PREVENTION

An infectious disease is characteristically spread by some form of
transmission. This may take place through direct contact, airborne
transmission, contaminated food or drink, contact with infected
animals, insects or birds, and also, unfortunately, through
occasional surgical procedures such as contaminated blood
transfusion.

      Because of the nature of infectious disease, its prevention is
just as important as its treatment, its basis built on three main
concepts, those of elimination of the source of the infection, the
prevention of its transmission and the protection of its target.

      The first is controlled through an official policy in most
civilised countries, the second requires a constant vigilance in
matters of hygeine and cleanliness, whilst the third is contained
in an active childhood immunisation schedule and the provision of
vaccination and immunisation to people travelling to areas which
would put them at risk of such contact.

STRUCTURE

Entry into this section presents an introductory text which
is paged with the <spacebar> and exited by pressing <Alt<F3>.

      The main section consists of a scrolling list of infectious
diseases in the top right window, controlled by the cursor keys,
a large bottom window in which the disease is described, and a
window in the top left which contains some pertinent notes about
the disease.  Choose by scrolling the list with the cursor keys and
confirming with a <CR>.

      The disease appears in the main window based upon a consistent
format detailing various attributes pertinent to their
classification in this section, and a short description of the
disease itself.  Some of the  diseases are also described elsewhere
in a different and usually  fuller format, access to which can be
effected through the Disease Library.

COMMAND KEYS

            <Alt><F1>.....Call up the relevant Help screen.
#
                        MEDICAL RECORDS


'Medical Records' is a dedicated but comprehensive database
used for the storage of personal medical contacts together with the
associated financial accounts.  Although it uses single screen,
predefined fields it also allows free form entry thus combining
simplicity in use with flexibility in entry.  Four fields are
automatically used as indices for any searches in a unique and
simple to use fashion.

      Each file has room for 50 records, as it has been optimised to
use a separate file for each financial year, although this is not a
necessary condition. 40 files are catered for from any single
directory. If more than 40 files are needed at any one time, a
separate directory should be created for each group of 40 or less.

      The database may use any disc or directory for its data files,
this being specified on ontry into the section with the Change
Directory option.

      Records and files are AUTOMATICALLY SAVED whenever the EDIT
function is exited. They are not saved on a time or record basis.


INITIALIZATION

After initialization, the quotation prompts insertion of the
data disc into the correct drive, confirming with <CR>. If the data
is held in the same directory on the hard disc as the program, a <CR>
will suffice.

      Entry into the controlling screen automatically logs the data
disc, or directory, for all files with the default extension of .MED,
and presents the available files on screen.

      Details of the number of files present and the disk free space
are presented on screen. Once a file is opened, its pathname, size,
number of records and date of the last changes made are logged onto
the screen in the primary menu until the file is closed.


FILE HOUSEKEEPING

The initial screen is controlled by a primary menu, at top
left, which allows a scrolling highlight, using the cursor keys, to
choose between the options :

      Open a file
      Delete a file
      New file
      Change Directory
      Exit

      The chosen option is confirmed with pressing the <CR>.


EXIT

'Exit' leaves Medical Records and returns control to the master
menu. Pressing <Esc> when in the primary menu achieves the same objective.


CHANGE DIRECTORY

At start up, the default directory is logged and presented on
screen. If another disc or directory is required, this option
should be used to log it. All data in/out will then occur in that
directory until it is changed again.

      The full path name needs to be entered viz;
      C:\            NOT      C:
      C:\MEDIDATA  NOT  C:MEDIDATA

      The normal <del> and backspace functions are available. It is
also possible to change a single letter, using the cursor keys,
rather than retype the whole line.

      Files will only be logged if they have an extender of *.MED,
which is the default extender supplied by the section. Care must
be taken that other, incompatible files, are not inadvertently
loaded as there is no check made to ensure compatibility.


DELETE A FILE

'Delete a file' is used to delete an unwanted file from the
data disc or directory, provided it has a *.MED extender and has been
recognized by the section. Upon selection, the command drops the
highlight cursor to the listed directory where it is controlled via
the cursor keys.

      Once a file is chosen, the header is displayed on screen and
a confirmation requested for deletion by pressing the <Y> or <N>
keys. Confirming the deletion by pressing <Y> deletes the file from
the disk.

      When the deletion is completed, the data disk is re-logged and
the new directory displayed.  The disk status is updated and the
cursor returns to the primary menu for further action.


NEW FILE

'New file' is used to create a new file on the data disk or
directory.  The choice prompts for a file name in the bottom window
under which the file is to be created.  The extender will be given
the default of .MED and the input will therefore only allow 8
characters to be used. Acceptance of the name must be confirmed
with a <CR>.

      The file is automatically opened and the user is then asked to
create the header which consists of invariable and specific data
by answering the questions on the botom line. These may be answered
as fully as required, to a maximum of 60 characters, or left blank
as required.

      Once the header is complete, control passes directly to the
EDIT mode and the first record is displayed for data entry (see File
Manipulation - EDIT).  When data entry is complete, or finished
with at least, then pressing <Esc> will return control to the
primary menu, the file being saved automatically in the default
directory.


OPEN  A FILE

Upon selecton of the OPEN function, the highlight cursor drops
to the directory window where the cursor keys allow preselection of
a file for opening and use. Choice is confirmed with pressing <CR>.

      Once a file has been opened, the HEADER appears on screen and
you are given the option of changing it . The default is NOT to
change and a <CR> will progress into the secondary menu for file
manipulation. The file's name, size in records and the date it was
last updated appear on screen at top right.


FILE MANIPULATION

Once a file is opened, a secondary menu appears, allowing the
following options:

          Edit
          Browse
          Search
          Print
          Exit

      A choice is made by scrolling a yellow highlight bar with the
cursor keys and confirming with pressing <Enter>. The scrolling
wraps round from top to bottom and vice versa.


EDIT

'Edit' allows full feature editing of the file chosen. The
record defaults to REC. 1 upon entry to the edit mode. The record is
displayed on screen with the record number in the box at top right.
All data entry is by overtype and in free form, apart from the
dates. These require entry in the form mm/dd/yy and are
copperplated as such. The individual fields are delimited and
require a <CR> to end the entry.

      The 4 fields acting as index fields are highlighted in yellow.
They are 'Date', 'Contact', 'Doctor' and 'Diagnosis'. It is
suggested that entry into these fields has a consistent pattern,
although any form is accepted.

      Data entry is at the cursor using overtype mode. The fields are
of fixed length and once the cursor is at the end of the field, no
more entry is accepted. During data entry the following commands
are available for editing:

      The records may be paged by <Pg Up> and <Pg Dn> and entry added
or changed at any record and field shown on screen without having
finished with the first one. Thus any field of any record of the
opened file is accessible during the edit mode for data entry.


PRINT

'Print' allows printing of selected fields through each record
of the complete file. Individual record printing should be done
through the BROWSE mode. The output is in standard ASCII and
therefore should work with most printers.

      When the print function is called, the screen clears to a
summary of the record fields which may then be tagged in total or
ANY combination therof. All the records in that file will then be
printed according to the tagged fields.

      The default line count is 55, the program automatically adjusting
the number of records printed per page to prevent part records
being printed on seperate pages.


BROWSE

'Browse' allows viewing of individual records by flicking
through the available records in the currently open file using the
<Pg Up> and <Pg Dn> keys. Any record may be printed by calling up the
print function while viewing that particular record. Pressing
<Ctrl><PrtSc> calls up the print help screen allowing tagging of all
or some fields (see File Manipulation - PRINT).


SEARCH

'Search' is used to search the curently open file on one of the
index filds. Once selected, it prompts for the field in the next
window, which can be scrolled with the cursor keys. <CR> confirms
the choice. The screen changes to provide a window at the top of
the screen showing the four index fields of the current file
together with the name of the file, the record number and the index
field chosen. The index fields are then listed below this window
in four columns.

      By using the cursor to highlight a particular entry, all four
complete fields of that record are displayed in the top window,
together with the record number.


EXIT

'Exit' leaves the secondary menu and returns control to the primary
menu. The function is duplicated by pressing the <Esc> key.
#
                        NUTRITION

The body is a dynamic mechanism that is constantly undergoing
change and expending energy.  In order to continue to do so it
needs a supply of fuel and the raw material with which it builds
and repairs itself.  We provide those needs with the food we eat.
Although its metabolic process is very specific and complicated,
it is extremely tolerant and adaptable of the substrate it ingests.
It is because of this marvellous adaptability that we are sometimes
prone to forget the primary  cause behind our nutritional needs and
to abuse them.


NUTRITIONAL DATA

We hope, in this section, to try and restate those needs in a
clear, concise and unbiased manner.  The major components of food
are enumerated and classified into their seperate elements.  A
description of their place in the diet is given along with
individual data on each item.  Recommended allowances are presented
in a tabular form of both energy and substrate requirements.

     Other than presenting the sources and availability of each
element, the urge to present culinary advice has been specifically
resisted for the sake of clarity and to avoid bias.


STRUCTURE

The section is entered displaying the usual introduction
coupled with the main menu consisting of 8 items, of which 6 are
concerned with dietary components and 2 with tabular recommendations.
A choice is made by accessing with the cursor keys and confirming
with a <CR>.

      A secondary selection screen is presented, with a scrollable
highlight bar controlled by the cursor keys, detailing the
individual items available.  Pressing <CR> confirms the highlighted
choice, and introduces the final screen.  This now presents the
details of the chosen item and is scrollable with the cursor keys.

      Pressing <Alt><F10> returns control to the main menu whereas
pressing <backspace> returns one level to the secondary menu. The
dictionary, notepad and help screens are available throughout.


COMMAND KEYS

            <Alt><F1>.....Call up the relevant Help screen.
#
                                    GENETICS


It has been variously estimated that about 5 percent of
hospital admissions for children are due to genetic disease of one
form or another. Most people are aware of the more common ones such
as Down's Syndrome, or mongolism, which are purely genetic in
causation, but the spectrum of genetically acquired disease is, in
fact, much greater.  Diseases such as Diabetes Mellitus and
Schizophrenia also show a genetic diatheseis, although on a
different basis.

     Rather than simply present the individual diseases as a list,
this section has been structured to incorporate a tutorial based
upon a structural classification of inheritance.  Thus each disease
may be called up singly or a pathway may be followed with
accompanying text giving background information.

     As the Mendelian theory of inheritance underlies a large part
of genetic study, two graphically explanatory pages have been to
show the effects of Dominant and Recessive inheritance upon single
gene disorders.  These can be called up at any time through the
section.


STRUCTURE

The chapter contains over thirty genetically determined
diseases which are presented in two different ways on screen. The
first presentation is by a listing of all the diseases, from which
any one may be called up for examination. The second presentation
is through a classification of genetic problems introduced by a
tutorial format which explains the genetic background to the
problem.

      Upon entering the chapter on genetics, the main screen is
presented containing three windows. The large window on the right
contains the usual pre-section introduction.  Pressing <Alt><F10>
will initialise the main section and the top left window will then
show a menu. This menu allows access to the tutorial or to the
disease look-up table.  A choice is made by pressing <A>, <B>, <C>
for the tutorial, or <D> for the index list, and confirming the
choice with <CR>.

     The two explanatory pages can be called up from this point
onwards by pressing <Shift><F1>, further key presses toggling
between them, while pressing <backspace> will clear them.  The
<backspace> key will also act as a backup to return one step along
the chosen pathway.  Pressing <Esc> will, of course, return control
to the master menu, while <Alt><F3> initialises the dictionary and
<Alt><F5> initialises the notepad.  Pressing <Alt><F1> calls up the
relevant help screen.


DISEASE LIST

If the look-up table is selected with <D>, the bottom left
window will become active with a scrollable list of the available
disease descriptions. Scrolling with the cursor keys highlights a
name in yellow, and pressing <CR> confirms the choice.  The main
window then displays the selected disease.  All the descriptions
follow the same pattern with details of the genetic background, the
incidence of occurrence and a description of the disease itself.

      To return to the look-up table press <backspace>. Pressing
<F10> will return control to the initial menu, otherwise the scroll
keys will allow further choice in the table.


TUTORIAL

Pressing keys A, B, or C from the main menu will enter the
tutorial with the selected section.  The bottom left window keeps
track of the classification, while the right hand window displays
the appropriate explanatory text, which can be scrolled using the
cursor keys if necessary.  The top left window now displays further
nodes which are chosen by pressing the appropriate key.  To reverse
a step, press <backspace>.

      Once the appropriate disease groups themselves are shown in the top
left window, their individual display in the main window follows
the same form as in the look-up section.  There is, purposefully,
no direct entry from the tutorial to the main menu except by
backing up with pressing <backspace>.


GENETICS COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
                              OBESITY


Obesity appears to be a major side effect of living in an
affluent country where the variety and quantity of food is available
so freely. There is no single definition of what constitutes obesity
although the two most commonly used yardsticks are those of body
mass and the height/weight ratio.



BODY MASS

The body mass formula is derived from dividing the weight (in
kilograms) by the height squared (in metres). The acceptable range
of body mass is between 20 and 25, obesity being said to be present
above 27, gross obesity above 40.  The height/weight ratio is
derived from figures which associate the two parameters with the
lowest mortality rates.  The commonly accepted tables are derived
from figures published by The Metropolitan Life Insurance Company,
from statistics gathered in the United States.  The latter method
is used in this package.


OBESITY

Although the basic reason for obesity lies with an excessive
intake of calories over and above the body's needs for energy and
repair, other factors also play a part in the reason for one person's
obesity and not another's.

      The perceived self-image varies from person to person, and what
may rationally be a normal weight may, in fact, be regarded rather
differently by different people. The type of metabolism also varies
between people, thus an efficient metabolism may allow far more
intake of food than an inefficient one for the same gain in weight.
The metabolic rate may also vary in one person, thus if a fat
person diets, metabolism can slow down thus decreasing even further
the calories allowed for a specific weight loss.

      It is not enough to specify such and such a diet for such and
such a weight loss. The calorific intake and the amount of loss
engendered should be generated specifically for individual people.


OBJECTIVES

This section does not recommend any diet over another, other
than specifying a general guide to losing weight, as the authors feel
that a good diet for a particular person requires some customising
for each individual and may not be satisfactory for another. We
have tried, however, to provide clear information and a basis for
a greater understanding of the problem of obesity so that the
individual can approach the problem more rationally and with a
better informed attitude.


STRUCTURE

The overall structure is of a menu driven series of vignettes
detailing complications, associated factors and treatment of
obesity, together with a graphically presented height/weight
assessment of the presence of obesity, or the lack of it.

      The opening screen presents a menu with the four main sections
available. Choose by scrolling a highlight with the cursor keys.
Pressing <CR> confirms the choice.


WEIGHT TABLES

If the tables are selected, the screen changes to present a
number of windows including a male/female select. To continue, make
a choice with the cursor keys and confirm it with <CR>. The bottom
window then becomes active and displays a triple bar in three
colors. The top bar represents a small body frame, the middle one
a medium frame and the bottom one a heavy frame. The minimum and
maximum weights for that category can be read off the scales at top
and bottom.

      A number at the left of the scale gives a height in inches for
the corresponding weights. The height can be varied with the cursor
keys, the weight ranges being automatically updated. Pressing
<backspace> allows reselection of sex, while <Alt><F10> returns
control to the main menu.


FACTORS IN OBESITY

Choosing treatment, complications or associated factors results
in a secondary menu appearing, covering the subsections in that area.
The active selection in this menu is highlighted in cyan and can
be changed with the cursor keys. Pressing <CR> confirms the choice,
presenting the end screen with the selected text. <Backspace>
returns to the secondary menu, <Alt><F10> returns to the main menu.


OBESITY COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
                        MEDICAL ABBREVIATIONS


Medicine, like any other discipline with a language of its own,
is beset with abbreviations.  In some cases it prevents a boring
repetition of long and convoluted phrases, often highly technical
in nature, in others it allows the expediency of replacing rather
meaningless phrases with a mnemonic, while in others it seems as
if the only reason for its use is to hinder communication with the
outsider.

      This section avoids the initials and abbreviations of
non-medical, although associated, terms and concentrates mainly
upon derivations from the Latin vulgate which are probably far less
likely to be known.


STRUCTURE

The main screen is entered directly from the master menu and
the 'dictionary' commences with the character A.  The abbreviation
is given with its full meaning and, where appropriate, the Latin
derivative.

      The screen can be scrolled by single entries with the cursor
keys, paged alphabetically with the Pg Up/Pg Dn keys or entered
alphabetically by pressing <S> and the character required.  The
dictionary, notepad and help screens are available  as usual.


ABBREVIATION COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
                        DISEASE LIBRARY



The Disease Library is a comprehensively cross referenced
index of over 400 individual descriptions contained in a 620 entry
library.

      Unlike an index, however, the library will allow almost
immediate access to each disease entry, extracting and displaying the
relevant disease on screen.  Floppy disc users are prompted for the
relevant disc to insert into drive B, whilst a hard disk usually
extracts and displays the relevant disease almost instantaneously.


STRUCTURE

Entry into the section is effected directly into the main
screen. A large window contains the various library entries which
scroll singly with the cursor keys, and page alphabetically with
use of the Pg Up/Pg Dn keys.

      The reference window automatically displays some details of
the entry, under the cursor, showing the main section and the
subsection of the disease source for reference. Thus the correct
section of the package may also be referenced to identify the
context in which the disease is originally described.

      Choice is made with pressing <CR>, whereupon the bottom
window displays the chosen disease as a cross check, and, if using
floppies, asks for the relevant disc to be inserted into Drive B.
The window at middle right also displays current information and
instructions.

      A further <CR> confirms the choice and the disease is extracted
from the correct section and displayed on screen with scrolling
enabled.  Pressing <backspace> returns control to the library.


LIBRARY COMMANDS

            <Alt><F1>.....Call up the relevant Help screen.
#
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