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[I am a doctor, so I am in control].

INTRODUCTION: A number of researchers and physicians have described that physicians often have difficulties and great resistance towards seeing themselves as patients. General practitioners (GPs) who are self-employed in their own small firms and who are registered in their own practice have special problems in connection with illness. MATERIAL AND METHODS: The project "The physician as patient" consisted of a questionnaire study of 198 GPs, followed by semistructured interviews of 28 GPs, who had been seriously ill or had been treated in hospital. The interviews were taped and word processed. The analysis of the interviews was inspired by Malterud's qualitative method. RESULTS: One of the 28 interviews (Marianne) is described i two main sections: confrontation with illness, and enhanced self knowledge. DISCUSSION: The discussion is divided into four sections: the GP's role as helper and feeling of omnipotence. The validity and transfer ability of the results of the study. The ill doctor's reluctance towards being a patient and the treating doctor's uncertainty towards treating a colleague.

Attitude of Health Personnel↗

Computing and information technology skills of final year medical and dental students at the College of Medicine University of Lagos.

This study was conducted to determine awareness, level of use of computers and the use of the Internet for medical research amongst final year medical and dental students at the University of Lagos. A self-administered structured questionnaire was used to collect data. A response rate of 88% was achieved (136/155). Eighty per cent had used the computer before. Use of software applications was poor with computer games being the most frequently used (19%) followed by word processing softwares (18%). The Internet and electronic mail had been used by 58% but only 23% had used the Internet for medical research. Twenty-one percent classified themselves as proficient on the computer, 59% had little skills and 20% had no skills. Younger students (age less than 26 years) were found to have significantly better skills than older colleagues (p = 004). Majority of final year students at College of Medicine, University of Lagos have little computing skills.

Adult↗

Utilization of information technology in medical education: a questionnaire survey of students in a Malaysian institution.

OBJECTIVE: The objective of this survey was to obtain a self-reported assessment of the use of Information and Communication Technology (ICT) by medical students at the International Medical University, Malaysia. MATERIALS AND METHODS: Students' perceived skills and extent of usage of ICT were evaluated using a questionnaire. Chi-square analysis were performed to ascertain the association between variables. Further statistical testing using Chi-square test for trend was done when one of the variables was ordered, and Spearman rank correlation when both variables were ordered. RESULTS: Overall, (98%) of students responded to the questionnaire. Twenty seven students (5.7%) did not use a computer either in the university or at home. Most students surveyed reported adequate skills at word processing (55%), e-mailing (78%) and surfing the internet (67%). CONCLUSION: The results suggests that in order to increase the level of computer literacy among medical students, positive steps would need to be taken, for example the formal inclusion of ICT instruction in the teaching of undergraduate medicine. This will enhance medical students' ability to acquire, appraise, and use information in order to solve clinical and other problems quickly and efficiently in the course of their studies, and more importantly when they graduate.

Computer Literacy↗

IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

Academic Medical Centers↗

Word stem priming in unilateral stroke patients: word type and laterality effects.

We explored word type and lesion laterality effects in visual word stem completion priming. Participants were 24 stroke patients (12 left, 12 right) and 11 non-brain damaged, medical controls. Participants studied 32 threatening and 32 nonthreatening words and completed cued recall and word stem priming tasks (Mathews, Mogg, May, & Eysenck, 1989). Stroke groups had lower cued recall than controls and the right hemisphere damaged group was lower in cued recall than the left. Word type did not affect cued recall. Groups were comparable in word stem priming, and there was a word type effect such that more nonthreatening than threatening words were produced. No laterality effects were found in word stem priming. Implications for models of how words are processed during word stem priming are discussed.

Journal Article↗

Are electronic medical records trustworthy? Observations on copying, pasting and duplication.

As routine use of on-line progress notes in US Department of Veterans Affairs facilities grew rapidly in the past decade, health information managers and clinicians began to notice that authors sometimes copied text from old notes into new notes. Other sources of duplication were document templates that inserted boilerplate text or patient data into notes. Word-processing and templates aided the transition to electronic notes, but enabled author copying and sometimes led to lengthy, hard-to-read records stuffed with data already available on-line. Investigators at a VA center recognized for pioneering a fully electronic record system analyzed author copying and template-generated duplication with adapted plagiarism-detection software. Nine percent of progress notes studied contained copied or duplicated text. Most copying and duplication was benign, but some introduced misleading errors into the record and some seemed possibly unethical or potentially unsafe. High-risk author copying occurred once for every 720 notes, but one in ten electronic charts contained an instance of high-risk copying. Careless copying threatens the integrity of on-line records. Clear policies, practitioner consciousness-raising and development of effective monitoring procedures are recommended to protect the value of electronic patient records.

Hospitals, Veterans↗

Using microcomputers to facilitate research studies.

Microcomputers can facilitate research studies planned by busy PACU nurses. PACU nurses need to become computer literate to take advantage of these time-efficient methods. Computer hardware and software can be used to word process a research proposal, statistical software can be used for data analysis, and graphic and clip-art software can be used to summarize and to graphically present the results of this study.

Clinical Nursing Research↗

Preparing student nurses, faculty and clinicians for 21st century informatics practice: findings from a national survey of nursing education programs in the United States.

Because healthcare delivery increasingly mandates data-driven decision-making, it is imperative that informatics knowledge and skills are integrated into nursing education curricula for all future nurse clinicians and educators. A national online survey of deans/directors of 266 baccalaureate and higher nursing education programs in the U.S. identified perceived informatics competencies and knowledge of under-graduate and graduate nursing students; determined the preparedness of nurse faculty to teach and use informatics tools; and elicited perceptions of informatics requirements of local practicing nurses. Frequency data and qualitative responses were analyzed. Approximately half of the programs reported requiring word processing and email skills upon entry into the nursing major. The use of standardized languages and the nurse's role in the life cycle of an information system were the least visible informatics content at all levels. Half of program faculty, rated as "novice" or "advanced beginners", are teaching information literacy skills. Findings have major implications for nurse educators, staff developers, and program administrators who are planning faculty/staff development opportunities and designing nursing education curricula that prepare nurses for professional practice.

Curriculum↗

Computer graphics and developmental theory: a powerful partnership.

Educating student nurses to successfully use computer technology involves conscientious planning from nursing faculty responsible for curriculum integration. Many computer elements may be considered such as computer literacy, word processing, and computer assisted instruction. Database programs, spreadsheet applications, and statistical packages are also often incorporated into curriculum integration efforts. Computer graphics and desk-top publishing can also be used as an effective teaching strategy. The following describes an attempt to combine a creative teaching approach for developmental theory within a course on human development while expanding on students' computer skills in the field of computer graphics.

Computer Graphics↗

[Alzheimer's dementia, sleep disorders and nuclear medicine].

In case new diagnostic procedures for Alzheimer's dementia (AD) appear, Nuclear Medicine (NM) would like to be aware of them in order to evaluate its own contribution to diagnose AD by SPET and PET brain studies. Recently, sleep disturbances were studied in AD and tend to be diagnostic for early AD. In AD the actual time of night sleep was found to be 5.7 h, while awakeness time for the same night sleep increased to 2.7 h. Also in AD, the REM and the slow wave stage (SWS) during sleep are shorter and hypopnea and apnea phases are abundant. Internal body temperature during night sleep is only slightly increased in AD, while in temporofrontal dementia and in normal individuals this increase is significant. The circadian rhythm of melatonin is disturbed in AD. The normal duration of inspiration and expiration during daytime which is reversed during normal night sleep, has not been studied in patients with AD. However, this reverse condition favoring inspiration is expected to provide more oxygen to the brain. Chronic but not acute stress causes memory loss and is currently being studied by us as a possible causative factor for memory loss in AD. Tomographic SPET and PET brain studies can locate the site of brain damage in AD. This is important since memory has recently been classified into four categories, namely episodic, semantic, procedural and working memory. In early AD only procedural memory remains intact. This means that these patients may drive a car, do computer word processing and play some games at home or/and in the field. This memory is located in specific nuclei in the cerebellum and the occipital frontal area which do not relate to sites of other kinds of memory. This difference could be well identified by tomographic SPET or PET studies. Thus NM may also diagnose the early stage of AD. Another issue refers to the indications that the unified Medicare and Medicaid system in the USA has issued on September 15, 2004 for performing a PET (18)F-FDG study for AD. These indications are fully described in this editorial.

Alzheimer Disease↗

Plugging into technology.

One of the most important things to consider before buying a computer is use. Where and how will you use your computer? At home (to do household budgeting, some word processing, and play games?), or at the office (to balance complex budgets, calculate payroll, keep a large database of clientele, and possibly have up to 16 users on the system at the same time?). Will you want to integrate your system with imaging, voice response charting and EDI? (The brilliance of EDI alone justifies automation.) Keep in mind that what you do with a computer will probably expand as you get more familiar with the technology, so make sure there's room for growth in the computer you select. Another important aspect to purchasing a computer is service. The company you buy from must be able to provide you with prompt service, and be available when you first explore the realm of microcomputing. If you manage to save money on the purchase price, but it takes six months to have your office computer repaired, you have definitely lost out in the long run.

Computer Systems↗

Identifying blood group antibodies...can a computer help?

Antibody identification is one of the last areas of laboratory medicine to embrace computerization. This is due in part to the complex nature of antibody identification. Until recently, computer programs written to assist with antibody identification have been slow and cumbersome. However, technological advances in computer hardware have greatly improved the response time for these applications. Still, blood bank technologists sometimes shun assistance from the computer because they consider anti- body investigation as an intellectually stimulating aspect of their job that they do not wish to turn over to a computer. Computer programs for antibody investigation are probably most useful for technologists who perform antibody investigations infrequently. They can also be invaluable for experienced technologists performing complex investigations. When integrated with a computerized blood bank record-keeping system, antibody investigation software can improve storage and retrieval of test results. Database applications for retrieving rare cells and sera offer the potential to improve the productivity and capability of any anti- body investigation laboratory. And word processing applications greatly enhance the potential for generating meaningful reports of test results.

Journal Article↗

Epi Info: a general-purpose microcomputer program for public health information systems.

Epi Info is a general-purpose set of computer programs for word processing, database management, statistics, and graphics developed over the past five years at the Centers for Disease Control and the World Health Organization. The programs allow rapid questionnaire construction, data entry, and analysis during epidemic investigation. Both data entry and analysis can be programmed to provide customization and automatic operation for more permanent systems, such as those for disease or injury surveillance. Epi Info is in the public domain and copies may be freely distributed. It requires an IBM-compatible micro-computer with at least 512 kilobytes of memory. Translations into French and Spanish are in progress; a translation kit is available to facilitate translation into other languages.

Centers for Disease Control and Prevention, U.S.↗

Perceived skill and utilisation of information technology in medical education among final year medical students, Universiti Putra Malaysia.

The objective of this survey was to obtain a self-reported assessment of the use of information technology (IT) by final year medical students. Two hundred and sixty five students responded to a questionnaire survey. 81.5% of students considered their computer skills adequate, while 87.9% had access to computers outside the campus. Most students reported adequate skills at word processing, e-mailing and surfing the Internet. Fifty three percent of students spent three hours or more each week on the computer. While students indicated a general willingness to access Internet-based materials, further steps need to be taken to increase the use of this method of instruction.

Computer Literacy↗

An initial assessment of the cost and utilization of the Integrated Academic Information System (IAIMS) at Columbia Presbyterian Medical Center.

The concept of "one stop information shopping" is becoming a reality at Columbia Presbyterian Medical Center (CPMC). The goal of our effort is to provide access to university and hospital administrative systems as well as clinical and library applications from a single workstation, which also provides utility functions such as word processing and mail. Since June 1987, CPMC has invested the equivalent of $23 million dollars to install a digital communications network that encompasses 18 buildings at seven geographically separate sites and to develop clinical and library applications that are integrated with the existing hospital and university administrative and research computing facilities. During June 1991, 2425 different individuals used the clinical information system, 425 different individuals used the library applications, and 900 different individuals used the hospital administrative applications via network access. If we were to freeze the system in its current state, amortize the development and network installation costs, and add projected maintenance costs for the clinical and library applications, our integrated information system would cost $2.8 million on an annual basis. This cost is 0.3% of the medical center's annual budget. These expenditures could be justified by very small improvements in time savings for personnel and/or decreased length of hospital stay and/or more efficient use of resources. In addition to the direct benefits which we detail, a major benefit is the ease with which additional computer-based applications can be added incrementally at an extremely modest cost.

Academic Medical Centers↗

Teaching problem handling in general practice: a computer assisted learning software package for medical students.

A computer assisted learning software package for medical students, EnMesh, designed to increase understanding of the problem-handling skills needed in general practice has been developed at the University of Liverpool. Users access the system anonymously and respond in sequence to problems in the form of clinical vignettes. Responses to each problem, in the form of up to six two-line text statements, are generated by the user with a simple word processing facility. Users compare their responses with those of established general practitioners, searching for similar or matching ideas. After completing not less than four problems users are provided with feedback on their performance in relation to the physical, psychological and social dimensions of the problems. The frequency with which the system is being used and the results of self scoring are monitored by a parallel teacher programme. The programmes are designed to run on a wide range of microcomputers. EnMesh was designed to provide an informal learning resource within an established clinical course. The challenge of valid problems, the option to respond anonymously, self scoring and feedback on performance are features designed to attract student participation in computer assisted learning. Although in EnMesh the expert data is categorized in three dimensions, in designing such software the number of categories is limited solely by the range of responses which feedback is required to reflect.

Computer-Assisted Instruction↗

Transformation of DNA sequence data into geometric symbols.

Comparative analysis of related DNA sequences has been simplified by the transformation of data in the standard A, G, C, T format into a set of geometric symbols that promote pattern recognition. Previously, comparing more than 2 or 3 sequences simultaneously has been difficult because of the monotonous patterns established by letters. Here 33 sequences are simultaneously compared to demonstrate the ease with which nucleotide substitutions are accurately identified. This has been accomplished by writing a Word-Perfect macro program to facilitate this transformation. Since this word processing program is widely used, performing this kind of analysis is readily achievable in most laboratories involved in DNA sequence analysis.

Animals↗

A local area network for medical research; planning, realization and experience.

This report focuses on the planning and realization of an interdisciplinary local area network (LAN) for medical research at the University of Heidelberg. After a detailed requirements analysis, several networks were evaluated by means of a test installation, and a cost-performance analysis was carried out. At present, the LAN connects 45 (IBM-compatible) PCs, several heterogeneous mainframes (IBM, DEC and Siemens) and provides access to the public X.25 network and to wide-area networks for research (EARN, BITNET). The network supports application software that is frequently needed in medical research (word processing, statistics, graphics, literature databases and services, etc.). Compliance with existing "official" (e.g., IEEE 802.3) and "de facto" standards (e.g., PostScript) was considered to be extremely important for the selection of both hardware and software. Customized programs were developed to improve access control, user interface and on-line help. Wide acceptance of the LAN was achieved through extensive education and maintenance facilities, e.g., teaching courses, customized manuals and a hotline service. Since requirements of clinical routine differ substantially from medical research needs, two separate networks (with a gateway in between) are proposed as a solution to optimally satisfy the users' demands.

Costs and Cost Analysis↗