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[The significance of computed tomography in ophthalmologic diagnosis. I: The place of computed tomography, indications, study technics, anatomic representation, computed tomography of eyeball and orbital injuries].

CT is recognized today as method of choice for examining pathological conditions of eyeball and orbit. Several techniques of CT examination are needed to attain the most accurate and detailed information about orbital and eyeball lesions. The exact knowledge of the normal anatomic CT feature of orbital structures is necessary. In traumatic lesions of the globe and the orbit foreign bodies, haematomas and fractures of the orbital walls can be proved and localized and traumatic sequelae can be diagnosed.

Eye Foreign Bodies↗

The role of computer-aided assessment in health professional education: a comparison of student performance in computer-based and paper-and-pen multiple-choice tests.

There is a lack of empirical research in the use of computers in assessment. A study was conducted to compare student performance in computerized and paper-and-pen multiple-choice tests and assess the extent and effect of 'computer anxiety'. The LXR.TEST 5.1 software was used for the computerized test. A validated rating scale was used to assess computer anxiety. Most students had little computer experience other than in word processing. Only about a third of the students had moderate to mild computer anxiety. Neither computer experience nor anxiety correlated significantly with performance in the computer test. Whereas students performed significantly better in the paper test than in the computer test, there was no statistical difference in ranking in the two assessments formats. This suggests that computer-based assessment could be used with confidence for the purposes of ranking students, but care should be taken in using it for grading.

Journal Article↗

Developing interactive computer-based simulations: an object-oriented development methodology enhances computer-assisted instruction.

The purpose of this research was to investigate the application of object-oriented technology and AI techniques to enhance development of computer-based training simulations. Towards that end, a comprehensive computer-assisted instructional unit was developed to teach the skills and concepts of window-based applications, the OS/2 desktop, and the use of a patient care information system. By taking advantage of sophisticated computer graphics for the visual representation of objects and the behavioral modeling capabilities of the object-oriented language, domain knowledge modeling and human-computer interactions were implemented without complex natural language processing techniques. The results of this research indicate that nurses and physicians are able to learn the basic skills and concepts of computer systems and how to query for patient information. The new methodology described for building these computer-assisted instructional simulations significantly eased the training and teaching of large numbers of nurses and physicians and simplified their transition to a complex, computer-based hospital information system environment.

Computer Graphics↗

Computer-aided 3-D simulation and prediction of craniofacial surgery: a new approach.

Background: In plastic and reconstructive craniofacial surgery, careful preoperative planning is essential. In complex cases of craniofacial synostosis, rapid prototyping models are used to simulate the surgery and reduce operating time. Recently, 3-D CT model surgery has been introduced for presurgical planning and prediction of the postoperative result. Objective: For simulation of craniofacial surgery a computer-based system was developed that allows visualization and manipulation of CT-data using computer graphics techniques. Surgical procedures in all areas of the bony skull can be performed interactively. Results: The case of a child with scaphocephalus is presented. Surgery is planned using the craniofacial surgery simulator described above. Conclusion: The computer-based interactive surgery simulation systems presented here allow precise visualization of craniofacial surgery. The accurate computer-aided 3-D simulation of bone displacements is also the prerequisite for transfer of the simulated surgery using a navigation system for surgery. Thus the preoperatively planned procedure could be transferred directly to the operating table. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗

A survey of computer use in Scottish primary care: general practitioners are no longer technophobic but other primary care staff need better computer access.

OBJECTIVE: To describe the use of computing systems by primary care staff in Scotland. Participants Practice managers in Scotland on behalf of their practice teams. METHODS: A survey of computer use in Scottish general practices was carried out by the Scottish Clinical Information Management in Primary Care (SCIMP) group in April 2001. Every practice was sent an electronic copy of a questionnaire using NHSnet. Practices that did not respond to the electronic version were sent a paper version of the questionnaire. MAIN OUTCOME MEASURES: Access to computers, use during consultations, links to laboratories, problems experienced by users. RESULTS: A total of 308 practices (30%) replied to the electronic questionnaire and 346 practices (33%) to a paper version, giving an overall response rate of 63% (654 practices). A total of 296 (29%) of practices could not receive the electronic version. It was reported that 94% of general practitioners and 74% of practice nurses frequently used a computer; 72% of practices used their computer for chronic disease management. There was great variability in links to laboratories for lab results (range 1-30% by region). Of responding practices, 16% had plans for a unified patient record, but access to a computer is still a major problem for community nurses. Satisfaction was expressed for all systems and many practices also use third-party programs. CONCLUSIONS: Most Scottish doctors make frequent use of computers for a variety of clinical and practice management activities. Many other staff want to make greater use of computers, but are often unable to obtain access.

Attitude to Computers↗

Trends in measures of computer experience and computer anxiety for students in three successive medical school classes.

Computer-related variables, including measures of computer anxiety and computer experience, were evaluated for three successive classes of matriculating medical students. Across the three classes, average computer anxiety measures declined and differences in the levels of computer anxiety for males and females diminished. Average measures of computer experience rose over time and were comparable for males and females, although there was a trend toward increasing divergence in the range and distribution of students' computer experience scores. Implications of these findings for addressing computer literacy in the medical curricula are discussed.

Anxiety↗

A non-computer expert's experience with the computer.

In summary, I have tried to illustrate how the computer is rapidly becoming indispensable to the physician. This is true for both the physician in private practice as well as the physician involved in research. Computer technology has progressed to the point that a personal computer is readily affordable. Technologic advances and new software packages permit individuals who possess no computer skills to operate almost any system without limitations. There are no age limits to learn how to use the computer. I was introduced to the computer through my clinical research in malignant melanoma as a medical student. Its utility in research is undeniable. The uses of the computer have increased dramatically during the past few years. Today the computer aids not only in research but in the day-to-day care of patients and in medical education. Access to the information explosion is literally at the tips of the physician's fingers.

Appointments and Schedules↗

Computer-assisted medication review for asthmatic patients as a basis for intervention. Constructing and validating an algorithmic computer instrument in pharmacy practice.

OBJECTIVE: To construct and validate a computer instrument that identifies asthma patients receiving--theoretically--suboptimal drug therapy in community pharmacies, by the use of patient medication records. This selection enables the pharmacist to assist these patients in using medicines appropriately. METHODS: According to Dutch asthma guidelines which describe a stepwise approach and in order to define correct profiles for the use at each level of these guidelines, the optimum use of drugs in the different levels in asthma treatment was expressed in defined daily doses (DDDs) per pharmacological drug-group during a period of one year. An algorithmic computer instrument was developed to select patients with medication use deviant from these profiles. By using nine different selection profiles, the computer instrument stratified patients according to the medication records filed in the pharmacy computer. Patient medication records in four community pharmacies were investigated to validate the selection profiles as indicators for theoretically suboptimal drug use by asthma patients. The validation was performed by comparing the professional judgement of participating pharmacists with the selections made by the computer. MAIN OUTCOME MEASURE: Positive predictive value and negative predictive value of the selection made by algorithmic computer instrument. Rate of false-positive results. RESULTS: The computer instrument identified asthma patients using theoretically suboptimal drug therapy with approximately 95% predictive value compared with the professional judgement of the pharmacists. The rate of false-positive results was 5%. CONCLUSION: The results of the algorithmic computer instrument and the professional judgement of the pharmacists are in close agreement. The instrument will be utilised in further research in the IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigating the role of Dutch community pharmacists in counselling patients who are at risk of suboptimal drug use in the treatment of their asthma.

Adolescent↗

Laboratory computer availability: a College of American Pathologists Q-probes study of computer downtime in 422 institutions.

OBJECTIVE: To determine the frequency, duration, and impact of computer downtime on laboratory operations. METHODS: Four hundred twenty-two laboratories monitored the frequency of computer system downtime and other computer malfunctions over a period of 30 days. Participants classified each instance of unavailability according to its cause, duration, and consequences. In all, data from 11 967 instances were submitted for analysis. RESULTS: During the 30-day study period, the participating institutions experienced a median of eight episodes in which all or a primary computer function was unavailable. The cumulative median duration of downtime during these 30 days was 14.3 hours. The most unfortunate 10% of participants reported having 44 or more episodes in which all or a primary computer function was lost during the 30 days, for a cumulative duration of 77.7 or more hours of system unavailability. Computer installations that served two or more full-service laboratories were significantly more likely to experience unscheduled loss of all or a primary computer function than were sites that served only one laboratory, and unscheduled events were more likely to be of longer duration. Participants reported that 1.3% of downtime events required the use of staff overtime to perform required work. Overtime was more likely with longer-than-average periods of downtime and losses that had not been scheduled. Of all the downtime instances, 0.2% led to the release of inaccurate results, and 0.1% led to an adverse clinical outcome. These events were associated with software failure, unscheduled downtime, a site's overall frequency of downtime, particular software vendors, and not having installed a software patch in the previous 1000 days. CONCLUSIONS: The frequency of laboratory computer downtime varies widely among institutions and is occasionally associated with adverse clinical outcomes or additional staff expense.

Chi-Square Distribution↗

Self-reported effects of computer workshops on physicians' computer use.

BACKGROUND: The need for physicians to be proficient in the use of computers is undeniable. As computers have become easier to use and more widespread, their use in medicine is expanding. Several organizations have produced continuing medical education programs to teach physicians about the use of computers in medicine but little has been reported on the effects of such programs. METHOD: We present the self-reported effects of a series of workshops that taught physicians about basic computer skills: information retrieval, the Internet, CD-ROMs, electronic mail, and computer-aided learning. RESULTS: A questionnaire mailed to 65 workshop participants yielded a response rate of 46% (n = 30). Of the 30 respondents, 27% (n = 8) had bought new hardware or software because of attending the workshops, with the most common purchase being a new computer. Fifty-seven percent (n = 17) had increased their use of computers, with the most common applications being use of the Internet for information retrieval and electronic mail.

Computer User Training↗

Learning preferences, computer attitudes, and test performance with computer-aided instruction.

BACKGROUND: Learning preference refers to how individuals choose to approach learning situations. Computer-aided instruction (CAI) permits the adaptation of educational content to individual student learning strategies. METHODS: To determine if learning preference and computer attitude influence the acquisition of knowledge using CAI materials, a prototype CAI program was developed that incorporated differing learning exercises. Students (n = 180) completed Rezler's Learning Preference Inventory (LPI) and a computer attitude survey (CAS). The LPI uses three sets of paired scales to characterize learning preference and choice of learning situation. The CAS assesses student attitudes toward computers in general (CAS-G), as well as the educational use of computers (CAS-E). After finishing the program students completed a program attitude survey (CAS-P). Immediate comprehension was assessed by pretests and posttests incorporated into the program. Retention was assessed by a repeat of the posttest 4 to 6 weeks after initial program review. RESULTS: Scores (mean +/- SEM) on the pretest, posttest, and late posttest were 38.1% +/- 1.35%, 70.9% +/- 1.24%, and 62.5% +/- 1.44%, respectively. There was no correlation between students' learning preferences or computer attitude and test performance. CONCLUSIONS: The data indicate that CAI provides a means of delivering educational content that results in an increase in knowledge that is not correlated with computer attitudes or learning preferences.

Angiography↗

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans.

PURPOSE: A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method. MATERIAL AND METHODS: The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient. RESULTS: The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region. CONCLUSIONS: This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.

Algorithms↗

Influence of direct computer experience on older adults' attitudes toward computers.

This research examined whether older adults' attitudes toward computers became more positive as a function of computer experience. The sample comprised 101 community-dwelling older adults aged 57 to 87. The intervention involved a 2-week computer training program in which subjects learned to use a desktop publishing software program. A multidimensional computer attitude measure was used to assess differential attitude change and maintenance of change following training. The results indicated that older adults' computer attitudes are modifiable and that direct computer experience is an effective means of change. Attitude change as a function of training was found for the attitude dimensions targeted by the intervention program: computer comfort and efficacy. In addition, maintenance of attitude change was established for at least two weeks following training.

Aged↗