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PubMed2003

Using patient-driven computers to provide cost-effective prevention in primary care: a conceptual framework.

This paper initially presents a rationale for the cost-effectiveness of using patient-driven computers in primary care services. It specifically defines the concepts of prevention and primary care, prior to outlining the advantages of promoting the implementation of prevention practices in primary care. It argues that greater use of computer technology represents one means of cost-effectively optimizing the integration of prevention into routine primary care, and identifies an apparent disjuncture between the potential of computers and the limited success with which attempts to integrate them into routine primary care services have been met, as evidenced in the published international literature. Among several possible explanations for this disjuncture, such as a possible lack of precision with which computers identify at-risk patients, perceived high costs associated with computers and physicians' concerns about the inflexibility and the more impersonal nature of computer interactions, is the apparent failure of researchers to utilize well designed and empirically tested models in the planning, implementation and evaluation of computerized care. An outline for such an approach, utilizing the Precede-Proceed model of health promotion planning and the Diffusion of Innovations theory, is presented.

British Columbia↗

PubMed2000

Comparison of computer-assigned Minnesota Codes with the visual standard method for new coronary heart disease events.

The Minnesota Code is the most widely used electrocardiogram (ECG) classification system for epidemiologic studies and has been incorporated into several Computer algorithms. The authors compared the Modular ECG Analysis System (MC-MEANS) and NOVACODE computer ECG findings with the Visual coding standard for agreement and prognostic associations with coronary heart disease (CHD) events occurring during follow-up from 1987 to 1995 in 2,116 individuals participating in the Atherosclerosis Risk in Communities (ARIC) Study. The exact agreement between Visual and computer findings was greater than 90% for all Minnesota Code categories except Q-code, which was 77% for MC-MEANS and 81% for NOVACODE. Approximately 60% of all Q-codes were assigned by computer methods only. Among the 2,116 participants, there were 246 (11.6%) new coronary events. Unadjusted relative risks for codes assigned by the three methods were similar. When computer methods disagreed on code severity, the CHD occurrence rates for MC-MEANS-detected severer code versus NOVACODE-detected severer code were 21% and 7%, respectively. This study provides clear evidence that computers assign more and severer Minnesota Codes with similar prognostic importance as does the Visual method; it also alerts researchers to potential problems in pooling Minnesota Code data read by different methods.

Algorithms↗

PubMed1988

Computer-aided personal interviewing. A new technique for data collection in epidemiologic surveys.

Most epidemiologic studies involve the collection of data directly from selected respondents. Traditionally, interviewers are provided with the interview in booklet form on paper and answers are recorded therein. On receipt at the study office, the interview results are coded, transcribed, and keypunched for analysis. The author's team has developed a method of personal interviewing which uses a structured interview stored on a lap-sized computer. Responses are entered into the computer and are subject to immediate error-checking and correction. All skip-patterns are automatic. Data entry to the final data-base involves no manual data transcription. A pilot evaluation with a preliminary version of the system using tape-recorded interviews in a test/re-test methodology revealed a slightly higher error rate, probably related to weaknesses in the pilot system and the training process. Computer interviews tended to be longer but other features of the interview process were not affected by computer. The author's team has now completed 2,505 interviews using this system in a community-based blood pressure survey. It has been well accepted by both interviewers and respondents. Failure to complete an interview on the computer was uncommon (5 per cent) and well-handled by paper back-up questionnaires. The results show that computer-aided personal interviewing in the home is feasible but that further evaluation is needed to establish the impact of this methodology on overall data quality.

Blood Pressure↗

PubMed2004

Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children.

OBJECTIVE: To investigate the relationship between the presence of a television set, a gaming computer, and/or an Internet connection in the room of adolescents and television viewing, computer game playing, and Internet use on the one hand, and time to bed, time up, time spent in bed, and overall tiredness in first- and fourth-year secondary-school children on the other hand. METHODS: A random sample of students from 15 schools in Flanders, Belgium, yielded 2546 children who completed a questionnaire with questions about media presence in bedrooms; volume of television viewing, computer game playing, and Internet use; time to bed and time up on average weekdays and average weekend days; and questions regarding the level of tiredness in the morning, at school, after a day at school, and after the weekend. RESULTS: Children with a television set in their rooms went to bed significantly later on weekdays and weekend days and got up significantly later on weekend days. Overall, they spent less time in bed on weekdays. Children with a gaming computer in their rooms went to bed significantly later on weekdays. On weekdays, they spent significantly less time in bed. Children who watched more television went to bed later on weekdays and weekend days and got up later on weekend days. They spent less time in bed on weekdays. They reported higher overall levels of being tired. Children who spent more time playing computer games went to bed later on weekdays and weekend days and got up later on weekend days. On weekdays, they actually got up significantly earlier. They spent less time in bed on weekdays and reported higher levels of tiredness. Children who spent more time using the Internet went to bed significantly later during the week and during the weekend. They got up later on weekend days. They spent less time in bed during the week and reported higher levels of tiredness. Going out was also significantly related to sleeping later and less. CONCLUSION: Concerns about media use should not be limited to television. Computer game playing and Internet use are related to sleep behavior as well. Leisure activities that are unstructured seem to be negatively related to good sleep patterns. Imposing more structure (eg, end times) might reduce impact.

Child↗

PubMed1997

A comparison of traditional textbook and interactive computer learning of neuromuscular block.

We designed an educational software package, RELAX, for teaching first-year anesthesiology residents about the pharmacology and clinical management of neuromuscular blockade. The software uses an interactive, problem-based approach and moves the user through cases in an operating room environment. It can be run on personal computers with Microsoft Windows (Microsoft Corp., Redmond, WA) and combines video, graphics, and text with mouse-driven user input. We utilized test scores 1) to determine whether our software was beneficial to be the educational progress of anesthesiology residents and 2) to compare computer-based learning with textbook learning. Twenty-three residents were divided into two groups matched for age and sex, and a pretest was administered to all 23 residents. There was no significant difference (P > 0.05) in the pretest scores of the two groups. Three weeks later, both groups were subjected to an educational intervention; one with our computer software and the other with selected textbooks. Both groups took a posttest immediately after the intervention. The test scores of the computer group improved significantly more (P < 0.05) than those of the textbook group. Although prior to the study the two groups showed no statistical difference in their familiarity with computers, the computer group reported much higher satisfaction with their learning experience than did the textbook group (P < 0.0001).

Anesthesiology↗

PubMed1999

Tomography versus computed tomography for assessing step off in intraarticular distal radial fractures.

Computed tomography scans have supplanted conventional tomography for many applications and often are considered the imaging study of choice for assessing intraarticular distal radial fractures. Concern about cost containment in healthcare delivery prompts the question of whether the two studies provide comparable information and at what cost. Common intraarticular distal radial fractures were created in 12 lightly embalmed cadaveric specimens. The fractures were fixed with radiolucent Kirschner wires. Articular step off was measured with a caliper. Plain radiographs, computed tomography scans, and trispiral tomograms were obtained of each specimen. Maximal step off was measured blindly by two musculoskeletal radiologists and four hand surgeons. The radiographic measurements were compared with the actual step off and expressed as a positive or negative deviation from the actual value. There was no statistically significant difference between computed tomography scans and tomograms in predicting step off. In addition, the difference between actual and radiographic measurements was insignificant in tomogram readings and different in one of the computed tomography measurements. In the authors' institution, a tomogram costs $200, and a computed tomography scan costs $562. Trispiral tomography is more accurate and cost effective than computed tomography, and thus when available should be considered the imaging modality of choice for assessing articular step off in distal radius fractures.

Analysis of Variance↗

PubMed1995

Right ventricular mass measurement by electron beam computed tomography. Validation with autopsy data.

RATIONALE AND OBJECTIVES: Validation of right ventricular mass quantitation by electron beam computed tomography in humans has not been performed. The ability of electron beam computed tomography to accurately determine the septal component of the right ventricle also has not been determined. This article addresses both issues. METHODS: Twenty human adult hearts obtained at autopsy were scanned by electron beam computed tomography in a short-axis projection. Planimetry of the right ventricular free wall and septal components of each slice was performed and summed to determine right ventricular mass. These measurements were compared against comparable measurements obtained by autopsy weights of the hearts. RESULTS: Right ventricular free wall weights by electron beam computed tomography (53.9 +/- 18.4 g) correlated well (slope = .92, r = .92, standard error of the estimate = 7.4 g, P < .001) with autopsy weights (55.8 +/- 18.4 g). Right ventricular septal weights by electron beam computed tomography (6.1 +/- 2.3 g) correlated poorly (slope = .04, r = .11, standard error of the estimate = 2.4 g, P = .65) with autopsy weights (13.9 +/- 6.3 g). CONCLUSIONS: Electron beam computed tomography quantitation of right ventricular mass is accurate in humans if only the free wall and not the septal component is utilized.

Aged↗

PubMed1995

Value of computed tomography in patients with persistent vertigo after stapes surgery.

RATIONALE AND OBJECTIVES: The value of computed tomography was evaluated in 14 patients with persistent vertigo after otosclerosis operation. METHODS: High-resolution computed tomography was performed with 1-mm slice thickness and table feed in the axial and coronal planes. RESULTS: Computed tomography scans showed in 13 case findings that related to symptoms. An air bubble at the end of the prosthesis as a new, indirect sign of a perilymphatic fistula was found in 6 cases. An incorrect position of the stapes prostheses was diagnosed in 7 patients. One patient had recurrence of otosclerosis, and two others developed scarring around the prosthesis. In 1 case, an incus necrosis was found. Some patients showed two signs simultaneously. The computed tomography results were confirmed by retympanotomy in 12 cases. CONCLUSIONS: Computed tomography proved to be a valuable method in the diagnosis of persistent vertigo after otosclerosis operation. The indication for a repeat operation was facilitated by the use of computed tomography.

Follow-Up Studies↗

PubMedDate not supplied

Analyze of hospital computer networks.

Methods for the analysis of hospital computer networks have been developed without the need for a large-scale computer simulation of the queueing events in the problem. A table-driven methodology and a simple computer program are provided for an analysis of the computer utilization and channel utilization for a network of computers supporting hospital tasks. An example, using a DEC 11/780 VAX and six DEC 11/44's is given. The example network is also analyzed by large-scale computer simulation techniques, and the results are compared.

Computers↗

PubMed1995

Computed tomography is inaccurate in estimating the severity of adult splenic injury.

Computed tomography (CT) is increasingly utilized in evaluation of adult splenic injury (SI). CT correlation with operative findings, CT relationship to successful nonoperative (NO) management, and CT reading reproducibility were examined. Records of patients > or = 15 years old admitted over a 3-year period were reviewed. Computed tomography scans were graded by two radiologists blinded to clinical results. Computed tomography scans were performed on 49 of 77 patients with SI. Eighteen underwent initial operation (OR) and 31 initial NO. Operative patients had higher Injury Severity Scores and Abdominal Abbreviated Injury Scale scores (p < 0.0001). Grade II readings predominated in the NO group (55%). Nonoperative management was successful for 9 grade III and 3 grade IV readings. Computed tomography matched OR grade in 10 readings, underestimated it in 18, and overestimated it in 6. Computed tomography missed SI in five patients. Radiologists disagreed on 9 of 45 (20%) scans. Computed tomography poorly predicted operative findings. Interobserver variability was common. SI management should not be based solely on CT severity.

Adult↗

PubMed2000

Use of computer-aided surgery for frontal sinus ventilation.

OBJECTIVES: To review our experience and evaluate the utility of computer-aided surgery for frontal sinus and frontal recess disease. STUDY DESIGN: A retrospective review of 31 consecutive patients undergoing computer-aided surgery for frontal sinus ventilation. METHODS: The hospital charts of 31 patients were reviewed. Previous sinonasal procedures, etiology of sinonasal disease, preoperative computed tomography (CT) scan findings, preoperative symptoms, endoscopic and intraoperative findings, type of frontal sinus ventilation procedure, complications, imaging system registration method or accuracy, and postoperative course were noted. RESULTS: In all 31 patients the surgery was successfully completed, and no intracranial or orbital complications were encountered during or after surgery. Six patients required additional surgery including revision transnasal endoscopic frontal sinus ventilation or osteoplastic flaps with fat obliteration. In the six cases requiring additional surgery, disease severity, most commonly, aspirin triad disease, predisposed to failure of frontal sinus ventilation. CONCLUSIONS: Computer-aided surgery is a useful adjunctive device for safe, efficient identification and surgery of the frontal sinus. However, it is not a replacement for sound surgical technique, anatomical knowledge, and experience. In particular, patients with aspirin triad disease with frontal recess and frontal sinus involvement are highly suited for computer-aided surgery and thorough removal of disease, although failures occur despite this technique. The long-term benefit of computer-aided surgery of the frontal sinus has not yet been demonstrated by this or other studies.

Adolescent↗

PubMed1997

Evaluating the effect of superficial temporal artery to middle cerebral artery bypass on pure motor function using motor activation single photon emission computed tomography.

OBJECTIVE: We evaluated and analyzed the effect of superficial temporal artery to middle cerebral artery bypass for internal carotid artery occlusion on pure motor function using motor activation single photon emission computed tomography. METHODS: Motor activation single photon emission computed tomographic (SPECT) images were obtained for nine patients who had undergone superficial temporal artery to middle cerebral artery anastomosis for symptomatic internal carotid artery occlusion. All motor activation SPECT images using the finger opposition task on the affected side were obtained before bypass surgery and at 1 week, 1 month, and 3 months after bypass surgery. The results of motor activation single photon emission computed tomography were expressed as negative or positive. RESULTS: Before bypass surgery, the resting SPECT images revealed reduction of cerebral blood flow (CBF) on the affected side in all nine patients. The results of motor activation single photon emission computed tomography in three patients were positive. One week after bypass surgery, the results of the resting and motor activation CBF studies did not demonstrate any marked changes. One month after bypass surgery, the resting CBF increased in four patients. The results obtained for two of the patients revealed preoperative positive motor activation. The results of motor activation single photon emission computed tomography obtained for five patients were positive. Three months after bypass surgery, eight patients experienced improvement in the resting CBF, and the results of motor activation single photon emission computed tomography obtained for seven patients were positive. Among these, the results of preoperative motor activation single photon emission tomography obtained for four patients were negative. CONCLUSION: Superficial temporal artery to middle cerebral artery bypass is useful not only for resting CBF but also for pure motor function based on motor activation SPECT images. From the preoperative motor activation study, it was concluded that patients with preoperative positive motor activation could attain the effect of bypass earlier than patients with preoperative negative motor activation.

Aged↗

PubMed1994

Using computed tomography/discography and enhanced magnetic resonance imaging to distinguish between scar tissue and recurrent lumbar disc herniation.

STUDY DESIGN: Patients who had lumbar spine surgeries and experienced residual symptoms were prospectively studied using computed tomography/discography and enhanced magnetic resonance imaging. OBJECTIVES: Determining the sensitivity and specificity of gadolinium-enhanced magnetic resonance imaging versus computed tomography/discography in distinguishing scarring from recurrent disc herniation was the first objective. The second goal was to determine if there were any imaging characteristics unique to either scar or recurrent disc herniation. SUMMARY OF BACKGROUND DATA: The results of reoperation for recurrent disc herniation are uniformly good, whereas the results of reoperation for scar tissue are poor. There have been no studies comparing the ability of enhanced magnetic resonance imaging and computed tomography/discography to distinguish between scar and herniation material. METHODS: Two neuroradiologists who were blinded to the surgical findings in 33 patients independently reviewed the imaging studies and labeled abnormalities as disc herniation or scar tissue. Their responses were compared with surgical findings to determine the accuracy, sensitivity, and specificity of each test. Also, imaging studies were used to determine if disc material or scar tissue had specific imaging characteristics. RESULTS: Computed tomography/discography was more sensitive and specific in distinguishing between scar tissue and recurrent disc herniation. Information from both studies improved the sensitivity over either test alone. Characteristics associated with recurrent disc herniation included nonenhanced or rim-enhanced abnormality surrounding a low signal intensity lesion on magnetic resonance imaging and extension of contrast into the epidural space and an enhancing abnormality on computed tomography/discography. CONCLUSIONS: Using computed tomography/discography alone or with enhanced magnetic resonance imaging enables surgeons to distinguish between scarring and recurrent disc herniation so they can determine the need to re-enter the spinal canal.

Adult↗

PubMed1995

Accuracy of pedicle screw placement in lumbar fusions by plain radiographs and computed tomography.

STUDY DESIGN: Postoperative radiographs and computed tomography scans were used to evaluate 74 pedicle screws in 16 consecutive patients who underwent lumbar spine fusion with pedicle screw fixation. OBJECTIVE: To evaluate pedicle screw placement using plain radiographs versus computed tomographic scans. SUMMARY OF BACKGROUND DATA: Plain radiographs are the primary means of assessing pedicle screw placement. Comparison of plain radiographs and computed tomography has not been done. METHODS: Screws were graded as IN, OUT, or QUESTIONABLE; the direction of misplacement was noted. All evaluations were performed independently by three observers. RESULTS: Fewer screws were clearly within the pedicle on computed tomography when compared with plain radiographs. Computed tomography showed 10 times as many screws violating the medial cortex as did radiographs. Interobserver differences were not statistically significant. Intraobserver differences approached statistical significance when the two tests were compared. No recognized neurologic complications resulted from pedicle screw placement. CONCLUSIONS: Plain radiographs alone may not accurately reveal pedicle screw placement. Plain radiographs and thin section computed tomographic scans should be used to evaluate postoperative neurologic deficits in patients undergoing instrumented lumbar spine fusion with pedicle screws.

Bone Screws↗

PubMed1996

Axial rotation measurement of scoliotic vertebrae by means of computed tomography scans.

STUDY DESIGN: This study evaluated the preconditions for exact axial rotation measurement and the possibility for other parameters to measure axial rotation and mechanical torsion. OBJECTIVES: Quality criteria for axial rotation measurement in computed tomography scans are not established yet. Criteria should be found to improve axial rotation measurement. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no systematic analysis of the errors of axial rotation measurement based on computed tomography scans has been performed. METHODS: Axial rotation was measured in 259 computed tomography scans of 11 cadaveric vertebrae from scoliotic specimens. The sagittal axial rotation measurement angle of Aaro and Dahlborn and a new rotation parameter were measured with a pencil and ruler. Five landmarks were digitized and consequently five axial rotation parameters were computed. The influence of insufficient visualization of bony landmarks, mechanical torsion of the vertebra itself, and oblique position of the vertebra was evaluated. RESULTS: Accuracy is considerably improved in central computed tomography scans (same distance to the top and bottom of the vertebral body) due to good visualization of landmarks and reduction of effects of mechanical torsion. The oblique vertebral position causes more errors. One mechanical torsion parameter with sufficient reliability is identified. CONCLUSION: The sagittal axial rotation measurement method of Aaro and Dahlborn is superior to other techniques of measurement. It can be improved considerably if computed tomography scans fulfill certain quality criteria.

Anthropometry↗

PubMed1999

Computed tomographic and magnetic resonance imaging of chronic odontoid fractures.

STUDY DESIGN: The analysis of the imaging characteristics found in chronic odontoid fractures. OBJECTIVES: To determine the efficacy of computed tomography and magnetic resonance imaging in diagnosing a chronic odontoid fracture. SUMMARY OF BACKGROUND DATA: Radiographic examination of the cervical spine is intrinsic to the evaluation of all patients with blunt trauma. Injury to the craniocervical junction constitutes 19-25% of all cervical spine fractures. At the authors' trauma center computed tomography is routinely used instead of the open-mouth odontoid radiograph to facilitate cervical spine evaluation. This practice has increased the detection of fractures that are unrecognized in plain radiography, and has, at the same time, raised questions about the age and significance of these fractures. METHODS: Radiography, computed tomography, and magnetic resonance imaging studies were performed on three patients who came to the emergency department with odontoid fractures. Two patients had a history of severe trauma, and one had a history inconsistent with an acute odontoid fracture. One patient also had a technetium Tc 99m methylene dihydroxyphosphonate bone scan. The studies were obtained to determine the age of the fractures. RESULTS: All three patients were determined to have chronic odontoid fractures. This diagnosis was facilitated by the use of computed tomographic and magnetic resonance imaging. Computed tomography showed increased sclerosis in the proximal fracture fragment in all cases and well-corticated fracture edges in one patient. Magnetic resonance images showed normal bone marrow or bone sclerosis in the odontoid process. Soft tissue edema was absent. A bone scan was not useful in resolving this issue. CONCLUSION: Computed tomography and magnetic resonance imaging can be useful in determining the chronicity of an odontoid fracture.

Aged↗

PubMed1999

Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography. A prospective study of 35 patients.

STUDY DESIGN: This was a prospective study of 35 consecutive patients in whom pedicle screw position was assessed after surgery, using lateral radiographs and computed tomography. OBJECTIVE: To evaluate the accuracy of plain radiographs and computed tomography in assessment of pedicle screw position. SUMMARY OF BACKGROUND DATA: Imaging techniques, such as postoperative anteroposterior and lateral plain radiographs and computed tomography, are currently the primary means of assessing pedicle screw placement. METHODS: Postoperative radiographs and computed tomographic scans were used to evaluate the position of 220 pedicle screws inserted in the spines of 35 consecutive patients who underwent thoracic and lumbar spine fusion and instrumentation. No recognized neurologic complication resulted from pedicle screw placement. Screw position was graded as in, out, or questionable. All observations were performed independently by three observers. The authors also analyzed the position of the screws according to the underlying spinal disease. RESULTS: More misplaced screws were clearly seen on computed tomographic scans than on plain radiographs; however, this difference was not statistically significant. Interobserver differences were not statistically significant. Intraobserver differences approached statistical significance when the results of the two test were compared. CONCLUSIONS: Although the accuracy of computed tomographic imaging is better than that of plain radiographs, the difference does not reach statistical significance. Postoperative use of plain radiographs remains a reliable method for evaluation of pedicle screw insertion in the absence of neurologic deficit.

Bone Screws↗

PubMed2001

Identification of ossification of the posterior longitudinal ligament extending through the dura on preoperative computed tomographic examinations of the cervical spine.

STUDY DESIGN: To establish the diagnosis of dural penetration on preoperative computed tomographic studies of the cervical spine in patients with ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To define before surgery the pathognomonic computed tomographic findings of OPLL extending to and through the dura. SUMMARY OF BACKGROUND DATA: On preoperative computed tomographic studies, Hida et al have described the single-layer sign characterized by a solid mass of hyperdense OPLL and the double-layer sign defined by two (anterior and posterior) ossified rims surrounding a central nonossified but hypertrophied posterior longitudinal ligament. Only 1 of the 9 patients exhibiting the single-layer sign but 10 of 12 patients showing the double-layer sign had no separate dural plane identified at surgery. METHODS: Only 2 of 54 patients undergoing multilevel cervical circumferential OPLL procedures had absent dura at surgery. Computed tomographic examinations for all patients were retrospectively reviewed to determine unique signs of dural penetration. RESULTS: Dura was absent in 1 of 12 patients who had the single-layer CT sign that was additionally characterized by an irregular C angular configuration. Only 1 of 4 patients exhibiting the double-layer computed tomographic sign had absent dura at surgery. The remaining 38 patients had the smooth-layer sign, characterized by more regular margins of classic (22 patients) or early OPLL (16 patients). CONCLUSIONS: The double-layer computed tomographic sign is more pathognomonic for dural penetration than the single-layer sign. The smooth-layer sign, indicating a clean dural plane, is more typical in North American patients.

Causality↗

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