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Using nursing expertise for non-nursing computer systems.

The nurse working with automated systems often uses the same practical and clinical skills used in the analysis, implementation, and evaluation of patient care. Transferring those cognitive skills from a clinical setting to a setting in which automated systems are the primary focus is practical, yet challenging. The intuitive processes of analysis, implementation, and evaluation are the same; however, the methods, procedures, and tools vary. The additional skills required to become a systems analyst, technical writer, information specialist, project officer, or consultant can be learned either formally by attending courses, seminars, workshops, or other educational programs or by on-the-job experience with the many aspects of systems implementation. Whenever possible, opportunities for learning should be sought by the nurse to develop her analytical and technical skills, depending on the nature of the role she fills in working with automated systems. Experience with non-nursing technology provides the nurse with a deeper understanding and appreciation of the applications of computer technology in a variety of settings. This kind of knowledge contributes to her ability to more accurately assess the capabilities desirable in automated health care system, with particular emphasis on nursing requirements. The combination of nursing, technical, and analytical skills places the nurse working with automated systems in a position to greatly expand her knowledge base and to identify mechanisms to transfer non-nursing technology to automation in nursing practice, education, and research. The challenge to the nursing profession will continue as automation continues to become an integral part of health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗

An integrated clinical computer system: implications for a medical information services department.

The hybrid record--both paper and electronic--is a cumbersome byproduct of the evolution to the computer-based patient record. Nancy Walker describes how William Beaumont Hospital managed its information services with this mixed media record. Her article provides practical solutions for health information managers including downtime procedures, report distribution plans, release of information steps, and audit procedures for maintaining confidentiality.

Computer Security↗

Evaluation of effectiveness of a computer system (CAD) in the identification of lung nodules with low-dose MSCT: scanning technique and preliminary results.

PURPOSE: Evaluation of the effectiveness of computer-aided diagnosis (CAD) in the identification of pulmonary nodules. MATERIALS AND METHODS: Two observers (A1, A2) with different levels of experience independently evaluated 20 chest MSCT studies with and without the aid of a CAD system (LungCheck, R2 Technology, Inc). The study parameters were as follows: 140 kVs, 40 mAs, collimation 4 x 1 mm, slice thickness 1.25 mm, reconstruction interval 1.0 mm. The observers analysed the images with and without CAD and evaluated: 1) nodule size (longer axis); 2) number and location of nodules; 3) reading time for each observer. The gold standard was represented by the evaluation of both readers in consensus with the aid of the CAD system. RESULTS: Without CAD support the two readers identified 77 (A1) and 79 (A2) nodules and with CAD 81 (A1) and 82 (A2) nodules. Working in consensus the two observers identified 81 nodules without the aid of the CAD and 84 nodules with the aid of CAD. Total number of nodules identified by CAD was 104, 25 of which were false positive and 5 false negative. The average reading time with the aid of the CAD decreased by as much as 40% for both the observers. CONCLUSIONS: The preliminary results of our study suggest that the CAD technique is an accurate automatic support tool in the identification of pulmonary nodules. It reduces reading time and automatically supplies the size, volume, density and number of nodules, thus being useful both in screening programmes and in the follow-up of cancer patients, in whom comparison of the images is particularly difficult.

Adult↗