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Design and preparation of a formulary--guide to the prescribing of medicines.

In recent years there has been a renewed interest in the use of local hospital 'formularies'. The development and preparation at The London Hospital (Whitechapel) of a guide of prescribing which embraces and extends the concept of a formulary is described. A method of involving staff in the preparation of text was developed to ensure the rapid production of a reasonably comprehensive guide which would command respect and a high degree of compliance. The use of word-processing techniques and graphic design expertise are described. The guide has been carefully introduced together with plans for monitoring compliance and its influence on drug expenditure. These are discussed in the light of one year's experience with the guide.

Drug Prescriptions↗

Sentence imitation by adolescents and young adults with Down's syndrome and other intellectual disabilities.

Sentence imitation performance was evaluated longitudinally in 26 adolescents and young adults with Down's syndrome (DS), and 26 age- and IQ-matched non-DS individuals with other causes of intellectual disability (ID). In each of three annual assessments, the DS group began sentence repetitions more slowly and imitated sentences less accurately than the ID group. DS sentence repetition accuracy was equivalent to the ID group only for two-word sentences and was poorer for every other sentence length. Comparisons of sentence imitation and auditory digit span scores suggested that only ID subjects benefitted from the additional meaning and structure provided by sentences. Correlational analyses performed between each year's sentence imitation score and a set of language, memory and hearing measures revealed that sentence imitation was related to grammatical comprehension, auditory short-term memory and IQ in both groups, and to expressive language ability, speed of spoken word processing, speech discrimination and acoustic reflexes in the DS group only. A significant relationship between sentence imitation and middle-ear functioning was further supported by a categorical analysis in which DS subjects with bilateral abnormal tympanograms tended to perform more poorly on sentence imitation tasks than DS subjects with at least one normal tympanogram. It was concluded that sentence imitation is a task that is sensitive to the auditory-perceptual, cognitive and expressive difficulties evidenced by individuals with DS.

Acoustic Impedance Tests↗

Information technology in postgraduate medical education.

Information technology in postgraduate medical education has developed rapidly over the last 5 years. This report describes the experience of setting up a computer-based information system in postgraduate centres in the West of Scotland. It includes a viewdata service, library facilities, computer-assisted learning, word processing, and statistics. An electronic mail system provides rapid communication between users. The costing and some of the problems in setting up such systems are discussed.

Education, Medical, Graduate↗

Microcomputers and microprocessors in urology: present and future.

Urology departments have a heavy outpatient workload requiring efficient secretarial, appointments and records services. Microcomputers are relatively inexpensive and can facilitate efficient routine clinical and research work. Unlike mainframe computers, formal training is not usually required, a simple introduction being sufficient for the enthusiast. An Apple computer is used in this department for word processing incorporating standard letters, paragraphs and phrases. With more sophisticated programs urological screening by computer interrogation could be linked to an appointments system to coordinate investigations, minimising hospital visits. Microprocessors can facilitate a wide variety of measurement recording and data handling. Urodynamic measurements can be computed and graphs superimposed to facilitate interpretation.

Computers↗

A relational database for storing clinical information.

In medicine, we are constantly acquiring, recording, and analyzing data. Database programs give us a powerful tool to save and report our data. While spreadsheets and even word processing software can store simple datasets, the complexity of data storage needs in medicine often requires the use of a database program. Using most database software was difficult task for the casual user until recently, new, powerful programs were introduced by several developers. Microsoft Access, which is licensed for use with the purchase of many new computers, is an extremely powerful and relatively easy to use program written for the Windows operating systems. With this program, even novices to database programming can learn to construct useful database management systems.

Database Management Systems↗

A survey of the computer literacy of undergraduate dental students at a University Dental School in Ireland during the academic year 1997-98.

As dental practice management becomes more computer-based, the efficient functioning of the dentist will become dependent on adequate computer literacy. A survey has been carried out into the computer literacy of a cohort of 140 undergraduate dental students at a University Dental School in Ireland (years 1-5), in the academic year 1997-98. Aspects investigated by anonymous questionnaire were: (1) keyboard skills; (2) computer skills; (3) access to computer facilities; (4) software competencies and (5) use of medical library computer facilities. The students are relatively unfamiliar with basic computer hardware and software: 51.1% considered their expertise with computers as "poor"; 34.3% had taken a formal typewriting or computer keyboarding course; 7.9% had taken a formal computer course at university level and 67.2% were without access to computer facilities at their term-time residences. A majority of students had never used either word-processing, spreadsheet, or graphics programs. Programs relating to "informatics" were more popular, such as literature searching, accessing the Internet and the use of e-mail which represent the major use of the computers in the medical library. The lack of experience with computers may be addressed by including suitable computing courses at the secondary level (age 13-18 years) and/or tertiary level (FE/HE) education programmes. Such training may promote greater use of generic softwares, particularly in the library, with a more electronic-based approach to data handling.

Chi-Square Distribution↗

A survey of the IT skills and attitudes of final year dental students at Bristol University in 1996 and 1997.

Surveys of final year dental students were conducted in 1996 and 1997 to see if there were any detectable differences in students' perception of their own information technology IT skills and attitudes towards information technology following the opening of a dedicated computer-assisted-learning (CAL) room. An increase was seen in students' confidence levels, with fewer assessing themselves as IT "beginners" (1996 = 36%; 1997 = 14%), and more assessing themselves as competent in some basic skills (52%; 41%). Although more students were found to be using basic computer facilities (word processing, email, the World Wide Web), there was little difference in attitudes towards these packages between the 2 years. There was a significant increase in the number of students agreeing or strongly agreeing with the statement "the use of IT had added value to this course for me" (1996 = 39%; 1997 = 67%). The main obstacle which was identified by students as a barrier to using IT was the lack of adequate training. Over half the students in both years felt that insufficient training had been provided to enable them to cope with the course without difficulty.

Attitude of Health Personnel↗

Voice recognition software for clinical use.

The current generation voice recognition products truly offer the promise of voice recognition systems, that are financially and operationally acceptable for use in a health care facility. Although the initial capital outlay for the purchase of such equipment may be substantial, the long-term benefit is felt to outweigh the expense. The ability to utilize computer equipment for educational purposes and information management alone helps to rationalize the cost. In addition, it is important to remember that the Internet has become a substantial source of information which provides another functional use for this equipment. Although one can readily see the implication for such a program in clinical practice, other uses for the program should not be overlooked. Uses far beyond the writing of clinic notes and correspondence can be easily envisioned. Utilization of voice recognition software offers clinical practices the ability to produce quality printed records in a timely and cost-effective manner. After learning procedures for the selected product and appropriately formatting word processing software and printers, printed progress notes should be able to be produced in less time than traditional dictation and transcription methods. Although certain procedures and practices may need to be altered, or may preclude optimal utilization of this type of system, many advantages are apparent. It is recommended that facilities consider utilization of Voice Recognition products such as Dragon Systems Naturally Speaking Software, or at least consider a trial of this method with one of the limited-feature products, if current dictation practices are unsatisfactory or excessively costly. Free downloadable trial software or single user software can provide a reduced-cost method for trial evaluation of such products if a major commitment is not felt to be desired. A list of voice recognition software manufacturer web sites may be accessed through the following: http://www.dragonsys.com/ http://www.software.ibm/com/is/voicetype/ http://www.lhs.com/

Faculty, Nursing↗

Computer use in private dental practice in Australia, 1991.

There was a 70 per cent response to a mail questionnaire to a 1:3 sample of Australian Dental Association members in private practices (n = 1931). Computers were used by 37 per cent of practices. Main computer applications used were for: accounting (84%); patient billing (80%); word processing (79%); and patient recall (61%). External bureau services were used by 4 per cent of practices with most computers being in-house (single terminal 66%; multiple terminal 33%). The more dentists in a practice, the more likely was a computer to be used. Principal users were secretary/receptionists. Service and software were the most important factors in choice of computer system. Many practice computer users (67%) also had a Personal Computer at home compared with only 36 per cent of the non-users. Many respondents indicated the need for continuing education in computers (67% users; 61% non-users). More than half of the non-users indicated future use of computers for accounting, billing and recall. There has been a considerable increase in the use of computers in private practice (37%) since the Australian Dental Association Dental Practice Survey in 1983/84 (9%).

Age Factors↗

From hard copy to computer integration: developing clinical indicators for quality improvement.

The Clinical Indicator Workbook is a computerized tool that allows users to develop measures of healthcare quality. The electronic workbook, which includes selected clinical indicators to measure various aspects of patient care and teaching examples, was developed by using a major word processing package and uses a point-and-click feature. Its distribution and installation are managed by a program that enables users to select one of three options: (a) installation of the required files and indicator documents, (b) duplication of material on two diskettes for future distribution within the user's facility, and (c) on-line help. Once the workbook is installed, users are able to copy and customize the indicators for use with interdisciplinary teams in clinical settings. A survey of initial users, who are, for the most part, quality managers in the Veterans Affairs system, indicated that they are satisfied with this tool overall.

Computer User Training↗

Combined computer generated discharge documents and surgical audit.

A computerised audit system using a commercially available database program and a word processing program was devised to produce discharge documents close to the time of discharge. The data were available for audit of the surgical unit's work. It was found that secretarial time was more efficiently used and general practitioners received more information about their patients earlier than before.

Computers↗

Language acquisition: the acquisition of linguistic structure in normal and special populations.

This review examines how language learners master the formal structure of their language. Three possible routes to the acquisition and mastery of linguistic structure are investigated: (a) the use of prosodic and phonological information, which is imperfectly correlated with syntactic units and linguistic classes; (b) the use of function words to syntactically classify co-occurring words and phrases, and the effect of location of function-word processing on structural mastery; and (c) the use of morphology internal to lexical items to determine language structure, and the productive recombination of these subunits in new items. Evidence supporting these three routes comes from normal language acquirers and from several special populations, including learners given impoverished input, learners with Williams syndrome, specific language-impaired learners, learners with Down syndrome, and late learners of first and second languages. Further evidence for the three routes comes from artificial language acquisition experiments and computer simulations.

Adolescent↗

The computer in the radiologist's office.

Today, the radiologist is able to equip his or her office with a powerful personal computer system equivalent to the large mainframe computers of just a few years ago. If funds permit, purchase of a 486 equivalent system with 200-300 Mbytes of hard-disk storage, 16 Mbytes of random access memory (RAM), a high-resolution color video card and monitor, and a laser printer is recommended. The practical uses for such a system are almost limitless and include word processing, spreadsheet and data-base management, telecommunications, multimedia presentations, business applications, teleradiology, resident and medical student education, and research applications. No matter how much one becomes involved in computer applications, it is essential to establish good habits for backing up critical data files and programs. Becoming familiar with computer technology is not easy at first. Finding a good computer buddy, taking simple night school courses, and reading computer articles and magazines are good ways to get started. Computers are wonderful devices. The day is fast approaching when they will become a necessary tool for every radiologist.

Microcomputers↗

Computerized scientific exhibit in radiology: a valuable format for delivering scientific information.

The computerized scientific exhibit (CSE) is gaining acceptance as a tool for delivering scientific information at meetings of radiologic societies. CSEs allow presentation of more material in a more space-efficient manner than do conventional exhibits, and the viewer can control the order and detail in which material is reviewed. As a disadvantage, currently, the radiologist must use a support team and learn new tools to create a CSE. The preparation and cost may also be greater. Meeting attendees must overcome a reluctance to use computers to benefit from a CSE. Creation of a CSE has design, production, and presentation phases. A team of content authors, software author, graphics acquisition person, and project manager works together through brainstorming, conceptual ordering, storyboarding, prototyping, and selection of authoring tools to design the exhibit. Production must include use of common word processing and image file formats, as well as standardization of image resolution. Accurate equipment specification is needed to ensure that the exhibit can be run on the equipment provided by the meeting organizers. In addition, some security steps are needed to prevent misuse of the exhibit. In addition to display at assemblies, the CSE can be made available to a larger audience by delivery on media such as compact disks and the Internet and can be continually modified as new material becomes available.

Computers↗

The computer-based cumulative report: improvement in quality and efficiency.

A cumulative radiology report, like clinical progress notes, contains a listing of examinations and findings in chronologic order. Word processing is the most efficient way to create such a report, with follow-up examinations handled as additions to an existing document. Since 1988, cumulative reports on 127 cases involving 483 examinations have been made for a long-term industrial chest radiology survey by using a personal computer and custom software that employs minimum keystrokes to manage files. The results were as follows: (a) Quality improved operationally owing to routine auditing of prior information. (b) Efficiency improved owing to computer speed and software functions that included a refined "last in-first out" index and user-defined macros. (c) The radiologist saved time by not having to reiterate previously reported findings that were unchanged. This method is ideal for long-term surveys and could be a useful option for follow-up examinations in general.

Humans↗

Handheld computers in radiology.

The next phase of the digital revolution in medicine is taking place through the dissemination of powerful handheld computers. Handheld computers, or personal digital assistants (PDAs), are no longer considered either a curiosity or a toy. The current handheld computer has many features (Internet access, simple e-mail client software, spreadsheet and database programs, word processing, and digital media) that make it an ideal tool for healthcare providers. Improvements in handwriting recognition, display characteristics, and wireless networking capabilities provide a platform for real-time review of both large static and dynamic repositories of patient data. Although earlier PDA models lacked the ability to display medical images appropriately, current PDAs boast display characteristics that approach low-resolution computer monitors. Although the handheld computer is not yet a reliable option for soft-copy reading, it offers many features that can improve work flow and efficiency for the radiologist. These features include improved personal information management, decision support via access to educational materials, and remote access to radiology-related information systems.

Computers, Handheld↗

Assistive technology and learning disabilities: today's realities and tomorrow's promises.

Many forms of technology, both "high" and "low," can help individuals with learning disabilities capitalize on their strengths and bypass, or compensate for, their disabilities. This article surveys the current status of assistive technology for this population and reflects on future promises and potential problems. In addition, a model is presented for conceptualizing assistive technology in terms of the types of barriers it helps persons with disabilities to surmount. Several current technologies are described and the research supporting their effectiveness reviewed: word processing, computer-based instruction in reading and other academic areas, interactive videodisc interventions for math, and technologies for daily life. In conclusion, three themes related to the future success of assistive technology applications are discussed: equity of access to technology; ease of technology, use; and emergent technologies, such as virtual reality.

Computer-Assisted Instruction↗

Current computer use by diabetes educators.

PURPOSE: The purpose of this study was to ascertain diabetes educators' current use of computer technologies. METHODS: The study population consisted of 279 randomly selected certified diabetes educators, all of whom were members of the American Association of Diabetes Educators. Participants were asked to complete the Attitudes Toward Patient Education Technology instrument. RESULTS: Descriptive findings showed that most educators (89.6%) have access to computers and use them primarily for word processing (43%). Nearly 30% of participants had never accessed the Internet, and no significant difference was noted when this variable was categorized by age. In addition, age and gender were not significant predictors of computer use, although age was significantly related to computer ownership. Patient access and organizational issues were the primary barriers to computer use in patient education. CONCLUSIONS: These findings provide further understanding of diabetes educators' computer use and integration of computer technology in the patient education process.

Allied Health Personnel↗