[Computer-assisted personnel- and service planning. 1. Results of a study of computer use in Hessian hospitals].
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Hospital Information Systems↗
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Guidelines for hospital laboratory computer systems. The Liaison Committee on Hospital Laboratory Computing--Ireland.
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Clinical Laboratory Information Systems↗
[PIPR 92--a computer program for autopsy protocols using the PC XT/AT computer series].
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Autopsy↗
The automated data used to assess quality at our agency are contained in different departments' computers and different computer programs.
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Data Collection↗
Development and initial validation of an instrument to measure physicians' use of, knowledge about, and attitudes toward computers.
UNLABELLED: This paper describes details of four scales of a questionnaire-- "Computers in Medical Care"--measuring attributes of computer use, self-reported computer knowledge, computer feature demand, and computer optimism of academic physicians. The reliability (i.e., precision, or degree to which the scale's result is reproducible) and validity (i.e., accuracy, or degree to which the scale actually measures what it is supposed to measure) of each scale were examined by analysis of the responses of 771 full-time academic physicians across four departments at five academic medical centers in the United States. The objectives of this paper were to define the psychometric properties of the scales as the basis for a future demonstration study and, pending the results of further validity studies, to provide the questionnaire and scales to the medical informatics community as a tool for measuring the attitudes of health care providers. METHODOLOGY: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with orthogonal varimax rotation. Weakly associated items (factor loading < .40) were deleted. The reliability of each resultant scale was computed using Cronbach's alpha coefficient. Content validity was addressed during scale construction; construct validity was examined through factor analysis and by correlational analyses. RESULTS: Attributes of computer use, computer knowledge, and computer optimism were unidimensional, with the corresponding scales having reliabilities of .79, .91, and .86, respectively. The computer-feature demand attribute differentiated into two dimensions: the first reflecting demand for high-level functionality with reliability of .81 and the second demand for usability with reliability of .69. There were significant positive correlations between computer use, computer knowledge, and computer optimism scale scores and respondents' hands-on computer use, computer training, and self-reported computer sophistication. In addition, items posited on the computer knowledge scale to be more difficult generated significantly lower scores. CONCLUSION: The four scales of the questionnaire appear to measure with adequate reliability five attributes of academic physicians' attitudes toward computers in medical care: computer use, self-reported computer knowledge, demand for computer functionality, demand for computer usability, and computer optimism. Results of initial validity studies are positive, but further validation of the scales is needed. The URL of a downloadable HTML copy of the questionnaire is provided.
Attitude of Health Personnel↗
Computational tools for the modern andrologist.
With such a wide array of computational tools to solve inference problems, andrologists and their mathematical or statistical collaborators face perhaps bewildering choices. It is tempting to criticize a method with which one is unfamiliar for its apparent complexity. Yet, many methods are quite elegant; neural computation uses nature's own best biological classifier, for example, and genetic algorithms apply rules of natural selection. Computer scientists will likely find no one single best inference engine to solve all classification problems. Rather, the modeler should choose the most appropriate computational tool based on the specific nature of a problem. If the problem can be separated into obvious components, a Markov chain may be useful. If the andrologist would like to encode a well-known clinical algorithm into the computer, the programmer may use an expert system. Once a modeler builds an inference engine, that engine is not truly useful until other andrologists use it to make inferences with their own data. Because a wide variety of computer hardware and software exists, it is a significant endeavor to translate, or "port," software designed and built on one machine to many other different computers. Fortunately, the World Wide Web offers a means by which computational tools may be made directly available to multiple users on many different systems, or "platforms." The World Wide Web refers to a standardization of information traffic on the global computer network, the Internet. The Internet is simply the linkage of many computers worldwide by computer operators who have chosen to allow other users access to their systems. Because many different types of computers exist, until recently only communication in very rudimentary form, such as text, or between select compatible machines, was available. Within the last half-decade, computer scientists and operators began to use standard means of communication between computers. Interpreters of these standard languages, such as Mosaic and Netscape, are now widely available, and they allow the casual user to access the most sophisticated multimedia aspects of computer information on a variety of different systems. Andrologists may thus use the World Wide Web to make inference engines that they have programmed available to other clinicians and researchers. For example, we programmed a World Wide Web interface to the neural networks that we trained in order to solve a number of andrology classification problems. Interested users connect to our address (at this writing http:@godot.urol.uic.edu), and they may fill out electronic forms with their own patient data, press a "predict" button, and nearly immediately view the results of our neural networks' prediction on their own computers. With the explosion in computer hardware technology, mathematics and computer science that once seemed esoteric can now be investigated on computers available to nearly all andrologists. Rapid advances in computer network technology now render a tool developed by one andrologist immediately available to many. Clearly, andrologists may expect that computational investigations in their field will be a productive ground in the near and far future.
Algorithms↗
Computer use and education in radiology residency programs.
Computers play an increasingly important role in radiology education and research. We surveyed all U.S. residency programs to assess computer availability, education, and use by residents. Out of 210 questionnaires sent, 132 were returned (63% response). Areas of inquiry included computer equipment and software as well as resident use of facilities. Opinions were also solicited concerning the importance of computer literacy and education. Sixty-nine percent of the respondents have computer facilities (61% within the department). Predominant uses include scientific papers, slides/audiovisual presentations and resume preparation. Popular software includes word processing, spreadsheets, databases and graphics. Of those training programs with computers, 85% provided computer education, and most (70%) felt computer training was very important. Forty-seven percent expected their residents to have at least passing acquaintance with computers. However, in 60% of programs with computers, the computers are used by less than half the residents. Of those programs without a computer, 61% provided no computer training, and only 44% felt computer education was very important. A sizable minority of radiology residency programs are still without computer facilities. Those programs that have computers tend to place a greater emphasis on computer education and literacy for radiology residents. However, even in programs that have computers, it seems they are often underutilized by residents.
Computer User Training↗
Computing knowledge, attitude and skills among healthcare professionals in Aminu Kano Teaching Hospital, Nigeria.
BACKGROUND: Health care professionals can no longer ignore the application of information technology to health care. This study was carried out to assess computing knowledge, attitude and skills among health care professionals and identify associated factors. METHODS: A cross section of 200 health care professionals- consisting of 64 doctors, 90 nurses, 35 laboratory scientists and 11 pharmacists in Aminu Kano Teaching Hospital were interviewed using a pre-tested, structured, closed-ended self-administered questionnaire. RESULTS: Only 181 (90.5%) of the respondents returned the completed questionnaires. Twenty six percent of the respondents had formal computer training whereas 34.8% owned a personal computer. Overall, 84 (46.4%) of the respondents had good knowledge of computing. Specifically, 41(66.0%), 5 (50.0%), 14 (51.0%) and 24 (30.0%) of these were doctors, pharmacists, laboratory scientists and nurses respectively. Computing knowledge was highest among doctors and lowest among nurses. These differences were statistically significant (chi2 = 19.1 df = 3 P < 0.01). Age, gender, computer ownership and formal computer training significantly influenced computing knowledge. Most healthcare professionals 160 (88.4%) had positive attitude towards computing and this was significantly influenced by respondent's age and previous computer training. Only 41 (22.7%) of the health care professionals had good computing skills and this was significantly associated with computer ownership (P < 0.01) and formal computer training (P < 0.01). CONCLUSION: Half of the healthcare professionals had good computing knowledge, majority had a positive attitude while many were quite deficient in computer skills. Computer loans and in-house computing courses were recommended to prepare our healthcare professionals for the challenges of the information technology age.
Adult↗
Variables that may enhance medical students' perceived preparedness for computer-based testing.
OBJECTIVE: To identify variables that may enhance medical student's preparedness for computer-based administration of the United States Medical Licensing Examination (USMLE). DESIGN: A cross-sectional survey of 301 medical students who completed a self-administered questionnaire. MEASUREMENTS: The questionnaire was designed to obtain information about students' computer resources, personal experience with computers, computer expertise, opinions about computers, experience with computer-based testing, perceived preparedness for the computer-based USMLE, and demographic variables. Variables related to students' perceived preparedness for the computer-based USMLE were identified by ordinal logistic regression. RESULTS: A significant regression model yielded four significant predictors: perceived preparedness for USMLE content (P: < 0.0001), opinions about computers (P: < 0.0012), gender (P: < 0.0001), and a gender by computer-based testing experience interaction (P: < 0. 0004). Computer resources, personal experience with computers, computer expertise, age, race, and year of medical school were not significant predictors. CONCLUSION: Students' perceived preparedness for computer-based administration of high-stakes examinations may be facilitated by preparing them for examination content, by enhancing their opinions about computers, and by increasing their computer-based testing experiences.
Attitude to Computers↗
Who's wired and who's not: children's access to and use of computer technology.
As computer technology becomes increasingly prevalent throughout society, concerns have been raised about an emerging "digital divide" between those children who are benefitting and those who are being left behind. This article presents results from new analyses of national survey data describing children's differential access to computers in school and at home, and the varying conditions that affect how children experience computers. For example, responses from a nationwide survey of teachers suggest that, as of 1998, more than 75% of students had access to computers at school. In fact, those teaching lower-income students reported weekly use of computers more often than those teaching higher-income students. But the nature of children's experiences using computers in school varied greatly by subject and teacher objectives, and the data suggest that lower-income students use computers more often for repetitive practice, whereas higher-income students use computers more often for more sophisticated, intellectually complex applications. Differences between low-income and high-income children's access to home computers were far less subtle. Survey data indicate that only about 22% of children in families with annual incomes of less than $20,000 had access to a home computer, compared to 91% of those in families with annual incomes of more than $75,000. And among children with access, those in low-income families were reported to use the computer less than those in high-income families, perhaps because most low-income families with computers lacked a connection to the Internet. The two most predictive factors of children's use of home computers were the child's age and the computer's capabilities. The author concludes that home access to computers will be a continued area of inequality in American society, and that schools must play a critical role in ensuring equal opportunity for less-advantaged children to access the benefits of the more intellectually powerful uses of computer technology.
Adolescent↗
Medical education as a science: the quality of evidence for computer-assisted instruction.
OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.
Computer-Assisted Instruction↗
Early childhood computer experience and cognitive and motor development.
OBJECTIVES: To explore the association between early computer experience (both accessibility and frequency of use) and cognitive and psychomotor development among young children. METHODS: The participants were 122 preschool children enrolled in a rural county Head Start program in the United States during 2001-2002. The following tests were administered to the children: the Bender Visual Motor Gestalt Test; the Boehm Test of Basic Concepts, Third Edition Preschool; the Test of Gross Motor Development, Second Edition; and a short form of the Wechsler Preschool and Primary Scales of Intelligence-Revised. Information pertaining to family characteristics and children's early computer experience was collected from parents. Both bivariate and multivariate analyses were used to assess the association between early computer experience and cognitive and motor development. RESULTS: Of the participating children, 53% had a computer at home. Among families who had a computer, 83% had children's software on the computer. According to parents' reports, 29% of these children played on the home computer on a daily basis, and an additional 44% of the children played on the computer at least weekly. Of those families who did not have a home computer, 49% reported that their children had access to a computer somewhere outside home. Among these children, 10% had daily access to the computer and 33% had weekly access. The presence of a computer in the home was significantly associated with the family's income and the educational attainment of the parents. There was no gender difference in computer accessibility and frequency use among the participating children. Children who had access to a computer performed better on measures of school readiness and cognitive development, controlling for children's developmental stage and family socioeconomic status. The data in the current study did not suggest a relationship between computer experience and visual motor or gross motor skills among the participating children. CONCLUSION: The findings in the present study suggest that early computer exposure before or during the preschool years is associated with development of preschool concepts and cognition among young children. However, frequency of use did not reveal such a relationship; neither did the ownership of other child electronic or video games in the household.
Aptitude Tests↗
Handheld computer use in U.S. family practice residency programs.
OBJECTIVE: The purpose of the study was to evaluate the uses of handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs in the United States. STUDY DESIGN: In November 2000, the authors mailed a questionnaire to the program directors of all American Academy of Family Physicians (AAFP) and American College of Osteopathic Family Practice (ACOFP) residency programs in the United States. MEASUREMENTS: Data and patterns of the use and non-use of handheld computers were identified. RESULTS: Approximately 50 percent (306 of 610) of the programs responded to the survey. Two thirds of the programs reported that handheld computers were used in their residencies, and an additional 14 percent had plans for implementation within 24 months. Both the Palm and the Windows CE operating systems were used, with the Palm operating system the most common. Military programs had the highest rate of use (8 of 10 programs, 80 percent), and osteopathic programs had the lowest (23 of 55 programs, 42 percent). Of programs that reported handheld computer use, 45 percent had required handheld computer applications that are used uniformly by all users. Funding for handheld computers and related applications was non-budgeted in 76percent of the programs in which handheld computers were used. In programs providing a budget for handheld computers, the average annual budget per user was 461.58 dollars. Interested faculty or residents, rather than computer information services personnel, performed upkeep and maintenance of handheld computers in 72 percent of the programs in which the computers are used. In addition to the installed calendar, memo pad, and address book, the most common clinical uses of handheld computers in the programs were as medication reference tools, electronic textbooks, and clinical computational or calculator-type programs. CONCLUSIONS: Handheld computers are widely used in family practice residency programs in the United States. Although handheld computers were designed as electronic organizers, in family practice residencies they are used as medication reference tools, electronic textbooks, and clinical computational programs and to track activities that were previously associated with desktop database applications.
Data Collection↗
Dependence of computer classification of clustered microcalcifications on the correct detection of microcalcifications.
Our purpose was to study the dependence of computer performance in classifying clustered microcalcifications as malignant or benign on the correct detection of microcalcifications. Specifically, we studied the effects of computer-detected true-positive microcalcifications and computer-detected false-positive microcalcifications in true microcalcification clusters. Using a database of 100 mammograms, we compared computer classification performance obtained from computer-detected microcalcifications to (1) computer classification performance obtained from manually identified microcalcifications, and (2) radiologists' performance. When an artificial neural network (ANN) was trained with manually identified microcalcifications, computer classification performance was comparable to or better than radiologists' performance as the number of computer-detected true-positive microcalcifications decreased to 40% and as the number of computer-detected false-positive microcalcifications increased to 50%. Further loss in computer-detected true-positive microcalcifications degraded classification performance substantially. Moreover, training the ANN with computer-detected microcalcifications also degraded computer classification performance. These results show that computer performance in classifying clustered microcalcifications as malignant or benign is insensitive to moderate decreases in computer-detected true-positive microcalcifications and moderate increases in computer-detected false-positive microcalcifications.
Breast Neoplasms↗
Perceptions of computer literacy among occupational therapy students.
OBJECTIVE: Educational programs for the occupational therapist and the occupational therapy assistant are mandated to include content on technologies in their curricula. Given the increasing use of technology skills among occupational therapists, especially computer technology skills, it seemed judicious to ascertain the current and desired levels of skill of occupational therapy students as well as their opinions about computer technology. METHOD: Program directors from five baccalaureate-level curricula distributed the Computer Opinion Survey and the Computer Knowledge Survey to 109 junior and senior occupational therapy students. The students were instructed to complete and return questionnaires to their program directors who, in turn, forwarded the questionnaires to the principal investigators. RESULTS: Respondents were generally positive about computer technology, and the level of knowledge they desired about computer technology applications in occupational therapy was much greater than their current level of knowledge. Although respondents' positive attitudes were significantly correlated with their current levels of computer knowledge, no significant relationship was established among positive attitudes, current levels of computer knowledge, and number of computer courses completed before entering an occupational therapy curriculum. CONCLUSIONS: Even though the respondents were computer literate (i.e., they had a general working knowledge of the uses, limitations, and impact of computers), no relationship was established between their previous computer course work and their current knowledge of the use of computer technology in occupational therapy. The linkage between generic computer literacy and knowledge of its relationship to the use of computer technology in occupational therapy was not evident to this sample of junior and senior students.
Adult↗
Comparison of nurse and computer charting of physiological variables in an intensive care unit.
OBJECTIVES: To compare charting of physiological parameters manually by nurses and automatically by computer and so decide whether this task could accurately be performed by computer. SUBJECTS/SETTING: 101 consecutive patients admitted for tertiary neonatal intensive care. DESIGN: Direct comparison of 48 hours of data collected by both methods. Computer data stored each second and the hourly median compared with the single hourly value noted by the nurse. METHODS: All patients were monitored by standard patient monitor and a computer. Four physiological parameters were compared between nurse and computer (both derived information from the standard patient monitor): heart rate, transcutaneous oxygen, mean blood pressure, central temperature. A random 51% of patients had the computer data displayed as trends at the cotside. Comparison of the hourly nurse observation and a computer hourly median value. Computer data was compared before and after the removal of artifact. In addition, the effects on nursing observations of either display or non display of the computer trend data was assessed. RESULTS: Nurse and computer observations were statistically significantly different (p < 0.001), though these were not clinically important. Nurses tended to note a higher figure than the computer median. The cotside display of computer data improved consistency between the nurse and computer observations. Artifact present in the data had little influence on the accuracy of the computer median value. CONCLUSIONS: Computer systems can accurately chart physiological data, providing a more flexible record with a minimal risk to data reliability from artifact.
Bias↗
Investigation of a computer virus outbreak in the pharmacy of a tertiary care teaching hospital.
OBJECTIVE: A computer virus outbreak was recognized, verified, defined, investigated, and controlled using an infection control approach. The pathogenesis and epidemiology of computer virus infection are reviewed. DESIGN: Case-control study. SETTING: Pharmacy of a tertiary care teaching institution. RESULTS: On October 28, 1991, 2 personal computers in the drug information center manifested symptoms consistent with the "Jerusalem" virus infection. The same day, a departmental personal computer began playing "Yankee Doodle," a sign of "Doodle" virus infection. An investigation of all departmental personal computers identified the "Stoned" virus in an additional personal computer. Controls were functioning virus-free personal computers within the department. Cases were associated with users who brought diskettes from outside the department (5/5 cases versus 5/13 controls, p = .04) and with College of Pharmacy student users (3/5 cases versus 0/13 controls, p = .012). The detection of a virus-infected diskette or personal computer was associated with the number of 5 1/4-inch diskettes in the files of personal computers, a surrogate for rate of media exchange (mean = 17.4 versus 152.5, p = .018, Wilcoxon rank sum test). After education of departmental personal computer users regarding appropriate computer hygiene and installation of virus protection software, no further spread of personal computer viruses occurred, although 2 additional Stoned-infected and 1 Jerusalem-infected diskettes were detected. CONCLUSIONS: We recommend that virus detection software be installed on personal computers where the interchange of diskettes among computers is necessary, that write-protect tabs be placed on all program master diskettes and data diskettes where data are being read and not written, that in the event of a computer virus outbreak, all available diskettes be quarantined and scanned by virus detection software, and to facilitate quarantine and scanning in an outbreak, that diskettes be stored in organized files.
Clinical Pharmacy Information Systems↗
Flat-panel volume computed tomography for cochlear implant electrode array examination in isolated temporal bone specimens.
HYPOTHESIS: Flat-panel based volume computed tomography could improve cochlear implant electrode evaluation in comparison with multislice computed tomography. BACKGROUND: Flat-panel based volume computed tomography offers higher spatial resolution and less metal artifacts than multislice computed tomography. Both characteristics could improve the evaluation of challenging but important questions in cochlear implantation assessment, such as an exact imaging of cochlea, osseous spiral lamina, electrode array position, and single electrode contacts. These questions are not currently fully answered by multislice computed tomography. METHODS: Four isolated temporal bone specimens were scanned in a current multislice computed tomography scanner and in two experimental flat-panel based volume computed tomography scanners before and after cochlea implantation. To compare flat-panel based volume computed tomography and multislice computed tomography, four features were rated according to the following criteria: 1) visibility of the cochlea; 2) visibility of the osseous spiral lamina; 3) discernibility of individual electrode contacts; and 4) the ability to determine the electrode array position relative to scala tympani and scala vestibuli. Layer-by-layer microgrinding pictures were used as the ground truth for verification of imaging findings. RESULTS: Flat-panel based volume computed tomography was superior to multislice computed tomography in all four features rated. The cochlea and facial nerve canal were much better delineated in flat-panel based volume computed tomography. The osseous spiral lamina and single electrode contacts were only visible in flat-panel based volume computed tomography. Assessment of implant position with regard to the cochlear spaces was considerably improved by flat-panel based volume computed tomography. CONCLUSION: Cochlear implantation assessment could be improved by flat-panel based volume computed tomography and, therefore, would be highly beneficial for cochlea implantation research and for clinical evaluation. However, these first results were shown by scanning isolated temporal bone specimens; scanning whole human skull bases might be more challenging.
Artifacts↗