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Modern day pirates. Software users and abusers.

Although the use of computers for word processing and spreadsheet analysis is widespread, other less well-known uses can also increase efficiency and productivity. In this bimonthly column, Dr. Nicoll discusses a variety of computer applications to help the nurse executive catch up, keep up, and get ahead.

Copyright↗

Faxes, modems, and fax/modems.

Although the use of computers for word processing and spreadsheet analysis is widespread, other less well-known uses can also increase efficiency and productivity. In this bimonthly column, Dr. Nicoll discusses a variety of computer applications to help the nurse executive catch up, keep up, and get ahead.

Communication↗

A more cost-effective method of preoperative computerized imaging.

Stimulated by the explosive expansion of the computerized desk top publishing industry during the past few years, microcomputer hardware and software are evolving at a staggering rate. Memory is rapidly increasing, and prices are declining. I have found that with the hardware and software described in this paper, I was able to obtain, in a much more cost-effective manner, as useful preoperative information for my practice as I could obtain with more expensive "turnkey" (only one use) computerized imaging systems. This type of microcomputer, of course, is not limited to just the imaging system, but can be used for a variety of other programs as well, such as word processing, slide labeling and production, spreadsheet functions, billing and filing, and numerous business and other applications. The ease of use with readily available 35-mm slides of my patients has greatly enhanced the appeal of this system. Computerized imaging, when used as an educational tool, can be very helpful in preoperative planning, resident teaching, and for illustration and discussion of a patient's proposed surgery. The electronic imaging disclaimer compiled by the American Society of Plastic and Reconstructive Surgeons has been extremely helpful in clarifying the limits of computerized imaging and reducing any false expectations that my patients might have. All of us are experiencing the dawn of a very exciting evolution.

Cephalometry↗

Nursing self-efficacy of an integrated clinical and administrative information system.

Self-efficacy is a user's confidence that he or she has the ability to use an information system. A survey gathered demographics, self-assessed computer skills, attitude and self-efficacy before installation of an integrated clinical and administrative information system. Results showed that higher levels of nursing education, home computer use, and average levels of self-assessed e-mail, Internet search, word processing, and general computer expertise predicted self-efficacy of the system. In addition, previous use of home and office electronics equipment, such as an answering machine, predicted self-efficacy. Implications for training and future adoption of clinical information systems are presented.

Computer Literacy↗

The BCI Competition 2003: progress and perspectives in detection and discrimination of EEG single trials.

Interest in developing a new method of man-to-machine communication--a brain-computer interface (BCI)--has grown steadily over the past few decades. BCIs create a new communication channel between the brain and an output device by bypassing conventional motor output pathways of nerves and muscles. These systems use signals recorded from the scalp, the surface of the cortex, or from inside the brain to enable users to control a variety of applications including simple word-processing software and orthotics. BCI technology could therefore provide a new communication and control option for individuals who cannot otherwise express their wishes to the outside world. Signal processing and classification methods are essential tools in the development of improved BCI technology. We organized the BCI Competition 2003 to evaluate the current state of the art of these tools. Four laboratories well versed in EEG-based BCI research provided six data sets in a documented format. We made these data sets (i.e., labeled training sets and unlabeled test sets) and their descriptions available on the Internet. The goal in the competition was to maximize the performance measure for the test labels. Researchers worldwide tested their algorithms and competed for the best classification results. This paper describes the six data sets and the results and function of the most successful algorithms.

Adult↗

A microcomputer-based information storage and retrieval system for the maintenance of records for a culture collection.

A microcomputer-based system for the storage and retrieval of information on strains in a culture collection is described. The system was designed around commercially available software packages written for microcomputers. Two additional programs were written using the BASIC language to allow a catalogue of the culture collection to be printed in a specific format. The details of each strain in the collection were stored on a floppy disc. Details of new strains were added to this database and information relating to existing cultures was modified or, where necessary, deleted from the collection. The database can be searched to supply details of a particular culture or to identify those cultures which possess certain attributes. The records for the whole collection were sorted alphabetically by species name, and numerically by accession number, and a word-processing package was used to print a catalogue of the culture collection.

Bacteriology↗

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↗

Early N400 development and later language acquisition.

Recent developmental research on word processing has shown that mechanisms of lexical priming are already present in 12-month-olds whereas mechanisms of semantic integration indexed by the N400 mature a few months later. In a longitudinal setting we investigated whether the occurrence of an N400 at 19 months is associated with the children's language skills later on. To this end children were retrospectively grouped according to their verbal performance in a language test at 30 months. Children with later age-adequate expressive language skills already displayed an N400 at 19 months. In contrast, children with later poor expressive language skills who have an enhanced risk for the development of specific language impairment (SLI) did not show an early N400. The results imply that children who have deficits in their expressive language at the age of 30 months are already impaired in their semantic development about one year earlier.

Data Interpretation, Statistical↗

Competence in nursing informatics among nursing students and staff at a nursing institute in Sweden.

BACKGROUND: Information technology (IT) has slowly been implemented in many health-care organizations (i.e. hospitals). The use of computers has advanced to home care and long-term facilities. Consequently, it is important that nurses are able to demonstrate competence and feel confident in the use of IT. Yet, research has reported that nursing students have varying degrees of competence and experience with IT. AIMS: The purpose of this study was to ascertain nursing students' and nursing educators' self-reported attitudes, skills and experiences using IT. METHODS: Data were collected through a written survey distributed and completed by 247 nursing students (45 of whom were registered nurses who participated in extension courses) and 52 staff members from the nursing faculty at a university in Sweden. RESULTS: Two-thirds of the students and 92% of the nursing educators had access to the Internet from their homes. Of the students, 71% identified their IT skills as being sufficient for their current or future work as a registered nurse. Nurse educators were less confident in the students' ability, reporting that only 29% of nursing students had sufficient IT skills. Comparatively, 48% of the nursing educators believed that they themselves had sufficient IT skills for their role as a nurse educator. CONCLUSIONS: It is important that nursing students have basic IT skills and are familiar with e-mail, word-processing and various databases on the World Wide Web. Findings indicate that participants had a deficit in these skills, suggesting the need to integrate IT into the nursing curriculum.

Adult↗

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↗