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Introduction: The WHO has qualified stress as a 'world epidemic' due to its increasingly greater incidence on health. The work described in this paper represents an attempt to objectively quantify the level of stress., Aim: The aim of the method developed here is to measure how close or how far a subject is from a situation that can be considered 'normal' in medical and social terms., Subjects and Methods: The literature on the pathophysiology of stress and its methods of study in experiments on both animals and humans was reviewed. Nine prospective observational studies were undertaken with different types of subjects and stressors covering the different types of stress., Results: The results of the literature review made it possible to identify the different types of stress, the indicators that yield significant results, the psychometric tests and the well-documented 'stressors'. This material was then used to design the general method and the details of the nine clinical trials. The preliminary results obtained in some of the studies were used to validate the indicators as well as the efficacy of the techniques used experimentally to diminish stress or to produce it., Conclusions: The early results obtained in the experimental trials show that we are on the right path towards defining and validating multivariable markers for quantifying levels of stress and also suggest that the method can be applied in a similar way to the study of mental disorders.

The AEDMI project, carried out in the Bellvitge University Hospital, near Barcelona, is proposed as an example of clinical decision system prototype development. Several difficulties have been encountered to develop this project. One of them was to find the adequate understanding for the project and proper funding for personnel resources. The support by FIS grants and from the hospital structures was essential to the survival of the project; however the resources always have been below the real needs for development. The difficulties with clinical coding systems, the excessive expectancies upon prototypes, and the lack of culture in information methods were other relevant hinders. The complexity of clinical realm, the uncertainty of medical decisions, and the current trends to substitute the clinical information by data obtained from electronic devices, or analytical monitoring of patients, are additional problems for clinical information managing.

Background: The methods and characteristics of clinical data gathered at the initial steps of development of a computerized system to aid medical diagnosis are reported. The objectives of the study were as follows: to describe the overall method and to set a framework for developing an intellectual model of the medical diagnosis procedure., Material and Methods: A structured medical interview and physical examination using an informatic program on PC compatible portable computers were completed in a sample 1,238 patients attending the outpatient clinics of our institution. Data obtained were compared with information in the patient's medical record taking as reference pattern the record of physicians in charge of the patients. Diagnosis were codified according to WHO International Classification of Diseases (ICD-9-CM)., Results: The distribution of symptoms and signs corresponding to the different organs and systems was analyzed. Each subdivision afforded a range of 1.3 to 3.9 abnormal findings per patient. A total of 3,571 diagnoses were codified for the whole group 1,238 patients with a mean (standard deviation) of 3 (2) diagnoses per patient (range 0-12). The distribution of diagnostic groups varied depending on the consideration of the main diagnosis or the concomitant diagnoses that defined the patient's clinical context. The most frequent main diagnoses included tumors, cardiovascular diseases, gastrointestinal disorders, and genitourinary tract diseases., Conclusions: As shown by results obtained in a sample of 1,238 patients, there is a very complex situation in clinical practice due to the simultaneous occurrence of several clinical patterns. This finding should be taken into account when developing clinical decision making support systems. The use of a structured medical interview or a structured and standard medical visit may be an adequate tool to clarify this matter and to contribute to standardization of clinical concepts and situations.

Some considerations are made on the importance of clinical, information and its transcendence in medical research, as well as on the ethical value of a qualitatively correct data treatment. After describing by means of a bibliographical search, the present-day tendency towards knowledge based systems, there is offered a general overview of clinical information management, from data collection through study design and statistical assessment, up to the building of a knowledge data base.