 In 1801, Joseph Marie Jacquard, a French weaver and merchant, made an improvement to the textile loom, a device used to weave cloth. This is by introducing a series of punched paper cards (“IBM/Hollerith card”), a piece of stiff paper that contains digital information represented by the presence or absence of holes in predefined positions, as a template which allowed his loom to weave intricate patterns automatically. The resulting Jacquard loom was an important step in the development of computers because the use of punched cards to define woven patterns can be viewed as an early, albeit limited, form of programmability. It was the fusion of automatic calculation with programmability that produced the first recognizable importers. In 1837, Charles Babbage, FRS, an English mathematician, philosopher, inventor and mechanical engineer, originated and designed the concept of a programmable mechanical computer, built from mechanical components such as levers and gears, rather than electronic components--his analytical engine. Limited faces and Babbage’s inability to resist tinkering with the design meant that the device was never completed--nevertheless his son, Henry Babbage, completed a simplified version of the analytical engine’s computing unit (the “mill”) in 1888. He gave a successful demonstration of its use in computing tables in 1906. In 1910, this machine was given to the Science museum, one of the three major museums on Exhibition Road, South Kensington, London, in the Royal Borough of Kensington and Chelsea.In the late 1880s, Herman Hollerith, an American statistician who developed a mechanical tabulator based in punched cards to rapidly tabulate statistics from millions of pieces of data, invented the recording of data on a machine-readable medium. Earlier uses of machine-readable media had been for control, not data. “After some initial trials with paper tape, he settled on punched cards...”; punched/perforated paper tape is a form of data storage, consisting of a long strip in which holes are punched to store data. To process these punched cards he invented the tabulator, or “tabulating machine,” an electrical device designed to assist in summarizing information and, alter, accounting; and the keypunch machines, devices used for the purpose of entering data onto punch cards by precisely punching holes in the cards at specific locations as determined by the keys struck by the operator. These three inventions were the foundation of the modern information processing industry. Large-scale automated data processing of punched cards was performed for the Eleventh United States Census, taken June 2, 1890, by Hollerith's company, which later became the core of IBM, or the “International Business Machines Corporation,” an American multinational technology and consulting corporation, with headquarters in Armonk, New York, United States. By the end of 19th century, a number of ideas and technologies, that would later prove useful in the realization of practical computers, had begun to appear: Boolean algebra (or “Boolean logic”), a logical calculus of truth values, developed by George Boole in the 1840s; the vacuum tube (“electron tube” (North America), “thermionic valve,” or “valve”) which in electronics is a device controlling electric current through a vacuum in a sealed container; punched cards and tape; and the teleprinter (“teletypewriter,” “Teletype” or “TTY”), an electro mechanical typewriter that can be used to send and received typed messages from point to point and point to multipoint over various types of communications channels. See: Internet On Satellite Broadband
 In clinical practice, doctors personally assess patients in order to diagnose, which refers both to the process of attempting to determine or identify a possible disease or disorder (and diagnoses in this sense can also be termed (medical) “diagnostic procedure”), and to the opinion reached by this process (also being termed (medical) “diagnostic opinion”), treat, and prevent disease using clinical judgment.The doctor-patient relationship, central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease, typically begins an interaction with an examination of the patient’s medical history, or “anamnesis” of a patient, the information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called “heteroanamnesis”), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient; and medical/health record/chart, the systematic documentation of a single patient’s medical history and care across time within one particular health care provider’s jurisdiction.
The second step is a medical interview and a physical/medical/clinical examination (more popularly known as a “check-up” or “medical”), the process by which a doctor investigates the body of a patient for signs of disease. Basic diagnostic medical devices, or instruments, apparatuses, implants, in vitro reagents, or similar or related articles that is used to diagnose, prevent, or treat disease or other conditions, and does not achieve its purpose through chemical action within or on the body (which would make it a medicine), are typically used; e.g. stethoscope, an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body, and tongue depressor, a device used in medical practice to depress the tongue to allow for examination of the mouth and throat.
After examination for (medical) signs--an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination or by a clinical scientist by means of an in vitro examination of a patient--and interviewing for symptoms, a departure from normal function or feeling is noticed by a patient, indicating the presence of disease or abnormality, the doctor may order medical tests, a kind of medical procedure to detect, diagnose, or monitor diseases, disease processes, susceptibility, and determine a course of treatment (e.g. blood tests, a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via finger prick); take a biopsy, a medical test commonly performed by a surgeon or an interventional radiologist involving sampling of cells or tissues for examination; or prescribe pharmaceutical drugs/medicine/medication, loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention or disease, or other therapies.
Differential diagnosis methods (sometimes abbreviated “DDx,” “ddx,” “DD,” “D/Dx,” “or “ΔΔ”), a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible (and the process may be termed “differential diagnostic procedure”), and may also refer to any of the included candidate alternatives (which may also be termed “candidate condition”), help out to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Followups may be shorter but follow the same general procedure.
The components of the medical interview and encounter are:
- Chief complaint (cc): the reason for the current medical visit. these are the ‘symptoms.’ They are in the patient’s own words and are recorded along with the duration of each one. Also called ‘presenting complaint.’
- HPI or History of present illness/complaint (sometimes referred to as “ill-health” or “ailment”), a state of poor health: the chronological order of events of symptoms and further clarification of each symptom.
- Current activity: occupation, hobbies, what the patient actually does.
- Medications (Rx), also referred to as “pharmaceutical drug” or “medicine,” loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease: what drugs the patient takes including prescribed, over-the-counter (OTC, medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription; and home remedies (a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items), as well as alternative and herbal medicines/herbal remedies (“herbalism,” the study and use of medicinal properties of plants). Allergies, or the hypersensitivity disorder of the immune system, are also recorded.
- Past medical history (PMH/PMHx): concurrent medical problems; past hospitalizations and operations; injuries; past infectious diseases, also known as “transmissible diseases” or “communicable diseases,” comprising clinically evident illness (i.e., characteristic medical signs and/or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism; and/or vaccinations, or the administration of antigenic material (a vaccine) to stimulate an individual's immune system to develop adaptive immunity to a pathogen; history of known allergies.
- Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet (which in nutrition is the sum of food consumed by a person or other organism), medications, tobacco smoking (the practice of burning tobacco and inhaling the resulting smoke consisting of particle and gaseous phases), alcohol).
- Family history (FH), which in medicine consists of information about disorders from which the direct blood relatives of the patient have suffered: listing of diseases in the family that may impact the patient. A family tree, or pedigree chart, a chart representing family relationships in a conventional tree structure, is sometimes used.
- Review of systems (ROS) or “systems inquiry”: a set of additional questions to ask, which may be missed on HPI; a general enquiry (have you noticed any weight loss, change on sleep quality, fevers, lumps and bumps? etc.), followed by questions in the body's main organ systems--the human heart, an organ that provides a continuous blood circulation through cardiac cycle and is one of the most vital organs in the human body; the human lungs, the organs of respiration in humans; the human gastrointestinal/digestive tract, the stomach and intestine, sometimes including all the structures from the mouth to the anus; the urinary tract/renal system, the organ system that produces, stores, and eliminates urine; etc.
The physical/medical/clinical examination (more popularly known as a “check-up” or “medical”) is the process by which a doctor investigates the body of a patient for signs of disease: ‘symptoms’ are what the patient volunteers, while ‘signs’ are what the healthcare provider detects by examination.
The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell; e.g., in infection, uremia/uraemia (a term used to loosely describe the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ), diabetic ketoacidosis (a potentially life-threatening complication in patients with diabetes mellitus). Taste has been made redundant by the availability of modern lab tests.
Four actions are taught as the basis of physical examination: inspection, which in medicine, is the through and unhurried visualization of the client; palpation (feel), used as part of a physical examination in which an object is felt (usually with hands of a healthcare practitioner) to determine its size, shape, firmness, or location; percussion (tap to determine resonance characteristics), a method to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen; and auscultation (listen), or the term for listening to the internal sounds of the body, usually using a stethoscope. This order may be modified depending on the main focus of the examination (e.g., a joint may be examined by simply “look, feel, move.” Having this set order is an educational tool that encourages practitioners to be systematic in their approach and refrain from using tools such as the stethoscope--an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body--before they have fully evaluated the other modalities).
The clinical examination involves study of:
- Vital signs including height, weight, body temperature, blood pressure (BP; sometimes referred to as “arterial blood pressure,” the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs), pulse (in medicine, it represents the tactile arterial palpation of the heartbeat by trained fingertips), respiration rate, hemoglobin oxygen saturation/dissolved oxygen (DO; a relative measure of the amount of oxygen that is dissolved or carried in a given medium)
- General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or nail clubbing, which in medicine, is a deformity of the fingers and fingernails associated with a number of diseases, mostly of the heart and lungs)
- Human skin, the outer covering of the body
- Head, eye, ear (the organ that detects sound), nose, and throat--HEENT
- Cardiovascular, or the circulatory system, an organ system that passes nutrients (such as amino acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to help fight diseases, stabilize body temperature and pH, and to maintain homeostasis: heart, a hollow muscle that pumps blood throughout the blood vessels by repeated, rhythmic contractions; and blood vessels, the part of the circulatory system that transports blood throughout the body
- Respiratory, or the respiratory/ventilatory system, the biological system of an organism that introduces respiratory gases to the interior and performs gas exchange: large airways and lungs, the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails
- Abdomen, in vertebrates such as mammals, constitutes the part of the body between the thorax (chest) and pelvis; and rectum, the final straight portion of the large intestine in some mammals, and the gut in others
- Genitalia (and pregnancy if the patient is or could be pregnant)
- Musculoskeletal system (including spine and extremities; also known as the “locomotor system”), an organ system that gives animals (and humans) the ability to move using the muscular and skeletal systems
- Neurological, medical specialty dealing with disorders of the nervous system: consciousness; awareness; brain; vision; cranial nerves, or nerves that emerge directly from the brain, in contrast to spinal nerves, which emerge from segments of the spinal cord; spinal cord; and the “peripheral nervous system” (“PNS,” or occasionally “PeNS”), consisting of the nerves and ganglia outside of the brain and spinal cord
- Psychiatry, the medical specialty devoted to the study and treatment of mental disorders: orientation; mental status examination (USA), or “mental state examination” (rest of the world), abbreviated “MSE,” an important part of the clinical assessment process in psychiatric practice; evidence perception or thought
It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.
A medical/clinical laboratory, a laboratory where tests are done on clinical specimens in order to get information about the health of a patient ads pertaining to the diagnosis, treatment, and prevention of disease; and imaging studies (“medical imaging”), the technique and process used to create images of the human body (or parts and function thereof) for clinical purposes (medical procedures seeking to reveal, diagnose, or examine disease) or medical science (including the study of normal anatomy and physiology), results may be obtained, if necessary.
The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses; sometimes abbreviated “DDx,” “ddx,” “DD,”” D/Dx,” or ΔΔ), a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible (and the process may be termed “differential diagnostic procedure”), and may also refer to any of the included candidate alternatives (which may also be termed “candidate condition”); along with an idea of what needs to be done to obtain a definitive diagnosis that would explain their patient’s problem.
The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation; a laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurements may be performed. Follow-up may be advised.
This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results, or specialist consultations.See: NewSat's Internet From Satellite
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