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PubMed2000

Toward an information society for all: challenges in health telematics.

In the emerging information society each hospital is supposed to become a node of a complex networked information system that has to be accessible to a variety of users. These include doctors, nurses, administrators and the patients themselves, whose role is briefly described. This asks for a new approach to the implementation of the interfaces of the information system, which are used to carry out different tasks by people with different interests and computer literacy. A new approach to the implementation of such interfaces, based on the concepts of User interfaces for All, is briefly outlined, describing the scientific and technical achievements in some projects partially funded by the European Commission and the activities of the International Scientific Forum "Towards an Information Society for All" set-up to discuss and promote the relevant scientific concepts and technical issues.

Hospital Information Systems↗
PubMed2001

Computer assisted learning. A review.

Since 1980 the amount of medical information has doubled approximately every second year. This implies that oral health students as well as professionals need to manage the flow of information rationally, in order to learn how to undertake evidence-based decision-making for diagnosis and treatment in a given patient situation. Current research indicates that computer connected databases and computer assisted learning (CAL) may enhance learning and provide the clinician with information for decision-making when treating patients. Multimedia for CAL, which combines audio and visual data in an interactive form, has proved to be an effective tool in education. CAL may supplement and reinforce more traditional learning and create opportunities to illustrate clinical situations in an interactive way. CAL has the potential to help students develop skills and knowledge. Students, staff and professionals consider CAL stimulating and motivating. Students easily adapt to CAL although their current computer literacy is still low. New authoring tools make it easier for faculties to develop their own CAL software. In the future we will see more sophisticated software with virtual patients who can communicate and interact with the student in a very realistic way. The software will even "step out" from the screen and help the student with clinical procedures. However, at present CAL should not replace traditional education, but rather be used more as a supplement and for self-directed studies.

Attitude↗
PubMed2001

Neurological teleconsultation for general practitioners.

A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.

Adolescent↗
PubMed2003

Delivering consumer health information digitally: a comparison between the web and touchscreen kiosk.

Employing survey and web log data the study presented here compares the use and users of two digital health information platforms geared toward consumers-web-sites and touchscreen information kiosks. The kiosks featured are those supplied by InTouch With Health and the web-site is surgerydoor (some analysis of NHSDirect Online is also supplied). Problems of making direct comparisons between the two platforms are discussed and comparative figures provided. The two platforms were compared using the following metrics: page view time, session duration, number of sessions conducted, pages viewed per session, and topic/subject of pages viewed. Possible reasons for the differences between the two platforms are discussed, including the environment in which they are housed, the proximity of the platform to the user, the specific purpose of the individual platform, the different audiences served, the extent of delegation, the computer literacy of the audiences served, the quantity and comprehensiveness of the platform's information, and user's perceptions of authority. The research reminds and informs web-site and kiosk designers of the different audiences that they serve. The work reported here forms part of a Department of Health funded study which is evaluating digital health information provision to the consumer, in particular the use and impact of more than seventy heath kiosks located in all kinds of locations throughout the United Kingdom.

Community Participation↗
PubMed2004

AutoTutor: a tutor with dialogue in natural language.

AutoTutor is a learning environment that tutors students by holding a conversation in natural language. AutoTutor has been developed for Newtonian qualitative physics and computer literacy. Its design was inspired by explanation-based constructivist theories of learning, intelligent tutoring systems that adaptively respond to student knowledge, and empirical research on dialogue patterns in tutorial discourse. AutoTutor presents challenging problems (formulated as questions) from a curriculum script and then engages in mixed initiative dialogue that guides the student in building an answer. It provides the student with positive, neutral, or negative feedback on the student's typed responses, pumps the student for more information, prompts the student to fill in missing words, gives hints, fills in missing information with assertions, identifies and corrects erroneous ideas, answers the student's questions, and summarizes answers. AutoTutor has produced learning gains of approximately .70 sigma for deep levels of comprehension.

Algorithms↗
PubMed2006

[Medical informatics education at medical schools in Bosnia and Herzegovina].

AIM: Standardization of education process and almost every aspect of life in EU moved the authors of this paper to evaluate medical informatics education at medical schools in Bosnia and Herzegovina. A very complex political structure and existence of two entities, one district and ten cantons in the Federation of Bosnia and Herzegovina caused great differences in the curricula, teaching methods and quality of acquired knowledge among medical schools in the country. Also, on the example of the teaching process at the Medical School, University of Sarajevo, the authors propose a future united and integrated system in the area. METHOD: Method of the study is descriptive, comparing education in medical informatics at five B&H medical schools. Over 500 students answered questionnaires designed at medical schools in Sarajevo and Tuzla. The questions tackled the contents of the subject of medical informatics, the possibility of acquiring knowledge from both practical and theoretic lessons, "good" and "bad" sides of the curricula as well as students' computer literacy. RESULTS: The subject of medical informatics is being taught in at least 3-4 different ways. Medical schools in Banja Luka and Foca/Srbinje are under a strong influence of the University of Belgrade, Serbia and Montenegro; the teaching staff in Mostar are from Croatia; the University of Tuzla has its own way; and Medical School in Sarajevo maintains high quality values and principles. Things and events that distinguish the Medical School, University of Sarajevo is the fact that it is the only medical school in Bosnia and Herzegovina which has a web site of of the Department of Medical Informatics, organized a number of events including a distance learning course, and has a highly competent teaching staff. Medical School in Sarajevo is the oldest medical school in Bosnia and Herzegovina established in 1944. As a required subject, medical informatics was introduced in the academic year 1992/1993, and it is the only medical school in Bosnia and Herzegovina where medical informatics is taught in two semesters, second and eleventh. DISCUSSION: Three important areas are discussed: the quality of education in secondary schools should be improved; the lack of multimedia equipment, good LAN, high-speed connection to Internet and well organized web design, and issues related to maintenance of equipment; and students should have free access to computer rooms to enable them to extend their knowledge in spare time; general information about health system should be available to students to allow them to require the role and importance of medical informatics in "real life". Naturally, we raise the question of unique and systematic medical informatics education in the whole country, irrespective of entities, nationality or religion of students. CONCLUSION: Medical informatics education at Medical School, University of Sarajevo, is based on the same concept as on prestigious universities all over the world and in accordance with recommendations of the working groups on education of EFMI and IMIA. Other medical schools in Bosnia and Herzegovina should employ the same methodology and system of work in order to have standardized education in medical informatics and to achieve high quality in education. To enable us to follow the European and global achievements in this area, the power of fact should predominate in the education system as well as in the health system.

Bosnia and Herzegovina↗
PubMed1994

Education review: applied medical informatics--informatics in medical education.

The importance of informatics training within a health sciences program is well recognized and is being implemented on an increasing scale. At Chicago Medical School (CMS), the Informatics program incorporates information technology at every stage of medical education. First-year students are offered an elective in computer topics that concentrate on basic computer literacy. Second-year students learn information management such as entry and information retrieval skills. For example, during the Introduction to Clinical Medicine course, the student is exposed to the Intelligent Medical Record-Entry (IMR-E), allowing the student to enter and organize information gathered from patient encounters. In the third year, students in the Internal Medicine rotation at Norwalk Hospital use Macintosh power books to enter and manage their patients. Patient data gathered by the student are stored in a local server in Norwalk Hospital. In the final year, we teach students the role of informatics in clinical decision making. The present senior class at CMS has been exposed to the power of medical informatics tools for several years. The use of these informatics tools at the point of care is stressed.

Attitude to Computers↗
PubMed1995

The availability of health information in South Africa.

The South African Medical Research Council (MRC) has provided access to on-line health and biomedical information since 1976, when the MRC became an international partner of NLM. This was done to support research and health care when the Institute of Biomedical Communication was established. The institute has since reorganized and is now the Information Systems Division in the Research Systems Support Group MRC. he MRC and medical libraries in South Africa are able to access various automated services via telecommunication. The major systems available are MEDLARS, DIALOG, DATASTAR and BRS, with ECRI being the latest addition; most used are MEDLARS and DIALOG. New technologies (e.g., CD-ROM) have given more people access. This technology is not available to many people working in Primary Health Care (PHC), as they do not have access to computer networks. Beyond on-line is statistical and printed information, called "Gray Literature," not accessible through on-line systems as it is not published in conventional sources used to build databases. With a shift to Essential National Health Research and the focus on PHC and preventative medicine, demand for health information and "gray literature" is growing. The MRC collects and produces this material and has its own database called SAMED, which is to be made available to others as our contribution to health. It is hoped to make this available for inclusion in the proposed African Index Medicus presently investigated by the World Health Organization. Africa as a continent, and South Africa as a country, are experiencing major changes in health care and medical practice, and inevitably, provision of health information services. With South Africa's re-entry into the global village and its acceptance by the rest of Africa, it can be a key player in information provision to the rest of the continent. The MRC, as a major provider of Health information, can play a vital role in the information flow throughout Africa by continuously improving and expanding its services. A large proportion of South Africans live in rural areas where health care is provided by clinics not linked to information networks. This does not mean these clinics are excluded from the use of information. The major challenge is to find the ways and means of getting the relevant information to these clinics. Information is needed to help with patient care and continuing education. With this in mind, the MRC is evaluating different formats in which information can be supplied. Due to the lack of computer literacy, facilities, and financial constraints, it is better to supply printed information. With the spread of technology through the country and continent, it can be assumed that information flow and transfer will be more rapid. Repackaging of information means that it is possible to get the relevant information to the right people at the right time. The first such package developed is for hospital managers. With the help from experts in the field of PHC, it is hoped to develop packages aimed specifically at the CHWs and other workers in the field. All packages developed by the MRC are backed by a document provision service, using the most cost-effective route to obtain documents. A printed product must comply with certain criteria; these are: 1) purpose for which the information is needed; 2) kind of information needed and the format in which it is needed; 3) when the information is needed; 4) is the information to be supplied on an ongoing basis i.e., updated with latest information; 5) cost involved; and 6) how to get the information to the relevant user.

Computer Communication Networks↗
PubMedDate not supplied

The initial RNF research survey: rehabilitation nursing research interests of ARN members.

The data from this survey provide baseline information for comparison with subsequent surveys. Respondents to this initial survey demonstrate involvement in research activities, primarily for the direct improvement of care. Findings from the data suggest that the research climate is right for collaborative efforts between rehabilitation nurses caring directly for clients and nurses with research degrees to conduct multisite research projects and to encourage enhanced research preparation, including computer literacy, for nurses at the graduate level.

Attitude of Health Personnel↗
PubMed1990

Computerization of plateletpheresis quality control records with a commercially available spreadsheet program.

Many apheresis units lack the resources to acquire customized computer software for record keeping. We have adapted a commercially available "spreadsheet" program (Lotus 1-2-3) to aid in quality control activities for plateletpheresis. Data are entered in a grid pattern wherein each donation occupies one row and successive columns contain numerical data derived from the donation. The last two columns contain formulas that calculate yield and collection efficiency from values entered in preceding columns. The program runs on an IBM PC or equivalent with 512 K RAM; the combined cost of a computer and software is currently under $2,000.00. Data entry requires fewer keystrokes per record than computation of yield and efficiency with a calculator, and creates an inclusive permanent record for future analysis. Data sorting and statistical functions allow rapid identification of incomplete records, and derivation of average platelet yield and/or collection efficiency for any time period of interest. The program also facilitates determining the proportion of donations that fall below any chosen cutoff. Performance characteristics of a particular instrument or operator can be assessed easily by isolating the pertinent records and analyzing them separately. The system will thus accomplish a variety of quality control activities, including those mandated by licensing agencies. It can be implemented by apheresis personnel with limited "computer literacy" and is superior to manual tabulation of quality control data in both ease of data entry and facility of analysis.

Data Interpretation, Statistical↗
PubMed2004

[Disease-oriented Internet use in outpatients with inflammatory rheumatic diseases].

OBJECTIVE: On behalf of the "systemic inflammatory rheumatic diseases network" comprehensive, nationwide horizontal and vertical cross-linking of research and care is to be developed for the first time. The quality of scientific work and patient care is to be increased in the medium term through this improved communication and co-operation. Our objective was to determine what hardware and software are available to the patients involved, with a view to the Internet being used as a basis for communication. The ultimate aim was to provide patients with an adequate source of information on care. METHODS: A survey was carried out among 400 patients attending our outpatient clinics. Data on the hardware and software used and on Internet access and patterns and degree of utilization were collected using a unilateral questionnaire. RESULTS: 326 patients filled in the questionnaire. 163 of those responding had Internet access, with younger and better educated patients using the Internet significantly more frequently. No dependency was noted on gender or marital status. Mean time duration for Internet use was longer in men. 55.8% of the internet users searched for medical questions. Major search topics included up to date therapeutic options (46.6%) and information on specific diseases (28.8%). CONCLUSION: Internet is an important information medium for patients. Technical requirements and high motivation make communication practicable for about 50% of patients. To ensure acceptance, the Internet platform of the systemic inflammatory rheumatic diseases network needs to be aligned to patients' requirements, bearing in mind the need for extensive high-value, reliable scientific information to be offered on the website.

Adult↗
PubMed1996

Human interaction with technology: the accidental user.

Information technology is part of a growing number of applications in work and everyday life. It seems inevitable that the average person soon will have to interact with information technology in many ways, even when there is no desire to do so. Examples include finding a book in a library, personal financial transactions, the health sector, traffic and transportation, process control, etc. People who in this way are forced to interact with information technology shall be called accidental users. The accidental users poses a particular challenge to the design of technological artefacts because the disciplines of dealing with human-machine interaction are predicated on the assumption that users are motivated and have a minimum level of knowledge and skills. In particular, models of 'human error' and human reliability implicitly assume that users are benign and only fail as anticipated by designers. In this paper we investigate the extent to which current models of human erroneous actions and cognitive reliability can be used to account for interactions between accidental users and technology.

Attitude to Computers↗
PubMed1995

Biomechanics for preoperative planning and surgical simulations in orthopaedics.

Surgical simulations are particularly appropriate for the large volume and expense of joint replacement procedures in orthopaedics. A first generation surgical simulator has been developed to model the implantation procedure for cementless acetabular and femoral components in total hip replacement surgery. The simulator is based upon finite element analysis and predicts the early postoperative mechanical environment that results from a proposed surgery. Since the short- and long-term clinical success of cementless hip replacement components is very dependent upon the initial mechanics of the bone-implant system, such simulations can help orthopaedic surgeons to develop better preoperative plans.

Biomechanical Phenomena↗
PubMed2004

Health informatics education for clinicians and managers--what's holding up progress?

This paper reports outcomes of a national survey of health informatics (HI) education and training carried out in the UK. A questionnaire to elicit details of HI and IT skills teaching was derived from a national consensus document (Learning to Manage Health Information, LtMHI). Forms were sent to all pre-qualification medical and nursing schools and to a stratified sample of postgraduate and post-registration programmes. Three case studies were carried out in acute hospital trusts to gain insight into opportunities for continuing professional development in health informatics and IT. Our evidence suggests that in the UK, health informatics is not yet integrated into the clinical curriculum. Nearly all the pre-qualification courses made some provision for teaching IT skills. Nonetheless, many respondents felt that students did not receive sufficient training. There was considerable variation in the amount of HI teaching provided in the different educational sectors. The case studies suggested very little HI training was provided for clinical staff and take-up of provision was not monitored. A number of factors are holding up progress, the most important being a lack of staff with the knowledge and skills to provide academic leadership. The paper outlines some steps that need to be taken to ensure health informatics is embedded in all clinical curricula.

Computer Literacy↗
PubMed2004

An exploration of four web-based open and flexible learning modules in post-registration nurse education.

UNLABELLED: This paper presents an exploratory evaluation of four newly developed web-based modules for post-registration nurses. The topics for the modules were: dermatology; diabetes; mentorship; and prescribing. STUDY OBJECTIVE: To explore the students' perceptions of the web-based modules before and after completing the modules. DESIGN: A pre-post test design using questionnaires and group interviews. PARTICIPANTS: 39 students enrolled on the modules, pre-module data were collected on 74% (n = 29) and post-module data on 71% (n = 28). None of students had previous web-based education experience. 79% (n = 31) completed and 66% (n = 26) passed the modules. Students level of IT skills prior to commencing the modules were important in explaining module completion and outcome. The modules were rated highly in terms of achieving learning outcomes with moderate ratings for level of support and utility of learning materials. The content analysis of the interviews highlighted the importance of preparing students ensuring they have the IT and independent learning skills necessary to participate in web-based learning programmes, together with a number of issues relating to the accessibility of the learning materials. The perceived benefits of this mode of learning were that they offered flexible and resource rich learning. The downside was that the learning can be isolating. CONCLUSIONS: This form of learning may not be suited to all groups of nurses or all educational topics. Further research is required to establish the educational benefits of different approaches to e-learning.

Adaptation, Psychological↗
PubMed2006

Knowledge work in nursing and midwifery: an evaluation through computer-mediated communication.

Recent changes in policy and culture require health workers to incorporate "knowledge work" as a routine component of professional practice. Innovative computer-mediated communication technologies provide the opportunity to evaluate the nature of "knowledge work" within nursing and midwifery. This study embedded an online discussion system into an acute NHS Trust to support interaction within communities of practice. The complete record of online communications was analysed. Nurses were found to predominantly engage in information work with knowledge work restricted to senior-to-senior level exchanges. In contrast, midwives were observed to employ the technology to support knowledge work between all grades. The study indicates that technology can support knowledge work, including conveying tacit knowledge effectively.

Acute Disease↗
PubMed2005

The experience of nursing students in an online doctoral program in nursing: a phenomenological study.

The increased sophistication of technology has led to greater use of distance learning, providing graduate nursing students with increased access to such programs, while more easily maintaining employment. Little information is available regarding the experience for those students enrolled on these programs. This information would be of value to both those who are considering online courses, and to those who are charged with developing and teaching these courses. A phenomenological approach was used in order to examine the experience of five students enrolled in an online doctoral program in nursing in the United States. Verbatim transcripts were analyzed for themes from which three main ones emerged as the essence of the experience: considering the fit, liking the fit, and making it fit. Recommendations are provided for future research pertaining to distance education, particularly in the form of graduate outcomes.

Adaptation, Psychological↗