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Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors.

BACKGROUND AND OBJECTIVE: The Marshall computed tomographic (CT) classification identifies six groups of patients with traumatic brain injury (TBI), based on morphological abnormalities on the CT scan. This classification is increasingly used as a predictor of outcome. We aimed to examine the predictive value of the Marshall CT classification in comparison with alternative CT models. METHODS: The predictive value was investigated in the Tirilazad trials (n = 2269). Alternative models were developed with logistic regression analysis and recursive partitioning. Six month mortality was used as outcome measure. Internal validity was assessed with bootstrapping techniques and expressed as the area under the receiver operating curve (AUC). RESULTS: The Marshall CT classification indicated reasonable discrimination (AUC = 0.67), which could be improved by rearranging the underlying individual CT characteristics (AUC = 0.71). Performance could be further increased by adding intraventricular and traumatic subarachnoid hemorrhage and by a more detailed differentiation of mass lesions and basal cisterns (AUC = 0.77). Models developed with logistic regression analysis and recursive partitioning showed similar performance. For clinical application we propose a simple CT score, which permits a more clear differentiation of prognostic risk, particularly in patients with mass lesions. CONCLUSION: It is preferable to use combinations of individual CT predictors rather than the Marshall CT classification for prognostic purposes in TBI. Such models should include at least the following parameters: status of basal cisterns, shift, traumatic subarachnoid or intraventricular hemorrhage, and presence of different types of mass lesions.

Adolescent↗

Assessment of the current computer literacy and future computer needs of emergency medicine residents and faculty.

The purpose of this study was to assess the current computer literacy and future computer needs of emergency medicine residents and faculty to aid in developing a computer literacy curriculum. All emergency medicine residents and full-time faculty from a random sample of emergency medicine residencies were mailed questionnaires assessing current computer familiarity and future computer needs. Twenty-one residencies were surveyed; 15 resident and 17 faculty questionnaires were returned. Thirty-seven percent (116 of 314) faculty and 29% (135 of 470) resident questionnaires were completed and returned. Eighty percent (12 of 15) of residencies had a designated computer for resident use; 93% (14 of 15) had a computer for use in the emergency department. Forty-seven percent of residents owned their own computer; 68% of faculty had a computer in their home, and 52% had computers in their office. Less than 30% of residents and faculty had formal computer training. Residents and faculty rated the current familiarity and future needs for various software applications on a five-point scale. Data were analyzed using the Wilcoxon-Rank Sum Test. Residents and faculty had the most anticipated need for word processing, graphics, literature searching, data base, and patient management programs. Future computer need was rated significantly higher than current computer familiarity in all computer application areas (P < or = .0002). It seems that emergency medicine residents and faculty have adequate access to computers, but minimal computer training. Residents and faculty have a high anticipated need for various basic computer applications.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Literacy↗

The efficacy of computer glasses in reduction of computer worker symptoms.

BACKGROUND: Computer workers with presbyopia are at greater risk for the development of symptoms with a conventional prescription vs. a computer prescription because general-wear multi-focal corrections often do not provide adequate correction for the viewing distances and angles needed at the computer workstation. "Computer glasses," as defined by the American Optometric Association, are specifically designed for the computer workplace and have a different lens design or prescription than general-wear glasses. The purpose of this study is to evaluate the effectiveness of computer glasses in reduction of symptoms of presbyopic computer users. METHODS: Subjects were 26 symptomatic presbyopic computer users who had had an eye examination within the past year and had 20/20 vision at distance and near with habitual glasses. Two interventions in planned alternating order were tested for 3 weeks each on all subjects. One intervention was computer glasses. The comparison intervention was an ergonomic self-assessment tool (ESAT) with their habitual Rx. Symptoms were assessed before and after each intervention. A post-comparative questionnaire asked subjects to reflect on the relative efficacy and ease of use of the two interventions. RESULTS: The computer glasses were significantly more effective at reducing the frequency and severity (p < 0.008) of the symptoms than the ESAT, and 24 of 26 subjects judged the computer glasses to bemore effective. Subjects attributed 80.7% of symptom reduction to the computer glasses and 19.3% to the ESAT. Although the ESAT was judged effective, it was not as effective as the computer glasses. CONCLUSION: Computer glasses have been shown to be effective in reduction of vision-related symptoms of computer users.

Computers↗

Computer experience and computer attitude: a model to predict the use of computerised information systems.

Computers are now essential technology in use by health workers. The literature shows that a number of factors effect the use of computers and many of them are related to attitude towards automation. Computer experience has been mostly used as a factor that effects computer attitude and its relationship with computer anxiety and computer use is not simple. Survey data from a study of 302 health workers, employed in a community setting was used to model the prediction of intention to use computers. The final model shows that 'positive computer experience' had a significant effect on computer attitude, computer anxiety and intention to use computers (both directly and indirectly). The model also confirms that those with a positive attitude towards computers had stronger intention to use computers. The value of these findings to health organisations in implementing automated systems is discussed.

Attitude to Computers↗

The roles of 'subjective computer training' and management support in the use of computers in community health centres.

There have been many changes made to information systems in the last decade. Changes in information systems require users constantly to update their computer knowledge and skills. Computer training is a critical issue for any user because it offers them considerable new skills. The purpose of this study was to measure the effects of 'subjective computer training' and management support on attitudes to computers, computer anxiety and subjective norms to use computers. The data were collected from community health centre staff. The results of the study showed that health staff trained in computer use had more favourable attitudes to computers, less computer anxiety and more awareness of others' expectations about computer use than untrained users. However, there was no relationship between management support and computer attitude, computer anxiety or subjective norms. Lack of computer training for the majority of healthcare staff confirmed the need for more attention to this issue, particularly in health centres.

Attitude to Computers↗

The use of wireless laptop computers for computer-assisted learning in pharmacokinetics.

OBJECTIVE: To implement computer-assisted learning workshops into pharmacokinetics courses in a doctor of pharmacy (PharmD) program. DESIGN: Workshops were designed for students to utilize computer software programs on laptop computers to build pharmacokinetic models to predict drug concentrations resulting from various dosage regimens. In addition, students were able to visualize through graphing programs how altering different parameters changed drug concentration-time curves. Surveys were conducted to measure students' attitudes toward computer technology before and after implementation. Finally, traditional examinations were used to evaluate student learning. ASSESSMENT: Doctor of pharmacy students responded favorably to the use of wireless laptop computers in problem-based pharmacokinetic workshops. Eighty-eight percent (n = 61/69) and 82% (n = 55/67) of PharmD students completed surveys before and after computer implementation, respectively. Prior to implementation, 95% of students agreed that computers would enhance learning in pharmacokinetics. After implementation, 98% of students strongly agreed (p < 0.05) that computers enhanced learning. Examination results were significantly higher after computer implementation (89% with computers vs. 84% without computers; p = 0.01). CONCLUSION: Implementation of wireless laptop computers in a pharmacokinetic course enabled students to construct their own pharmacokinetic models that could respond to changing parameters. Students had greater comprehension and were better able to interpret results and provide appropriate recommendations. Computer-assisted pharmacokinetic techniques can be powerful tools when making decisions about drug therapy.

Computer-Assisted Instruction↗

Evaluating graduate and undergraduate nursing students' computer skills to determine the need to continue teaching computer literacy.

1. INTRODUCTION. This descriptive study examined undergraduate and graduate nursing students' perceptions of their computer literacy skills to determine whether faculty should continue teaching basic computing skills in nursing programs. As in Bryson's study [1] the computer literate nurse is one who understands the concepts of hardware, software, and operating systems; who is able ot use the computer to learn; and who is able ot use such applications as word-processing, spreadsheets, and databases. Zeimer [2] predicted that by 1994 students entering nursing schools would be prepared to use computers and that further teaching of computer skills would not be needed. Some faculty, however, have felt that students are not entering nursing programs prepared to use computers. 2. TOOLS. A Level of Computer Experience (LCE) tool was developed to measure the computer literacy skills of students entering the first of three Masters' level nursing informatics courses over a six-year period. The instrument's 25 items determined experience with: operating systems, hardware, learning tools, applications, and information systems (IS) life cycle (design, selection, implementation, evaluation and project management). The instrument was modified for undergraduate students; this eliminated the items relating to the IS life cycle since these items reflect advanced skills. The resulting instrument was composed of the first 16 items of the original Level of Computer Experience tool. For each item, a four pint Likert scale allowed respondents to choose from the words "none," "some," "moderate," and "extensive" to describe their level of experience. For scoring purposes each word was assigned a numerical value as follows: none = 1, some = 2, moderate = 3, and extensive =4. 3. DATA. The LCE was administered to 65 sophomore nursing students and 74 graduate nursing informatics students. Undergraduate scored 4 items (use of microcomputer, use of IBM type computer, keyboard skills and use of WordPerfect). This score was above the 2 or 'some' experience level. Mean scores for all other items ranged between 1 and 2. Graduate informatics students also had higher mean scores for the 4 items. No mean scores reached the 'moderate' level for either group. One-way analysis of variances showed significant differences between the undergraduate and graduate students on the item concerning use of statistical packages. 4. CONCLUSIONS. In this population, both graduate and undergraduate nursing students continue to possess low levels of computer literacy skills. Since many students come into nursing programs without the capability of using information technology in practice, schools need to continue providing a way for students to obtain computer literacy skills.

Baltimore↗

From computing with numbers to computing with words. From manipulation of measurements to manipulation of perceptions.

Interest in issues relating to consciousness has grown markedly during the last several years. And yet, nobody can claim that consciousness is a well-understood concept that lends itself to precise analysis. It may be argued that, as a concept, consciousness is much too complex to fit into the conceptual structure of existing theories based on Aristotelian logic and probability theory. An approach suggested in this paper links consciousness to perceptions and perceptions to their descriptors in a natural language. In this way, those aspects of consciousness which relate to reasoning and concept formation are linked to what is referred to as the methodology of computing with words (CW). Computing, in its usual sense, is centered on manipulation of numbers and symbols. In contrast, computing with words, or CW for short, is a methodology in which the objects of computation are words and propositions drawn from a natural language (e.g., small, large, far, heavy, not very likely, the price of gas is low and declining, Berkeley is near San Francisco, it is very unlikely that there will be a significant increase in the price of oil in the near future, etc.). Computing with words is inspired by the remarkable human capability to perform a wide variety of physical and mental tasks without any measurements and any computations. Familiar examples of such tasks are parking a car, driving in heavy traffic, playing golf, riding a bicycle, understanding speech, and summarizing a story. Underlying this remarkable capability is the brain's crucial ability to manipulate perceptions--perceptions of distance, size, weight, color, speed, time, direction, force, number, truth, likelihood, and other characteristics of physical and mental objects. Manipulation of perceptions plays a key role in human recognition, decision and execution processes. As a methodology, computing with words provides a foundation for a computational theory of perceptions: a theory which may have an important bearing on how humans make--and machines might make--perception-based rational decisions in an environment of imprecision, uncertainty, and partial truth. A basic difference between perceptions and measurements is that, in general, measurements are crisp, whereas perceptions are fuzzy. One of the fundamental aims of science has been and continues to be that of progressing from perceptions to measurements. Pursuit of this aim has led to brilliant successes. We have sent men to the moon; we can build computers that are capable of performing billions of computations per second; we have constructed telescopes that can explore the far reaches of the universe; and we can date the age of rocks that are millions of years old. But alongside the brilliant successes stand conspicuous underachievements and outright failures. We cannot build robots that can move with the agility of animals or humans; we cannot automate driving in heavy traffic; we cannot translate from one language to another at the level of a human interpreter; we cannot create programs that can summarize non-trivial stories; our ability to model the behavior of economic systems leaves much to be desired; and we cannot build machines that can compete with children in the performance of a wide variety of physical and cognitive tasks. It may be argued that underlying the underachievements and failures is the unavailability of a methodology for reasoning and computing with perceptions rather than measurements. An outline of such a methodology--referred to as a computational theory of perceptions--is presented in this paper. The computational theory of perceptions (CTP) is based on the methodology of CW. In CTP, words play the role of labels of perceptions, and, more generally, perceptions are expressed as propositions in a natural language. CW-based techniques are employed to translate propositions expressed in a natural language into what is called the Generalized Constraint Language (GCL). In this language, the meaning of a proposition is expressed as a generalized constraint, X isr R, where X is the constrained variable, R is the constraining relation, and isr is a variable copula in which r is an indexing variable whose value defines the way in which R constrains X. Among the basic types of constraints are possibilistic, veristic, probabilistic, random set, Pawlak set, fuzzy graph, and usuality. The wide variety of constraints in GCL makes GCL a much more expressive language than the language of predicate logic. In CW, the initial and terminal data sets, IDS and TDS, are assumed to consist of propositions expressed in a natural language. These propositions are translated, respectively, into antecedent and consequent constraints. Consequent constraints are derived from antecedent constraints through the use of rules of constraint propagation. The principal constraint propagation rule is the generalized extension principle. (ABSTRACT TRUNCATED)

Consciousness↗

Beyond input-output computings: error-driven emergence with parallel non-distributed slime mold computer.

The emergence derived from errors is the key importance for both novel computing and novel usage of the computer. In this paper, we propose an implementable experimental plan for the biological computing so as to elicit the emergent property of complex systems. An individual plasmodium of the true slime mold Physarum polycephalum acts in the slime mold computer. Modifying the Elementary Cellular Automaton as it entails the global synchronization problem upon the parallel computing provides the NP-complete problem solved by the slime mold computer. The possibility to solve the problem by giving neither all possible results nor explicit prescription of solution-seeking is discussed. In slime mold computing, the distributivity in the local computing logic can change dynamically, and its parallel non-distributed computing cannot be reduced into the spatial addition of multiple serial computings. The computing system based on exhaustive absence of the super-system may produce, something more than filling the vacancy.

Animals↗

The desk-top computer as a magic box: patterns of behaviour connected with the desk-top computer; GPs' and patients' perceptions.

BACKGROUND: The use of computers in general practice is becoming increasingly common. There has been concern about effects on doctor-patient communication. OBJECTIVES: The aim of this study was to identify common patterns in the use of desk-top computers by GPs with regard to interaction with the patients, and to assess the GPs' and patients' perceptions of the use of the computer. METHOD: Thirty-nine video-taped consultations with five different GPs were analysed inductively, inspired by the principles of 'grounded theory'. On separate occasions the five GPs and 12 of the previously video-taped patients watched and commented on the video recordings of their own consultation. RESULTS: The study showed that the computer was sometimes used in a way that was not originally intended. Use of the computer could be identified as a way of obtaining 'time-out' in the consultation. It could also be a referral to a 'magic box'. The conversation often changed when the computer was used. The interviews showed that the patients lacked understanding about the computer's functions. They also lacked knowledge about the possibility of loss of confidentiality with electronic files. The patients found it disturbing not knowing what their doctor was doing when he worked on the computer, and they preferred being able to see the computer screen. The GPs were surprised at how their own use of the computer looked on the video, and as a result of the interview they wanted to change their behaviour. CONCLUSIONS: It is concluded that patients need more information about the use of computers by GPs, and that GPs may benefit from paying more attention to their computer use.

Adult↗

Psychology of computer use: XXIII. Validating a measure of computer-related stress.

Prediction of the final grade in a computer course using the Computer Technology Hassles Scale, a measure of computer-related stress, was investigated. A sample of 154 university students enrolled in computer courses completed questionnaires covering demographic data, information on computer use, the Computer Technology Hassles Scale, and somatic complaint items of the Hopkins Symptom Checklist. Pearson correlations indicated scores on the Computer Technology Hassles Scale were significantly associated .27 with somatic complaints, -.24 with computer-course grades, and -.18 with self-rated computer knowledge. Regression analysis indicated that self-rated computer knowledge and scores on the Computer Technology Hassles Scale significantly predicted computer-course grade.

Adult↗

Computer skills and attitudes to computer-aided learning among medical students.

One hundred and forty-four third-year medical students at the University of Edinburgh were surveyed as to levels of computing skills and confidence in carrying out computing tasks. Attitudes to computer-aided learning for clinical teaching were also measured. Thirty-one per cent of students had not used a computer in the previous year and 38% had not used a computer outside supervised laboratory work. Twenty-two per cent had never used the university library computerized catalogue and 43% had never carried out a medline search using the library CD-ROM. Students were not confident of their ability to carry out simple computing tasks. Fifty-four per cent said they would need support or instruction in printing out a document, 69% were not confident they could copy a file onto a disk and 74% did not believe they could independently create a graph in a document. Students who had completed an intercalated honours year were significantly more skilled and confident in computing tasks. Attitudes to computer-aided learning were related to computing confidence. Medical students who have not acquired basic computer information technology (IT) skills by the third year of undergraduate training are unlikely to do so in the final hospital-based years. Undergraduate curricula for medical students must incorporate specific computer (IT) training.

Attitude to Computers↗

Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer.

BACKGROUND: General practice computer databases are being increasingly seen as a source of data for public health monitoring and commissioning. Such ambitions depend on routine clinical data being recorded with acceptable completeness and accuracy. AIM: The aim of this study was to assess the completeness and accuracy of the computer medical records in four high-recording general practices. METHOD: Four general practices in the Trent Region that use the EMIS computer system, and were known to be high recorders of clinical data on their computer databases, were selected. A retrospective analysis of the computer records, a prospective comparison of a sample of computer records with manual records, and a prospective comparison between videorecorded consultations and their manual and computer records were undertaken. RESULTS: Checks for completeness in computer recording of diabetes mellitus and glaucoma showed high levels of accurate recording, 97% and 92% respectively. Prevalence rates between practices were reasonably comparable. No practice consistently, across 10 diagnoses, recorded prevalences higher or lower than the other practices; those diagnoses with recognized objective diagnostic criteria were recorded with a more consistent prevalence than those without. Lifestyle data recording was low; overall, smoking habits and alcohol consumption were recorded for 52% and 38% of patients aged over 16 years, respectively. Comparison of the manual records with the computer records showed that the computer records were sufficiently complete with regard to diagnoses (82% of all items recorded), prescriptions (100%) and referrals (67%), but missed most of the remaining data that a manual record captured. The videorecorded validation study showed that there were no important lapses in the recording of diagnoses, prescriptions or referrals when the computer recording was compared to the actual process of the consultations. CONCLUSION: In these four high-recording practices the data in computer records were of sufficient completeness and accuracy to allow meaningful data aggregation for some diagnoses, prescriptions and referrals. Standardized protocols for defining which patients are included and excluded from major disease groups are required.

England↗