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Influence of a computer database and problem exercises on students' knowledge of bacteriology.

This study compared the performances of students at the University of North Carolina at Chapel Hill School of Medicine who had access to sets of problem exercises and a computer database to support their learning of bacteriology with the performances of students at the University of Iowa College of Medicine who did not have such access. The study also examined the extent of a student's database use as a predictor of posttest performance. The students studied were randomly selected groups of 32-44 first-year students per year at each school; the study was conducted in three academic years (1988-1990) with some modifications in the intervention as the host environment evolved. The criterion measure was a posttest created from the same pool of problems used to generate the problem sets. The students at the intervention school scored significantly higher on the posttest in two of the three years, and overall. Also in two of the three years and overall, there was a significant relationship between the extent of a student's database use and his or her posttest score. Although the observed effects may have been due to other factors in this quasi-experimental design, the authors conclude that the use of problem sets and a computer database had a positive influence on the students' learning.

Bacteriology↗

A reexamination of the NRMP matching algorithm. National Resident Matching Program.

Most graduating medical students in the United States find their first professional appointments through the National Resident Matching Program (NRMP). This service receives rank-order lists of preferences from students and from hospitals, and then generates final assignments of students to hospitals through the use of a specific computerized matching algorithm. The author uses recent findings from the mathematics and economics literatures to demonstrate three difficulties with the NRMP's matching algorithm and the official descriptions thereof. First, the algorithm favors hospitals over students, a feature known to the NRMP since at least 1976, but, in the author's opinion, not made clear in NRMP literature for students. Second, the author argues that the NRMP's justification that its algorithm mimics orderly, noncentralized admission processes is not correct. Institutions operating under non-centralized procedures must typically make more initial offers than there are positions, in the realization that some fraction of their offers will be declined. This arrangement enlarges the choices available to many applicants, and thereby benefits them, whereas the NRMP's algorithm unrealistically assumes that no institution would ever send out any extra offers. Third, the NRMP's algorithm contains incentives for students to misrepresent their true preferences when constructing their rank-order lists. This feature is a substantial disadvantage of the current algorithm and is incorrectly described in literature distributed to students and in published articles from the NRMP.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

The NRMP matching algorithm revisited: theory versus practice. National Resident Matching Program.

The authors examine the algorithm used by the National Resident Matching Program (NRMP) in its centralized matching of applicants to U.S. residency programs ("the Match"). Their goal is to evaluate the current NRMP matching algorithm to determine whether it still fulfills its intended purpose adequately and whether changes could be made that would improve the Match. They describe the basic NRMP algorithm and many of the variations of the matching process ("match variations") incorporated over the last 20 years to meet participants' requirements. An overview of the current state of the theory of preference matching is presented, including descriptions of the characteristics of stable matches in general, program-optimal and applicant-optimal matchings, and strategies for formulating preference lists. The characteristics of the current NRMP algorithm are then compared with the theoretical findings. Research conducted long after the original NRMP algorithm was devised has shown that an algorithm that produces stable matches is the best approach for matching applicants to positions. In the absence of requirements to satisfy match variations, the NRMP's deferred-acceptance algorithm produces a program-optimal stable match. When match variations, such as those handled by the NRMP, must be introduced, it is possible that no stable matching exists, and the resulting matching produced by the NRMP algorithm may not be program-optimal. The question of program-optimal versus applicant-optimal matchings is discussed. Theoretical and empirical evidence currently available suggest that differences between these two kinds of matchings are likely to be small. However, further tests and research are needed to assess the real differences in the results produced by different stable matching algorithms that produce program-optimal or applicant-optimal stable matches.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

Outcomes management of mechanically ventilated patients: utilizing informatics technology.

This article examines an informatics system developed for outcomes management of the mechanically ventilated adult population, focusing on weaning the patient from mechanical ventilation. The link between medical informatics and outcomes management is discussed, along with the development of methods, tools, and data sets for outcomes management of the mechanically ventilated adult population at an acute care academic institution. Pros and cons of this system are identified, and specific areas for improvement of future health care outcomes medical informatics systems are discussed.

Adult↗

Tritium dose overestimates by CAP88-PC.

The dose assessment software CAP88-PC may overestimate doses from tritium under some conditions. The overestimates are linked to three key assumptions implicit in the software that may not be immediately parent. The three assumptions are (1) the contribution of home grown food, (2) the distances at which food is produced, and (3) the number of people consuming locally produced food.

Agriculture↗

Meeting the educational needs of clinical equipment users.

Training equipment users to operate medical equipment effectively and safely is one of the most important and difficult tasks of clinical engineers. As medical equipment proliferates and becomes more complex, the task of education also becomes more difficult. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that all equipment users be trained annually in proper operating procedures for the equipment they use and that the training be documented. Therefore, each hospital must develop educational programs to meet those needs. This paper illustrates the use of an interactive computer-assisted instruction (CAI) program, entitled EquipTeach, to provide an effective, standardized and cost-effective method of training equipment users at the John Dempsey Hospital of The University of Connecticut Health Center in Farmington, Connecticut.

Computer-Assisted Instruction↗

An intravenous medication safety system: preventing high-risk medication errors at the point of care.

Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months.

Academic Medical Centers↗

Minding the store: how IT impacts outcomes measurement.

Today, the question is not whether organizations should measure outcomes, but how. Right now, there are several initiatives, but no single, collaborative effort to tie them all together. This article will discuss the rise and early history of outcomes assessment in health care and highlight some key current initiatives (for example, OASIS [home health], QISMC [managed care organizations], HCQIP [inpatient care], ACQIP [ambulatory care], Joint Commission's ORYX accreditation initiative [hospitals, long-term care, home care, behavioral health care, and networks]). It will also delineate some of the problems with measuring outcomes and discuss where more work is needed. It will go on to discuss the role of IT in outcomes measurement, including its contributions, goals, effects, categories of IT support, infrastructure solutions, and analysis.

Data Interpretation, Statistical↗

Assisting students at risk: using computer NCLEX-RN review software.

In response to a decline in the success rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination, the authors developed a program to identify and assist students at risk for failure. The use of a computerized NCLEX-RN practice examination and an individualized student review and study process is described.

Computer-Assisted Instruction↗

Developing an evaluation tool for instructional software programs.

The use of instructional software is predominant in many nursing programs. The need for cost-effective, quality programs requires faculty to evaluate instructional software before its purchase and use. The purpose of this work was to develop a tool for evaluating instructional software programs. The tool was based on data from the literature, as well as input and feedback from nurse educators and multimedia specialists. The evaluation tool assists faculty to ensure proper evaluation and selection of instructional software.

Choice Behavior↗

UK audit of single photon emission computed tomography reconstruction software using software generated phantoms.

The purpose of this study was to undertake an audit of the quantitative characteristics of single photon emission computed tomography software using projection data from an analytically generated software phantom and a measured line source. The phantom consisted of three structures. A uniformly filled cylinder, a series of cylindrical rods of various diameters in a background activity with a rod to background ratio of 2:1 and lastly, a set of three concentric rings of activity in the ratio 1:0:1. The phantom contained no added statistical noise. No attenuation was imposed on the data. The phantom was generated analytically and projections were distributed at six different count densities. A single set of projections from a thin line source was also distributed. These data were distributed to centres throughout the UK. Centres were asked to reconstruct the data using a 'ramp only' reconstruction with no additional smoothing function applied. Data were requested for mean and standard deviation in the uniform cylinder, the maximum counts for each cylindrical rod and the mean counts in regions placed within the concentric rings. For the measured line source, centres were asked to measure the full width at half maximum and peak pixel counts for a profile through the reconstructed line. Results from 115 systems were obtained from 100 centres throughout the UK. These provided data from 12 software providers, 11 of these being commercial companies. Data were compared with the known input values and histograms of the distribution of results obtained. Significant differences in quantitative parameters were noted for the different input count densities as well as between suppliers and revisions of software from single suppliers.

Computer Simulation↗

Repeatability of left ventricular ejection fraction and volume measurement for 99mTc-tetrofosmin gated single photon emission computed tomography (SPECT).

OBJECTIVES: This study was carried out to assess the repeatability of left ventricular ejection fraction (EF) and volume values obtained using Cedars-Sinai quantitative gated single photon emission computed tomography (SPECT) (QGS) software and relatively low doses of 400-600 MBq of 99mTc-tetrofosmin. METHODS: Repeatability was assessed in a group of 75 patients, with both normal and reduced EF, who underwent repeat 99mTc-tetrofosmin gated SPECT studies and showed no clinical change in cardiac status. Gated SPECT data were acquired 1 h after injection at rest of 400-600 MBq of 99mTc-tetrofosmin. The standard patient dose was 400 MBq; however, some patients with a weight of >90 kg were given increased doses up to a maximum of 600 MBq. RESULTS: There was good correlation of EF and volumes between the first and repeat measurements, and no significant difference between the mean EF and volumes for both the initial and repeat measurements. Background-corrected counts in the left ventricle were calculated and patients were divided into two groups: one with low counts and one with high counts. The mean difference in EF between the first and repeat measurements was significantly higher for patients in the low count group compared with those in the high count group, but there was no significant change in volume. Similarly, the mean sequential difference in EF was significantly higher for patients with normal EF, but there was no significant difference in volume. CONCLUSIONS: We have demonstrated that EF measured using 99mTc-tetrofosmin gated SPECT is repeatable, particularly for patients with low EF, provided that adequate left ventricular counts are obtained. This will require doses greater than 400 MBq in larger patients. Ventricular volumes calculated using QGS may not be sufficiently repeatable for clinical use.

Algorithms↗

Large variations occur in bone density measurements of children when using different software.

BACKGROUND: Paediatric dual X-ray absorptiometry (DXA) studies present a number of technical problems. One of these is that the edge detection algorithms designed for the adult skeleton may fail for paediatric studies. Hologic provide alternative algorithms for low bone density studies. AIM: To assess low-density software for the analysis of paediatric DXA studies and to compare with the adult protocol. METHODS: Our centre has scanned 450 normal children as part of a normal range study. A subgroup of 103 children was selected using a random number generator. The group was distributed evenly between males and females and across the age range 5-17 years. Each individual underwent both a lumbar spine and a whole-body scan on a Hologic QDR-4500W DXA scanner. Both scans were analysed using the standard adult protocol and then re-analysed using the Hologic experimental paediatric protocol for whole body and the Hologic low-density protocol for lumbar spine. RESULTS: Both lumbar spine protocols showed an increase in bone mineral density with age; however, the low-density protocol always produced a lower bone mineral density result than the adult protocol. Bland-Altman analysis showed limits of agreement of 0.031-0.093 g x cm(-2) (male, 0.032-0.089 g x cm(-2); female, 0.031-0.096 g x cm(-2)). This represents a mean difference of 9%. Five results showed differences greater than the upper limit of agreement. All these cases were children under 11 years of age who had large areas of spine not identified as bone by the adult protocol. These children were all below the 30th percentile for the body mass index. The whole-body protocols showed similar increases in bone mineral density with age; however, the experimental paediatric protocol always produced a lower bone mineral density result than the adult protocol. Paired results showed limits of agreement of 0.0668-0.130 g x cm(-2) (male, 0.063-0.124 g x cm(-2); female, 0.073-0.134 g x cm(-2)). This represents a mean difference of 11%. Five results showed differences greater than the upper limit of agreement. CONCLUSIONS: For anteroposterior (AP) lumbar spine scans, the use of the paediatric algorithm in children under 11 years of age would prevent the largest failures in analysis. For whole-body scanning, the adult algorithm showed no major failures in children of 11 years or older. It is hoped that forthcoming improvements in whole-body density analysis will improve the results for those under 11 years of age. Normal range data should be generated for any new algorithm to allow proper interpretation of clinical studies.

Absorptiometry, Photon↗

Staffing and scheduling at your fingertips.

Learn how staff-scheduling software can help you reach goals for data gathering and management, outcomes improvement, or cost savings goals, and how to select the best system for your organization.

Choice Behavior↗

Evaluating the appropriateness of a nurse expert system's patient assessment.

The Urological Nursing Information System (UNIS) is an expert-system prototype designed to help nurses perform patient assessments on elderly nursing home residents known to be incontinent of urine. A study was conducted to evaluate the appropriateness of the patient-assessment parameters stored in the knowledge base of UNIS. These parameters were stored as objects--a kind of template for holding related clusters of data, facts, rules, hypotheses, or any knowledge in a single conceptual unit. Each object was rated for its appropriateness by 14 nurse experts. Resulting scores ranged from +14 to -14. The effect of the nurse experts' educational backgrounds and work settings on their ratings were also analyzed. The results indicated that 95.6% of the objects received favorable ratings from the nurse experts. Educational background was not a significant factor chi 2 = 5.2, but work settings did have a significant affect chi 2 = 21.07, p = 0.01.

Aged↗

Interactive data collection: benefits of integrating new media into pediatric research.

Despite the prevalence of children's computerized games for recreational and educational purposes, the use of interactive technology to obtain pediatric research data remains underexplored. This article describes the development of laptop interactive data collection (IDC) software for a children's health intervention study. The IDC integrates computer technology, children's developmental needs, and quantitative research methods that are engaging for school-age children as well as reliable and efficient for the pediatric health researcher. Using this methodology, researchers can address common problems such as maintaining a child's attention throughout an assessment session while potentially increasing their response rate and reducing missing data rates. The IDC also promises to produce more reliable data by eliminating the need for manual double entry of data and reducing much of the time and costs associated with data cleaning and management. Development and design considerations and recommendations for further use are discussed.

Child↗