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Delivering genetic screening to the community.

Concern is often expressed that, in the future, screening for genetic risk will become too widespread. Haemoglobin disorders (the thalassaemias and sickle cell disorders) offer an excellent model for genetic screening, because they are common and severe. They are recessively inherited. Carriers can be detected by conventional blood tests with an accuracy of 99%, so couples at risk can be identified before they have children and offered genetic counselling and prenatal diagnosis. Carrier-screening programmes have been in place in several countries for over 20 years and now offer extensive practical experience of the problems of delivering the service equitably to entire populations. This experience suggests that the main risk is of too little rather than too much genetic screening, and of doing it badly, and demonstrates the need for a discipline of 'community genetics'. Here I propose that modern information technology has a central role in providing communities with adequate access to correct genetic information.

Anemia, Sickle Cell↗

Teaching information mastery: creating informed consumers of medical information.

BACKGROUND: The concepts of evidence-based medicine are permeating all specialties, including family practice. This article describes a curriculum to teach residents the principles and practices of information mastery, a derivation of evidence-based medicine that is more relevant to family physicians. METHODS: The curriculum is a 2-year longitudinal experience consisting mainly of didactic presentations and demonstrations in the first year followed by small-group sessions in the second year. Residents are taught the concepts of the previously described approach of information mastery and the application of these concepts to the variety of information resources available to them. Specifically, residents are taught how to find, evaluate, and apply information available from original research literature, review articles, meta-analyses, translation (controlled-circulation) journals, continuing education lectures, experts and colleagues, pharmaceutical representatives, and clinical experience. RESULTS: Using a before-after design at two institutions, the curriculum improved residents' attitudes, confidence regarding the medical literature, their perceptions of their ability to evaluate the published literature, and their use of information sources. CONCLUSIONS: Offering a structured curriculum to family practice residents creates dynamic, confident, and independent clinicians skilled in the art of information mastery.

Curriculum↗

Using open-source solutions to teach computing skills for student research.

A course that relies on open-source software for teaching introductory computer programming and Web development to psychology graduate and advanced undergraduate students is described. The rationale, content, learning goals and outcomes of the course are described, along with the specific software used. The advantages of relying on open-source solutions rather than commercial software for implementing such a course are discussed.

Computer-Assisted Instruction↗

Psychosocial assessment for treatment planning and evaluation.

1. Use of standardized measures to document a client's psychosocial status and circumstances yields readily interpretable data. These data can provide a basis for treatment selection and make possible reliable documentation of change. 2. Identification of the best measure(s) for a particular purpose requires consideration of the reason for the assessment, intended use of the data, characteristics of instruments, capabilities of respondents, and available resources. 3. Increased use of measures can advance efforts to obtain rigorous and comparative data in psychosocial nursing research and practice. Such information advances science, develops clinical acumen, and documents the results of interventions.

Humans↗

On the essential integration of nursing and informatics.

This paper asserts that nursing knowledge is fundamentally inseparable from the strategies and structures that represent it. Nursing informatics comprises a new disciplinary focus that results from a blend of nursing and informatics. The technologies of informatics, communications, computer science, decision science, human information processing, and knowledge engineering, provide critical care nurses with the support necessary for contemporary nursing practice. Informatics technologies enable nurses to communicate, process knowledge in new and more efficient ways, and better understand the nature of nursing thinking.

Humans↗

Challenges and obstacles in measuring outcomes.

Numerous factors contribute to the need for consultant pharmacists to understand and measure outcomes. Consumer groups, legislatures, regulatory and certification agencies, among others, are interested in this information. The science of quality improvement is still young. Distinguishing among three terms--quality indicators, quality measures, and benchmarks--is easy enough once they become familiar. The roots of most long-term care quality models rest on the Donabedian model. Care is necessary when selecting outcomes measures because several pitfalls exist. When carefully selected, outcomes measures can improve care immensely and decrease the risk of adverse events.

Humans↗

Summary recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, The Computer-based Patient Record Institute, The Medical Library Association, The Association of Academic Health Science Libraries, The American Health Information Management Association, and The American Nurses Association.

Clinical software systems are becoming ubiquitous. A growing literature documents how these systems can improve health care delivery, but concerns about patient safety must now be formally addressed. In 1996, the U.S. Food and Drug Administration (FDA) called for discussions on regulation of software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. These recommendations were revised and approved by the American Medical informatics Association Public Policy Committee and Board. Other organizations reviewed, modified, and approved the recommendations, and the Boards of Directors of most of the organizations in the consortium endorsed the guidelines. The consortium proposes four categories of clinical system risk and four classes of monitoring and regulatory action that can be applied on the basis of the risk level. The consortium recommends that most clinical software systems be supervised locally and that developers of health care information systems adopt a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively; therefore, the FDA should exempt most clinical software systems and focus on systems that pose high clinical risk and provide limited opportunity for competent human intervention.

Clinical Medicine↗

[The digital revolution in Japan].

The digital revolution will be achieved using three types of technology: platform; distribution; and content. Japan is advanced in these technologies, although its transformation to a new society has been slow. To keeping up with this global revolution, we need to change our mind set.

Computer Communication Networks↗

Educational implications for copyright in a digital world.

Statutory law and court cases currently leave fair use of copyrighted material poorly defined and fail to provide effective guidance for the use of others' work. Copyright legislation is undergoing significant change, accelerated by the evolution of computing and communication technologies. This paper reviews copyright issues, fair use guidelines, and applicable laws and statutes to help administrators and educators understand and comply with copyright regulations. The paper describes principles of copyright and ownership, the rights of copyright holders, and the conditions under which copyrighted material can be used by others. Recently introduced legislation, such as the 1998 Digital Millennium Copyright Act, may significantly affect how educators can use copyrighted material in the future. The integration of computer and communication technology into education raises a number of intellectual property issues for dental schools. This paper provides some general guidelines regarding copyright issues in academic environments.

Communication↗

Development and implementation of a decision support system for carotid artery stenosis: the Carotid Ultrasound Report Enhancement (CURE).

The management of carotid artery stenosis is an art evolving into a science, increasingly informed by clinical trials of medical management versus carotid endarterectomy (CEA). Ideas about optimal management depend on the confluence of patient-specific variables, surgical expertise, and the state of medical knowledge. In this complex and progressing setting, an up-to-date decision support system could help physicians apply the latest evidence to patient care. Carotid ultrasonography (US) studies provide an excellent opportunity to aid in the therapy of carotid stenosis. We developed a Carotid US Report Enhancement (CURE) to augment carotid US reports with treatment-specific prognostic information and patient-specific portions of the American Heart Association's 1998 guideline for the management of carotid artery stenosis. In the process of designing and implementing the CURE software, we encountered and eventually solved a variety of problems. The first problem was that US test was not always precise enough to distinguish between a moderate and mild carotid stenosis. Likewise, the standard US reports did not elucidate several technical problems that decreased the reliability of the US result. Third, although 17 of 18 physicians agreed to receive the CURE reports, they requested non-incriminating wording. Fourth, vascular surgeons supervising the US laboratories were reluctant to support the CURE report if they thought it would be construed as prompting self-referral. Finally, information about some comorbid conditions (e.g. a history of atrial fibrillation) could not be obtained reliably from the patients. The result of responding to these problems is a decision support program that is increasingly robust, able to detect many of its own limitations, and capable of integrating data from multiple sources. A randomized controlled trial now in progress will evaluate the clinical impact of the CURE program.

Algorithms↗

[The advance of research for technique of fusing physiological information].

With the increase of human life's pace and people's psychological burden, the spectrum of morbidities changed, and the dynamic disease which is caused by the maladjustment between heart and body becomes the main menace to human being. Through fusing various physiological information, dynamic disease can be diagnosed effectively. The paper discussed the principle of analyzing physiological system's dynamic property and evaluating dynamically human body's health level. It emphasized on introducing the progress of foreign research, and analyzed briefly the problems needed to be dealt with and the future resrarch direction of this field.

Arrhythmia, Sinus↗